Following from our considerations of crisis focus, crisis definition, and cumulative effects, let us now focus our attention on causes and effects. Figure 4 indicates that our question is, What could cause a crisis like this one? It is important to see that the question is not What did cause? but rather, What could cause? For example, what could cause someone to want to kill himself? What could cause someone to become extremely upset or hysterical? What could cause a teenager to want to run away from home? What could cause someone to want to quit his job? What could cause someone to abuse or misuse drugs or alcohol?
The focus on could cause is, on one hand, a relatively simple notion but, on the other hand one that goes against our usual way of thinking about problems. Typically, we look at a problem and want to know in detail, the situations, circumstances and events leading to the specific problem. In crisis intervention, however, we need to have in mind a set of likely causes of a variety of crisis situations. When we are dealing with a person in crisis, we need to know the most likely causes of a crisis such as the one we now see. For example, the three most likely causes for crises involving threats of suicide are: severe marital or family difficulty or disruption, having done something or having experienced a situation that causes extreme feelings of guilt or worthlessness, or some external event that threatens an individuals social and/or economic well-being. For each type of crisis situation with which we deal, there are one or more likely causes. As we look at the individual and his crisis, we want to consider the kinds of things that probably have caused his crisis.
Understanding the possible causes for crisis reinforces the social interaction characteristic of this crisis intervention model. The model argues that crises always involve disruption or conflict within the interaction between the individual and his total situation. Possible causes of crises, then, always relate to factors, situations, conditions, and so on, that cause conflict or disruption in the interaction. As we know, crises are caused, or set off, by precipitating events. Our own life experience, our experience with people in conflict, our supplementary reading, and our understanding of precipitating events help us understand the kinds of things likely to cause a variety of crisis situations. If a teenager runs away from home, he has probably experienced a blow up with his parents; has had a significant problem at school or with one or more of his friends; or has been tempted by the opportunity to be on his own or with his girl friend or boyfriend. If a child appears to be extremely fearful and apprehensive on his first day of school, the likelihood is that he is afraid to move out from the protection and shelter provided by his mother. As you encounter various crisis situations, it becomes increasingly less difficult to speculate about the possible problems and factors in an individuals interaction that were sufficient to cause the crisis.
We see the crisis and have a good understanding of the situations, circumstances, and events that could cause this kind of problem. Our next step is to look carefully at the individual and his total situation in order to discover what caused his particular crisis. Knowing that gives us two special advantages. First, we know what a cause looks like. This point may seem trivial, but it is important to be able to recognize a cause when we see it or are told about it. People in crisis are frequently unable to tell us what happened or to explain what caused the crisis situation. They tend to attribute causality to situations or circumstances that are either too far removed from the crisis to have caused it or else are only incidentally related to it. For example, a young man becomes extremely tense and depressed. We ask him, What happened? He says, I dont know. I have never been a very happy person and have been nervous since I was a child. It must have something to do with my background. Our understanding of crisis and our orientation to precipitating events tell us that, although what he says is probably true, this does not explain why he suddenly became tense and depressed. Something must have happened to precipitate the present crisis. This understanding leads us to ask additional questions and helps us keep him focused on the present situation and what happened to make things worse today. We would probably ask if anything unusual happened at work, at school, with his family or friends, and so on. With our understanding of possible causes, we can help him discover circumstances that might have caused his present crisis. This helps him focus on the real problem instead of on possibly irrelevant or tangential events or circumstances.
A clear notion of the most likely possible causes of crisis also enables us to help people think in a relevant way about what happened when they are feeling confused, somewhat disoriented, or are having difficulty organizing their thinking and feelings. Moreover, the individual will develop feelings of security and trust because we understand what causes people to find themselves in crisis and are able to understand how things got that way.
Let us emphasize a point that may be easily overlooked. Since the crisis developed now or at least in the immediate past, the cause or at least a major portion of the cause also occurred in the immediate past. As we work with people in crisis, we will remember the significance of the precipitating event, and we will continue our search for it until we have found it. In crisis intervention, our commitment to the individual is in part an implicit agreement to continue our involvement with him until the crisis is resolved and until both of us understand what happened.