Crisis usually refers to a traumatic experience or event in one’s life that leaves a prolonged effect on his/her psyche. However, according the scholars of psychology, crisis denotes an individual’s response towards such experiences or events. These critical responses can affect the entire extent of one’s life experiences and encompasses a wide range of triggers, including the death of a loved person, natural disasters, developmental hurdles, abuse, near death experiences and so on (Webb, 2015). In order to address and mitigate the effects of such issues, crisis and trauma counselling is regarded as an effective solution. Crisis counselling is a form of intervention that offers support and assistance to the individuals so that they can deal with crisis.
The history of crisis counselling dates back to World War I and World War II, as a measure to offer support to the soldiers affected by the trauma of war and death. Prior to that, soldiers who showed signs of psychological distress would be considered as weak or disloyal. Soon, it was observed that the soldiers who were offered clinical intervention recovered much faster than those who did not receive any treatment (Yeager & Roberts, 2015).
According to American Psychological Association, crisis counselling is a form of intervention that helps people to cope with difficult situations and offers support post a traumatic experience or crisis. It is a brief and time-bound process that entails specific goals of achieving stability, increasing an internal sense of safety and empowerment. Usually, it lasts from 15 minutes to 2 hours and requires 2 to 3 session minimum. However, crisis counselling can only serve as a support system that can only provide immediate assistance and a safe outlet, it is to be never used to substitute long-term therapy or psychiatric treatment. (Center for School Mental Health Assistance., 2002)
Unlike psychotherapy, the scope of crisis counselling is much more specific. Psychotherapy focuses on a wider range of client’s information such as their history and background, whereas crisis counselling focuses on clients’ immediate situation, safety and current needs. Crisis and trauma counselling includes assessment, planning and treatment. Overall, there are several treatment models and tools for effective treatment consistent with established theories of crisis and trauma counselling (Yeager & Roberts, 2015).
Crisis and trauma counselling has been recognized as an instrumental technique to support and care for the victims of child abuse. The phenomenon of child abuse and neglect is coming up as a rising threat to the children across the world. In the United States of America alone, 3.6 million referrals on child abuse and neglect are made to various child protection agencies, encompassing an estimated 6.6 million children (Kennedy et al., 2016) whereas in Australia, around 1.3 million men and women report experiences sexual abuse prior to the age of 15. More shockingly, almost in 95% cases, the offenders are known to the victim. (Mathews et al., 2017) Over 220000 children were suspected of being at a risk of abuse or neglect during the year 2015-2016 alone (Krnjacki et al., 2016). And this is a similar case all around the world. Furthermore, these incidents leave a long-lasting effect on individuals that can surface in their later lives as well. Therefore, intervention for such cases is a necessary and significant requirement.
It is very much essential to provide emotional support to those people who have endured child abuse in any of the aforementioned form, although everyone’s need for such support may vary. Not everyone has a strong support system that they can confide in. Even if someone has it, they may not be able to talk to them comfortably regarding such issues that are traumatizing and humiliating at the same time. Therefore, creating a safe space is necessary for them so that they can open up about their issues. And to receive professional assistance in this regard would be particularly beneficial. Thus the significance of crisis and trauma counselling is established, where the survivors can talk about their issues to a counsellor or a therapist, where they can comfortably discuss their issues without the fear of being judged or facing any adverse consequences (Van der Kolk et al. 2017).
Child abuse is defined as infliction of harm, exploitation or neglect upon a child, specifically of under 18 years of age. It encompasses several areas such as physical abuse, emotional abuse, sexual abuse, neglect, abandonment, exploitation and child labour (Van der Kolk, 2017). Such actions could potentially harm both the physical as well as mental health of a child. Moreover, such experience could affect the development of a survivor, who would suffer from the consequences of such trauma even in their adulthood. As has been mentioned earlier, children receive such abusive behaviour from their parents or someone they closely know. Children belonging to families in which there are occurrences of alcoholism, anger or substance abuse issues are likely to experience child abuse. It can occur in any ethnic, social, cultural or income group. More importantly, some children may be completely unaware of the fact that they are victims of abuse, exposing themselves to more mental or physical distress.
The effects of child abuse or neglect can be critical, long lasting and even fatal in many cases. These effects can be physical, emotional and psychological. Apart from bodily damage caused by physical abuse or neglect, the emotional and psychological consequences of child abuse may cause serious mental health concerns. The survivors may suffer from anxiety disorders, where they would be afraid or apprehensive of people or situations that remind them of the traumatic experience. They may be afraid of solitude, strangers or physical intimacy depending on the graveness of the abuse. Several anxiety related symptoms such as disturbed sleep pattern, panic attacks, anger issues etc. The survivors may subsequently suffer from depression or dissociation as well. Most importantly, they may well be affected by Post Traumatic Stress Disorder (PTSD), entailing mood issues, flashbacks, hyper vigilance, nightmares etc. The stress of the experience may lead them to self-harming behaviours, even to suicidal tendencies (Vachon et al., 2015).
Apart from the immediate consequences, the survivors may be affected by the post traumatic experience in their later life. They would feel ashamed of themselves and develop a negative self-perception. They may have concerning trust issues including interpersonal and relationship issues. Most importantly, they may grow a sense of misplaced responsibility regarding the abuse, blaming themselves for it. This aspect is a serious concern to be addressed and mitigated in order to provide an assertive crisis counselling (Lueger-Schuster et al., 2018).
Crisis and trauma counselling usually involves assessment of the situation, educating the survivors about their conditions and offering support and assistance to develop coping skills. Therefore, it can be said that the first step to an effective intervention consists of accurate assessment and screening (Itzin, 2018). There are several assessment tools used by crisis and trauma counsellors all over the world. These assessment tools are used for evaluating the traumatic events of childhood abuse and measuring the affected individual’s response to those events. There are two major types of assessment tools, namely general mental health assessment tools and trauma oriented tools. In some cases, the counsellors use domestic violence assessment tools to evaluate the survivors’ tendency to become abusers themselves. Although there are no standard trauma assessment tool that can be regarded as comprehensive on its own, both the primary groups use structured interviews and self-reporting (Sommers-Flanagan & Sommers-Flanagan, 2018).
The structured interviews are usually time-limited, comprehensive and efficient. And this interviews help assess the clients who are marginally literate or unable to self-report. The interviews are targeted at obtaining general mental health reports through a framework of systematic review of the client’s mental health, especially those associated with child abuse or neglect. These interviews are based on the system prescribed by Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV). (Cooper, 2018)
Diagnostic Interview Schedule (DIS), version 4 is an effective assessment tool that can diagnose on both current and lifetime basis. Current disorder has been specified for 4 concurrent time periods—the last 2 weeks, the last month, the last 6 months and the last year. As the client need not meet all criteria, the severity of the mental disorders are measured by how many criteria the client meets and the number of symptoms present (Kearney, Freeman & Bacon, 2019).
Mini International Neuropsychiatric Interview (MINI) is a widely used assessment tool. It is a brief structured interview that screens the major psychiatric disorders pertaining to several mental disorders and post traumatic experiences. It focuses on a core set of diagnostic question for specific disorders and considers specific timeframe relevant to the diagnosis based in a clinical setting. It consists of 120 questions encompassing 17 axis I disorders from DSM-IV. It contains 2 to 4 targeted questions for each disorder, along with a follow- up questionnaire to endorse the diagnosis. It focuses on the information on dysthymia, OCD, anxiety, depressive episodes, mania, substance abuse disorder, anorexia and bulimia nervosa, PTSD, suicidal tendency, hyperactivity and antisocial disorder (Duncan et al., 2018)
In case of self-reporting, Beck Depression Inventory (BDI) is one of the most effective tool widely used by counsellors. It is 21 item scale that measures the severity and presence of cognitive, affective, vegetative, psychomotor and motivational components of depression. (Beck, 1976). There is also a short 13 item version of BDI that is concurrently valid with the longer version. (Jackson-Koku, 2016)
The treatment of child abuse survivors follow several established theories or approaches pertaining to the field. Two of the major approaches are family-based intervention and behavioural intervention. .
Family based intervention for child/ren abuse and neglect targets to change the home environment involving the primary caregivers (usually parents) of the affected child. It maintains that changing the behaviours of the parents or the overall environment of the home can provide a safe space for the child/ren (Mendelson & Letourneau, 2015). The rationale for adopting such approaches is recognized as the improvement of the behavioural skill, parenting abilities, interactions and parents’ perception of their children, so as to improve the overall quality of life for the child/ren. Intensive home-based service and family preservation facility provided to the families of the affected children have been proved to effective as they correspond to developmental and ecological theories of maltreatment. Besides, this approach incorporates empirical findings to develop the ecological and development theories (Mendelson & Letourneau, 2015).
Family-based screening and intervention has often been criticized as involving high risk and inadequate access as well as infrastructure. The more contemporary approach to intervene the cases of child abuse and neglect has been proposed as behavioural intervention (Geldard, Geldard & Foo, 2017). It is a flexible component-based counselling session involving both joint and individual child-parent sessions. It mostly uses cognitive behavioural therapy (CBT). More specifically, trauma focused cognitive behavioral therapy (TB CBT) is used as the instrumental model in this approach. The components of TB CBT model are aimed at the children suffering from PTSD, anger, depression, anxiety and other behavioural problems. The rationale for the proposed approach is its merit to relate with the children manifesting behavioural conditions pertaining to trauma and crises. Thus, it stands as an evidence-based treatment that offers assistance for coping up traumatic experience (Cohen & Mannarino, 2015).
In conclusion, it can be asserted that with the continuous development in the field, trauma and crisis counselling has been emerging as a powerful way to address and treat survivors of child abuse and neglect. The various established theories and evidence based approaches enable counsellors to successfully intervene in such cases, while providing researchers of the field with substantial data to further the study on the issue so that a heinous phenomenon like child abuse can be combatted effectively.
References
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