Crisis intervention combines several types of professional assistance, be it psychological, medical, social or legal assistance. Crisis intervention helps the client on the way to change to a better and more valuable life. It is usually carried out in cases where the client is in danger immediately or shortly after a traumatic event. In the most general sense, the term crisis evokes a negative emotional response in us, whether we are in the role of crisis worker, parent, spouse, etc. However, the crisis also carries the potential for growth and change in a positive direction, as written by Knoppová (2002), Eis (1994), Kastová (2000) and many others. A crisis can launch us into a more intense life. We can also derive this potential from the name itself - crisis worker = helping worker, that is, a client's crisis for a crisis worker means "help" in redirecting the client's personal growth to more positive values and activities compared to the usual strategies of the "habit is an iron shirt" type. In crisis intervention (Špatenková, 2004) it is important to restore the individual's psychological balance, disturbed by a critical life event.
The crisis worker cannot focus on the complex picture of the problem in isolation, but is constantly looking for potential client resources that can be utilized in solving an acute crisis (cf. Bell, 2003). Within the framework of crisis intervention methods and techniques, there is a wide range of tools that lead to transparency of the client's experience and to stopping counterproductive behavioral tendencies (cf. Vodáčková, 2002). Coping with these tasks requires (see Špatenková, 2004) the full commitment of crisis workers:
- Availability and constant readiness of interventions to provide assistance.
- The content of the work is a wide range of issues (from school, family, work problems to crimes and suicidal clients).
- It is about contact with people experiencing strong emotions.
- The need for workers to make decisions under pressure and often without enough information.
- The unpredictability of the tasks, the duration of the intervention and the conditions under which it will be implemented, which is related to the difficulties of planning specific procedures.
- The burden resulting from the imbalance of work, the transition from intensive situations to variously long waiting times for the next client.
- Cooperation with other institutions and thus the necessary ability of cooperation, negotiation and management.
All this can contribute to the high emotional exhaustion and depersonalization of crisis workers.
Empathy, compassion, warmth are among the many important qualities of a crisis counselor and counselor or psychologist, which we will discuss further.
Empathy is a prerequisite for providing emotional support, space for venting emotions, reflecting the needs and desires of the client, as well as for expressing understanding. Empathy presupposes a temporary identification with the client, which enables the crisis worker to gain emotional knowledge of the client's experience. It is clearly a difficult process to process and understand these experiences. A crisis worker is not a depersonalized being or some kind of robot, but an individual with his own emotions, desires and needs.
Empathy in the work of a crisis worker - therapist can take on different degrees. In the case of excessive identification with the client, there is an overwhelming of the client's experience and a loss of objectivity to compassion, which paralyzes him in his ability to create possibilities for the client's shift. It often brings a feeling of powerlessness to influence a tragic life situation, anger at circumstances in the client's life that prevent a positive outcome, and the like.
On the other hand, it may happen that the crisis therapist may not be capable of empathy (anti-warmth), which may be a consequence of the negative impact of personal events of the crisis worker - his experience of permanent or temporary conflicts, beliefs, values not directly related to helping the client. An undesirable consequence here can be the creation of a defensive attitude when he does not find a common language with the client, cannot experience warmth towards the client, or create any alliance with him (Davis, 1987).
The client and the crisis worker are bridged by a mutual relationship. This relationship is the core of the crisis-intervention process, and therefore it is necessary to look for protective phenomena that mitigate the possible negative consequences of the demanding work of crisis workers. One of the effective means against the therapist's burnout and also the defensive relationship towards the client is the therapist's self-efficacy.
We rank self-efficacy among essential elements ensuring the desired and expected effect of the helping process; - forms a key component of the Self system; - it can be characterized as certainty in carrying out activities connected with the intervention.
Self-efficacy in a certain situation is influenced by two types of expectations: 1. expectations of effectiveness; 2. expectations of results.
According to Hall and Lindzey (1999), an individual's efficacy expectations are the individual's beliefs that he is capable of performing the behavior required in the situation, while outcome expectations are the individual's evaluations of the outcome of the given behavior. In the case of self-interest, the reward and at the same time profit for the crisis worker is an increase in self-efficacy and confirmation of the value of one's self.
The interconnectedness of the expectation of effectiveness and results in the intervention of the helping worker leads us to consider the importance of emotions in the intervention process with the client. Here we come to the motif of "hedonistic altruism" (ipsocentric motivation) simply expressed in the words "I help and it gives me satisfaction".
According to Stamm (2009), compassion satisfaction shows consequences such as joy, enthusiasm, a sense of fulfillment, a good mood, a sense of self-efficacy, a sense of competence, finding the value of meaning, etc.
On the contrary, when exhausted from compassion t. j. empathy overwhelming the therapist, secondary traumatic stress follows.
Secondary traumatic stress or mediated trauma manifests itself similarly to post-traumatic stress disorder. During empathic listening, the crisis worker empathizes with the other person and begins to experience the same feelings as her. He thus creates his own internal idea of the event, which can result in intrusive images. In the next stage, the therapist tries to avoid memories of the client's trauma, and the accompanying phenomenon is also social withdrawal, as a result of the assumption of misunderstanding from others.
Insomnia, irritability, exaggerated panic reactions, problems with memory concentration can be added to this, which are an expression of the growing effort to protect against danger, attack.
It is clear from the above that empathy - important in the helping profession of a crisis worker - is also a threat to it. The symptoms of secondary traumatic stress can disrupt the social, work and other important functioning of the helping worker, especially by experiencing clinically significant distress. Lerias and Byrne (2003) state that in mediated trauma, disruption takes on varying severity. They add that by accumulating stress there is a potential risk of creating a psychological disorder.
The opposite of compassion exhaustion and prevention of secondary traumatic stress is compassion satisfaction associated with hedonistic altruism.
We classify satisfaction from compassion among the protective mechanisms that support well-being - as experiencing the well-being of life. Compassion satisfaction is supported by self-centered care (Kraus, 2005) and also explains why people perform stressful jobs despite being a source of stress and injury. It is also suggested that these individuals perceive their work as a personal or social challenge with meaningful content. The power of the protective effect of satisfaction from compassion is also in the formation of the so-called mediated resistance, which the intervening worker receives from the client. The transmitter is the therapist's perception of resistance in the client, the client's coping strategies, hope, forgiveness. The unique and positive effect of this process leads the crisis worker to reevaluate his attitudes, opinions, and ultimately to increase his frustration tolerance.
Attuning to the client - empathy - can change the experience of the situation not only for the client, but also for the helping worker. The change in the experience of the crisis worker during the intervention following the therapeutic relationship, either in a negative direction as secondary traumatic stress, or in a positive direction as mediated resistance, manifests itself in work efficiency and overall psychological well-being.
It is obvious that the present day brings before us more and more questions regarding coping strategies in all aspects of an individual's life. It is no different for the helping workers, who must constantly assess the client's situation and consider the suitability of strategies to manage them. They are repeatedly exposed to the clients' traumatic events, which leads to an increased rate of post-traumatic stress disorder symptoms in them compared to individual exposure to such a burden. Finding and applying mechanisms that act preventively against the negative consequences of stress, in our opinion, becomes an effective and necessary psychohygiene of a helping worker.
Author: Iveta Schusterová The contribution was created within the framework of the Vega Grant no. 1/0177/08 Literature:
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The paper was presented at the 5th annual conference entitled ,,Psychology of health 2010", which took place on May 19, 2010 in Bratislava. The conference was organized by the health psychology section of the SPS at SAV in cooperation with the health section of the Ministry of Health of the Slovak Republic. The following participated in the preparation of the event: National Institute of Heart and Vascular Diseases in Bratislava, VŠZaSP St. Elizabeth in Bratislava, WHO Office in Slovakia, KISH Košice, Department of Psychology FF KU in Ružomberok and Department of Psychology FF TU in Trnava.
Proceedings from the 5th conference of health psychology, Bratislava, 2010 was published only in electronic form Availability: http://www.prohuman.sk/psychologia/zbornik-prispevkov-z-konferencie-psychologia-zdravia-2010