The outcomes of consultation sessions at health centers offering crisis therapy vary widely. In the saddest cases, some clients attempt or commit suicide. Other clients can’t figure out a new coping method that works for them: they revert to their old ways, and may end up crippled by their grief, anger, or frustration. In the best cases, though, the client does discover a new and better way of coping, and emerges from the crisis stronger than before. That outcome is reflected in the Chinese written character translated as “crisis,” which is pronounced “wei-ji” and consists of two characters: the Chinese character “wei,” meaning “danger,” plus the Chinese character “ji,” meaning “crucial occasion, critical point, opportunity.” The German philosopher Friedrich Nietzsche expressed a similar idea by his quip “What doesn’t kill us makes us stronger.” Winston Churchill’s corresponding quip was “Never let a good crisis go to waste!”
A frequent observation by those helping others in an acute personal crisis is that something happens within a time span of about six weeks. During that short transitional period, we question our cherished beliefs, and we are much more receptive to personal change than during our previous long period of relative stability. We can’t live for much longer than that without some ways of coping, although we can grieve, suffer, or remain unemployed or angry for much longer. Within about six weeks, either we start to explore a new way of coping that will ultimately prove successful, or we embark on a new maladaptive way of coping, or we revert by default to our old maladaptive ways.
Of course, those observations about acute crises don’t imply that our lives conform to an oversimplified model of: (1) receive shock, set alarm clock for six weeks; (2) acknowledge failure of previous coping methods; (3) explore new coping methods; and (4) alarm clock goes off: either give up and revert, or else succeed / crisis solved / live happily ever after. No: many life changes instead unfold gradually, without an acute phase. We succeed in identifying and solving many impending or growing problems before they ever become crises and overwhelm us. Even crises with an acute phase may merge into a long phase of slow rebuilding. That’s especially true of midlife crises, when the initial burst of dissatisfaction and glimmerings of a solution may be acute, but putting a new solution into effect may take years. A crisis doesn’t necessarily stay solved forever. For instance, a couple that resolves a serious dispute and avoids divorce may outgrow their solution to the dispute and have to deal again with the same problem or a similar one. Someone who has dealt with one type of crisis may eventually encounter a new problem and face a new crisis, as did I. But even those caveats don’t change the fact that many of us do traverse crises with the approximate course that I described.
How does a therapist deal with someone in crisis? Obviously, the traditional methods of long-term psychotherapy, which often focus on childhood experiences in order to understand root causes of current problems, are inappropriate in a crisis because they are much too slow. Instead, crisis therapy focuses on the immediate crisis itself. The methods were initially worked out by the psychiatrist Dr. Erich Lindemann in the immediate aftermath of the Cocoanut Grove fire, when Boston hospitals were swamped not only by the medical challenge of trying to save the lives of hundreds of severely wounded and dying people, but also by the psychological challenge of dealing with the grief and the guilt feelings of the even larger numbers of survivors, relatives, and friends. Those distraught people were asking themselves why the world had permitted such a thing to happen, and why they were still alive when a loved one had just died a horrible death from burns, trampling, or asphyxiation. For example, one guilt-stricken husband, berating himself for having brought his now-dead wife to Cocoanut Grove, jumped out a window in order to join her in death. While surgeons were helping the fire’s burn victims, how could therapists help the fire’s psychological victims? That was the crisis that the Cocoanut Grove fire posed to psychotherapy itself. The fire proved to be the birth hour of crisis therapy.
Struggling to assist the huge number of traumatized people, Lindemann began to develop the approach that is now termed “crisis therapy,” and that expanded soon from the Cocoanut Grove disaster to the other types of acute crises that I mentioned above. Over the decades since 1942, other therapists have continued to explore methods of crisis therapy, which is now practiced and taught at many clinics such as the one at which Marie trained. Basic to crisis therapy as it has evolved is that it’s short-term, consisting of only about half-a-dozen sessions spaced out at weekly intervals, spanning the approximate time course of a crisis’s acute stage.
Typically when one is first plunged into a state of crisis, one feels overwhelmed by the sense that everything in one’s life has gone wrong. As long as one remains thus paralyzed, it’s difficult to make progress dealing with one thing at a time. Hence a therapist’s immediate goal in the first session—or else the first step if one is dealing with an acknowledged crisis by oneself or with the help of friends—is to overcome that paralysis by means of what is termed “building a fence.” That means identifying the specific things that really have gone wrong during the crisis, so that one can say, “Here, inside the fence, are the particular problems in my life, but everything else outside the fence is normal and OK.” Often, a person in crisis feels relieved as soon as he or she starts to formulate the problem and to build a fence around it. The therapist can then help the client to explore alternative ways of coping with the specific problem inside the fence. The client thereby embarks on a process of selective change, which is possible, rather than remaining paralyzed by the seeming necessity of total change, which would be impossible.
Besides that issue of building a fence that gets addressed in the first session, another issue is also often addressed then: the question “Why now?” That’s short-hand for: “Why did you decide to seek help in a crisis center today, and why do you feel a sense of crisis now, rather than some time earlier, or not at all?” In the case of a crisis arising from a single unanticipated shock, such as the Cocoanut Grove fire, that question needn’t be asked because the obvious answer is the shock itself. But the answer is not obvious for a crisis building up slowly until it explodes, or for a developmental crisis associated with an extended life phase such as the teen-age years or middle age.
A typical example is that a woman may say that she came to the crisis center because her husband is having an affair. But it then turns out that she has known for a long time that he has been having the affair. Why did the woman decide to seek help about the affair today, rather than a month ago or a year ago? The immediate impetus may have been a single sentence spoken, or else a detail of the affair that the client held to be the “last straw,” or a seemingly trivial event reminding the client of something significant in the client’s past. Often the client isn’t even conscious of the answer to that question “Why now?” But when the answer is discovered, it may prove helpful to the client, or to the therapist, or to both, in understanding the crisis. In the case of my 1959 career crisis, which had been building for half-a-year, the reason why the first week of August 1959 became “now” was the visit of my parents, and the practical necessity of telling them whether or not I would return next week to the Cambridge Physiological Laboratories for a second year.
Of course, short-term crisis therapy isn’t the only approach to dealing with personal crises. My reason for discussing it isn’t because of any parallels between the time-limited six-session course of crisis therapy and the course of dealing with national crises. The latter course never involves six national discussions within a short time frame. Instead, I focus on short-term crisis therapy because it’s a specialty practiced by therapists who have built up a large body of experience and shared their observations with one another. They spend much time discussing with one another and publishing articles and books about the factors influencing outcomes. I heard a lot about those discussions from Marie, almost every week during her year of training at the crisis therapy center. I found those discussions useful for suggesti
ng factors worth examining as possible influences on outcomes of national crises.
Crisis therapists have identified at least a dozen factors that make it more or less likely that an individual will succeed in resolving a personal crisis (Table 1.1). Let’s consider those factors, starting with three or four that inevitably are critical at or before the beginning of the course of treatment:
1. Acknowledgment that one is in crisis. This is the factor that leads people to enter crisis therapy. Without such an acknowledgment, they would not even present themselves at a crisis therapy clinic, nor (if they didn’t go to a clinic) would they begin to deal with the crisis themselves. Until someone admits, “Yes, I do have a problem”—and that admission may take a long time—there can’t be any progress towards resolving the problem. My 1959 professional crisis began with my having to acknowledge that I was failing as a laboratory scientist, after a dozen years of uninterrupted successes in school.
Table 1.1. Factors related to the outcomes of personal crises
1. Acknowledgment that one is in crisis
2. Acceptance of one’s personal responsibility to do something
3. Building a fence, to delineate one’s individual problems needing to be solved
4. Getting material and emotional help from other individuals and groups
5. Using other individuals as models of how to solve problems
6. Ego strength
7. Honest self-appraisal
8. Experience of previous personal crises
9. Patience
10. Flexible personality
11. Individual core values
12. Freedom from personal constraints
2. Acceptance of personal responsibility. But it’s not enough just to acknowledge “I have a problem.” People often then go on to say, “Yes, but—my problem is someone else’s fault. Other people or outside forces are what’s making my life miserable.” Such self-pity, and the tendency to assume the role of victim, are among the commonest excuses that people offer to avoid addressing personal problems. Hence a second hurdle, after a person has acknowledged “I have a problem,” is for the person to assume responsibility for solving it. “Yes, there are those outside forces and those other people, but they aren’t me. I can’t change other people. I’m the only person whose actions I can fully control. If I want those other forces and other people to change, it’s my responsibility to do something about it, by changing my own behavior and responses. Those other people aren’t going to change spontaneously if I don’t do something myself.”
3. Building a fence. Once a person has acknowledged a crisis, accepted responsibility for doing something to resolve it, and presented himself at a crisis therapy center, the first therapy session can focus on the step of “building a fence,” i.e., identifying and delineating the problem to be solved. If a person in crisis doesn’t succeed in doing that, he sees himself as totally flawed and feels paralyzed. Hence a key question is: what is there of yourself that is already functioning well, and that doesn’t need changing, and that you could hold on to? What can and should you discard and replace with new ways? We shall see that that issue of selective change is key also to reappraisals by whole nations in crisis.
4. Help from others. Most of us who have successfully gotten through a crisis have discovered the value of material and emotional support from friends, as well as from institutionalized support groups such as those of cancer patients, alcoholics, or drug addicts. Familiar examples of material support include offering a temporary spare bedroom to enable someone whose marriage has just collapsed to move out; thinking clearly, to compensate for the temporarily diminished problem-solving ability of a person in crisis; and providing practical assistance in obtaining information, a new job, new companions, and new child-care arrangements. Emotional support includes being a good listener, helping to clarify issues, and assisting someone who has temporarily lost hope and self-confidence to regain both.
For a client at a crisis therapy clinic, that “call for help” is inevitably among the first factors arising to resolve the crisis: the client came to the center because they realized that they needed help. For people in crisis who don’t come to a crisis therapy clinic, their call for help may come early, later, or even not at all: some people make things difficult for themselves by trying to solve a crisis entirely without assistance. As a personal example of a call for help outside a crisis therapy center—when my first wife jolted me by (finally) telling me that she wanted a divorce, during the next few days I called four of my closest friends and poured out my heart to them. All four understood and sympathized with my situation, because three had themselves been divorced, and the fourth had managed to rebuild a troubled marriage. While my call for help didn’t stave off eventual divorce in my case, it did prove to be the first step in a long process of reexamining my relationships, and eventually making a happy second marriage. Talking to close friends made me feel that I wasn’t uniquely flawed, and that I too might eventually gain happiness, as they had.
5. Other people as models. Related to that value of other people as sources of help is their value as models of alternative coping methods. Again, as most of us who have weathered a crisis have discovered, it’s a big advantage if you know someone who has weathered a similar crisis, and who constitutes a model of successful coping skills that you can try to imitate. Ideally, those models are friends or other people with whom you can talk, and from whom you can learn directly how they solved a problem similar to yours. But the model can also be someone whom you don’t know personally, and about whose life and coping methods you have merely read or heard. For example, while few readers of this book could have known Nelson Mandela, Eleanor Roosevelt, or Winston Churchill personally, their biographies or autobiographies have still yielded ideas and inspiration to other people who used them as models for resolving a personal crisis.
6. Ego strength. A factor that’s important in coping with a crisis, and that differs from person to person, is something that psychologists call “ego strength.” That includes self-confidence, but it’s much broader. Ego strength means having a sense of yourself, having a sense of purpose, and accepting yourself for who you are, as a proud independent person not dependent on other people for approval or for your survival. Ego strength includes being able to tolerate strong emotions, to keep focused under stress, to express yourself freely, to perceive reality accurately, and to make sound decisions. Those linked qualities are essential for exploring new solutions and overcoming the paralyzing fear that often arises in a crisis. Ego strength begins to develop in childhood, especially from having parents who accept you for who you are, don’t expect you to fulfill their dreams, and don’t expect you to be older or younger than you actually are. It develops from parents who help you learn to tolerate frustration, by not giving you everything that you want, but also by not depriving you of everything that you want. All of that background goes into the ego strength that helps one work through a crisis.
7. Honest self-appraisal. This is related to ego strength but deserves separate mention. For an individual in crisis, fundamental to making good choices is an honest, albeit painful, self-appraisal to assess your strengths and weaknesses, the parts of you that are working, and the parts of you that are not working. Only then can you selectively change in ways that retain your strengths while replacing your weaknesses with new ways of coping. While the importance of honesty in resolving a crisis may seem too obvious to require mention, in fact the reasons why people often are not honest with themselves are legion.
The issue of honest self-appraisal constituted one of the key struggles of my 1959 professional crisis. I overestimated my abilities in one respect, and I underestimated them in another respect. As for my overestimate, my love for languages deluded me into thinking that I had the abilities necessary to becoming a simultaneous translator. But it began to dawn on me that love of languages by itself wouldn’t be enough to make me a successful simultaneous translator. Growing up in the U.S.,
I didn’t even begin to learn my first spoken foreign language until I was 11 years old. I didn’t live in a non-English-speaking country and become conversationally fluent in any foreign language (German) until I was 23 years old. Because I thus came to speak other languages only relatively late in my schooling, my accents today in even my best foreign languages are still recognizably American accents. It wasn’t until my late 70’s that I finally became able to switch quickly between two languages other than English. But, as a simultaneous translator, I would be competing with Swiss translators who had already developed fluency, accents, and ease of switching in several languages by the age of eight. I eventually had to admit to myself: I was deluding myself if I dreamed that I could ever compete as a linguist with the Swiss.
The other area of self-appraisal with which I struggled in 1959, and in which I underestimated rather than overestimated my abilities, concerned scientific research. I overgeneralized from my inability to solve a technologically challenging problem, namely, how to measure ion fluxes across electric eel membranes. But I was still perfectly capable of measuring water transport in the gallbladder by the simple method of weighing a gallbladder. Even now, 60 years later, I still use only the simplest of technologies to do science. I’ve learned to recognize important scientific questions that can be addressed with simple technologies. I still can’t turn on our home television set with its 47-button remote control; I can do only the simplest things with my recently acquired iPhone; and I depend completely on my secretary and on my wife for anything requiring a computer. Whenever I’ve wanted to carry out a research project that required complicated technology—cable analysis of epithelial current spread, noise analysis of membrane ion channels, statistical analysis of pairwise bird species distributions—I’ve been fortunate to find colleagues who were skilled at doing those analyses, and who were willing to collaborate with me.
Upheaval: Turning Points for Nations in Crisis Page 4
