Category Archives: Crisis Continuum

My Plans for this Evening are…

One of the things we did at Sheppard Pratt’s Trauma Disorders Program, was every evening after dinner, we convened in our small group to go over our progress on our goals for the day.

In 2007/2008, everyone led off their share, by saying “Our goals for today were A, B, and C.  Today….(explain what we accomplished towards these goals).  My safety is….(explain any issues with safety), and my plans for this evening are….(explain what we are going to do to wind down, make sure parts are in their safe places, use coping skills, etc.).

During our last stay in 2018, it wasn’t as structured, but still had the same goal.  We reviewed what progress we made on our goals and chatted about what we were doing that evening.

It’s still a helpful technique, to wrap our mind around the day’s events. There have been days I’ve been surprised to find out I had gaps of time loss, and a little internal communication helped improve awareness.  It also helps parts feel heard and not ignored or avoided.

Here’s our basic outline for our night check-in.  I hope it helps give yous some ideas that are helpful!

Evening Check-In:

  1. Read off goals for today and progress/outcomes of working on these goals.
  2. Celebrate successes! Even small wins can be huge for some parts.
  3. What number am I on the Crisis Continuum right now?
  4. Did we experience any triggers today?
  5. Is anyone having intense emotions right now? (If so, are there self-soothing skills, grounding skills, imagery, or other things that might help you contain?
  6.  Do I need to ask anyone (external) for help right now?  If not, try to engage with an outside person before bed in a positive way (e.g. give 1 complement to them).

Then when we get into bed and get ready for sleep, we’re usually in a safer space.  We pay attention to our body to help parts relax any muscles they have tensed (facial, neck, or lap muscles) and do deep breathing to fall asleep well.

Tomorrow is therapy day! So, here’s to a good night’s sleep!

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Crisis Continuum

The Crisis Continuum is a detailed plan to help identify impulses on a continuum of severity.  Then, for each level of severity, you identify actions necessary to stay safe.

Ok, that’s a lot of words, so let me give you an example.

Imagine a time you went from 0 to 100.  You escalated seemingly from a state of calm to a state of crisis.  Think about the crisis and what you (or parts) were thinking, feeling, and experiencing in the body at the time.

To give you an idea, here is an example.  I bolt upright in bed, awakened due to a nightmare.  I’m alone in the dark.  I’m feeling helpless because this is the 7th night in a row of nightmares.  It seems like my work in therapy is just making nightmares worse.  I’m trembling, my heart is beating fast, and I hear something fall off a shelf in the closet, really kicking my panic over the edge.

Here’s what my Crisis Continuum might look like for this scenario:Screen Shot 2018-12-27 at 9.38.01 PM

A complete Crisis Continuum will have “levels” of severity from 1 through 5.  1 = state of calm up to 5 = state of crisis.  Generally, it’s easier for PTSD/DID folks to by filling out the continuum with level 5, since that’s the level we’re most familiar with.  Then, go all the way back to 1 and fill out for the polar opposite, a state of calm.

Once you have the 2 extremes done, you can go back in and fill in the other levels.  An empty Crisis Continuum might look like this…

Screen Shot 2018-12-27 at 9.55.37 PM

It’s okay if you don’t know a whole lot of actions you can take to stay safe.  This is probably the hardest tool to complete in the beginning of doing this work, but it’s the most important one to have in place.  You will likely find yourself re-doing CC’s as you increase awareness about your system and learn new symptom management skills.

Be safe

-Nel