This book shows mental health providers how to envision crises as time-limited windows of opportunity—as tipping points clients can seize to achieve new insights and move in positive directions in their lives.

"It is a positive, strength-based frame for seeing crisis as an opportunity…The author skillfully brings to the fore the idea of crisis shaped in culture; a brilliant and important way to excavate through crisis as a determinant for change…This is an easy read, but profound in its content. This is a book to keep, as it will be malleable for practitioners as they develop skills and professional goals.”—Doody’s Reviews

Aligns with APA Divisions 38 and 50. 

Most mental health practitioners have been taught to do risk assessments and to reduce danger to their clients and those around them. However, many providers lack a thorough understanding of the cause and nature of mental health crises and struggle to safely and successfully provide crisis intervention. Instead of seeking to return clients in crisis to their previous baseline, providers can seize the opportunity presented by crises and tip them toward rapid resolution.
 
In Part One of the book, J. Scott Fraser outlines his Process of Change model, a clear and concrete approach to understanding crises in their proper context; engaging with clients through their values, culture, and language; honoring their goals; and breaking cycles of crisis for good. In Part Two, he shows how different types of crises—trauma, suicidality, grief, intimate partner violence, and sexual assault—reflect similar vicious cycles. Real life case studies illustrate the Process of Change model in action, demonstrating how each of those cycles can be tipped toward resolution by embracing the contextual process of change perspective.

J. Scott Fraser, PhD, is a clinical psychologist with nearly 40 years of clinical practice, supervision, training, and academic teaching He has served as director of internship training, associate dean, and director of clinical training and as professor of clinical psychology in the doctoral program at the School of Professional Psychology at the Wright State University in Dayton, Ohio. Before that, he was director of a crisis/brief therapy center in a large general hospital setting for 14 years. He has published many papers and books, including Unifying Effective Psychotherapies: Tracing the Process of Change (APA Books, 2018), and the DVD titled The Process of Change in Integrative Psychotherapy, which uses the process model described in this book.

Contents 

ACKNOWLEDGEMENTS8 

Prologue: Wei Ji9 

Introduction12 

Chapter One19 

Defining Crisis20 

Misguided Assumptions21 

Mistaken Applications21 

System Levels.22 

• Mechanical Systems22 

• Organismic systems22 

• Sociocultural Process-based systems23 

Problems with the Traditional Views of Crisis23 

• Assuming stability versus change23 

• Perceiving danger not opportunity23 

• Assuming change is mainly gradual verses rapid24 

• Assuming reality is stable and fixed versus co-created through process24 

• The importance of context25 

• The need to unify all crises within an appropriate model of change25 

Chapter Two27 

Feedback is the heart of systemic causation.27 

The quest for a stable and predictable world.28 

Making sense of our chaotic world.29 

Stability and Change:29 

The Threat Rigidity Hypothesis31 

Paradox and Creative Change32 

The history of a process view of our world.33 

Process and Chaos35 

Chaos and Flow35 

Context39 

Crisis Attractors41 

Fractals42 

Catastrophe Theory44 

Following the Process47 

• Observers define crises47 

• Rules, Regularities and Constraints within open systems channel their ongoing interaction patterns47 

• Positive and Negative Feedback Loops are Complimentary48 

• Constancy/Stability and Change are interrelated48 

• Change is constant and can be rapid48 

• Small changes can have cascading large results.48 

• Not all small changes will initiate cascading change49 

• A small sample of current patterns may reflect much larger system patterns49 

• The goal of crisis intervention is thus shifting patterns49 

Chapter Three51 

Crisis as a “Window of Opportunity” for rapid intervention.52 

Key Elements of All Effective Rapid Intervention53 

Key Crisis Concepts55 

Trigger Points55 

• Developmental life crises56 

• Incidental life crises:56 

• Endemic life crises:57 

Crisis Attractors58 

Solution-generated problems59 

Problem-generated systems60 

Crisis Patterns60 

Generic response patterns61 

Specific response patterns62 

The Process of Change Intervention Process70 

Relationship Establishment70 

Generic Intervention Options74 

• Rationales and Reframing74 

• Context and Contracting:76 

• Normalizing77 

• Predicting77 

• Positioning and Restraints78 

• Prescribing79 

Chapter Five83 

Trauma and Post-trauma85 

PTSD Models88 

Vicious Cycles of PTSD91 

Treatments That Work For PTSD94 

Exposure-Based Approaches95 

Present-Centered Treatment95 

Posttraumatic Growth as an Alternative98 

Growth as an Alternative99 

Violating Our Assumptive World100 

Searching for Meaning101 

Positively Re-Solving Crises and Trauma103 

Disclosure in a positive context105 

A Process of Change Approach to Crises and Trauma106 

Chapter Six109 

Hazardous Intersections110 

Predicting Suicide113 

Psychache and Tipping Points114 

Suicide as not a “thing-in-itself”116 

Risk versus Treatment Oriented Assessments118 

The Problem with No-Suicide Contracts119 

Promising Pathways to Positive Intersections122 

The Therapist Sphere123 

The Client Sphere124 

The Cultural Sphere125 

The Alliance—The Intersection of all three Spheres125 

The Golden Thread of Effective Intervention126 

Chapter Seven135 

Definitions138 

A history of grief models138 

Stage Models140 

Task Models141 

Intervening in Grief and Mourning144 

The debate over what works.144 

Complex Grief or Complicated Grief Disorder as an intervention target146 

The “New Wave” of Grief Interventions147 

The Process of Change in Grief Intervention147 

Being there with most grieving people.149 

The Dual Process Model.151 

Making Meaning of Loss and Growing Beyond155 

Meaning making.155 

Posttraumatic Growth156 

Revisiting the Chapter’s Initial Cases157 

Recycling With Grief Intervention163 

Chapter Eight165 

Intimate Partner Violence as an Endemic Crisis165 

Defining the Problem and its Scope167 

Definitions:167 

Incidence167 

Barriers to Change.170 

Changing the Cultural Context173 

Changing Laws174 

The shelter movement175 

The Duluth Model and its impacts.177 

General Reversals yet Inconclusive Results178 

The Client and Practitioner Spheres179 

“Battered Woman’s Syndrome” as a potential Generic Pattern180 

The Power and Control Wheel183 

Victim/Survivor Interventions184 

Women’s Groups184 

Social Advocacy.184 

CBT185 

Perpetrator Intervention186 

Batterer’s Groups187 

The ACTV approach189 

Research on ACTV192 

Reprising the Process of Change at Tipping Points Individually192 

Chapter Nine198 

Rape as an Endemic Crisis200 

Attractors and tipping points.201 

MeToo:201 

Defining Sexual Assault and Rape203 

Definitions203 

Incidence:204 

Vast Underreporting204 

Barriers206 

Interventions in Sexual Assault207 

Changing the Cultural Context208 

The Violence Against Women Act (VAWA) of 1994208 

Culture Wars209 

The advent of Rape Crisis Centers210 

International Women’s Day and Take Back the Night212 

The advent of SANE Nurses213 

Video and Online Options.216 

The Uphill Battle to change the cultural context sphere.217 

Intervention with bystanders217 

RAINN219 

The Client and Practitioner Spheres220 

“Rape Crisis Syndrome” as a potential Generic Pattern221 

Effective Interventions with Sexual Assault Survivors224 

Most common response patterns.224 

Second-order change.225 

Broad-based effectiveness226 

Post-traumatic growth from sexual assault227 

Chapter Ten231 

Following the Thread235 

Trauma.235 

Suicide as a potential Incidental Crisis236 

Grief and Mourning as a Developmental Crisis236 

Intimate Partner Violence as an Endemic Crisis237 

Sexual Assault as another Endemic Crisis238 

Convergence239 

Conclusions and Directions240 

Endings and Beginnings241 

REFERENCES243