Crisis Intervention: The First Few Days

The National Institute for Trauma and Loss in Children
A program of Children's Home of Detroit

Crisis Intervention: The First Few Days
Summary of Dr. Lennis Echterling’s Presentation
William Steele

Reprinted from Trauma and Loss: Research and Interventions V4 N2 2004

Please note: This paper is adapted from the July 17, 2004 presentation given by Dr. Lennis Echterling, James Madison University, Harrisonburg, VA. at the National Institute’s Summer Institute in Detroit, MI. Dr. Echterling’s newest publication, Echterling, L. G., Presbury, J., & McKee, J. E. (2005). Crisis intervention: Promoting resilience and resolution in troubled times. Upper Saddle River, NJ: Merrill/ Prentice Hall (available through The Self Esteem Shop 1-248-549-0511) describes the different processes and strategies that are briefly summarized in this article. His approach is highly recommended and provides very specific language and techniques for helping victims in the first few days before formal debriefing or more intrusive or intense intervention would be appropriate.

Definitions of Crisis:

A danger, an opportunity (Chinese definition)
Momentous decision; end of one chapter, beginning of a new chapter; a turning point (Greek definition)

At the Time of Crisis:

Everyone is a resource.
Suicide rates highest during the depression and times when country is divided or fragmented.
Suicide rates lowest during war when all men and women are seen as resources.
People reach out in crisis.
People come together in a crisis. Sometimes they convene for comfort and protection, and sometimes to work through their fears and feelings via rituals.
Crisis is a time for empathetic action not a time to be processing feelings. Example: So how does it feel to be covered in mud? Versus, Come on, let’s get you cleaned up.
We all have the inner resources needed to become a survivor when we are given the opportunity to discover and experience our own resources.

The process of recovery is not about grief and trauma, but is about moving from victim to survivor or thriver by making contact, making meaning, managing emotions, taking action, finding resolve, and normalizing the future.

Making Contact
This refers to: empathetic action – Let’s clean you up. Let’s find you a place to sit. Let me help you find your friends. Let me just sit with you just in case you need something.

Active Listening
Face the child and give your undivided attention. Assume an open, receptive posture. Lean in; touch the person with expression of concern. Maintain eye contact (Note: they may not be able to look at you, but when they do glance and see you looking at them, contact is made.)

Active Understanding
Repeat or paraphrase what is said. Use words and phrases similar to what the person used.

Active Validation
Nod affirmatively and slowly as child speaks. Smile warmly. Lassie Twist (Echterling, 2004) Show your confidence by NOT GIVING ADVICE.

Making Meaning
Ask “Making Meaning” questions.

What worries you the most right now?
What scares you the most now?
What advice would you give someone going through a similar situation right now?
What do you think you can possibly learn from this?

Managing Emotions
Ask “getting through” questions.

Where are you finding it in your heart to be so brave to get through this as difficult as it is?
Have you ever had this kind of feeling before, even if it wasn’t to this degree?
How did you get through that?
What helped the most?
Who helped the most?
What did you do to feel a little bit better?

Lowering Emotional Distress

Acknowledge feelings (normalize). I can’t imagine not feeling scared, confined, etc.

Reminding them they are safe right now. Now that you are here and safe for a while it’s okay to …

Physiologically find a “Safe Place.” Use activities that for that individual would bring some calmness and respite. What would make you feel the most comfortable now, even for just a few minutes? What would make you feel the safest? What part of your body feels the calmest, most relaxed right now…stay there for a moment. Provide a glass of water. It does help to slow down the system, as does comfort food.

Provide teddy bears and “blankies.” They do make a difference and bring comfort for many.

NOTE: The purpose is not to “process” or “resolve” emotions. Simply, acknowledge, normalize, soothe.

Taking Action

Think in terms of short periods of time. What can you do the rest of today that will help you … until we meet again tomorrow?
Think in terms of simplistic actions. What can you do just for a brief time to give your brain a rest? Walk, exercise, listen to music, cook, play a sport, work.
Ask What else do you feel you need to do right now? It can be as simple as gathering more information. Often it is new information and details that help calm a person. Example: Surgical waiting.
Think in terms of the possibility of helping other survivors in small ways. As difficult as this is, you’re showing me a lot of compassion. What do you think you might do that might help others that are having a difficult time (surviving family members, etc.)?

NOTE: This can encompass a full range of activities depending upon the nature of the situation and survivors involved. Food, clothing and shelter are what a family who has been left homeless from a major hurricane could use. The sudden death of a loved one, friend or peer is very difficult for the survivors. A card or brief note letting them know what their family member/friend meant in your life, is a small way to help, but very supportive.

Finding Resolve and Resolution
Resolution comes in stages. Getting through the first day, the next day, the next few weeks will take resolve and each day different aspects created by the crisis can be resolved.

Begin in the present
How you feel later today will be a little different than how you feel right now. We know that because you’re likely to have new information, others who come to your support. Sometimes it’s just having the time to feel whatever you feel that helps to get through this.
Move to the future
By focusing each day on the next day and how the next day will be a little different as well.
By asking: It’s been two days now. What has made it possible for you to get through this? How have you gotten yourself through those past few days? How have you managed all your worries, your fears?
Ask “What If?” future oriented questions: What if you had the opportunity tomorrow to experience more relief or feel a bit stronger, what would you do when you woke up tomorrow?
Offer encouragement: You’ve shown me a lot of courage. I don’t know how I would respond if something like this were to happen to me, but I do know I’ll remember you and know that I will find a way.

Several Days Later - Focus on the Survivor (Additional strategies provided by William Steele)
Ask the following questions:

Now that you’ve had a few days to try to make sense of all that happened what one thought stands out the most in your mind?*
What have you learned that you did these past few days that helped you the most?
What did others do that really made a difference for you?
Where do you think you’ve gotten the strength to go on?
If something similar were to happen again what might you do differently?
What really surprised you the most about yourself these past few days/weeks?*
How has this changed the way you think about yourself?*
How has this changed the way you think about those closest to you?*
How has this changed the way you think about life in general?*
If you give me one piece of advice to help me better help others in the future what would it be?

Normalize the Future
Communicate the following: Every time we make it through one crisis, we learn a little more about ourselves, especially our strength. There will be other crises – that is a definition of life – the end of one chapter and the beginning of another chapter in our life. Future crises may be less difficult, they may be more difficult, but your strength will help you find a way to get through those tough times too. You really are a survivor.