Brief Crisis Sensorimotor Therapy Part 1: What is Crisis?

As the LA Fires ripped through the city in January, I knew that devastation and crisis were on the horizon. I’ve been an LA based psychologist long enough to know the mental health impacts of such disasters. As I thought about how to best help my clients in the coming days and weeks two treatment models intertwined. Brief Crisis Sensorimotor Psychotherapy combines brief crisis intervention with Sensorimotor Psychotherapy – a body based talk therapy developed to address trauma and attachment wounds. Crisis intervention is designed to be focused and time limited, (4-6 sessions). By using what I have learned about trauma and the body in the early stages of Crisis Intervention, my hope is to help people process and integrate traumatic experiences and avoid long-term psychological symptoms. In the series that follows, I will share information about crisis and coping as well as skills to integrate the wisdom of the body as a resource for daily life.

What is Crisis?

I first encountered Brief Crisis Intervention during my internship in clinical psychology. First described in the early 1960s, crisis was a first defined as occurring “when a person faces an obstacle to important life goals, that is for a time, insurmountable through the utilization of their customary methods of problem solving” (Caplan, 1961). In other words, you are going along in life and a tragedy befalls you. You try to cope in the best ways you know how but nothing is working. Suddenly you are falling apart, breaking down and unable to think clearly, eat, sleep or perform your basic life functions.

Stages of Crisis

What I find so fascinating is that a state of crisis is that it follows a predictable course and offers a unique therapeutic opportunity. In a crisis a person moves from equilibrium or homeostasis to disequilibrium. This movement in an out of homeostasis and back again will occur within about six weeks as our bodies are designed to recalibrate towards equilibrium in that time frame. In this brief window of time, during a state of crisis, our typical defenses are dismantled. Or another possible way to look at it is our default mode network gets disrupted. This opens up the space in a person’s mind to add in effective coping and improve the course of someone’s life. Let’s take a look at the stages of crisis and some examples.

1.        The Hazardous Event: A stressful circumstance that disrupts equilibrium. These can be out of the blue such as a car accident, sudden illness, natural disasters, or anticipated such as a new baby or retirement.  This event starts a series of actions and reactions on the part of the individual.

2.        The Vulnerable State: In the vulnerable state there is a rise in tension as the person takes in the hazard and makes initial attempts to cope. A person’s subjective interpretation of the event greatly influences their reaction. If an event is interpreted as a threat,  loss or challenge then there is an increase in tension. If attempts at coping are unsuccessful the tension continues to build ultimately, leading to a decrease in functioning.  

3.        The Precipitating Factor: The precipitating factor is the ‘straw that breaks the camel’s back.’ This can be a relatively small event that throws a person from a vulnerable state into a crisis state. In some cases the hazardous event and precipitating  event are the same. However, in other situations, the precipitating event occurs at some point after the hazard. How does look in real life? Let’s say a person finds out they have a dangerous health condition (hazard). They are going through the steps to take care of themselves when they are informed that their insurance policy is canceled due to an administrative error (precipitating event). Suddenly the person finds themselves unable to sleep, eat or think clearly and are in a state of disequlibrium as they move into an active crisis state.

4.        Active Crisis State: The active crisis state is characterized by physical and psychological agitation. Folks in a state of crisis may have trouble eating or sleeping, difficulty concentrating and making decisions as well as ruminative thinking about the events that led to the crisis. People in this state are typically highly anxious and or depressed. It is usually during the active crisis stage that folks realize that their current coping is inadequate and take a drastic step such as calling a helpline for help or self-harm. During this stage people are usually highly motivated to seek and accept outside help. Following a crisis state there is a gradual return to a state of equilibrium.

5.        Reintegration: Successful reintegration (restoration of equilibrium) is dependent on a number of factors including the individual's ability to objectively evaluate the crisis situation and to develop and utilize effective coping strategies. Interestingly, though we all will return to homeostasis, some may develop maladaptive coping and return to a lower baseline of functioning, e.g. drink to numb the pain of loss during grief and develop alcohol misuse disorder.

A pause….

As so many of us are impacted by a variety of hazards and threats in our environments, I would encourage the practice of turning our gaze inward to take stock. I would invite you take a minute and check in with yourself, briefly scanning for areas of tension, noting the quality and pattern of your breath, the presence of repetitive thoughts/images that may arise. Bring a spirit of compassion and witnessing, especially if you have suffered recent losses. Can you identify some of the symptoms of crisis listed above? If so, perhaps you need additional kinds of coping to assist you during this time. Take a few minutes to journal about what came up for you. By checking in gently with ourselves throughout the day, we can make wise choices that are resourcing and supportive.

In the next article in the Brief Crisis Sensorimotor Therapy series, I will explore practices that help us to tap into and use the wisdom of the body as a source of support and information.

Caplan, G. (1961). An approach to community mental health. New York: Grune and Stratton.

Roberts, A. R. & Ottens, A. J. (2005) Brief Treatment and Crisis Intervention Advance Access originally published online on October 12, 2005
Brief Treatment and Crisis Intervention 2005 5(4):329-339; doi:10.1093/brief-treatment/mhi030