Crisis Counseling in Times of Child Abuse Briana D

March 29, 2019 Critical Thinking

Crisis Counseling in Times of Child Abuse
Briana D. Wyrick
Liberty University

Abstract
Crisis and trauma are frequently concurrent. This research paper is designed to take a look into the nature and effects of trauma and the general principles and guidelines in crisis intervention. The proposal is that trauma is a natural part of life that can trigger a state of crisis and how these crises are managed by an individual is dependent upon a number of factors. Discussed more in detail is the cycle an individual experiences in crisis. The focal trauma discussed is child abuse, the nature and effects of, as well as the role of crisis counseling and the crisis interventionist in this realm in particular. Further discussion will involve the common types of child abuse, the longstanding effects into adulthood, and dependent upon the age and developmental stage of the youth, what crisis interventions and techniques are most effective. There will be a focus on incorporating the love of Christ as a crisis interventionist and how that looks for both the person in crisis and the crisis interventionist.

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Crisis Counseling in Times of Child Abuse
Crisis counseling is defined as “…a configuration involving a precipitating event, an emotional response and an intervention” (Zanello, Berthoud, & Bacchetta, 2017, p. 2). Daily stressors plague the typical individual. As those stressors mount coupled with a traumatic event, a crisis ensues and a downward spiral into a lower state of functioning begins. This is the moment in an individual’s life when a crisis counselor assumes their role as the person’s ego and begins to work with them through the situation using a variety of methods and techniques. Infinite examples of crises exist but regardless of which, the end goal of a crisis intervention is the same: with a heart of compassion, guide the individual through the crisis and bring him or her back to a higher state of functioning.

Trauma
Trauma defined is complex and dependent upon numerous factors. To define a complex experience simply, trauma is a deeply distressing or disturbing event. The nature and causes of trauma vary widely, influenced by ecological, social, and personal factors. While trauma is complex and differing, the crisis intervention is a steadying response to the chaotic nature of trauma and attempts to restore a normal state of functioning.

Nature of trauma
Within the realm of trauma exists a plethora of different types of trauma that are influenced by numerous factors including but not limited to: frequency, perpetrator, age, ecological variables and socioeconomic status. However, a defining characteristic of all traumas is the activation “…of the biochemical stress response system in the brain that changes an individual’s ability to respond efficiently and efficaciously to future stressors…” (Wilson et al., 2011, p.87). Physical and emotional traumas both greatly affect the individual’s capacity to carry out daily functions, thus requiring intervention. Additionally, an individual expresses “…emotional, behavioral, and cognitive process–response difficulties” (Wilson et al., 2011, p.87). Trauma affects both the mind and body of the individual often requiring long-term physical and cognitive therapies. However, crisis intervention can greatly diminish the severity of symptoms, more adequately prepare the individual to seek long-term treatment, and bring the individual to a higher state of functioning.
Causes of trauma
The causes of trauma generally fall within two groups: emotional and physical. An intense emotional response elicited from an event that is traumatic is emotional trauma. This is an unseen trauma that can be difficult to diagnose and therefore more difficult to treat. Physical trauma is more identifiable because the symptoms are most often seen and therefore diagnosed and treated more accurately. Whether emotional or physical, “…early life trauma is a known risk factor for depression and anxiety disorders…” (Chu et al, 2013, p. 23). Bringing Christ into the crisis can bring much comfort if the individual is open and available to receive Him. Scripture provides a look into the comfort found in Christ during times of trauma: “He will cover you with his feathers, and under his wings you will find refuge; his faithfulness will be your shield and rampart” (Psalms 91:4, New International Version). With trauma linked as a risk factor to later disorders, the importance of crisis intervention is emphasized to lessen or eliminate the effects of trauma.
Crisis intervention in trauma
The term crisis “…usually refers to negative life events, such as those termed emergencies…” (da Silva et al., 2015, p.172). Ideally crisis intervention should occur within 24 to 48 hours of the traumatic experience. If addressed within a reasonable amount of time, a crisis can move from a danger to an opportunity. Crisis intervention involves “… short-term, abbreviated services that typically include a focus on preventing mental health issues within the family system” (Jacobson & Butler, 2013, p. 418). Two models that are appropriate for implementation in crisis intervention when working with adults are the ABC Model and the CISD approach. Both are effective and it is advised that crisis counselors implement them at appropriate times; however, children are unique in how they should be counseled. Christ places an enormous value on children and their wellbeing saying,
“If anyone causes one of these little ones—those who believe in me—to stumble, it would be better for them to have a large millstone hung around their neck and to be drowned in the depths of the sea” (Matthew 18:6, NIV).
A crisis interventionist that views the world through a Christ-like lens should understand the importance of aiding children after a traumatic event. Regarding children, research has revealed due to their differing physiological and cognitive condition, crisis intervention should be executed differently.
Child Abuse
Child abuse is a unique trauma in and of itself due to the age of the victims, their notable innocence, and developing nature both emotionally and physically. Unfortunately child abuse is rarely a singular event categorizing it as complex trauma which involves “…victims of prolonged and repeated trauma, such as child sexual and physical abuse and domestic violence exposure” (Wamser-Nanney, 2016, p. 2). The malleable nature of children makes them especially vulnerable to symptoms of trauma requiring that crisis intervention occur as soon as is possible to begin reframing the event.
Family violence
Two common types of child abuse include family violence and sexual abuse. Family violence is “… violence that occurs within an intimate relationship…” (Powell & Morrison, 2017, p.137). Children develop learned behaviors due to family violence in a way that effects their social interaction in the long-term. These behaviors are because “…a child’s brain may operate on ‘high alert’ ready to protect against real or perceived threats” due to the violence within the family structure. Biological factors are foundationally set to allow a child to function in a healthy family structure, therefore in what would otherwise be a nurturing, attached family, a child’s behavior may be at an imbalance exhibiting aggression or hyperactivity because “…the brain and body are literally at the ready to fight or run for their life” (Powell ; Morrison, 2017, p.138).
Child sexual abuse
Child sexual abuse is “…a sexual act between an adult and a child in which the child is utilized for the sexual satisfaction of the perpetrator” (Early et al., 2013, p. 933). Sexual abuse at any age is traumatic and requires intense healing to recover from. Children are at a stage of development where learning imprints are occurring daily. The fracturing of safety and security, innocence, and caregiving attachment can all occur with one act of sexual abuse. Unfortunately with children, “…especially traumatic experiences in attachment relationships during childhood were significantly associated with other trauma in life” (Schimmenti, 2017, p. 1).
Abuse into adulthood
Further research shows the correlation between childhood abuse and issues into adulthood. These issues range from the physical to the cognitive. Physical issues may be underdeveloped body structure or broken bones as a result of neglect within family violence or untreated wounds as a result of rape or sexual assault. Cognitive disorders are often harder to diagnose and treat and include personality disorders, social dissociative tendencies, and remaining in a crisis state and lower state of functioning. Additionally, being exposed “… to either type of abuse has been strongly associated with alcohol and drug abuse and/or dependency in adulthood, in both clinical and population-based samples” (Fuller-Thomson et.al., 2016, p. 1452). Child abuse of any type has long with-standing effects, but there is hope through Christ that with crisis intervention, the effects can be minimized. He promises that a person can “Cast all your anxiety on him because he cares for you” (1 Peter 5:7, NIV) and as a crisis counselor, it is crucial to emphasize that message in light of abuse.
Effects of child abuse
The effects of child abuse are physical and/or cognitive. Some research is presentative on an interdisciplinary approach to child abuse treatment due to the overlapping nature of the effects and proposes treatments from both medicine and psychology as a means to full recovery for the abuse child. Full recovery of the abuse child is presented as the absence of cognitive and physical disorders or if present, the continued successful treatment of either. The effects on an adult versus a child who has been abused differs because of the “…significant neurodevelopmental changes that occur during the first decade of life…as well as that trauma is thought to have a different impact when it occurs during the first decade of life” (Wamser-Nanney, 2016, p. 4). The brain, body, and emotional intelligence of a child are developing during this time and there is a real, measurable component that is effected due to the trauma of abuse which “…include the hypothalamic–pituitary–adrenal axis, the amygdala, the hippocampus, and prefrontal cortex and are linked to children’s compromised ability to process both emotionally-laden and neutral stimuli in the future” (Wilson et al., 2011, p.87). Major components of the brain are affected, thereby instigating a trickle effect into the cognition and physical development of the child. Due to the impact of the trauma, crisis intervention is imperative in the emotional and physical health of a child who has experienced abuse.

Crisis intervention in child abuse
Crisis intervention in a child should be approached differently than what is implemented with adults in crisis. Wright (2011) suggests three steps of crisis intervention beginning with reliving the traumatic event, followed by releasing feelings, and ending with reorganizing thoughts and feelings (p. 409). While reliving the traumatic event may appear counterintuitive, this allows the child to remember the event in detail thereby allowing the full range of emotions to be available to process. For a child who has been abused, this means talking through the event, asking appropriate questions, and not limiting the child’s emotional reactions. Children do not have the ability to express themselves as adequately as adults, so it is imperative to find the means by which a child can completely release all feelings associated with the abuse. This step requires a deep sense of trust with the crisis counselor and open communication. Releasing feelings is likely the most intense and challenging part of the crisis intervention for a child, however “…successful resolution of a child’s crisis is dependent on the adult’s ability to respond in the most caring, therapeutic and developmentally appropriate manner possible” (Soenen et al., 2014, p. 269). Once the two previous steps have been addressed fully, the reorganizing of thoughts and feelings begins. This is similar to reframing if a crisis counselor were working with an adult. The difference lies in the child has had his or her security disrupted and the work of giving new meaning to people, places, and events in the child’s life begins. Ultimately, a crisis counselor’s work with children is to “…provide support for these children so that they can emerge from this crisis situation and heal…” (Ray et al., 2017, p. 126). A crisis interventionist has a monumental task of guiding a person through thoughts, feelings, and perceptions of trauma. This task is even more challenging with children, but comfort and assurance can be found in Christ in Isaiah 41:10: “So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand” (NIV).

Conclusion
There is no replacement for crisis counseling in the moments following a traumatic event, but especially in the life of a child who has experienced abuse. Wright (2011) explains there are four messages children receive in light of trauma: your world is no longer safe, no longer kind, no longer predictable, and no longer trustworthy (p. 339). As a crisis interventionist understanding the foundational shift that occurs for a child in light of trauma, and even more so with direct abuse, is necessary in providing children with the right tools for healing. A child that heals becomes an adult that can help others. Matthew 25:40 says “…whatever you did for one of the least of these brothers and sisters of mine, you did for me” (NIV). A crisis interventionist with a heart for Christ is doing unto Christ what he or she does for children. References
Chu, D. A., Williams, L. M., Harris, A. W. F., Bryant, R. A., & Gatt, J. M. (2012;2013;). Early life trauma predicts self-reported levels of depressive and anxiety symptoms in nonclinical community adults: Relative contributions of early life stressor types and adult trauma exposure. Journal of Psychiatric Research, 47(1), 23-32. doi:10.1016/j.jpsychires.2012.08.006
da Silva, Juliana Amaral Medeiros, Siegmund, G., & Bredemeier, J. (2015). Crisis interventions in online psychological counseling. Trends in Psychiatry and Psychotherapy, 37(4), 171-182. doi:10.1590/2237-6089-2014-0026
Earley, M. D., Chesney, M. A., Frye, J., Greene, P. A., Berman, B., & Kimbrough, E. (2014). Mindfulness intervention for child abuse survivors: A 2.5?Year Follow?Up. Journal of Clinical Psychology, 70(10), 933-941. doi:10.1002/jclp.22102
Fuller-Thomson, E., Roane, J. L., & Brennenstuhl, S. (2016). Three types of adverse childhood experiences, and alcohol and drug dependence among adults: An investigation using population-based data. Substance use & Misuse, 51(11), 1451-1461. doi:10.1080/10826084.2016.1181089
Jacobson, L., & Butler, S. K. (2013). Grief counseling and crisis intervention in hospital trauma units: Counseling families affected by traumatic brain injury. The Family Journal, 21(4), 417-424. doi:10.1177/1066480713488530
Powell, O., & Morrison, K. (2017). Therapeutically supporting children to recover from the impact of family violence. Children Australia, 42(3), 137-141. doi:http://dx.doi.org.ezproxy.liberty.edu/10.1017/cha.2017.25
Ray, D. C., Lilly, J. P., Gallina, N., MacIan, P., & Wilson, B. (2017). Evaluation of bikers against child abuse (BACA) program: A community intervention for child abuse victims. Evaluation and Program Planning, 65, 124-130. doi:10.1016/j.evalprogplan.2017.08.003
Schimmenti, A. (2017). The trauma factor: Examining the relationships among different types of trauma, dissociation, and psychopathology. Journal of Trauma & Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD),1-20. doi:10.1080/15299732.2017.1402400
Soenen, B., Volckaert, A., D’Oosterlinck, F., ; Broekaert, E. (2014). The implementation of life space crisis intervention in residential care and special education for children and adolescents with EBD: An effect study. Psychiatric Quarterly, 85(3), 267-284. doi:10.1007/s11126-014-9288-4
Wamser-Nanney, R. (2016). Examining the complex trauma definition using Children’s self-reports. Journal of Child & Adolescent Trauma, 9(4), 295-304. doi:10.1007/s40653-016-0098-8
Wilson, K. R., Hansen, D. J., & Li, M. (2011). The traumatic stress response in child maltreatment and resultant neuropsychological effects. Aggression and Violent Behavior, 16(2), 87-97. doi:10.1016/j.avb.2010.12.007
Wright, H. N. (2011). The complete guide to crisis & trauma counseling: What to do and say when it matters most!. Bloomington, MN. Bethany House Publishers.

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