The definition of a traumatic event is precisely defined in the US psychiatric guide “Diagnostic and Statistical Manual of Mental Disorders” (DSM-IV):
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“The person experienced, witnessed, or was confronted with an event or events involving actual or threatened death or serious injury, or a threat of physical injury, or a threat of death or serious injury, or a threat to the physical integrity of themselves or others. The person’s response included intense fear, helplessness, or horror.”(Bastine 1998, p. 469). This addresses a series of events that also affect clients of a crisis facility, such as:
- Suffering from acts of violence such as sexual violence and rape
- hostage taking
- sudden death of a relative
- Neglect, abuse and sexual abuse of children.
The range of psychological trauma is extremely extensive and individual and includes a large number of groups of people, such as traumatized train drivers who have run over a suicide. In all cases, sufferers may experience long-lasting symptoms and impairments (see DSM-IV and the WHO International Classification of Diseases ICD-10 ), often requiring trauma treatment. Horowitz presented a model of normal and pathological responses to coping with traumatic experiences(Bastine 1998, p. 498), which describes a process with different stages, during which different help is required. Specially designed crisis facilities and emergency hotlines target specific groups of traumatized people, such as the emergency hotline for raped women or women who have experienced domestic violence, centers for victims of torture. In an emergency, these offers offer those affected quick, targeted help in cooperation or networking with the respective institutions that may be involved in processing the traumatic event, such as the police, judiciary, hospital, youth authority, employer, therapeutic institutions.
Those affected often come to a crisis center shortly after the traumatic event, for example after experiencing domestic violence. In this case, an understanding, non-judgmental attitude is required from the counselor, which does not further victimize the victim and clearly leaves the responsibility with the perpetrator. Disclosing an experience of violence is often associated with shame, which is why it is often not easy for the person affected to talk about it. At the same time, however, a certain openness is necessary in order to be able to bring up the trauma. Concrete questions should be asked about the experience of violence and its consequences. It may also be necessary to arrange for a medical examination and for evidence to be secured, even if the person concerned does not want to report the crime at this point in time. Inquiring about security needs and enabling appropriate measures, such as enforcing civil protection measures based on the Violence Protection Act, are just as important as initiating support in the social network of those affected. Resource activation is particularly urgent here so that something can be done to counteract the damaged self.
5.3.4 The psychiatric emergency
In the classification of crises, a distinction is made between crises and emergencies. However, only in the course of the contact between the person seeking help and the crisis advisor can it become clear that there is an emergency or that the crisis has developed in this way. It is the task of a crisis facility to catch people in psychiatric emergencies, to help prevent inpatient accommodation if possible, or to provide competent support for accommodation in a psychiatric clinic that has become necessary(Zimmerman 2004). In addition to the psychiatric emergency, there are other emergencies that require intervention, such as interpersonal conflict, alcohol and drug abuse, suicidality, and attempted suicide.