Overcoming crisis – support in emergency situations

Małgorzata Kwiatkowska: Psychological support in emergency situations differs in many ways from the standard therapeutic process. What is crisis intervention and what is its purpose?

Agata Fryś: It's assistance for people who have experienced a sudden and difficult-to-control event, such as an accident, natural disaster, unexpected job loss, assault, or the suicide of someone close. The aim is to help manage stress and emotions, minimise the negative effects of the situation on mental health, and restore the victims' state of balance. Often, crisis intervention helps to regain good cognitive functioning, as difficult moments can disrupt not only emotions but also the understanding of what is happening around the person in crisis. I would also say it may involve restoring the victim's subjectivity and ability to make independent decisions. In some cases, support also involves meeting basic needs and ensuring access to medical or social care. These issues are no longer the responsibility of the psychologist, but of the appropriate services.

MK: So it's help given in an emergency situation that has overwhelmed someone and which they are unable to cope with on their own. We then deal with feelings of powerlessness and helplessness, and as a consequence, there is a need for someone else to take control.

AF: Yes, in a therapeutic situation, the person receiving help from a psychologist has much more decision-making power. In an intervention, however, the specialist has greater authority and decision-making ability – of course, with the client's consent. They take the initiative and additionally provide advisory assistance. Depending on the scale of the crisis the person is facing, they should receive support tailored to their individual state.

MK: It all depends on how much the situation has affected them and how many resources they have to face it?

AF: The concept of a crisis cannot be confined within strictly defined boundaries. Each crisis may look different and, even if it arises from a similar event, it is a very individual matter. Unfortunately, there is also no single effective remedy that will heal everyone. There are people for whom a particular event will have a deep impact, and there are those who, in an identical situation, will experience minor or even no consequences. From the same car accident, two people sitting next to each other may come out with different experiences and ways of coping. A lot depends on our personality, past experiences, and the support we receive. We have different sensitivities, smaller or larger reserves of mental strength, and a diverse range of tools and ways to cope with intense stress. But even if we initially cope well, it is possible that the crisis will hit us only some time after the event. In the first period, we invest all our intellectual and emotional resources in dealing with priority tasks, taking care of our own safety and that of our loved ones, and only later are we overwhelmed by powerlessness. Of course, extreme emotions, concentration disorders, sleep disturbances, periods of agitation, irritability and anger, or withdrawal, absence, and alienation are common reactions. Sometimes the signs of a crisis are very visible – crying or screaming, as well as changes in behaviour at work, in contact with other people. Some, on the other hand, close themselves off and do not want to talk to anyone. This state can be prolonged, without releasing emotions that accumulate inside. Each of us experiences difficult events in our own way.

MK: In any case, it is worth realising that a psychological crisis is one of those moments in our lives when we really have permission to stop coping on our own. Taking care of oneself and reaching for help is a sign of psychological maturity.

AF: Of course, it's often difficult for us to admit to a problem, to a weakness, and we feel ashamed. A crisis is usually a very challenging experience, which requires a lot of effort focused on regaining mental balance. In many cases, it means a long journey to go through, but at its end, immense relief may await. Sometimes touching serious events from the past – distant or not – is so burdensome for us that we're simply afraid to cross that boundary. Working on a crisis is largely personal work, but it's worth having someone trustworthy by your side during the process. In my opinion, the most natural and supportive thing is the bond with another person. We should take care of it in the first reflex. Without a sense of fear, strive for good communication and flow of thoughts and emotions. It's certain that no one should be left alone with difficult experiences. Sharing emotions is very helpful. If we don't want to confide in a partner, friend or someone in the close family, let's reach out for expert help. Not every intervention is long-lasting and requires many meetings with a specialist. Sometimes one conversation can help.

MK: And who has the competence to carry out an intervention? Where and how to seek help in a crisis?

AF: Basic safety is, of course, provided by the appropriate services – police, fire brigade, or rescue units. Meanwhile, immediate psychological assistance often helps to cope with post-accident shadows. For most of us, strong emotions (not just negative ones, but positive ones as well) are exhausting, which is why a quick response is so crucial. It's definitely worth remembering the operation of crisis intervention points or centres, which offer free, fast and usually interdisciplinary support. There should be at least one such centre in every district. Crisis interveners work there, i.e., people with specialist knowledge in the field of crisis psychology. And the intervention itself consists primarily of identifying the problem, ensuring safety, providing emotional support, among other things, by building trust. Then, a qualified person presents the client with various problem-solving options.

MK: How can people other than specialists provide support?

AF: First emotional support in many situations can be provided by any of us. It's mainly about showing empathy to the person, calming them down, surrounding them with compassion, and listening. Waiting is not advisable in any case. The faster a person in crisis feels safe, the easier it will be for them to eventually face the consequences.

MK: That's why after difficult unpredictable events, it's worth observing the surroundings, being alert and attentive to what's happening with people directly affected by the crisis situation, and reacting if needed.

AF: If we have someone like that in our immediate environment, we should definitely not leave them alone. Let's try to talk, but ask specific questions: do you want a hug, do you want to talk about what happened, or do you want to direct your thoughts to a completely different subject. Check their needs. It's also very important not to speed up the whole process, ensure peace and comfort for the other person. Do not impose our views, do not try to improve someone's mood at all costs. Do not give advice forcefully. Allow the close person to express their negative feelings. Then there's a good chance that the affected person will feel relief, resulting from the mere fact that we're there and give them permission to experience and work through difficult emotions. It's good to create a safe space for talking about their experiences. Of course, let's remember that we're not supposed to be psychologists for our friend, sister, mother or husband. However, we can suggest professional help and look for it together. We can also learn how best to support someone in crisis at the crisis intervention centre I mentioned earlier.

MK: It's worth noting that for employees of companies with the ICAS Employee Assistance Program and their families, the EAP Line can also provide help.

AF: The EAP Line is a kind of first lifebuoy. And I believe that even if someone, experiencing an event, doesn't feel strong enough to use regular psychological support, it's still worth making that contact. One phone call doesn't commit you to anything – we can always decide during the conversation that we're not ready for it. But perhaps such an attempt will give us the strength to face what's hurting us. At a given moment, we may not be ready for anything, as we are governed by strong emotions. Then, alleviating emotional reactions can facilitate work on the crisis, especially when they hinder our daily life and communication with loved ones. Importantly, psychologists available by phone around the clock know how to defuse them and will direct us to a specific specialist or find an address where we can get support tailored to our current needs. Regardless of the path we choose – whether we make a call, go to a crisis intervention centre, or talk to someone trustworthy who can listen and wants to understand us – the process of rebuilding a sense of control over our lives will slowly begin to sprout within us. However, let's note that it doesn't happen overnight.

MK: And when the period immediately after the event is over, how do the needs change over time and what help is needed then?

AF: Assistance in crisis situations can be ad hoc – to immediately reduce the stress experienced by the victims, or it can take the form of regularly attended psychotherapy, which will be handled by a specialist. Psychotherapists are professionals who have specialized knowledge in psychotherapy in selected approaches, they usually work individually, and sessions can continue from several weeks to even several years. It all depends on how strong the reaction to the crisis is and which tools will be most appropriate.

MK: By making an effort, we have a chance to initiate an important process because the crisis that has affected us can eventually build something positive within us. But how to work on improving our condition?

AF: Specialist support can help us, firstly, rebuild a sense of control, an awareness that action lies within our power, despite the difficult experience; secondly, reorganize our values; and thirdly, rediscover our identity – who we are and what we have experienced. It is important to take action, even small, which directly challenges helplessness. It is worth reminding ourselves of our strengths. Definitely, do not run away into solitude, which brings out the worst fears, do not seek comfort in alcohol or other substances, and do not impose additional duties on yourself at work or home – this will deepen psychological tension and may further weaken the body. Remember that there are many methods that can help us reduce our anxiety and fear. It is also worth talking to a specialist about all of this. During joint work, many questions and individualized options will appear. These are specific tools that will help you find strength. Certainly, do not demand immediate changes from yourself, do not expect your life to return to its pre-event state as soon as possible. Give yourself time. Sometimes you need to make decisions that will change your life, respond to the needs you have today. It does not mean that you will lose something. On the contrary, you may gain a new quality, thanks to which peace will prevail in your heart and mind.

MK: Maybe it's worth just listening carefully to ourselves, feeling and accepting both what is strong within us and what is weak?

AF: Of course. Sometimes it's about raising our competencies and understanding what our emotional system looks like. Sometimes we need to rebuild trust in ourselves and the belief that we can cope with obstacles, while at other times we need to build and maintain close relationships with family and the closest community, and in other cases, we just need to let go. It is important to create a coherent system of values that brings a sense of integrity, to work on ourselves, on the awareness of contributing to the world, on the awareness of what we can influence and what we cannot. These are very individual needs. They require careful listening to ourselves or allowing a specialist to help us understand the most difficult issues that have shaken our psychological balance.

MK: So what about sayings like "What doesn't kill you makes you stronger" or "Suffering ennobles"?

AF: I would rather say that it is not suffering that ennobles anyone, but our response to it. In my opinion, it is worth moving away from the theory that evil generates good, and instead think that since evil has already appeared in our lives, we can extract something good from it, something hidden in those difficult experiences. Sometimes I change the content of the mentioned adage, saying: "what doesn't kill you, delays you." If we are harmed, there is always some loss involved. So the question arises as to how we will respond to this loss. If something bad happens to us, something probably interrupted our previous plans. And maybe we will be forced to pause, focus on ourselves, think about what we can do to make our lives, after overcoming obstacles, richer and more mature than before. Our reaction, combined with psychological support and the help of loved ones, may indeed make us emerge from the crisis as, in a sense, more beautiful people. In my opinion, this concept involves working on our own priorities, overcoming fears, communication, and expressing our needs. Allow ourselves to suffer, and perhaps a readiness for change for the better will sprout from it. Rediscover what is most precious to us at this moment and try to take care of it.

MK: Thanks to our own work on ourselves and the support of others, we have a chance to avoid the long-term consequences of the crisis.

AF: Unfortunately, a lack of support can cause the crisis to become chronic. If we stay in the emotional reaction phase for a long time, or if the emotions are so intense that they do not allow us to function properly, I definitely recommend seeking professional help. The consequence of a situational crisis is extreme stress, which can lead to trauma. This is an extensive and complex topic, so let's just emphasize how lasting a mark trauma can leave on our lives, how significant (and often unconscious) an impact it has on our functioning. It's like a dormant inner volcano that can wake up at any moment and wreak havoc. Also, remember that it is impossible to compare two trauma experiences. Often everything depends on our resilience, adaptability, and the way we respond to adversity. Self-destruction, suicide attempts, anxiety disorders, neurosis, panic attacks, or depression are related to various forms of trauma. People who have experienced it also suffer from PTSD, or post-traumatic stress disorder. And this is associated with nightmares, recurring, intrusive, and painful images, and memories that take us back to the traumatic event. Sometimes normal functioning may seem almost impossible. That's why it's so important to seek help. Therapy and proper diagnosis can make the traumatized person aware of the problem, facilitate understanding of oneself and one's behaviors, acceptance of irreversible damage, and also the existence of evil in the world.

MK: In the case of mass events, consequences also affect individuals who haven't directly experienced them. What challenges do they face? What is difficult for them?

AF: Sometimes strong identification with the place of the event or similar memories from the past – once experienced earthquake, traffic accident, flood, or fire – is enough for strong stress to take control over us. Often in such cases, we also deal with the survivor's syndrome. There is a surreal fear that something bad may happen at any moment. It's a subconscious expectation of a crisis. In addition, people affected by this syndrome often believe that they cannot seek the help of a specialist, as they are in a better situation than those directly affected by the tragic accident. Because if nothing happened to me or anyone around me, I have no right to feel bad. I will repeat once again – let's give ourselves permission to experience this event in our own way. Of course, it is important to express our thoughts, share emotions, but also not to escalate tensions and be careful not to let an excess of information become overwhelming.

MK: In any case, let's think about ourselves with kindness, without judgment and listen to our needs without imposing demands.

AF: And accept that not all situations can be rationally explained and we do not have control over everything that happens around us. This is natural. Also, let's admit that it is difficult for us to understand what a person directly affected by a sudden event feels. Here it is worth arming ourselves with understanding. Not everyone experiences the same situations in the same way. Also, remember that even if we want to help the victims, they may not immediately express their willingness to accept help. Let's give them space and show patience. At the same time, don't forcibly look for people responsible for the event, don't blame anyone. We can't turn back time. It's about being aware that some things are beyond our ability to intervene.

MK: It's worth facing the crisis, even though it's certainly not an easy process. But let's remember that our well-being, balance, and high psychological resilience, which will help us cope with other difficult situations in the future, depend on it, and may open up new perspectives for us. Thank you very much for the conversation, and I encourage the audience to contact the ICAS EAP line in difficult life moments. If your company does not yet have an employee mental health support program, please contact us.