SWK208- GENERALIST PRACTICE I

The Seven-Stage Crisis Intervention Model: A

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Road Map to Goal Attainment, Problem

Solving, and Crisis Resolution

Albert R. Roberts, PhD

Allen J. Ottens, PhD

This article explicates a systematic and structured conceptual model for crisis assessment

and intervention that facilitates planning for effective brief treatment in outpatient

psychiatric clinics, community mental health centers, counseling centers, or crisis

intervention settings. Application of Roberts’ seven-stage crisis intervention model can

facilitate the clinician’s effective intervening by emphasizing rapid assessment of the

client’s problem and resources, collaborating on goal selection and attainment, finding

alternative coping methods, developing a working alliance, and building upon the client’s

strengths. Limitations on treatment time by insurance companies and managed care

organizations have made evidence-based crisis intervention a critical necessity for millions

of persons presenting to mental health clinics and hospital-based programs in the

midst of acute crisis episodes. Having a crisis intervention protocol facilitates treatment

planning and intervention. The authors clarify the distinct differences between disaster

management and crisis intervention and when each is critically needed. Also, noted is the

importance of built-in evaluations, outcome measures, and performance indicators for all

crisis intervention services and programs. We are recommending that the Roberts’ crisis

intervention tool be used for time-limited response to persons in acute crisis. [Brief

Treatment and Crisis Intervention 5:329–339 (2005)]

KEY WORDS: crisis intervention, lethality assessment, establish rapport, coping,

performance indicators, precipitating event, disaster management.

We live in an era in which crisis-inducing
events and acute crisis episodes are prevalent.
Each year, millions of people are confronted
with crisis-inducing events that they cannot

resolve on their own, and they often turn for
help to crisis units of community mental health
centers, psychiatric screening units, outpatient
clinics, hospital emergency rooms, college
counseling centers, family counseling agencies,
and domestic violence programs (Roberts,
2005).
Imagine the following scenarios:

� You are a community social worker or
psychologist working with the Houston

From Rutgers, The State University of New Jersey (Roberts)

and Northern Illinois University (Ottens).
Contact author: Albert R. Roberts, Professor, Criminal

Justice, Faculty of Arts and Sciences, Rutgers, The State

University of New Jersey, Lucy Stone Hall, B wing, 261
Piscataway, NJ 08854. E-mail: prof.albertroberts@comcast.net.

doi:10.1093/brief-treatment/mhi030

Advance Access publication October 12, 2005

329

ª The Author 2005. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
journals.permissions@oxfordjournals.org.

Police Department to deliver crisis
intervention services to police, emergency
responders, and survivors of Hurricane
Katrina who just arrived at the Houston
Astrodome disaster shelter. It is midnight
and one of the survivors (who was
brutally raped 1 week prior to Hurricane
Katrina) wakes up screaming and
throwing things at the young man in the
cot next to hers. You were walking out the
door to drive home and get a few hours
sleep, but instead you are called on the
loudspeaker to defuse the acute crisis
episode and provide crisis intervention
services.

� You are a crisis consultant to a large
Fortune 500 corporation, and a volatile
domestic violence-related shooting
took place last week at the corporate
headquarters. The employee assistance
counselor, the director of training, the
director of strategic planning, and the
director of disaster planning want you to
provide crisis intervention training to all
employee assistance counselors and all
corporate security officers.

� You are the new psychiatrist in an
inpatient psychiatric unit with 50 patients
diagnosed with co-occurring disorders;
over the weekend a patient assaulted the
psychiatric resident you are supervising.
The resident wants to be transferred to
another unit of the hospital because he
had a nightmare and cold sweats last
night. What do you do now? What
types of training should be provided to
all psychiatric residents and mental
health clinicians in order to prevent
patient–staff conflict from reaching
a crisis point?

� You are the counseling psychologist at
a state university assigned to see walk-in
emergency clients. An 18-year-old
freshman appears one afternoon and tells

you she just came from her residence hall
room and found her boyfriend in bed with
her ‘‘best friend’’ roommate. Now she tells
you she is seriously considering taking an
overdose of nonaspirin pain capsules in
their presence to ‘‘teach them a lesson.’’
How can crisis intervention help her to
find adaptive coping skills and a more
effective problem-solving approach to
her predicament?

This article delineates and discusses a system-
atic and structured conceptual model for crisis
intervention useful with persons calling or
walking into an outpatient psychiatric clinic,
psychiatric screening center, counseling center,
or crisis intervention program. A model is
a prototype of the real-life clinical process the
crisis clinician/counselor would like to imple-
ment. A systematic crisis intervention model is
analogous to establishing a road map as a model
of the actual roads, highways, and directions
one will be taking on a trip. Thus, the clinician
can visualize the implications of each proposed
crisis intervention guidepost and technique in
the model’s process and sequence of events and
make any necessary adjustments before the
program is fully operational. The model is
a series of guideposts that makes it easier to
remember alternative methods and techniques,
thus facilitating the counseling process. By
learning about each component or stage of a
model, the clinician will better understand how
each component relates to one another and
should facilitate goal attainment, problem
solving, and crisis resolution.
The focus of this article is on the clinical

application of Roberts’ seven-stage crisis in-
tervention model (R-SSCIM) to those clients
who present in a crisis state as a consequence
of an interpersonal conflict (e.g., broken ro-
mance or divorce), a crisis-inducing event (e.g.,
dating violence and sexual assault), or a preex-
isting mental health problem that flares-up.

ROBERTS AND OTTENS

330 Brief Treatment and Crisis Intervention / 5:4 November 2005

Crisis states can be precipitated by natural
disasters, such as Hurricane Katrina, which
took place as this article went to press.
However, there is a functional difference
between crisis intervention and disaster man-
agement. A large-scale community disaster
such as a major hurricane first requires disaster
management, then emergency rescue services.
The first two phases address the event itself,
rather than the psychological needs and
responses of those who experienced the di-
saster. For some, the event will overwhelm their
ability to cope; it is those people for whom
R-SSCIM is invaluable. We will discuss the
differences between disaster management and
crisis intervention later in this article.
Crisis clinicians must respond quickly to the

challenges posed by clients presenting in a crisis
state. Critical decisions need to be made on
behalf of the client. Clinicians need to be aware
that some clients in crisis are making one last
heroic effort to seek help and hence may be
highly motivated to try something different.
Thus, a time of crisis seems to be an opportunity
to maximize the crisis clinician’s ability to
intervene effectively as long as he or she is
focused in the here and now, willing to rapidly
assess the client’s problem and resources,
suggest goals and alternative coping methods,
develop a working alliance, and build upon the
client’s strengths. At the start it is critically
important to establish rapport while assessing
lethality and determining the precipitating
events/situations. It is then important to
identify the primary presenting problem and
mutually agree on short-term goals and tasks.
By its nature, crisis intervention involves
identifying failed coping skills and then
helping the client to replace them with adaptive
coping skills.
It is imperative that all mental health

clinicians—counseling psychologists, mental
health counselors, clinical psychologists, psy-
chiatrists, psychiatric nurses, social workers,

and crisis hotline workers—be well versed and
knowledgeable in the principles and practices
of crisis intervention. Several million individ-
uals encounter crisis-inducing events annually,
and crisis intervention seems to be the emerg-
ing therapeutic method of choice for most
individuals.

Crisis Intervention: The Need for

a Model

A ‘‘crisis’’ has been defined as

An acute disruption of psychological homeo-
stasis in which one’s usual coping mecha-
nisms fail and there exists evidence of distress
and functional impairment. The subjective
reaction to a stressful life experience that
compromises the individual’s stability and
ability to cope or function. The main cause of
a crisis is an intensely stressful, traumatic, or
hazardous event, but two other conditions
are also necessary: (1) the individual’s
perception of the event as the cause of
considerable upset and/or disruption; and
(2) the individual’s inability to resolve the
disruption by previously used coping mech-
anisms. Crisis also refers to ‘‘an upset in the
steady state.’’ It often has five components:
a hazardous or traumatic event, a vulnerable
or unbalanced state, a precipitating factor, an
active crisis state based on the person’s
perception, and the resolution of the crisis.
(Roberts, 2005, p. 778)

Given such a definition, it is imperative that
crisis workers have in mind a framework or
blueprint to guide them in responding. In
short, a crisis intervention model is needed, and
one is needed for a host of reasons, such as the
ones given as follows.
When confronted by a person in crisis,

clinicians need to address that person’s distress,

The Seven-Stage Crisis Intervention Model

Brief Treatment and Crisis Intervention / 5:4 November 2005 331

impairment, and instability by operating in
a logical and orderly process (Greenstone &
Leviton, 2002). The crisis worker, often with
limited clinical experience, is less likely to
exacerbate the crisis with well-intentioned but
haphazard responding when trained to work
within the framework of a systematic crisis
intervention model. A comprehensive model
allows the novice as well as the experienced
clinician to be mindful of maintaining the fine
line that allows for a response that is active and
directive enough but does not take problem
ownership away from the client. Finally,
a model should suggest steps for how the crisis
worker can intentionally meet the client where
he or she is at, assess level of risk, mobilize
client resources, and move strategically to
stabilize the crisis and improve functioning.
Crisis intervention is no longer regarded as

a passing fad or as an emerging discipline. It has
now evolved into a specialty mental health field
that stands on its own. Based on a solid
theoretical foundation and a praxis that is born
out of over 50 years of empirical and experiential
grounding, crisis intervention has become
a multidimensional and flexible intervention
method. The roots of crisis intervention come
from the pioneering work of two community
psychiatrists—Erich Lindemann and Gerald
Caplan in the mid-1940s, 1950s, and 1960s. We
have come a far cry from its inception in the
1950s and 1960s. Specifically, in 1943 and 1944
community psychiatrist, Dr. Erich Lindemann at
Massachusetts General Hospital conceptualized
crisis theory based on his work with many acute
and grief stricken survivors and relatives of the
493 dead victims of Boston’s worst nightclub fire
at the Coconut Grove. Gerald Caplan, a psychi-
atry professor at Massachusetts General Hospital
and the Harvard School of Public Health,
expanded Lindemann’s (1944) pioneering
work. Caplan (1961, 1964) was the first clinician
to describe and document the four stages of
a crisis reaction: initial rise of tension from the

emotionally hazardous crisis precipitating event,
increased disruption of daily living because the
individual is stuck and cannot resolve the crisis
quickly, tension rapidly increases as the in-
dividual fails to resolve the crisis through
emergency problem-solving methods, and the
person goes into a depression or mental collapse
or may partially resolve the crisis by using new
coping methods.
A number of crisis intervention practice

models have been promulgated over the years
(e.g., Collins & Collins, 2005; Greenstone &
Leviton, 2002; Jones, 1968; Roberts & Grau,
1970). However, there is one crisis intervention
model that builds upon and expands the
seminal thinking of the founders of crisis
theory, Caplan (1964), Golan (1978), and
Lindemann (1944): the R-SSCIM (Roberts,
1991, 1995, 1998, 2005). It represents a practical
example of a stepwise blueprint for crisis
responding that has applicability across a broad
spectrum of crisis situations. What follows is an
explication of that model.

Roberts’ Seven-Stage Crisis Intervention

Model

In conceptualizing the process of crisis in-
tervention, Roberts (1991, 2000, 2005) has
identified seven critical stages through which
clients typically pass on the road to crisis
stabilization, resolution, and mastery (Figure 1).
These stages, listed below, are essential,
sequential, and sometimes overlapping in the
process of crisis intervention:

1. plan and conduct a thorough
biopsychosocial and lethality/imminent
danger assessment;

2. make psychological contact and rapidly
establish the collaborative relationship;

3. identify the major problems, including
crisis precipitants;

ROBERTS AND OTTENS

332 Brief Treatment and Crisis Intervention / 5:4 November 2005

4. encourage an exploration of feelings and
emotions;

5. generate and explore alternatives and
new coping strategies;

6. restore functioning through
implementation of an action plan;

7. plan follow-up and booster sessions.

What follows is an explication of that model.

Stage I: Psychosocial and Lethality
Assessment

The crisis worker must conduct a swift but
thorough biopsychosocial assessment. At a min-
imum, this assessment should cover the client’s
environmental supports and stressors, medical
needs and medications, current use of drugs
and alcohol, and internal and external coping
methods and resources (Eaton & Ertl, 2000).

3. Identify dimensions of presenting problem(s)
(including the “last straw” or crisis precipitants)

4. Explore feelings and emotions
(including active listening and validation)

5. Generate and explore alternatives
(untapped resources and coping skills)

6. Develop and formulate
an action plan

7. Follow-up
plan and agreement

2. Establish rapport and rapidly establish collaborative relationship

1. Plan and conduct crisis and biopsychosocial assessment
(including lethality measures)

Crisis
resolution

FIGURE 1

Roberts’ Seven Stage Crisis Intervention Model

Source: Copyright ª Albert R. Roberts, 1991. Reprinted by permission of the author.

The Seven-Stage Crisis Intervention Model

Brief Treatment and Crisis Intervention / 5:4 November 2005 333

One useful (and rapid) method for assessing the
emotional, cognitive, and behavioral aspects
of a crisis reaction is the triage assessment
model (Myer, 2001; Myer, Williams, Ottens, &
Schmidt, 1992, Roberts, 2002).
Assessing lethality, first and foremost, in-

volves ascertaining whether the client has actu-
ally initiated a suicide attempt, such as ingesting
a poison or overdose of medication. If no suicide
attempt is in progress, the crisis worker should
inquire about the client’s ‘‘potential’’ for self-
harm. This assessment requires

� asking about suicidal thoughts and
feelings (e.g., ‘‘When you say you can’t
take it anymore, is that an indication you
are thinking of hurting yourself?’’);

� estimating the strength of the client’s
psychological intent to inflict deadly harm
(e.g., a hotline caller who suffers from
a fatal disease or painful condition may
have strong intent);

� gauging the lethality of suicide plan (e.g.,
does the person in crisis have a plan? how
feasible is the plan? does the person in
crisis have a method in mind to carry out
the plan? how lethal is the method? does
the person have access to a means of
self-harm, such as drugs or a firearm?);

� inquiring about suicide history;
� taking into consideration certain risk
factors (e.g., is the client socially isolated
or depressed, experiencing a significant
loss such as divorce or layoff?).

With regard to imminent danger, the crisis
worker must establish, for example, if the caller
on the hotline is now a target of domestic
violence, a violent stalker, or sexual abuse.
Rather than grilling the client for assessment

information, the sensitive clinician or counselor
uses an artful interviewing style that allows
this information to emerge as the client’s story
unfolds. A good assessment is likely to have

occurred if the clinician has a solid understand-
ing of the client’s situation, and the client, in
this process, feels as though he or she has been
heard and understood. Thus, it is quite under-
standable that in the Roberts model, Stage I—
Assessment and Stage II—Rapidly Establish
Rapport are very much intertwined.

Stage II: Rapidly Establish Rapport

Rapport is facilitated by the presence of
counselor-offered conditions such as genuine-
ness, respect, and acceptance of the client
(Roberts, 2005). This is also the stage in which
the traits, behaviors, or fundamental character
strengths of the crisis worker come to fore in
order to instill trust and confidence in the
client. Although a host of such strengths have
been identified, some of the most prominent
include good eye contact, nonjudgmental
attitude, creativity, flexibility, positive mental
attitude, reinforcing small gains, and resiliency.

Stage III: Identify the Major Problems or
Crisis Precipitants

Crisis intervention focuses on the client’s
current problems, which are often the ones
that precipitated the crisis. As Ewing (1978)
pointed out, the crisis worker is interested in
elucidating just what in the client’s life has led
her or him to require help at the present time.
Thus, the question asked from a variety of
angles is ‘‘Why now?’’
Roberts (2005) suggested not only inquiring

about the precipitating event (the proverbial
‘‘last straw’’) but also prioritizing problems in
terms of which to work on first, a concept
referred to as ‘‘looking for leverage’’ (Egan,
2002). In the course of understanding how the
event escalated into a crisis, the clinician gains
an evolving conceptualization of the client’s
‘‘modal coping style’’—one that will likely
require modification if the present crisis is to
be resolved and future crises prevented. For

ROBERTS AND OTTENS

334 Brief Treatment and Crisis Intervention / 5:4 November 2005

example, Ottens and Pinson (2005) in their
work with caregivers in crisis have identified
a repetitive coping style—argue with care
recipient-acquiesce to care recipient’s demands-
blame self when giving in fails—that can
eventually escalate into a crisis.

Stage IV: Deal With Feelings and Emotions

There are two aspects to Stage IV. The crisis
worker strives to allow the client to express
feelings, to vent and heal, and to explain her or
his story about the current crisis situation. To
do this, the crisis worker relies on the familiar
‘‘active listening’’ skills like paraphrasing,
reflecting feelings, and probing (Egan, 2002).
Very cautiously, the crisis worker must
eventually work challenging responses into
the crisis-counseling dialogue. Challenging
responses can include giving information,
reframing, interpretations, and playing
‘‘devil’s advocate.’’ Challenging responses, if
appropriately applied, help to loosen clients’
maladaptive beliefs and to consider other
behavioral options. For example, in our earlier
example of the young woman who found
boyfriend and roommate locked in a cheating
embrace, the counselor at Stage IV allows the
woman to express her feelings of hurt and
jealousy and to tell her story of trust betrayed.
The counselor, at a judicious moment, will
wonder out loud whether taking an overdose of
acetaminophen will be the most effective way
of getting her point across.

Stage V: Generate and Explore Alternatives

This stage can often be the most difficult to
accomplish in crisis intervention. Clients in
crisis, by definition, lack the equanimity to
study the big picture and tend to doggedly
cling to familiar ways of coping even when they
are backfiring. However, if Stage IV has been
achieved, the client in crisis has probably
worked through enough feelings to re-establish

some emotional balance. Now, clinician and
client can begin to put options on the table, like
a no-suicide contract or brief hospitalization,
for ensuring the client’s safety; or discuss
alternatives for finding temporary housing; or
consider the pros and cons of various programs
for treating chemical dependency. It is impor-
tant to keep in mind that these alternatives
are better when they are generated collabora-
tively and when the alternatives selected are
‘‘owned’’ by the client.
The clinician certainly can inquire about what

the client has found that works in similar
situations. For example, it frequently happens
that relatively recent immigrants or bicultural
clients will experience crises that occur as
a result of a cultural clash or ‘‘mismatch,’’ as
whenvaluesorcustomsofthetraditionalculture
are ignored or violated in the United States. For
example, in Mexico the custom is to accompany
or be an escort when one’s daughter starts
dating. The United States has no such custom. It
may help to consider how the client has coped
with or negotiated other cultural mismatches. If
this crisis precipitant is a unique experience,
then clinician and client can brainstorm
alternatives—sometimes the more outlandish,
the better—that can be applied to the current
event. Solution-focused therapy techniques,
such as ‘‘Amplifying Solution Talk’’ (DeJong &
Berg, 1998) can be integrated into Stage IV.

Stage VI: Implement an Action Plan

Here is where strategies become integrated
into an empowering treatment plan or co-
ordinated intervention. Jobes, Berman, and
Martin (2005), who described crisis interven-
tion with high-risk, suicidal youth, noted the
shift that occurs at Stage VI from crisis to
resolution. For these suicidal youth, an action
plan can involve several elements:

� removing the means—involving parents
or significant others in the removal of

The Seven-Stage Crisis Intervention Model

Brief Treatment and Crisis Intervention / 5:4 November 2005 335

all lethal means and safeguarding the
environment;

� negotiating safety—time-limited agree-
ments during which the client will agree
to maintain his or her safety;

� future linkage—scheduling phone calls,
subsequent clinical contacts, events to
look forward to;

� decreasing anxiety and sleep loss—if
acutely anxious, medication may be
indicated but carefully monitored;

� decreasing isolation—friends, family,
neighbors need to be mobilized to keep
ongoing contact with the youth in crisis;

� hospitalization—a necessary intervention
if risk remains unabated and the patient is
unable to contract for his or her own
safety (see Jobes et al., 2005, p. 411).

Obviously, the concrete action plans taken
at this stage (e.g., entering a 12-step treatment
program, joining a support group, seeking tem-
porary residence in a women’s shelter) are critical
for restoring the client’s equilibrium and psy-
chological balance. However, there is another
dimension that is essential to Stage VI, as Roberts
(2005) indicated, and that is the cognitive dimen-
sion. Thus, recovering from a divorce or death of
a child or drug overdose requires making some
meaning out of the crisis event: why did it
happen? What does it mean? What are alternative
constructions that could have been placed on the
event? Who was involved? How did actual events
conflict with one’s expectations? What responses
(cognitive or behavioral) to the crisis actually
made things worse? Working through the
meaning of the event is important for gaining
mastery over the situation and for being able to
cope with similar situations in the future.

Stage VII: Follow-Up

Crisis workers should plan for a follow-up
contact with the client after the initial in-

tervention to ensure that the crisis is on its way
to being resolved and to evaluate the postcrisis
status of the client. This postcrisis evaluation of
the client can include

� physical condition of the client (e.g.,
sleeping, nutrition, hygiene);

� cognitive mastery of the precipitating
event (does the client have a better
understanding of what happened and
why it happened?);

� an assessment of overall functioning in-
cluding, social, spiritual, employment,
and academic;

� satisfaction and progress with ongoing
treatment (e.g., financial counseling);

� any current stressors and how those are
being handled;

� need for possible referrals (e.g., legal,
housing, medical).

Follow-up can also include the scheduling of a
‘‘booster’’ session in about a month after the
crisis intervention has been terminated. Treat-
ment gains and potential problems can be
discussed at the booster session. For those
counselors working with grieving clients, it is
recommended that a follow-up session be
scheduled around the anniversary date of the
deceased’s death (Worden, 2002). Similarly, for
those crisis counselors working with victims of
violent crimes, it is recommended that a follow-
up session be scheduled at the 1-month and
1-year anniversary of the victimization.

Differentiating Crisis Intervention From

Disaster Management

For those in need, the third phase of disas-
ter response—crisis intervention—usually
begins 1–4 weeks after the disaster unfolds.
Phase I is generally known as ‘‘Impact’’ and
Phase II is known as the ‘‘Heroic or Rescue’’

ROBERTS AND OTTENS

336 Brief Treatment and Crisis Intervention / 5:4 November 2005

phase. Phases I and II involve the disaster
management and emergency relief efforts of
local and state police, firefighters and rescue
squads, emergency medical technicians, the
American Red Cross volunteers, the Salvation
Army, and the Federal Emergency Manage-
ment Agency. The disaster and emergency man-
agement agencies focus on public safety; on
locating disaster shelters, temporary housing
units, and host homes; and on providing food,
clean water, clothing, transportation, and
medical care for survivors and their families.
After the survivors and their families are
rescued and transported to dry land and safe
shelter, the goal is to provide them with well-
balanced meals, continued medical care, sleep,
and rest. It is also critically important to help
survivors to reconnect and reunite with family
members and close friends. Then, 1–4 weeks
after surviving the loss of their home, neigh-
bors, and/or community, Phase III—crisis in-
tervention can begin—if it is requested.
Crisis intervention must be voluntary, de-

livered quickly, and provided on an as-needed
basis. A crisis is personal and is dependent on
the individual’s perception of the potentially
crisis-inducing event, their personality and
temperament, life experiences, and varying
degrees of coping skills (Roberts, 2005). A
crisis event can provide an opportunity, a
challenge to life goals, a rapid deterioration of
functioning, or a positive turning point in the
quality of one’s life (Roberts & Dziegielewski,
1995). One person with inner strengths and
resiliency may bounce back quickly after an
earthquake, tornado or hurricane, whereas
another person of the same age with a preex-
isting mental disorder may completely fall apart
and go into an acute crisis state. A young
emergency room physician might adapt well
upon reaching Atlanta or Houston, whereas
a young social worker suffering from major
depression may completely go to pieces upon
arrival at her cousin’s house in Dallas, TX.

R-SSCIM is the same for survivors of commu-
nity disaster. But we suggest that extra care be
taken in applying R-SSCIM so that the mental
health professional understands and distin-
guishes an acute stress reaction from the intense
impact of the disaster from which most people
rapidly recover. This takes skill on the surface
because both reactions often look the same.
Normal and specific reactions frequently in-
clude shock, numbness, exhaustion, …