Crisis Management Tips From A Residential Treatment Center

By Kris Kilpatrick
Working with struggling teenage girls, I have had many opportunities to deal with crisis in unique forms and situations. Crisis comes at unexpected times and can be overwhelming, causing us to react in ways that escalate the crisis. While our intention as parent, friend, or professional is to be helpful and ensure the situation is resolved safely, it is easy to inadvertently add intensity to the situation or “fuel to the fire” by our actions, words, and even mannerisms.

Sarah’s Story

As tends to happen in a residential treatment center, I learned about crisis management rather abruptly and through direct experience. During one of my first group sessions, a young woman I’ll call Sarah was confronted by another student for some destructive behaviors that were a concern to the whole community. The advice was well intentioned and delivered appropriately, by Sarah was not ready to hear it. Hurt and embarrassed by the confrontation, Sarah got up from her seat, walked across the room, and hit the student that gave her the feedback. She then took off down the stairs and ran to her room where she took her anger out on all of the furniture in her bedroom. I followed a more experienced colleague to Sarah’s room, where she had already pulled drawers out of dressers, turned over mattresses, thrown vases, and broken picture frames. As soon as we opened the door, she looked up at us and fell to her knees with her hands over her face, sobbing.
Following my colleague’s lead, I gave Sarah her space by remaining quiet and keeping as much physical distance as the room would allow. Sarah had already cycled out of the peak of her crisis and was now in the “cooling down” or reflective phase. After a few minutes of silence, my colleague slowly approached Sarah in a round-about way to avoid the appearance of a confrontation. My friend made sure to respect Sarah’s personal space by keeping about 3-4 feet of distance between them. She sat next to Sarah, putting herself at the same level as the crying girl. Then she gently moved Sarah’s hands from her face, placing them on her lap.
Even though I was new to this work, I was able to pick up on the subtle things my co-worker did to prevent the crisis from escalating to self-harm or the need for physical intervention. Because this event was so early in my professional experience, I have referred back to it often as a reference point for the basic principles of de-escalation.
Here are some of those principles:

Remove Triggers

A crisis always has a “trigger.” In the case of individuals that have experienced trauma, it could be a song that was playing during a rape, or the smell of the perpetrator’s cologne, or a word or phrase that reminds the person of the trauma. These concrete links to emotional memories are what we refer to as triggers. Triggers launch someone who is otherwise doing well almost instantly into a very agitated, out of control, irrational state.
It’s often a person who either presents or pulls the trigger that launches a crisis situation. We can intentionally or unintentionally say and do things that pull these triggers and escalate others. Whatever the trigger is that is agitating the person, we need to remove it from the person in crisis or remove the person in crisis from it-whichever represents the quicker, easier task. If there is a song playing that is causing the escalation, we can simply turn it off. If another person is making provocative statements, we can ask that person to stop or have them leave. Alternatively, it’s often easier for us to remove the individual who is being triggered from the charged situation.
The best solution to crisis is prevention. By staying alert and quickly removing triggers from the individual or vice versa, we can frequently achieve the goal of preventing a crisis from happening.

Remain Calm

It is always important to be even and calm in our speech and actions. If I, as the adult caregiver, am not calm, the young person in or approaching crisis will certainly not be calm. If we allow our voice to escalate in pitch, intensity or volume, or if we come across as agitated, we can very easily escalate or re-escalate someone into crisis.

Validate

When someone is having difficulty, the last thing they want to hear is that they are wrong or that they shouldn’t be feeling a certain way. Their feelings are their own and they can’t always control them. One way to alleviate tension is to make validating comments such as, “that makes sense,” or, “it’s okay for you to be hurt or frustrated,” or, “wow, that must be very difficult,” or, “If that had happened to me, I would probably feel very similar to what you are feeling,” or, “I’m really sorry you are feeling this way.” Staying connected and compassionate, and verbalizing that compassion, can help the person in crisis realize that you are on their side and that you understand them and their emotions. This can have a profoundly calming effect.

Manage Non-Verbal Signals

What we say (verbally) and do (non-verbally) can make or break a difficult situation. Awareness of posture, eye contact, expressions, sighs, etcetera, is critical in managing a crisis situation. In the situation described earlier, my colleague masterfully used non-verbal communication to avoid re-escalating Sarah. She gave Sarah physical, and therefore emotional, space; she allowed Sarah time to gather her thoughts and cool down; she slowly and carefully approached Sarah. Had she gone quickly and directly toward the Sarah, she might have triggered her right back into crisis.
The way we physically position ourselves in crisis situations can also reduce the threat. I always find a way to make myself smaller and less threatening than the young person in crisis. If a student is standing, I will sit in a chair. If they are sitting in a chair, I will sit on the floor. I remain aware of my surroundings and what is going on so that I can provide safety for the young person, others, and myself if she acts out physically, but I always want to avoid the appearance that I am intimidating or a threat.

Play Dumb

This is an easy one for most people! During crisis situations we often come in late and have little or no idea of the circumstances. In accordance with our effort to validate the young people in our care, we want to get them talking. Talking can help the young person pull herself out of an impending crisis, especially when we balance their talking with tender validation. Providing a context for talking quickly demonstrates that we are an ally, which is reassuring and calming.

Remember the Emotional Context

When a teen is in crisis, it’s easy to be distracted from the emotional source of the crisis by what is being expressed physically or verbally. Only by staying tuned in to the emotional source of the crisis can we take the proper course of action. We want to be present and tuned-in enough to discern environmental triggers so that we can separate them from the person in crisis or vice versa. If they will take a walk, that is great. Get them away from the trigger if you know what that trigger is.
At the peak of a crisis, it’s helpful to resist the urge to intervene immediately-either verbally or physically (unless there is an immediate risk of harm to self or others). A crisis, as a general rule, doesn’t last long. If the young person isn’t hurting herself or others, or if there isn’t a high risk of this happening, the best course is to let her cycle out of the escalated emotions on her own. There is no need to talk, because they are not in a place to listen-they are in a place of emotion, not logic. If they are being unsafe to themselves or are hurting another person, then of course it’s critical to ensure safety, either by calling the police, an ambulance, or-as professionals-using your training to physically hold the person in such a way as to prevent injury.
Cooling down comes after the person has passed through the crisis cycle. Their breathing slows down and they are able to speak and take direction and feedback. This is the appropriate time to talk them through the crisis experience. This can be an emotionally vulnerable and open period; if we use our words correctly we can build an even stronger relationship during this time immediately following crisis. We can also use these experiences to establish new boundaries by telling them what was and was not appropriate in their behavior during the crisis, and helping them construct a self-management plan for future crises.

Summary

Crises can easily catch us off guard and elicit responses from us as caregivers that escalate instead of de-escalate the situation. By being vigilant for environmental triggers, remaining calm, and understanding crisis as cyclical and therefore temporary, we are more likely make the crisis cycle both shorter and safer. These approaches are critical for turning what could be a destructive event into a constructive opportunity for increased trust and personal growth.
Kris Kilpatrick is a counselor at New Haven Residential Treatment Center, part of the InnerChange family of adolescent treatment programs.