Community Mental Health: The Role of Church and Temple by Howard J. Clinebell, Jr., (Ed.)
Howard J. Clinebell, Jr., is retired professor of Pastoral Counseling, School of Theology at Claremont, California. Published by Abingdon Press, New York, Nashville, 1970. Used by permission. This material was prepared for Religion Online by Ted & Winnie Brock.
Chapter 11: The Clergyman’s Role in Crisis Counseling by Paul W. Pretzel
Charlie Johnson is a big man, well over six feet tall, with coarse, rugged-looking features.
He had come to the Suicide Prevention Center in Los Angeles because his physician had told him to, but he had little hope of being helped. He even doubted that he wanted help. His life had been unsatisfying for years, and now with this latest stress there was no reason or desire to go on. He was forty-seven years old, married for twenty years to a woman whom, he felt, offered him no warmth. His two children were now grown and gone, and he seldom heard from either of them. He had no close friends and few interests. The one thing he did well, he felt, was his work. For seventeen years he had driven a truck for a Los Angeles firm, and he took some pride and felt his self-esteem increased because his near-perfect work record.
Two weeks ago, after a fight with his wife, he had gone to a local bar and begun drinking. Driving home, he was arrested for drunk driving, and since this was a second offense he was sure he would lose his license. Without a driver’s license and therefore without his job, he did not want to live. Charlie’s plan was to wait until he received the final court decision, then drive his car to a deserted place and sleep his life away with carbon monoxide. It was a lethal plan. He had the car, the necessary length of hose, and the location already selected. All that was left was for the time to run out, and next Monday, after the court hearing, was the time.
The pastoral counselor to whom Charlie spoke at the Suicide Prevention Center recognized him as a high suicidal risk. Having temporarily lost the ability to deal with the conditions of his life and to cope with the stress that he was facing, he was in a state of emotional crisis. He felt that life no longer held any satisfaction for him and there was only one solution that he could now see -- only one way out -- suicide.
The experienced crisis counselor, in this case a pastoral counselor, although recognizing Charlie as a serious suicidal risk, also knew that the situation was not as hopeless as it first appeared. Although the person in an emotional crisis is overwhelmed and feels as though his situation will never improve, experience indicates otherwise. Acute feelings of hopelessness, helplessness, and depression are seldom of long duration. They usually abate within a few weeks. In addition, the person in crisis, because he is overwhelmed by his own feelings, may magnify the difficulties that he is facing and, at the same time, underestimate the possibilities and resources that he has. The crisis counselor makes an important contribution by more realistically assessing both the dangers and the possibilities inherent in the crisis situation and adding the elements of perspective and stability.
Crisis theory, as developed by Erich Lindemann and Gerald Caplan, holds that when a person is in a state of crisis, he is especially vulnerable to change. This change may take either a negative or a positive direction, depending, in part, on the influences that affect the individual when he is in crisis. Crisis intervention has to do with exerting the type of influence which will encourage personal growth.
Crisis intervention takes place whenever one person responds to another human being who is overwhelmed by his own feelings and is unable to function in his normal manner. The alert parish clergyman routinely functions as a crisis counselor when his people come to him at times of stress in their lives. Most clergymen have many experiences in dealing with people who are reacting to a crisis by expressing psychological panic, paralysis, or depression, which is distorting their judgment and leading them either into inappropriate action or into an inability to make any response at all. The clergyman who is familiar with the theory and techniques of crisis intervention is well equipped to help his parishioners turn their crises from disaster into creative solutions where personal growth can take place.
Although the long-term result of good crisis intervention is often a significant improvement in the individual’s overall adaptation to life, the specific goal of crisis intervention is to help the individual to deal with the specific stress that has brought about the crisis. Whenever the crisis counselor deviates from this goal, he is no longer involved in crisis counseling. In Charlie’s case, the goal which the crisis counselor adopted had to do with the immediate suicide feelings springing from his fear of losing his driver’s license.
Method of Crisis Intervention
The method of crisis intervention can be organized into four steps: the assessment of the problem, planning the nature of the intervention, the intervention itself, and the resolution and withdrawal.
1. The assessment of the problem. When first faced with a crisis situation the counselor needs to make two kinds of assessments.
a. First he must determine whether or not there is an immediate physical emergency. Relevant questions are: Has the person already ingested pills? Has he already cut his wrists? Has he already wounded himself with a gun? If the counselor determines that there is a physical emergency, then he must respond to it by providing what is needed. In some cases, he will help the patient get to an emergency hospital; in other instances he may involve the help of the police.
b. If the counselor decides, however, that there is no imminent physical emergency then he will be free to move into the second kind of assessment and determine, in detail, what kind of crisis is now in effect, what the stresses are, and what they mean to this person at this time. If the person has experienced similar kinds of crises in the past the counselor will want to know how they were resolved.
At the same time that the counselor is assessing the nature of the crisis, he will also be assessing the strengths of the person’s resources. The resources will be of two kinds. (1) The internal characteriological resources -- the ego strength and the rationality that the patient still possesses. (2) The external resources. The counselor will want to know something about who the person has in his life who can be counted on to help at such a time. Does he have a family? Is he married? Does he have a doctor, a therapist, a clergyman, an employer, a drinking friend? Does he have money? Is he employed?
In the case of Charlie Johnson, it was clear to the pastoral counselor that there was no physical emergency. Charlie had not yet done anything to harm himself, nor was he chaotically out of control. Upon inquiry, he found that Charlie had never been suicidal before, and that this was a new and frightening experience for him. He had no idea of how to cope with such feelings. His resources seemed tenuous. His ego strength was low, and there seemed to be few people in his life who cared for him. It was only after questioning that the counselor discovered that Charlie’s mother and father lived locally and might be of some help.
2. Planning the Intervention. Once the assessment of the problem has been made, the counselor begins discussing with the person what might be done to alleviate the stress or otherwise adapt to the stressful situation. Thus the patient begins to have the feeling that stress is something that can be dealt with, and there grows in him the hope that the situation is not as overwhelming and as hopeless as he had at first experienced it. The counselor and the counselee explore the possibilities and alternatives, turning them over and over, discussing ins and outs while taking all the limitations of the situation seriously. At this point, there is a commitment being made by the counselor that a solution will be found and that the discussion will continue as long as it takes to find a solution. If this cannot be accomplished in one interview, then appointments are made for subsequent interviews.
The role of the person in the intervention into his own crisis needs to be carefully considered. The person should be encouraged to do everything that he can realistically be expected to do for himself. It is only when he has reached the limits of his own present ability that the counselor will take the initiative to perform some action. When it is clear that the person is temporarily unable to function in some area for himself, the crisis counselor will take responsibility. It is not unusual, for example, for a crisis counselor to take the initiative to speak with some significant other person in order to mobilize help for his counselee.
The important thing is that whatever decision is made about intervention should be carefully planned. The temptation is to overemphasize the need for speed and to begin intervention without careful planning. This frequently has the effect of confusing an already confused and involved situation. It is important, therefore, that the crisis counselor take whatever time is necessary to gather the information he needs and to carefully evaluate the situation, working out an intervention plan with the person that seems to stress economy of movement and yet promises maximal results.
Although Charlie represented a high suicide risk, the counselor felt, at the end of the first hour, that there was time to work and that Charlie had been able to involve himself enough in the problem-solving process that there was no need for urgent action. A subsequent appointment was set up for three days later.
3. The Intervention. Crisis intervention can take such a variety of forms that it is impossible to list them all. Each individual situation carries within itself the seeds of its own resolution. The process of crisis work consists of carefully and doggedly sifting through the possible alternatives until the intrinsic solution is discovered. Sometimes it is enough for the person to be able to redefine his own problems with a different perspective. Failures that he now experiences as being monumental often diminish in importance when compared to other important factors in his life, and he may then find himself able to cope with them. At other times crisis intervention is carried on by helping the person to gain cognative control of his own thought processes -- by helping him to structure, to outline, to list in an organized and rational way the different elements of his life. Sometimes crisis intervention can take place simply by the counselor reminding the person that he has experienced similar crises in the past, and that the way he resolved them then may still be applicable now.
At other times, crisis intervention calls for more direct activity, either on the part of the counselee or the counselor or both. If the counselee is immobilized to the point of inaction, the crisis counselor will take the responsibility to contact resource persons in the counselee’s life -- a spouse, parent, a friend, or doctor -- and facilitate their involvement in the crisis situation.
In Charlie’s case, although the counselor stood ready to phone his wife or his parents, if necessary, it was decided that Charlie could do this for himself, and he decided that what he should do was to attempt to reestablish his relationship with his parents, which he did with some success.
4. Resolution and withdrawal. Crisis theory holds that the counselor begins to plan his withdrawal from the situation as he enters it. Crisis intervention is never a long-term activity, and the counselor must continually be aware that although he will become intimately involved in the person’s life for a short time, he must be prepared to withdraw from it at the earliest possible moment. Usually, this will be when the counselee or one of the resource people is able to take responsibility for the situation. Premature withdrawal from a crisis situation, especially a suicidal situation, can have disastrous results. In such cases, the clergyman should have the benefit of competent consultation and good coordination with other helping persons. In some cases, the counselor will want to maintain contact with the particular person over a long-term period, but when he does this, he should be aware that he is no longer fulfilling the function of crisis intervention, but has moved into a different role -- one of ongoing emotional support or of helping the person deal with underlying problems.
The resolution of Charlie’s crisis came when he reestablished his relationship with his parents and made plans to enter counseling to work through his marital difficulties. He discussed these plans at length with the crisis counselor, who was able to help him by suggesting a qualified therapist. Once Charlie began this new relationship the crisis counselor withdrew from the situation.
Crisis Intervention as a Tool for the Clergyman
Crisis theory has some important characteristics which make it especially applicable for the use of clergymen, both those who function in a local parish and those who function in other kinds of settings.
a. Crisis intervention calls for minimal knowledge about personality theory. Long and detailed psychiatric histories have no place in crisis intervention, and the crisis counselor finds that he can function in an effective way with minimal theoretical or psychiatric knowledge. What is needed in place of this is what most clergymen already have -- an intense interest in helping someone who is in trouble, the ability to conceptualize a problem, and the ability not to be overwhelmed by the person’s feelings of depression or confusion.
b. Crisis theory affords a way of providing significant help to people, while demanding a minimum of long-term commitment. The clergyman who is interested in being a counselor is continually being frustrated by the great time demands that the counseling normally takes. Crisis intervention is by definition time limited, and offers the advantage of producing maximal results with minimum time involvement.
c. Clergymen have an almost unique access to certain resources that can be mobilized on a person’s behalf. Whereas it is very difficult for certain professional therapists to learn to take initiative by contacting people on a patient’s behalf, the clergyman usually is very much at home in taking such initiative. In many communities it is expected that when the clergyman hears of somebody in crisis he will take the initiative to seek them out and offer what help he can, and he is used to mustering community support for people in need. Such activity is integral to crisis intervention and is particularly pertinent to the normal functioning of the clergyman.
d. In crises where suicide is an issue, the clergyman is frequently the recipient of the cry for help that suicidal people customarily make prior to their suicide attempt. This places the clergyman in an important position in that if he can recognize the existence of an emotional crisis in one who is communicating to him, he can often take the initiative and begin his work of crisis intervention early in the developing crisis and often forestall serious suicidal behavior.
For additional reading
Caplan, Gerald. Principles of Preventive Psychiatry. New York: Basic Books, 1964.
---------An Approach to Community Mental Health. New York: Grune & Stratton, 1961.
Farberow, N. L. and Shneidman, E. S. The Cry for Help. New York: McGraw-Hill, 1961.
Lindemann, Erich. "Symptomatology and Management of Acute Grief," American Journal of Psychiatry, September, 1944.
Parad, Howard J., ed. Crisis Intervention. New York: Family Service Association of America, 1965.
Shneidman, E. S. and Farberow, N. L. Clues to Suicide. New York: McGraw-Hill, 1957.