Time in a Bottle:Time in a Bottle:Supporting Families in CrisisSupporting Families in Crisis

Linda McKellar, RN., BSWSeptember 19, 2008

It is important for us to remember:

We are involved in the lives of these individuals and families for only a brief moment in the

bigger picture of their lives

For many, perhaps most, this experience will be the first, and most devastating in their lives

For others, this experience may be one among many

What is a Crisis?

An internal experience of emotional change and distress. A crisis can be precipitated by a perceived life problem or pose an obstacle to an important goal resulting in internal discord because the individual’s typical coping strategies are inadequate.

• .

• The Social Work Dictionary (1996)

The outcome of the crisis can be positive if the individual eventually finds new coping mechanisms to deal with the unfamiliar event, thus adding to the repertoire of effective adaptive responses.

• The Social Work Dictionary (1996)

What does a person in a “crisis”

look like?• Crying• Angry• Laughing• Withdrawn• Agitated• Demanding• Silent• Absent• “Normal”

In other words, just like many of us!

Possible Underlying Needs and Interests Evident in Individuals and Families

Experiencing a Crisis•Resource needs not met:

inadequate time, staff, space, information, supplies, equipment, money

•Psychological needs not met: control, respect, authority, recognition as an expert, power, safety, inclusion, sense of belonging, feel wanted, feel needed, success, sense of achievement, need to compete, need to be seen

•Emotional needs not met: fear, shame, remorse, guilt, anger, frustration, sadness, loss, disappointment, love, support

Paying attention to unexpressed needs

How might these present? Perceived to be overly solicitous Repeated questioning Checking with more than one person Withdrawal Silence Talkativeness Anger ? ? ?

Common roles we play in crisis situations

• Advocate (negotiator)• Facilitator (mediator)• Go-between• Information provider (expert)• Interpreter – clarifier – reality tester• Observer (witness, audience)• Referee• Resource Broker• Supporter• Listener

We must be mindful of cultural and individual differences.

Some cultures foster open and public expressions of emotions, others tend to be more private or controlled.

Particularly in North American/British cultural groups, we often acknowledge that anger and outrage are tolerable, however, it seems that we are often embarrassed by sadness.

Is this because we are afraid to be seen as fragile and vulnerable in a world that champions control?

Important skills for us to keep in mind:

• Active listening for ‘understanding’• Importance of acknowledgment of loss:

hopes, dreams, plans• Future orientation• Reframing• Clarifying/validating• Identifying unexpressed interests and

needs

• Ask:– How have they managed to get through

other difficult times in their lives?– If babe is ill, ask about the infant’s name –

had they thought of a name? was there any special significance to the name?

– Are there other children, how old, what do they know?

– Perhaps ask about funeral/memorial service plans

– If it is a mom, (or a woman of any age), who is ill, ask about memories, what about special times, legacies (journals, audio/video tapes, etc.)

– What are her wishes about where she will die, funeral plans, fears, unfinished business

– Who are the supports (formal and informal) for the family

– What do the children know– Who will provide care for the children

Possible Indicators for Escalation

• Be aware of:• Changes in number of visitors and

time spent with the infant or mom• Symptoms of depression• Increased vigilance• Evidence of alcohol or drug use

• Be aware of the words you use when talking with families. “I think the selection of words these people use is so critically important”.

• Phrases such as: “I’m so sorry, this is so sad” can be very supportive

• Communicate what you need to “without using words that open the wound” (brouvard & Gladu: 1998)

There may also be other factors we are not aware of that are causing the family increased distress.

Some of these might be:Marital conflict; medical, physical, or

emotional concerns with other children or family members; financial issues; pressure from extended family or friends; guilt; …

People will need to tell their stories over and over.

If we are able to listen in an accepting, non-judgmental,

respectful manner we will have assisted them them to find and use

the tools to begin their recovery process.

Tangible Ways to Provide Support

Listen, Listen, Listen

Have Kleenex handy

Listen with your ears, eyes, and your heart!