You lose your job, your partner falls in love with someone else, a lifelong dream is shattered or a loved one dies – and suddenly you can’t go on. Emotional stress can trigger mental crises. Nobody is immune from this. There are some measures and psychological help that can support you in a crisis. In this article I give tips on what you and the people around you can do to get through these difficult times better. I also shed light on advisory, psychotherapeutic outpatient support services.

A crisis is a subjective state of excessive demands

A crisis is a subjective state of excessive demands. Our usual strategies are no longer sufficient to cope with the situation. If you are unexpectedly faced with a particularly stressful event, it can lead to a type of system overload. You become unbalanced internally. The sensation can vary: It can hurt inside like physical pain, or it can feel empty and numb. The normal demands of everyday life suddenly seem almost impossible to cope with.

The reaction to an event is not the same for every person. Some people cope with loss better than others or cope with a particular insult more easily. There is generally no one level of stress or specific triggering situation and the typical emotional reaction to it.

In a crisis, it’s important to have the right tools in your inner toolbox

There are some factors that have a general impact, which I will come to later and which we can influence directly. But ultimately, when a crisis arises, what matters is whether you have the right ‘tool’ in your inner toolbox for exactly this problem situation. How you are equipped is very individual and has to do with your history and your development. A woman can be well equipped and well positioned in many areas of life and then decompensate at a certain point and end up in a crisis.

Crises, even for no apparent reason

Even in connection with an existing mental disorder, a crisis-like deterioration can occur without any serious external cause, for example as part of a depressive episode or a personality disorder. Or a longer deterioration process, such as burnout, which describes a certain path, can end in a depressive crisis.

The reason for the crisis can then be vividly described as water in a rain barrel; the occasion is the extra amount or the straw that breaks the camel’s back. If the bin is already full to the brim or generally small, a small drop is enough.

Whether it occurs suddenly or slowly and gradually: fundamentally, how we are emotionally and socially positioned has an influence on how well we can cope with a crisis. Our past and how we learned to trust ourselves, how we deal with our feelings, and whether we have a supportive social network. All of this has an influence. If you have experienced mental overload, there are some measures that can help you:

What helps in a crisis:

1. Short planning

The most important thing is to first acknowledge that you are in a state of emergency. Don’t expect yourself to continue functioning as usual. This means lowering the demands on yourself. This makes planning much shorter. Depending on how stressed you are, it’s all about how you can get through the day or the next hour well –
what do you need at this moment, what is helpful now?

The big questions of your life will not be answered now and the solution to big problems will also be postponed for the time being.

2. A safe environment

If you are emotionally upset, it is important to create a safe, calm and clear situation outside. Satisfying physical needs, such as eating and drinking, are also important. ‘Safe’ also means knowing what happens, when and for how long. Shortly after an emotional shock, people who talk to you should state the next steps in a calm, friendly, clear and easily understandable manner.

3 . Talking helps! Painting too!

Talk about your feelings! Just ask your friends to listen to you first, without offering any solutions. (If you’re thinking, ‘But I don’t have anyone to talk to’, more on that later in the text.)
Expressing your feelings in creative ways is also helpful! Write down, paint or sing/make music. We often feel powerless in this situation. By expressing ourselves creatively, we come into the creating position.

4. Connect with your strengths

In a crisis situation we feel overwhelmed and helpless. As a result, awareness of our strengths can be lost. But they are still there!

Take a closer look: This won’t be the first difficult situation you’ve had to deal with, right? What was it like back then, how did you manage to get through it? What was a good decision back then? What helped? By remembering your strengths and becoming aware of them, you connect with your skills and resources.

5. Rituals and structure

In turbulent times, everything that stays the same is good. If the relationship breaks down, there can be support: the job is secure, there is the weekly appointment at the sports club or the drawing course continues. If there is little structure, create some now! Even small rituals and routines in everyday life, even if it’s just one series on a certain day or a regular telephone appointment with a friend, provide your subconscious with security.

6. Activate resources

If the inner resources, i.e. what is there effectively for your well-being, are simply not enough, it is best to bring in additional ones from outside. Friends or family who provide short-term support, who take on specific tasks, accompany you or are simply there. The best thing to do is to arrange specific help with a fixed place and time.

Psychological counseling and psychotherapy

If no one is there, or you have the impression that your friends can’t help you, it definitely makes sense to seek professional support. This can only be the family doctor at first.

If you want to go to a psychotherapist, the months-long wait for a therapy place is a big problem. If you therefore decide to go to a psychological psychotherapist as a self-payer, it is important to clarify your concerns. Usually, in the first sessions (the probatorics), in addition to your symptoms to make the diagnosis, we talk about your life history in more detail, starting with very early childhood with depth psychologists and analysts.

In a crisis, however, this approach does not apply to your situation. Crisis intervention or supportive therapy is helpful. So the focus is on the here and now. (More on that later)

There have also been psychotherapeutic consultation hours for a while now, which must be offered by statutory health insurance psychotherapists. You can usually get a consultation appointment quicker than a therapy place – although you have to wait up to 4 weeks. You have to consider whether attending a psychotherapeutic consultation makes sense in your crisis.

What you can expect from psychotherapeutic consultations in a crisis situation

In a psychotherapeutic consultation, which the psychological psychotherapist has to offer with a cash register, the therapists have 50 minutes (2x25min) for you. During this time they have more tasks than a purely supportive conversation. Above all, they must clarify diagnostically how your situation can be classified.

The task of the psychotherapeutic consultation is to:

• Orientative, diagnostic clarification of the disease-related disorder,
• differential diagnostic clarification of the disease-related disorder,
• Clarification of individual treatment needs and recommendations for further treatment,
• psychotherapeutic intervention,
• Information about further options for help,
• Individual patient information with written report of findings,
  (Source: kbv.de)

 

Since a crisis does not necessarily mean illness, in some cases this only applies to a limited extent.

During this time they also have to scan your card, collect your data and fill out the PTV11 recommendation form, which certifies whether psychotherapy is necessary. Then they usually have no capacity to offer further treatment. This means that you will probably have to repeat your story somewhere else if you need further support.

On the other hand, they can offer three times 50 minutes for you. The psychotherapeutic consultation hours can be billed up to 6 times (25 minutes each) in the event of illness. For insured persons up to the age of 21, consultations with a child and adolescent psychotherapist can be billed up to 10 times in the event of illness. The case of illness includes the quarter in which the consultation was billed for the first time and the three following quarters.

A crisis is not an illness

A crisis in itself is not an illness. In our health system, therapy is only covered by health insurance if there is a mental disorder. In other words, if in this case your reaction to stress is not classified as ‘normal’ but as illness-related.

However, a highly stressful situation can very well be the trigger for a mental illness. That’s why I think , sick or not, that support definitely makes sense when the stress is great. Early help helps prevent the development of a mental disorder.

Soulmates offers quick help, specializing in crises, with and without a diagnosis, for example with relationship problems, heartache and the pain of separation. We will first focus on the current situation.

Crisis intervention – a special focus

In a crisis, particularly targeted (therapeutic) support is required. In technical language this is called crisis intervention. This is not conventional psychotherapy but rather a so-called supportive therapy.

‘A psychotherapeutic crisis intervention is understood to mean a quick, short-lasting, intensive psychotherapeutic treatment in the event of a crisis, in which the current conflict or the immediate trigger, such as a traumatic experience, is discussed.’ (Wikipedia)

A supportive form of therapy is about supporting the client. This means that the conversation supports you in dealing with a situation or conflict in the here and now. The key words are security, orientation and relief.

The goal is to keep the negative health effects of a crisis as low as possible. What matters is not how bad an experience is viewed from the outside, but rather how serious the client experiences it. You should be taken seriously in your individual experience and the focus should be on concrete support in the development and implementation of immediate goals.

Therapeutic support, in the here and now

In psychotherapy, when dealing with deeper issues, it is usually accepted that the discussion may feel unpleasant and stressful at that moment. During the healing process, it is not uncommon for the client to initially feel worse at times. During crisis intervention, revealing and additionally stressful procedures should be avoided.

Therapy or counseling essentially focuses on the here and now. An empathetic (sensitive), appreciative attitude is of great importance. In addition to the concrete defusing of the most urgent difficulties, for example through problem-solving strategies or information transfer, relief through activation of existing resources (the “individual strengths and sources of energy”), as already mentioned above, is also an essential component here.

Crisis interventions are often very effective in providing immediate relief.

Counseling center, social psychiatric service, psychiatrist?

If a crisis triggers suicidal thoughts, professional help should be sought immediately. In Berlin, the crisis service is a very good point of contact. The various locations offer both telephone and personal consultations free of charge. They also have doctors in the background who can be called in if necessary.

The Social Psychiatric Service of the Health Department is responsible for the mental health of all citizens. There are social workers and psychiatrists there who mostly look after the seriously mentally ill people in their district. They offer discussions and also arrange psychosocial help from appropriate providers or carers.

Another option is psychological counseling centers, which often offer consultations for a small fee or on a donation basis. These often have specific office hours and sometimes a waiting list. There are church counseling centers or ones on specific topics, such as experiences of violence and abuse, gay counseling, drug counseling, etc.

Students can also visit the psychological counseling center of the relevant student union at their university. The consultation is free, provided you are enrolled. The consultation can include several sessions (usually up to five). If there is a greater need for advice and support, we recommend starting psychotherapy.

Off to the doctor

Anyone who makes an appointment with a psychiatrist in a crisis should keep in mind that they will often primarily offer medication treatment, because that is what psychiatrists, as medical professionals, can do above all else. They are primarily concerned with brain chemistry. This also means that a psychiatrist does not necessarily have therapeutic training (some do) and does not always have to be particularly empathetic in their contact.

A visit to a psychiatrist can be particularly useful when it comes to sick notes, self-termination due to bullying, etc., because then specialist documentation and statements about health consequences have the most legal weight

If you have psychotic or manic symptoms, you should always consult a psychiatrist!

If you do not have acute suicidality or a serious psychological disorder, short-term, supportive therapeutic discussion is the most appropriate help.

Take good care of yourself!

As you can see, a crisis is not just one crisis – but varies greatly from person to person and situation to situation. A great deal of suffering does not have to mean ‘being sick’.

Either way, don’t hesitate to seek support. It is always a situation that is accompanied by excessive demands or suffering. The experience of taking good care of yourself and doing something to get help is good for your self-confidence. If you then have the positive experience of being understood and held, a bad situation can turn into a good one.

I don’t need to repeat the hackneyed saying that crises are opportunities. But a crisis usually makes you do something different and realign yourself.

It can help to see times of crisis as times of change.

 

Tina – Soulmates

If you have suicidal thoughts:
If you are thinking about suicide, talk about it! Unspecific, general thoughts about your own death are initially nothing unusual and are not automatically dangerous. If the thoughts contain concrete intentions and plans, then it is time to get professional help immediately! Experts can assess whether and how dangerous your condition is and help you. Either way, being able to talk about your suicidal thoughts is a lot of relief.
If someone says they want to kill themselves, it must always be taken seriously! You, but also your relatives, can call an institution such as the crisis service or the social psychiatric service at any time and get support. The telephone counseling service or youth emergency mail are also contact points. In an acute suicidal or psychotic crisis, call 112! (You don’t have to be afraid of having to pay the costs if it wasn’t that bad after all.) Or go to the emergency room at a hospital yourself – or first to the crisis service if there is one in your city .

Tina Steckling – Soulmates