Crisis Intervention Plan

The aim of a crisis intervention plan is to make sure that the patient has the adequate level of support or support system in place to ensure a safe and effective attainment of treatment aims.  The plan can be created with the assistance of a clinician or a patient advocate (Ruchlewska et al., 2009).  The plan should also include making a list of things that the patient needs whenever symptoms strike.  This crisis intervention plan will go over the elements that will allow Pat, who suffers from bipolar disorder, to have the safety net of support and assistance required of one in his situation.

To develop a crisis plan, the goals of the plan have to be identified.  In Pat’s case, he does not want to go to therapy or accept a diagnosis of bipolar disorder.  He is uncomfortable with the diagnosis, primarily because he possesses a feeling of taboo towards it.  He comes from a family wherein masculinity is defined by strength and the ability to overcome anything.  Accepting such a diagnosis would mean he is weak and unable to achieve success on his own—so he rejects the diagnosis.  The problem is that in rejecting the diagnosis he is also rejecting the treatment that can help, including maintaining a realistic level of self-awareness, willingness to comply with pharmacological treatment protocols, and positive engagement with therapy—i.e., a willingness to apply the topics that are covered in therapy to his own life.  Increased insight, increased self-efficacy, increased therapy adherence, increased acceptance of the illness, increased social support and increased quality of working alliance are the six primary goals of the crisis intervention plan (Ruchlewska et al., 2009).  These six primary goals, once reached, will lead to improved health and social functioning as well as treatment satisfaction.   However, it is important to explain, using logic and reason, why the plan is needed in the first place.  Patients respond more positively when they can understand the purpose of the plan and the reason for its development and implementation.  They also respond more favorably when they are included in its design and proactively take part in its development rather than passively receive it regardless of their feelings about it.  Thus, the plan should be developed with the patient’s willing involvement and input, as coercion can be seen as a negative factor in the treatment process and crisis plan development (Swartz, Swanson & Hannon, 2003).

The first step in a crisis intervention plan is to be aware of the issues that can trigger a negative emotional response.  A list should be made of the signs and symptoms that the person may be having a manic attack.  This provides an idea of the triggers that the person should be aware of because they can lead the person into behaviors and modes of thinking that are unhealthy.  Pat should work with the clinician to identify triggers and know what signs and symptoms to be on the lookout for.  Once these are identified they can begin to discuss what to do when these signs and symptoms occur.

This is what helps to increase the level of insight for the person.  It leads to the next stage of the crisis intervention plan:  the build-out of the social support system.  For Pat, it is about identifying ways in which this build-out can be achieved.  If they dig far enough, they find that one of the trigger points for Pat is being in situations where there is a lot of male aggression and potential for hostility to come to the fore.  One of the events where this is most likely to occur is at the football game, where bravado and macho antics abound.  Though football is near and dear to the family’s heart, it is probably something Pat should avoid for the time being until he has better understood how to negotiate and navigate his feelings, especially in environments where escalation can occur without warning.

With football being out for the moment (and all the friends who go along with it), Pat will need another social activity to fill the gap—and that is where dancing can come into play.  Dancing is an activity that could give Pat the emotional and social support he needs, especially if he is working with a partner who is understanding and supportive of his needs, so that he can be the same in return.  Maintaining contact with other peers and friends who are also sympathetic to his needs and who are able to provide support will also be ones he will want to keep in his life.  The goal here is to avoid triggering situations with people who may lead him down a slope towards a manic episode and to surround himself with people who will assist him towards maintenance and governance of his disorder in a healthy manner.

A plan towards increased therapy adherence should also be developed.  Currently, Pat is going to therapy, but only because he is forced to go as a condition of his release from the hospital.  He needs to get to a point where he is wanting to go on his own.  To facilitate this process, the value of therapy should be emphasized and the good fruits that it has produced should also be identified so that Pat can see clearly why it is important to keep going and to truly engage with the treatment.

To work on increasing Pat’s self-efficacy, it is important to celebrate minor victories and the accomplishment of small goals—i.e., any victory over a trigger, which means applying what is learned in therapy to a situation wherein a trigger warning is raised.  In therapy he will learn about what behaviors to implement whenever a trigger episode occurs; for example, if his father is being antagonistic about his son’s condition, Pat may implement one of the behaviors he has learned in therapy to counteract the negative attack in a healthy manner.  When Pat tells of small victories like this, the therapist should celebrate with him.  On occasions when Pat slips and fails to effectively counteract a trigger, the therapist should remain supportive and not get down on Pat for failing a test.  The road to self-efficacy will be filled with setbacks and stumbles, but the best thing for Pat to receive from his therapist and from his support network is unconditional support and the knowledge that no matter how many times he falls, they will still be there for.