Crisis Care

Notes for Gray's Crisis Care Seminar for Chaplains

 

What is a Crisis?

When you hear the word “Crisis” what pictures or words pop into your mind? (Urgent, upset, helpless, nonfunctional, hopeless, anxious)

What are some biblical terms that reflect a crisis? (trial, tribulation, test, persecution and affliction)

Name some people in the Bible who experienced Crisis?

Saul-Paul: On the road to Damascus.

1.    He was affected physically - he could not see.

2.    Affected spiritually - he became a believer.

3.    He was affected mentally and emotionally - he did not eat or drink for 3 days

4.    His conversion caused a crisis - he experienced a turning point for the better.

 

Crisis— “A turning point.”  “A crucial time in one’s life.” It’s an upset in a person’s baseline level of functioning.  It’s a disruption of the balance of life.  Anxiety, depression, tension increase.  A crisis usually involves a loss.  The person acts differently, they are not the same.

Crisis Care is when a person effectively copes with the threat or loss, and he or she returns to prior levels of functioning.

During a crisis, a person may go in one of two directions, towards despair or opportunity.  A change for better or worse may occur.  A person can move forward in growth, enrichment and improvement or they can move toward dissatisfaction, chronic pain and dissolution.  (turning point)

Causes of a Crisis

A crisis can be the result of one or many factors: 

• It can be a problem that is too great or overwhelming for a person to cope. 
• It can run the gamut from the loss of a child to the 
  • loss of a house.
  • loss of a marriage.
  • loss of a pet.
  • loss of a job. 
  • loss of an appliance (refrigerator went out).

To you it may not be that serious, but for a given person, this loss has special significance, or it comes at a time of special vulnerability (the last straw) or when a person in unprepared for it.(For example: ordinarily, people handle a stopped-up sink with no problem, but if it happens when the kids are sick, the car broke down, and unexpected bills arrive) The person now feels overwhelmed.

Repeat: Crises are not always bad; they represent a pivotal point in a person’s life. They can bring opportunity as well as danger.  As people search for their methods of coping (this is where chaplains come in), they may choose paths of destruction—examples: alcohol, drugs, affairs -  or they may discover new and better methods of coping that they had not thought of previously, finding fulfillment and new opportunities.

 The Phases of a Crisis

1.    The Impact Phase

It is becoming aware of the crisis and experiencing the effect of being stunned.  This period can last a few hours to a few days depending upon the event and the person involved.  Tears may come immediately or a few days later.  The more severe the crisis or loss, the greater the impact.  

There are basically six types of losses, and a person may experience more than one at the same time.

A)   Material Loss—The loss of a physical object. (car, flood, fire, thief)

B)   Relationship Loss—The ending of a relationship, to talk with, share life with, make love to, being in the presence of another. (death, divorce)

C)   Intrapsychic Loss—The loss of “what might have been.” The dying of a dream, abandonment of plans for the future. (a person learns they can’t have children)

D)   Functional Loss—The loss of a bodily function. (stroke)

E)    Role Loss—The loss of a specific role or function in an accustomed place. (job, retirement)

F)    Systemic Loss—The absence of family members or a change within the family structure.  (military, family move away, children get married)

G)  Ambiguous Loss—Unclear, uncertain what the loss may be.  Someone may be physically present but psychologically absent. (a parent who is in the home but ignores his/her family)

The chaplain may be trying to determine what exactly has been lost.

During this phase the person may run from the problem, give up, or fight the problem. (divorce proceeding)

Confronting the crisis seems to be the healthier response.  Running away only prolongs the crisis and avoiding reality does not make for good judgment because pain is usually prolonged instead of resolved.

Thinking capability.  In the impact phase, thinking capability is less competent than normal; we are somewhat numb and disoriented.  It may be some people feel as though they cannot think or feel at all.  It is as if their entire system shuts down.  Insight is lessened, information you give may not fully register and may have to be repeated many times.  “The mind seems to be in its own place”.  Unfortunately, important decisions may be necessary and postponing them may not be an option.  This where they need the help of their chaplain and other people and what is suggested needs to be in writing.

What do I do as a chaplain?  LISTEN, LISTEN, LISTEN.  Their feelings should not be buried or denied.  They may feel guilt.  (It’s my fault, I could have done something to prevent this).  Help them talk it through, ask, “why do you feel this way?”. They may wonder if these feelings are normal and will feel relieved when they realize these feelings are normal.

2.    The Withdrawal-Confusion Phase

There seems to be a lot of turmoil in the emotional area during this phase.  Their emotions are churning, they may feel worn out emotionally or depressed.  They may even try to deny their feelings.  Intense anger may occur toward whatever happened, which brings guilt for having these feelings.  Shame then results so the tendency is to suppress the feelings.  Usually this is when the person refuses to let the process of grief occur.  Here are nine disruptions that signal a person’s inability to cope:

 

1.    A sense of bewilderment: “I never felt this way before”

2.    A sense of danger: “I feel so scared—something terrible is going to happen.”

3.    A sense of confusion: “I can’t think clearly—my mind doesn’t seem to work.”

4.    A sense of impasse: “I’m stuck—nothing I do seems to help.”

5.    A sense of desperation: “I’ve got to do something, but I don’t know what to do.”

6.    A sense of apathy: “nothing can help me—what’s the use of trying.”

7.    A sense of helplessness: “I can’t cope by myself—please help me.”

8.    A sense of urgency: “I need help now.”

9.    A sense of discomfort: “I feel so miserable and unhappy”.

 

 

What do I do as a chaplain? 

Affirm what they are feeling. 

• “Tell me, why do you think that is?”
• “Could it be that you just can’t think clearly, like your mind isn’t working?”
• “Could it be that you feel stuck, like nothing you do seems to help?”
• “Tell me why you feel that way?”

If what they are saying and feeling appears shocking and alarming to you, the chaplain, they may feel the need to repress their feelings.  We may be the only person in their life who they feel safe talking to because we bring no judgement to their feelings.  After all, God knows what they are thinking and feeling.

This stage is when many friends and relatives pull away because they cannot deal with the raw emotions they are hearing.

When this happens, how do you think most people will cope?

(alcohol, drugs, isolation…)

Usually spiritual insight or teaching does no good during this stage.  They are not in a good place to hear, and their emotions interfere with the information you are trying to share with them.  However, your presence during this time will give you the “authority” to speak into their life when they are ready to hear.

 

Counseling Guidelines

1.    Be careful what you say.  In an effort to bring calm to a crisis situation, we may say: “Everything is going to be all right.” We don’t know that.  We must be careful not to give false assurance.

You can say: “You are not alone, we are going to walk through this together.”

2.    An example of what you could say: “Hey John, my name is Chaplain ________________, and I’m here to help you walk through this process.  Let’s come and sit over here where I can hear you better and you can be more comfortable. Let’s start this journey together.”

3.    As you ask questions, keep them short and concise.  Open-ended questions are best unless you need specific factual information.  Do you remember what happened?

Where were you?

What did you see?

Were there any particular smells that stood out?

What did you hear?

Above all, let them tell their story.

4.    When silence occurs, just let it happen.  Those in crisis have slowed reactions.

5.    If you need to interrupt because the person is rambling, do so gently; “I just want to make sure I am hearing you correctly”.

6.    Listen with your eyes as much as your ears.  Look for what is being verbalized.

7.    If the person vents on you, don’t take it personally.  You may be the first safe person they feel comfortable talking to.

8.    Be sure to follow up with phone numbers of local and national agencies that can help.

9.    Remind them of when you will see them again.  Follow up with a phone call the next day or two.

10.Be prepared to work through several options to help the person     

           through the process.

 

As you are working with people in Crisis, you might ask the question, “What am I looking for to see if this person is making progress in a good direction?”

A.   Look for a change in behavior patterns.  Ask, “Are they sleeping better at night?”  Are they losing weight, not eating?  What changes in their work have you noticed.

B.    Help them talk through their feelings.  Are they open and willing to share their emotions and feelings with you or someone else?

C.    Have you noticed any physical symptoms out of the ordinary?

(Headaches, stomach issues, heart racing, hurting in joints, aches, pains.  You might suggest they go see their primary physician)

D.   Ask about their support system, family, friends, church, etc…

E.    Are they having any unusual thoughts, dreams, destructive fantasies.

 

3.    The Adjustment Phase

This is where you begin to see the person “turn the corner”.  Positive attitudes have begun.  People talk about hope, future possibilities, new job, new location, rebuilding, remarriage.

 

Climbing Out

This is when insight is returning, they can become objective about what has occurred and now can process new information and suggestions.  They are beginning to let go of the past and begin to grasp for the future.  The decisions they begin to make may not be what you would do so we must be careful in offering suggestions, remember, they need us as their chaplain, not their critic.  However, some words of caution may be needed from you, such as:

Ø It’s a good idea to wait a year after a death or divorce to begin dating again.  Recovery needs to occur first, or the person will select a partner from a position of weakness instead of strength.

Ø It’s a good idea to remain in the home for a year before you decide to move.

This is where you, the chaplain, can help the person in crisis learn patience.  Let’s unpack the baggage so it does not interfere with a new start.

 

 

Gaining Hope

This is the phase where spiritual insights can be shared.  This is the time to share the scriptures that you have been gleaning from God’s Word that apply specifically to this Crisis situation.

Verses like:

Jeremiah 29:11, Romans 8:28, Proverbs 3:5-6, John 3:16, John 10:10,

This is the time where the gospel can be shared from a place of hope.

Remember, share from what you know, not from what you don’t know.

There are many things about life I do not know, but what I do know is this:

• God loves you.
• God has a plan for you that includes peace and hope.
• Our sin separates us from a relationship with God.
• Our attempts to have a relationship with God never work.
• God sent His only Son, Jesus, to die on a cross for our sins. Jesus makes it possible for you to have a relationship with God.
• Our response is to receive Christ, ask Jesus to be my Lord and Savior and rule my life.
• Would you like to receive Jesus right now?

Resources for Counselee:

Lucado, Max. You’ll Get Through This

Jeremiah, David. A Bend in the Road

Macintosh, Mike. When your World Falls Apart

Wright, H. Norman. Will My Life Ever Be The Same

4.    The Reconstruction Phase

This is where confidence begins to spring forth.  The person takes the initiative for progress, and reattachments are occurring.  New people, new places, new activities and new spiritual responses are now taking place.  Forgiveness is being offered, anger and blame are leaving, time for reconciliation is taking place.

You, the chaplain, are seeing a new person emerge.  Remember we said a crisis is an opportunity for the person to gain new strengths, new perspective on life, exciting times of growth.

• Helping start an intervention program for people who have been through the same crisis,
• Reaching out to others.
• Showing more kindness and compassion to those who are suffering.
• Watching God open doors of opportunity that never would have occurred otherwise.

Many people who work through their crisis find that they can then minister in a much better way to others.  Out of our difficulties, our hurts, our pain we can help others walk through their trials in a new way.

What causes a major crisis to become a restrictive, crippling, eternal tragedy rather than a growth-producing experience in spite of the pain?

A PERSONS ATTITUDE

“Grief can change your outlook.  You don’t ever forget the shock, the sadness, and the pain.  But I do not believe that grief changes who you are.  Grief, if you let it, will reveal who you are.  It can reveal depths that you did not know you had.  The startling weight of grief can burst any bubble of complacency in how you live your life and help you to live up to the values you espouse.”              Prince William, Duke of Cambridge

Helpful Hints for the Chaplain from the person in Crisis:

• Do not explain—Even when I cry out “Why?”  I am not looking for rational, logical answers, but I want God and you to be with me in my pain.
• Do not try to take away my pain—The pain shows me how much I have lost.  It might be uncomfortable for you, but please respect my reality.  I will not always be like this, be patient and walk with me through “the valley of the shadow of death”.
• Stay close to me—I need you to lean on right now.  I may withdraw for a while, weep, grieve, mourn, or want to talk.  Stay close so I can reach out to you.
• Remember me when everyone else has gone back to their normal routines—Be the person who will listen to my story and pain again and again.  Mention my loved one by name and remember with me.
• Listen to my doubts—There will be days I will have doubts and I need you to listen to my doubts without judging me.  Help me move through my doubts so a more meaningful faith can emerge.
• Do not be afraid of my anger—I need to be honest about the pain I feel, help me work through it.
• Be patient with me—My progress may not be as fast as you think it should be.  Let me reveal my weaknesses and regression to you, I will get better in time with your patience and God’s help.
• Remind me that this is not all there is to life—I need to be reminded that there is more to life than the pain, anger and sadness I am feeling.  Speak about God to me as the hope of my life.  I need Him and you to be a companion on this painful journey, knowing that one day His eternal presence will penetrate my grief.

Conclusion

Providing care to employees in crisis is a difficult task.  There are few quantitative and visible ways to measure its effectiveness.  However, we must remember that the ministry is the willingness to enter the place of pain and hurt and offer the ministry of presence and compassion to the person in need.

That’s the ministry of a chaplain.