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What Is Therapeutic Crisis Intervention?

By Synthia L. Rose
Updated Mar 03, 2024
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Therapeutic crisis intervention (TCI) is a mode of counseling that is practiced in extremely volatile and dangerous patient environments and that seeks to alter a patient’s maladaptive coping mechanisms and destructive responses while encouraging constructive stress management habits. Rather than relying on force and restraint when dealing with aggressive patients, therapeutic crisis intervention emphasizes sensitivity, rules, leadership, and redirection. Counselors use diversions, bonding strategies and verbal interaction to calm clients, leaving physical intervention as a last resort practiced only for a short amount of time. Even then, physical restraint and suppression in TCI require supervision and cannot be used as a form of discipline — only a way to protect patients and workers.

TCI is not practiced only at the point of conflict or crisis. Instead, it is an ongoing intervention designed to make crisis moments more tolerable and manageable. Originally developed in the 1980s to be used in residential treatment centers serving children and teens, therapeutic crisis intervention is credited for de-escalating crisis scenarios, mitigating the risk of physical injury during an emotionally charged confrontation and reducing the likelihood that the patient will repeat dangerous actions.

Still largely practiced in teen residential centers, TCI is a specific and formal research-based therapy model that is taught through certified curriculum and literature by certified trainers. Licensed therapists and mental health care workers who have been coached and evaluated in TCI methods and strategies are the main users of therapeutic crisis intervention. For safety and effectiveness, this intervention model relies on a team approach and is rarely executed by one lone counselor dealing with a frustrated or violent patient. Rather than relying on force and restraint when dealing with aggressive clients, therapeutic crisis intervention emphasizes sensitivity, leadership, and redirection.

During training for TCI, which can last 30 hours or more, workers are first taught the phases of child development so that any exhibited behavior encountered can be understood as normal or abnormal. Workers are taught how to plan activities to create a pleasing environment for troubled patients and how to use group processing so all patients can share feelings and express themselves. Trainers also teach mental health care professionals how to properly build relationships with children and youth while establishing routines and transitions so that patients are regularly in a predictable, calming milieu.

After completing training, mental health professionals receive certification in TCI, which has to be updated yearly after short periods of re-training. Patients in facilities using therapeutic crisis intervention are also trained, but by staff members; staff members teach youth emotional competency skills and methods for handling stress in advance of any crisis or trauma. Listening and communication skills are also taught, including non-verbal ways to communicate needs and anxieties.

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Discussion Comments
By ddljohn — On Oct 16, 2014

Therapeutic crisis intervention (TCI) actually came out of a desire to reduce child abuse at care institutions. It was discovered that child abuse often occurred because caretakers did not know how to deal with conflicts and had to detain the children physically to stop violent behavior. This was leading to child abuse and neglect even though that wasn't really the intention of the caretakers.

So TCI was developed in hopes of resolving the cause of the problem. If caretakers can resolve problems and calm down violent children, then there wouldn't be a need for physical interventions. This in turn will reduce child abuse incidents. I think it's a great idea.

By burcinc — On Oct 16, 2014

@ysmina-- There have been studies done on TCI and it has been found to be effective. Child care agencies that used TCI saw a decrease in violence, verbal abuse and the need for physical restraint. Teachers also felt more confident about dealing with crises after receiving training in TCI.

So it appears that TCI is an effective method to diffuse conflicts. But as far as I know, it is a method designed and used for children and maybe adolescents. I don't think it is meant to be used for adults and I have no idea if it would be effective if it were.

And I'm also sure that effectiveness and success varies a little bit from agency to agency and teacher to teacher.

By ysmina — On Oct 15, 2014

I don't much about this topic but as a teacher, I find it very interesting. Does therapeutic crisis intervention really work though?

It sounds great but I'm wondering if it's truly applicable and effective. There can be nothing more difficult than managing a violent individual-- child or adult. And if the person is so angry and violent as to harm himself or others, I don't think that speaking to them will be very effective. These are such unpredictable situations and things could turn ugly very fast.

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