Introduction
The case of Emma showcases one of the crisis instances when an individual is in dire need of help and guidance on how to cope with her emotions. Emma, a Grade 10 student in South Africa, struggles emotionally and physically. On the one hand, the young girl experiences drastic weight gain, which makes her frustrated. On the other hand, Emma faces family issues, with her father leaving the family and remaining distant. In addition, the girl’s mother is rarely present due to being engaged with work and financial issues, with Emma being responsible for her younger brother. All of these factors, combined with her recent breakup and poor academic performance, have led to feelings of anxiety, sadness, suicidal thoughts, difficulty sleeping, and poor concentration.
When earlier efficient coping methods fail and are replaced by unhelpful attitudes and behaviors, people experience a crisis. A crisis can be defined as a state of confusion with significant levels of stress and anxiety when coping mechanisms are not helpful. Previous research in psychology has made many developments throughout the 20th and 21st centuries.
For example, professionals gained a new perspective on crises in the 20th century owing to Erich Lindemann’s studies, publications, and teachings (James & Gillan, 2017). Lindemann’s basic crisis theory and work significantly improved human understanding of how clients behave during grief crises brought on by loss (James & Gillan, 2017). Concern with those gone, identification with that person, expressions of resentment and hatred, a disorder in everyday life, and some bodily issues are among these standard grief responses.
Application of Crisis Theories to the Case
Fundamental Crisis Theory
The fundamental crisis theory can be used to explain the behavioral patterns of Emma, who experiences grief related to her parents. On the one hand, the young girl grieves over her father, who is no longer present in the family and rarely contacts his children. On the other hand, Emma grieves over her mother, who has several jobs and does not have time to spend with her daughter. As a result, even when both of her parents are alive, the child experiences a sense of grief and likelihood.
Expanded Crisis Theory
Since basic theory, which solely relied on a psychoanalytic technique, was insufficient in addressing the social, environmental, and situational variables that define a crisis, expanded crisis theory was established. It has become apparent that a strategy that views preexisting variables as the primary or sole causal agent does not offer a complete picture as a crisis theory and interventions have developed (Everly & Mitchell, 2000). Expanded crisis theory incorporates broad structures, environments, adaptational, interpersonal, chaotic, and developmental concepts in addition to psychoanalytic theory (James & Gillan, 2017). Therefore, this approach accentuates the importance of looking at the bigger picture, where Emma’s crisis can be viewed holistically, and internal and external factors can be considered.
Acceptance and Commitment Therapy
Another model that is worth mentioning is the ACT model. The abbreviation for the paradigm stands for assessment of the current issue, connecting individuals with treatment systems, traumatic reactions, and PTSD (Flynn & Black, 2020). The model’s seven essentially linear steps are crisis assessment, rapport-building, problem-spotting, emotion-handling, generating and examining alternatives, formulating strategies, and giving follow-up (James & Gillan, 2017).
This model was created to address the beginning of a traumatic event and, perhaps more correctly, behavioral crises (Flynn & Black, 2020). Considering the case of Emma, the young girl must receive a proper assessment and access to a further support system, which the ACT model can help establish. Given the lack of people Emma can rely on, there is a strong need to build counselor-client trust and rapport to help the child.
Contextual Ecological Model
A contextual ecological model was created by Rick A. Myer and Holly B. Moore that emphasizes the background of the situation. According to their primary tenet, contextual factors may be viewed as multifaceted (Flynn & Black, 2020). The physical proximity to the issue influences these layers, and responses are influenced by cognition and the significance of the occurrence (James & Gillan, 2017).
The second tenet of this paradigm is that the person in question and the systems impacted by the event have an equal effect on one another (James & Gillan, 2017). Recognizing two factors, the interaction between primary and secondary links and the level of change brought on by the event, will help a professional comprehend the crisis’ reciprocal effects.
The third premise holds that the passage of time directly affects how a crisis unfolds. The two main temporal components are the time that has gone by and notable events, including anniversaries and holidays, since the incident (Flynn & Black, 2020). Emma’s case demonstrates how her reactions to a break-up with her boyfriend and deteriorating relationship with her father, who is not present even at her birthdays, directly impact the child’s well-being.
Developmental-Ecological Model
Lastly, some earlier and newer models can be taken into consideration. Collins and Collins created a developmental-ecological model of crisis intervention that considers a person’s surroundings as well as their developmental stages and problems (James & Gillan, 2017). According to this concept, the crisis professional must evaluate the client, the surrounding circumstances, and their interactions before considering the client’s developmental stage (Flynn & Black, 2020). Therefore, it is essential to evaluate Emma’s responses, perceptions, and the recent events she experienced.
Equilibrium Model
Finally, in the context of the equilibrium model, it is claimed that people who are experiencing a crisis are in a condition of psychological or emotional instability when their typical coping strategies and problem-solving techniques fail to be effective. The equilibrium model aims to assist individuals in regaining their pre-crisis balance. When someone needs help promptly because they are out of control, confused, or unable to make intelligent decisions, the equilibrium model seems to be the best option (James & Gillan, 2017). In Emma’s case, given her suicidal thoughts, it is first essential to address her attitudes and instill hope before addressing the underlying factors that contributed to the condition.
Assessment of Emma’s Emotional State
Regarding Emma’s emotional state, the Triage or ABC Assessment can be effective. The abbreviations in the assessment stand for Affective, Behavioral, and Cognitive processes. The first one, affective, gives a more in-depth analysis of the client’s emotional responses to the events. Emma’s sadness is pervasive due to difficulties she experiences in her family, feeling lonely and unwanted. Moreover, the young girl’s struggles are connected with her frustrations due to weight gain, which she believes to be the reason for her breakup. As a result, Emma has difficulty experiencing joy and finding positive emotions that could remind her of her strengths.
As for the behavioral processes experienced by Emma mainly include a lack of motivation, concentration, and difficulty sleeping. Given the stress in Emma’s life, it is significantly overwhelming for a young girl to be engaged with her studies and remain concentrated. Consequently, failure to meet academic expectations only exacerbates the student’s confidence and well-being further. Moreover, difficulty sleeping can be connected to Emma’s anxiety and unpredictability in life, given financial instability and her constant thoughts about her parent’s divorce, which has not been finalized.
Cognitive processes are connected to Emma’s overall emotional responses and attitudes. On the one hand, Emma’s poor perceptions of herself are fueled by external factors, such as her boyfriend’s decision to break up and her father’s unwillingness to communicate with her. On the other hand, Emma’s negative thoughts keep fueling her emotional distress. Weight gain, which can be driven by the hostile environment in which she lives, continues to affect her sense of self-worth. Therefore, while internal factors significantly influence Emma’s attitudes, external factors exacerbate the girl’s health and quality of life.
Coping Mechanism
Emma’s coping mechanisms within the context of anxiety and loss include avoidance, denial, and disengagement. First, avoidance is frequently viewed as a maladaptive behavioral reaction to excessive fear and worry, which keeps anxiety-related conditions active (Hofmann & Hay, 2018). Repeated and sustained exposure to a threat while inhibiting individuals from employing avoidance techniques, including escape or safety behaviors, is a critical component of treatment (Hofmann & Hay, 2018).
In the case of Emma, her avoidance can be seen through her struggle to attend school, do homework, and prepare for exams. There are several reasons behind such choices, such as being overwhelmed by her situation in her family and being bullied at school by her teacher, who emphasized her weight problem. As a result, her safety behavior is based on staying home, where she will experience less social anxiety and a fear of being judged by others.
Disengagement involves people in her life and her disengagement with reality. Reduced effort or completely giving up the effort to achieve goals that the stressor prevents someone from achieving is called disengagement (Korosec-Serfaty et al., 2022). By opting for sedentary behavior and avoiding school, homework, or other people, Emma tries to disengage with reality by watching TV, which helps her forget her problems. However, her disengagement can be seen in her attitude toward her boyfriend. She admits that she sent messages to him, but he did not reply. However, Emma is unsure whether they broke up since she did not communicate with him in real life.
Therefore, by avoiding stressors and disengaging with the triggers, she denies their existence. Denial is based on ignoring the undesirable reality of an event by focusing on internal justifications or illusions rather than the external reality (Bailey & Pico, 2023). Ceasing to communicate with her boyfriend and establishing an illusion that their break-up was based on her weight is the result of her low self-esteem. By denying the reality and the need to deal with the issues, Emma wants to protect herself.
Integrative Intervention Model
The Golan model is the integrative intervention model that can be used to help Emma. The approaches that can be applied during crisis counseling sessions with Emma are cognitive-behavioral, narrative, and solution-focused therapy. First, in terms of cognitive-behavioral therapy, it is mandatory to use active listening, empathetic responding, and emotional support (Swain & Clark, 2016). With cognitive-behavioral therapy being aimed at letting the client share their feelings and perspectives, such techniques can enhance the support provided to Emma and make her emotions be validated and heard. This will additionally help Emma stop avoiding her genuine feelings and understand the situation.
Furthermore, narrative therapy is a helpful element of the therapy that will help Emma focus on her values and coping skills. This kind of therapy can be used to identify the meaning Emma puts into her experiences and how she perceives events in her life. Additionally, it will help her communicate her emotions, focus on the events in her life, and understand that she is not the problem and cannot blame herself for feeling lonely and unwanted. Such a technique will help modify the client’s behaviors and redirect them toward embracing her strengths and starting to value herself.
Finally, solution-based therapy will help address the issues concerning relationships, family issues, anxiety, and depression holistically. After allowing the client to voice her concerns and emotions, it will be possible to focus on the solutions available to Emma. Through this approach, Emma will understand what practices can help her cope with events occurring in her life. Therefore, the Golan model represents a comprehensive framework for tackling issues and guiding clients.
Crisis Intervention Techniques
Another point worth attention to is crisis intervention and techniques to help contain Emma. The first techniques that can be applied in the case of Emma are building rapport and clarifying the problem. One should be careful when clarifying the issues since it is essential to ensure that Emma feels safe and trusts the person she communicates with. Given that she feels isolated and unwanted, she tends to be fragile, and building trust is especially crucial to make the intervention successful.
The second stage and the techniques that will be essential are to assess Emma’s level of danger and explore her emotions and thoughts. Considering that Emma wants to go to sleep and never wake up, which signals depression and suicidal thoughts, one should understand the extent to which such attitudes are present (Van Rooyen, 2016). Moreover, to understand the situation and the most acute issues, discussing the problems and asking Emma how she feels can be helpful. Here, one should consider giving feedback and support to the young girl to make her feel heard and not simply listened to.
Lastly, after analyzing Emma’s situation, emotions, dangers, and other external and internal factors, one should develop a plan of action. Although communicating about her feelings might alleviate the depressive and stress symptoms, it is still important to consider offering a course of action for Emma. Overall, such techniques should help the client feel supported and not alone.
Countertransference and Crisis/Trauma Counselling
The final aspect that is a crucial component of successful therapy is the management of countertransference in trauma counseling. Countertransference refers to the therapist’s response and emotions toward a patient (Pau et al., 2020). If not adequately handled, countertransference—a frequent, unconscious phenomenon—can harm the therapeutic interaction (Pau et al., 2020). Such a phenomenon can be frequently seen in crisis or trauma counseling due to patient sharing their vulnerabilities and traumatizing experiences. An approach to psychotherapy known as trauma counseling identifies and places emphasis on the influence that a traumatic incident has on an individual’s psychological, behavioral, physical, and mental health (Herbst & Reitsma, 2016). Therefore, it is essential to manage one’s attitudes as a professional and not become emotionally involved.
To deal with countertransference, a counselor needs to acknowledge their feelings and understand the sources of such emotions, which can later be handled through supervision and psychotherapy. In the case of Emma, it is crucial to apply self-care techniques and be aware of moments when one feels sad, helpless, or hopeless. By remaining objective in the situation, a counselor can provide the best support they can (Duffey & Haberstroh, 2020). Thus, the primary goal of the counselor and other professionals in psychology is not to become emotionally entangled in the process and focus on the issue and solutions.
Conclusion
The Emma case serves as an example of a crisis situation where a person desperately needs support and advice on how to manage her emotions. Emma is dealing with family troubles, and her father is no longer living with them. The girl’s mother is rarely around because she is preoccupied with her job and finances, leaving Emma to care for her younger brother. Having problems in her family and feeling undesired contribute to Emma’s pervasive sadness. Emma struggles to discover happiness and other good feelings that might remind her of her abilities. Emma uses avoidance, denial, and disengagement as coping strategies in the face of worry and loss. The girl must, therefore, seek assistance from a specialist in crisis and trauma counseling.
References
Bailey, R., & Pico, J. (2023). Defense mechanisms. National Library of Medicine. Web.
Duffey, T., & Haberstroh, S. (2020). Introduction to crisis and trauma counseling. American Counseling Association.
Everly, G. S., & Mitchell, J. T. (2000). The debriefing” controversy” and crisis intervention: A review of lexical and substantive issues. International Journal of Emergency Mental Health, 2(4), 211-226. Web.
Flynn, S. V., & Black, L. L. (2020). Crisis, trauma, and disaster: A clinician′s guide. SAGE Publications.
Herbst, A. & Reitsma, G. (2016). Trauma counselling principles and practice in South Africa today. Juta and Company.
Hofmann, S. G., & Hay, A. C. (2018). Rethinking avoidance: Toward a balanced approach to avoidance in treating anxiety disorders. Journal of Anxiety Disorders, 55, 14–21. Web.
James, R. K. & Gillan, B. E. (2017). Crisis intervention strategies (8th ed). Cengage Learning.
Korosec-Serfaty, M., Riedl, R., Sénécal, S., & Léger, P. M. (2022). Attentional and behavioral disengagement as coping responses to technostress and financial stress: An experiment based on psychophysiological, perceptual, and behavioral data. Frontiers in Neuroscience, 16, 1–22. Web.
Swain, K. & Clark, K. (2016). Trauma counselling. In Naidu, T. (Ed.), Talk therapy toolkit: Theory and practice of counselling and psychotherapy (pp. 167-171). Van Schaik.
Pau, K., Ahmad, A., & Tang, H. Y. (2020). Crisis, disaster, and trauma counseling: implication for the counseling profession. Journal of Critical Reviews, 7(8), 736-39. Web.
Van Rooyen, K. (2016). What is traumatic stress? In A. Herbst & G. Reitsma (Eds.), Trauma counselling: Principles and practice in South Africa today (pp. 1-21). Juta and Company.