Crisis Intervention in Social Work – Psychosocial Crises and Suicidality

A client turns up at the counselling centre remarkably composed the day after being evicted from his flat. A young woman withdraws more and more after finishing her degree. A mother can hardly think clearly after her child’s serious diagnosis. However different these situations are, they have something in common: people are thrown off balance because what is happening to them exceeds their usual ways of coping. Social work professionals meet such moments every day – in counselling, in child and youth welfare services, in integration assistance for persons with disabilities, in homelessness services and in hospital social services. This first module lays the conceptual and theoretical foundation for the whole course. It is not yet about specific intervention techniques, but about the question of what a crisis actually is, how it can develop and how you can recognise it in everyday practice.

PART 1 – Introduction and definition: what is a psychosocial crisis?

Why a clear concept of crisis matters

In everyday speech the word ‘crisis’ is used far too loosely: from a relationship crisis to a crisis of meaning to the crisis of a football club, almost anything seems to qualify. For professional practice this vagueness is a problem. Anyone who calls every strain a crisis risks overlooking genuine escalations or, conversely, dramatising everyday difficulties. A precise professional concept, by contrast, helps to place situations in context, to find a shared language in the team and to decide what kind of support is appropriate. It also guards against prematurely pathologising people who are reacting, in an entirely understandable way, to exceptional strain.

The crisis according to Sonneck: loss of emotional balance

In German-speaking countries, a definition has become established that goes back to the Viennese crisis intervention approach. Sonneck et al. (2016) understand a psychosocial crisis, in essence, as the loss of emotional balance that a person experiences when confronted with events or life circumstances that they cannot cope with at that moment. Three elements of this definition are particularly revealing for practice. First, it refers to a balance in the sense that people normally have established ways of dealing with demands. The crisis begins where this structure starts to waver. Second, the definition stresses the confrontation with events and life circumstances – so the crisis has a trigger that comes from outside or arises from the life situation. Third, it refers to the moment: being overwhelmed is tied to the present point in time and is not to be understood as a lasting characteristic of the person.

This time-boundedness is central to social work. It means that the same person who sees no way out today may well be able to act at another time and with different support. Crises are therefore fundamentally changeable and – this is the hopeful message of the concept – in principle can be overcome. At the same time, the definition makes clear that the event alone does not decide whether a crisis exists; what matters is the relationship between the strain and the coping resources available. A house move can be a welcome change for one person and, for another who loses their social network, trigger a deep shock (Sonneck et al., 2016).

A crisis is not an illness – distinguishing it from mental illness and from an emergency

A psychosocial crisis is not a diagnosis and not a mental illness. It describes a state of acute overload that can affect anyone – regardless of previous illness, education or social status. This distinction has considerable consequences for the stance of professionals: those who understand a crisis as a normal human reaction to exceptional strain do not approach those affected as ‘sick people’ but as people in a difficult situation who need support for a while. That said, crises and mental illness can coincide. An existing illness can increase vulnerability to crises, and a crisis can develop into an illness or make an existing one worse. Judging whether a mental illness is present, however, is a matter for doctors or psychotherapists. Social workers do not make diagnoses; they observe, describe and, where needed, refer on (Sonneck et al., 2016).

Distinguishing a crisis from an emergency is just as important. An emergency exists when there is immediate danger to life or health and immediate action is required – for example in a life-threatening injury or acute danger to oneself or others. A crisis can turn into an emergency, but does not have to. The following comparison illustrates the differences.

The mind map summarises the building blocks developed in this module: the concept, the two types of crisis, the phases, typical triggers and the resources on which support can build.

PART 2 – Theoretical foundations: types of crisis and crisis models

The roots of the crisis concept

The modern understanding of psychosocial crises goes back largely to the psychiatrist Gerald Caplan, regarded as the founder of the crisis concept in preventive psychiatry. His basic idea – that in a crisis people lose a previous balance and in this phase are particularly in need of support but also particularly open to change – still shapes the standard literature today. In the German-language professional discussion this concept is taken up above all in the account by Sonneck et al. (2016) and linked to the distinction between two types of crisis: the traumatic crisis and the crisis of change.

Traumatic crisis and crisis of change

A traumatic crisis is triggered by a sudden, usually unexpected event that changes the life situation abruptly: the unexpected death of someone close, a serious diagnosis, an accident, an experience of violence or the loss of one’s home through eviction. The event hits the person unprepared and fundamentally calls into question their familiar view of themselves and the world. The term ‘traumatic’ here refers to the quality of the event as an emotional shock and is not to be equated with a clinical trauma-related disorder (Sonneck et al., 2016).

A crisis of change by contrast arises from life changes that are in themselves part of human life: transitions such as leaving the parental home, entering working life, the birth of a child or retirement, but also upheavals such as a separation or release from prison. Such changes become a crisis when the usual coping resources are no longer enough to meet the new demands. The change is often foreseeable or even wanted, and yet it can shake a person’s balance lastingly. In these cases the build-up is rather gradual: tension and helplessness increase, attempts at solutions fail, and at some point the overwhelm becomes noticeable to the person and those around them (Sonneck et al., 2016).

Cullberg’s phase model of the traumatic crisis

For the traumatic crisis, the Swedish psychiatrist Johan Cullberg described a model of its course that is still widely used in crisis intervention today (Cullberg, 1978). It distinguishes four phases, which are to be understood not as a rigid sequence but as fluid transitions. In the shock phase those affected often appear astonishingly calm and composed to the outside world, or seem to function normally, while inside there is a chaos of unreality, numbness and disorientation. It is precisely this outward lack of visible distress that can mislead professionals. In the reaction phase the person is confronted with the reality of what has happened. Strong, changing feelings arise – grief, anger, fear, guilt, despair – and previous certainties collapse. This is often when the strain is greatest. In the processing phase the person begins to detach from the event and gradually turns back towards everyday life and the future. The last phase is reorientation – the phase in which what has been experienced is integrated into the person’s own life story; new relationships, tasks or perspectives gain importance. Sonneck et al. (2016) also take up this model in their account of the traumatic crisis.

It is important what the model does not say: it sets no fixed duration for the individual phases, and it does not describe an automatic process in which every person passes through all stages in the same order. People can move back and forth between phases, individual phases can overlap, and a new source of strain can throw someone who had already reorientated back into an earlier phase. The model is therefore above all a framework for orientation that helps professionals to understand reactions as comprehensible and to tailor their own support accordingly.

PART 3 – Triggers of crisis and resources in the fields of social work

Typical triggers at a glance

Social work is concerned with crises in a particular way, because the people it supports are often in life situations in which strains accumulate and resources are scarce. Some triggers come up again and again for professionals. The loss of one’s home – through eviction, notice to quit or separation – means not only losing a roof over one’s head but also privacy, security, routines and often social contacts. Separation and divorce shake relationships, finances and future plans all at once. The death of someone close can trigger a traumatic crisis, especially if it occurs suddenly. A serious diagnosis – one’s own or that of a relative – calls life plans into question and is a frequent trigger of crisis in hospital social services. The release from prison is a transition that promises freedom but can also bring the search for housing, dealings with authorities, unemployment and stigma. And young people moving out of the parental home or a youth welfare setting face the task of organising an independent life, often without a reliable family network in the background.

These triggers cannot always be assigned clearly to one type of crisis. A separation can happen suddenly and unexpectedly and then proceed like a traumatic crisis; but it can also be the end point of a long process and take the form of a crisis of change. Several strains also often overlap: the separation leads to loss of home, the loss of home endangers the job, and the threat of job loss deepens the shame. For professionals, what matters is therefore less the exact categorisation than understanding how the person affected experiences the event.

Keeping resources and protective factors in view

Because a crisis arises from a mismatch between strain and coping resources, a key to overcoming it lies in the resources of the person affected. These include personal resources such as earlier experiences of coping, abilities, humour, faith or values, social resources such as family, friends, neighbourhood, colleagues or peer groups, and structural resources such as an accessible support system, financial security and safe housing. In crises, resources have often not disappeared but are temporarily out of reach: the person does not remember having come through a hard time before, or does not dare to ask relatives for help. A resource-oriented stance therefore asks not only ‘What happened?’ but also ‘What has helped you in the past?’ and ‘Who could be at your side now?’. According to Sonneck et al. (2016), involving the person’s surroundings is one of the cornerstones of crisis intervention, which is covered in detail in the next module.

PART 4 – Recognising and placing crises in everyday practice

Observing and describing rather than diagnosing

In everyday practice, crises rarely announce themselves with a clear statement from the person. More often they show up in changes: a normally reliable client misses appointments, a young person reacts irritably to small things, a resident withdraws from group activities, someone seems unusually exhausted or unusually quiet. Such observations are not yet evidence of a crisis, but they are a reason to ask attentively. It helps to separate observation from interpretation: ‘I notice you’ve been coming less often lately’ is a description that opens an invitation to talk; ‘You are depressed’ would be a diagnosis that neither fits the role of social work nor does justice to the person.

A few guiding questions have proved useful for placing a possible crisis in context, and professionals can keep them in mind: Is there a recognisable trigger, and how long ago was it? Is it more of a sudden event or a transition? How does the person themselves experience the situation? Which previous ways of coping no longer work? Which resources are still available or could be reactivated? And are there signs that the crisis is escalating – such as hopelessness or remarks about death? The answers do not replace a professional evaluation in the team, but they give orientation about how urgent the situation is and what support fits.

What follows from this for action

Distinguishing the type and phase of a crisis is not an end in itself. It has direct consequences for the kind of support offered. In the shock phase of a traumatic crisis, people need above all stability, safety and simple, clear information; lengthy conversations about feelings or complex planning usually overwhelm them. In the reaction phase, by contrast, it is important to allow and bear intense feelings rather than to soothe them too quickly. In crises of change, the focus is often on sorting out the demands together: What exactly is overwhelming? Which small steps are possible now? Where can the person’s surroundings offer relief? How this support looks concretely in conversation is explored further in the modules on conducting conversations and on the basic principles of crisis intervention (Sonneck et al., 2016).

From understanding crises to suicidality – a preview

Not every crisis involves suicidal thoughts, and the great majority of crises are overcome without suicidal escalation. Even so, the link between crisis and suicidality is of great importance for social work. When people see no way out, experience their situation as unbearable and unchangeable, and feel cut off from others, the thought of death can appear as an apparent solution. In its National Suicide Prevention Strategy, the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) stresses that, in particular, members of the professions who come into contact with people in suicidal crises should be made even more aware and trained in dealing with people at risk (Bundesministerium für Gesundheit [BMG], 2024). In the field of action ‘health literacy and empowerment’, the strategy also highlights early recognition of the need for help and onward referral (BMG, 2024). Social work professionals are in a key position here: they often have earlier and lower-threshold contact with people in crises than medical services do. A sound understanding of crises is therefore the prerequisite for noticing warning signs and acting in good time. Modules 4 and 5 explore in depth how suicidality can be recognised, raised and evaluated.

PART 5 – Critical perspective: limits, tensions and consequences

Limits of phase models

Phase models such as Cullberg’s (1978) are valuable for teaching because they bring complex experience into a comprehensible order. But that is precisely where their limit lies. People process distressing events in very different ways, and not every reaction can be assigned to a phase. Anyone who misreads the model as a norm risks measuring those affected against an ideal course: ‘By now she really ought to be in the processing phase.’ Such expectations can create pressure and devalue individual courses. It is professionally appropriate to use the model as a heuristic that makes understanding easier, not as a yardstick against which progress is measured. The phases do not necessarily run in a straight line, setbacks are part of the process, and no generally valid statement can be made about their duration.

Crisis and living situation: the social perspective

Crisis models mostly come from the psychiatric and psychological tradition and focus on the experience of the individual. Social work adds to this perspective a view of living situations. Whether an event becomes a crisis depends not only on personal coping abilities but also on material means, housing conditions, legal status, access to support and experiences of exclusion or discrimination. People living in poverty, without secure housing or with an insecure residence status often have less of a buffer to absorb strain. A purely individualising view that interprets crises solely as personal overload would leave out these structural factors. Crisis support grounded in human rights therefore takes both seriously: the subjective experience and the social conditions that make crises more likely or make it harder to overcome them.

A tension: de-pathologising and staying alert

Stressing that a crisis is not an illness has a de-stigmatising effect and strengthens a resource-oriented stance. But it carries a risk: if every strain is interpreted as a ‘normal crisis’, serious mental illness or suicidal escalation can be overlooked. Conversely, premature pathologising leaves people feeling not taken seriously or labelled. Professionals therefore work within a tension that cannot be resolved but can be handled reflectively: open and de-pathologising in approach, alert to warning signs and ready to involve medical or psychiatric help when there are signs of illness or acute danger. This balance works best in a team and in line with the procedures of the organisation concerned.

Open questions in care provision

An understanding of crises is only useful if people in crisis can actually reach help. Here an open issue shows itself: the National Suicide Prevention Strategy recommends developing a concept for a central, round-the-clock crisis service emergency number with forwarding to the state crisis services; no such nationwide number exists so far (BMG, 2024). An act to strengthen national suicide prevention exists only as a ministerial draft; among other things it provides for a concept for a nationwide uniform number for people in crisis, but is not in force (BMG, 2026). For practice this means: professionals need to know the services available in their region and record in their organisation whom to contact in which situation.

Consequences for practice

Several consequences can be drawn from the considerations in this module. First, a professional understanding of crises demands an accurate, open-minded look: outward calm can mean shock, anger can be an expression of despair, and withdrawal can point to an escalation. Second, professionals should use crisis models for orientation without forcing people into schemes. Third, the question of resources belongs from the start, because overcoming a crisis depends largely on whether coping resources become accessible again. Fourth, working with people in crisis requires clarity about one’s role: social work supports, relieves, connects and refers on – it does not make diagnoses and does not replace treatment. And fifth, crisis work is teamwork: evaluations should be shared, approaches agreed and one’s own strain noticed (Sonneck et al., 2016).

Self-reflection – 5 questions

Voluntary · not evaluated – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.