Crisis management, according to Parad and Parad (as cited in Lewis & Roberts, 2001), is mostly based on anecdote and tradition, the assumptions of clinical practice experience, and lack the basic research, implementation, and review, confusing theory with sound methodology. One of the more acclaimed methods to date is Roberts’ (2005, 2009) seven-stage crisis intervention model.
Roberts’ seven-stage crisis intervention model is a culmination of work by Roberts and his colleagues over the past 50 years, extending that of Eric Lindemann1, in exploring the utility and best practices of crisis intervention (Roberts, 1995, 2005; Roberts & Yeager, 2009). The seven-stage crisis intervention model involves 1) a rapid biopsychosocial assessment, 2) creating collaborative rapport with the client, 3) defining the crisis, 4) an emotional exploration, 5) generating coping strategies, 6) restoring function using an action plan, and 7) following up with the client (Roberts, 2005; Roberts & Ottens, 2005; Roberts & Yeager, 2009). Though each stage is described as essential and sequential, this is not a strict model but one that values flexibility in its implementation, (Roberts, 2005; Roberts & Yeager, 2009).
Timely access to crisis intervention has been shown to reduce the need for hospitalization (Guo, Biegel, Johnsen, & Dyches, 2001). The biggest strength of Roberts’ model is the adaptability and scope of utility. Simply, this model provides a rapid assessment to quickly determine the need for enhancement of coping strategies or further and, perhaps, more structured care in the form of in-patient counseling, psychiatric, or other directed care. Though the coping strategies developed during the intervention may not be applicable or effective to all cases, identification of the need for further strategies is important.
Another strength of Roberts’ model is its scope beyond lethality. “Not all individuals who are in crisis are either suicidal or homicidal” (Lewis & Roberts, 2001, p. 22). Crisis intervention models should be focused at addressing the root of the crisis state to develop means of assisting the patient to cope with these stressors; however, obtaining a measurement of lethality is obviously important.
One of the limitations of any crisis intervention tool is the question of applicability. Regehr (2001) describes how mandating psychological debriefings after traumatic events can actually result in an increase of post-traumatic stress symptoms with increased persistence, recommending that any intervention should be at the behest of and initiated by the victim. The emergency services use crisis intervention techniques in order to provide a psychological debriefing to responders of critical incidents, and these sessions are often mandatory, which could cause serious psychological harm to the provider. Another limit of applicability is the attempted use of the model to intervene with a drug or alcohol issue or a truly psychiatric issue, such as severe depression, bipolar disorder, or any of the personality disorders that might inherently cause a state of crisis, such as schizophrenia or affective psychosis (Guo et al, 2001).
Roberts’ seven-stage model provides a framework built upon years of parallel research efforts over the last century and appears to be a best practice when assessing those in crisis. More research is being done to assess the mode and applicability of using this tool by providing measurement data. Thus far, Roberts’ model is the most appropriate tool to begin an assessment, especially on an emergency basis.
Guo, S., Biegel, D. E., Johnsen, J. A., & Dyches, H. (2001). Assessing the impact of community-based mobile crisis services on preventing hospitalization. Psychiatric Services, 52(2), 223-228. doi:10.1176/appi.ps.52.2.223
Lewis, S. & Roberts, A. R. (2001). Crisis assessment tools: the good, the bad, and the available. Brief Treatment and Crisis Intervention, 1(1), 17-28. doi:10.1093/brief-treatment/1.1.17
Regehr, C. (2001). Crisis debriefing groups for emergency responders: reviewing the evidence. Brief Treatment and Crisis Intervention, 1(2), 87-100. doi:10.1093/brief-treatment/1.2.87
Roberts, A. R. (Ed.). (1995). Crisis intervention and time-limited cognitive treatment. Retrieved from http://books.google.com
Roberts, A. R. (2005). Crisis intervention handbook: assessment, treatment, and research (3rd ed.). Retrieved from http://books.google.com
Roberts, A. R. & Ottens, A. J. (2005). The seven-stage crisis intervention model: a road map to goal attainment, problem solving, and crisis resolution. Brief Treatment and Crisis Intervention, 5(4), 329-339. doi:10.1093/brief-treatment/mhi030
Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University Press.
1 Eric Lindemann, while working at Massachusetts General Hospital, introduced the concepts of crisis management and time-limited treatment after researching the effects of psychological trauma on the survivors of the Coconut Grove nightclub fire in Boston that killed 493 people on November 28, 1942 (Roberts, 2005; Roberts & Ottens, 2005).