What do we learn from the professional field of Crisis Intervention, or Critical Incident Stress Management (CISM) that especially informs the work of pregnancy crisis intervention (PCI)? 

Previously, we noted that it is accepted practice within the field of crisis intervention to rely on volunteers and to provide them in-house training to serve as “counselors.” This is normative within the field of CISM.

Now, I ask, what is the textbook understanding of crisis? What are the presenting characteristics? And how does this stack up to what we see every day in a PHO?

 The textbook, Crisis Assessment, Intervention and Prevention, describe the human experience of crisis.

“People are in a state of crisis when they face an obstacle to important life goals—an obstacle that is, for a time, insurmountable by the use of customary methods of problem-solving. A period of disorganization ensues, a period of upset, during which many abortive attempts at solution [sic] are made.”

All of us working in a PHO not only recognize this definition of crisis, but we also recognize the presenting characteristics as well. In Helping People in Crisis, Douglas A. Puryear writes,

A state of crisis is characterized by: 

  1. Symptoms of stress
    The person in crisis is experiencing both psychological and physiological stress in ways that can include headaches, depression, anxiety, bleeding ulcers, etc.
  2. An attitude of panic or defeat
    A person who has tried every way he can to solve a problem and has failed feels overwhelmed, inadequate, and helpless. He will tend to be either agitated, with unproductive behavior. . . or he will tend to be apathetic (retreating into bed or into a drunken stupor).
  3. A focus on relief
    In this state, a person is primarily interested in relief of the pain of stress—the headache, the depression. . . There is little gathering or noticing of new facts or new ideas, and little organized effort at problem-solving. Relief will generally be sought by discharge behavior, withdrawal behavior, or turning to others for rescue. 
  4. A time of lowered efficiency
    In this state, a person may continue to function normally, but his efficiency is markedly lower, and those problem-solving efforts that persist are inefficient.
  5. A limited duration
    People cannot exist in this state for long—it is unbearable. It will end and a state of equilibrium be regained within a maximum of six weeks.

By both definition and by presenting characteristics, our PHO’s are in the business of crisis intervention or critical incident stress management (CISM). If you want to help someone prepare for PHO work, encourage them to get a degree in CISM. I wrote PCI in part to provide teachers and trainers a textbook for our area of expertise within the larger field of CISM, since at this point, our work is not recognized in CISM textbooks.

Not only should we identify with CISM as our professional field of work, we ought to see ourselves as leaders within this field. Why do I say this? Because pregnancy-related crisis is the most common crisis in the world today.

Guttmacher’s Fact Sheet, Global Incidence and Trends reports that “during 2010–14, an estimated 56 million induced abortions occurred each year worldwide.”

Remember, people generally will not live in a state of crisis more than 6 weeks before they take some action, even desperate action, to end the unbearable emotional disequilibrium that they are experiencing. Approximately 56 million women a year see abortion as the quickest way to end their pregnancy-induced crisis. 

This is our mission field. You and your PHO are in the CISM business! Understanding the presenting characteristics of those in a pregnancy related crisis and understanding what to do and say when it matters most will determine your effectiveness. Keep sharpening your training. Keep sharing your insights. That is how a crisis intervention movement grows into a profession.

This article is part 2/4.  You can find the first article in the series here and the third article in the series here.