Ellen Inverso, PsyD, Beck Institute Faculty and Paul Grant, PhD, Director, Beck Institute Center for Recovery-Oriented Cognitive Therapy
On a street corner, a person talks loudly to themselves, becomes more and more upset, tightens their fists, and lashes out. Seeing this feels uncomfortable. Does this person live on the street? Are they having a mental health crisis? What is going on?
What Happens During a Mental Health Crisis?
Think of a recent time when you became very angry. Did you feel disrespected, rejected, misunderstood, or frustrated? Did it seem that you were alone in your pain? Chances are that the person going through a mental health crisis is experiencing something similar. They see themselves as vulnerable and powerless; they believe others do not care, may be dangerous, and cannot be trusted; the world seems unsafe and threatening. Isolated and upset, the person has no one to protect them but themselves.
If you can remember a recent time you were angry, you might also remember a time when someone was not helpful. Maybe they told you to calm down or tried to solve your problem for you. Did these actions make you more angry? More isolated? A person in a mental health crisis likely feels similarly.
With Recovery-Oriented Cognitive Therapy (CT-R), we train professionals to use these insights into the psychology of being in crisis to say and do practical things that empower individuals relative to their mental health challenges. The understanding and skills of CT-R are portable, enabling professionals and paraprofessionals— on the street, in hospitals, in residences— to help a person stop escalating and get out of an immediate crisis.
Since the individual’s crisis involves being disconnected and not understood, the CT-R approach creates connection through understanding by asking questions like: “You seem very frustrated. Do I have that right?” and making statements like “I imagine most people would feel upset. I get it.” These questions help the person feel heard. The questioner demonstrates they care, want to get it right, can empathize with the feelings underneath, and see this as a relatable reaction that many would have.
Why is Connection Important During a Crisis?
Getting upset stirs up a lot of energy. As the person calms down, their speech slows and their shoulders relax, and we can channel that energy into something they care about. Energy that was destructive can become productive, helping a person to realize their values: “If this weren’t bothering you so much, what would you want to do?” and “I know that making rhymes to share with your son is important to you, what do you say we do that now?”
When another person shows they care, shows they understand, and is able to connect with an individual, this leads the individual to feel less stressed. Their mind slows down and their body relaxes. It is the “we” part of connection that undercuts the momentary rage, brings out a different side of the person, and helps them use the energy to do the things that matter most to them. This is the recipe for empowering de-escalation.
What Makes CT-R an Empowering Approach to De-Escalation?
In short, CT-R provides a way of understanding crises and other challenges in terms of the beliefs a person holds– in this case, about not being understood, being blocked, being rejected. Questions and statements counter these beliefs and demonstrate concern, understanding, and desire to establish connection. And, importantly, CT-R focuses on how people can realize their chosen lives and experience their best selves. In a moment of crisis, the CT-R approach focuses the energy stirred up by the crisis into an activity that embodies the person’s interests and values, helping them see they have control in the situation and are capable of handling stress this way in the future.
It can feel risky for professionals and paraprofessionals to balance personal safety with attempts to connect and diffuse a potentially dangerous situation– one that substance use can further complicate. However, we know that through CT-R and related approaches, those who work in mental health settings can turn such difficult situations into occasions to effectively foster an individual’s sense of safety and being understood. This can reduce the need for individuals to rely on aggressive acts to get their needs met, ultimately reducing hurt and suffering, saving lives, creating more trust and wellbeing, and enabling a life of participation in a chosen community.
Recommended Reading:
Related Program: Center for Recovery-Oriented Cognitive Therapy
Read more about CT-R: