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In recent years, crisis intervention and emergency mental health have gained increased visibility, especially after the terrorist attacks of September 11, 2001. One issue that has not been adequately addressed is the concept and practice of communication with regards to confidentiality and privilege. This paper reviews key aspects of this important process.
Crisis intervention and its subset, Critical Incident Stress Management, have experienced a century of successful application across a broad spectrum of populations. Numerous positive outcome studies including Randomized Controlled Trials, controlled studies, and detailed literature reviews attest to its achievements. The success of crisis intervention services has not, however, gone without critical reviews. Some reviews have, unfortunately, generated a series of misconceptions and factual misrepresentations. This article presents some of the most common misconceptions and offers arguments to counter those errors.
Crisis intervention techniques in a community-based setting, including factors of immediacy of response, location, prior identification and flexibility of service, are examined. Using a community-based program which has received and dealt with 231 crisis situations over a 2-year period as a model, this study shows crisis intervention techniques to be viable and valuable in the identification of problems in the family and individual. Families which request service due to a crisis must be dealt with differently from those who seek service through traditional channels. Preventive intervention is employed to reduce the onset of more serious personality disturbance and family decomposition. Using Caplan's phases of crisis as a guide, most families dealt with in the model program showed signs of reduced conflict and a greater willingness to seek more traditional types of services.
Crisis intervention, as it has evolved over the last five decades, has clearly demonstrated its effectiveness as a tool to reduce human distress. Nevertheless, as with any effort to alter human behavior, there are risks associated with crisis intervention. One such risk is that of premature intervention. Premature intervention may not only waste valuable intervention resources, but may serve to interfere with the natural recovery mechanisms of some victims. By clearly defining the nature of the crisis phenomenon itself, premature intervention may be averted.
"Crisis" is defined as the lack of the development of defense- and/or coping-mechanisms in the conflict between drive-claims or narcissistic needs versus the influences of the super-ego and/or conditions of outside reality. The term crisis, introduced by Erich Lindemann (1944), characterizes a state which was already known to Sigmund Freud. Central to his thought was an antagonism between the pleasure principle dominating the unconscious and the reality principle being directed toward the outside world. Different possible causes of crises are for example sudden and unexpected intrusions in a life situation which was previously experienced as stable, or a narcissistic trauma and loss that could not be worked through as grief and that lead to a reactive-depressive state, or a shock resulting from demands of the super-ego during inner or outer experiences. Principles of a psychoanalytically oriented therapy are discussed, the outcome of which is the better, the more there is a good working alliance and good development of insight.
A controlled study that examined the effects of a short-term crisis service given to a group of families recently bereaved through a sudden death within the family is reported. The results reveal that sudden death does have a major impact on recently bereaved families in terms of increased risk of ill health, poor coping behavior, and disturbed social functioning when compared to nonbereaved families. However, the short-term crisis service appeared to have no major impact upon postbereavement adjustment. Discussion centered around possible reasons for failure of the short-term crisis services.
Using the psychiatric admission unit of the Max-Planck- Institute for Psychiatry as an example, the principles of inpatient treatment of psychiatric emergency patients respectively inpatient crisis intervention are presented. It can be demonstrated, that small units with short treatment duration and a multidisciplinary team with psycho-therapeutic orientation are most useful. Supportive psychotherapy with emotional support, cognitive support and support by direct intervention in the environment of the patient are used. The therapeutic endeavours are done in single and group sessions. A regular supervision is necessary. Most of the patients are referred after the completion of the inpatient stay for further treatment on an in- or outpatient basis.
With a case-history of a puerperic psychosis we describe the crisis-interventions-technique in six steps used in our 16-bed, socio-psychiatric ward in the city of Berne at a general hospital. Out of more than 5 years of work we illustrate one year with client-data, working-methods and statistical results. With such a ward in the community, embedded in a complete net of socio-psychiatric institutions, we can treat quite serious psychosocial crisis adequately and in relatively short time.
This report presents 2 patients who were diagnosed to have acute stress disorder (ASD), received early psychiatric intervention (crisis intervention as a short-term psychotherapy), and subsequently had good outcome. Encounter with an event that causes psychological trauma may induce post-traumatic stress disorder (PTSD). However, the 2 patients described here have shown no particular mental symptoms for more than 2 years after the event and are leading normal lives. Psychological debriefing as a group used to be regarded as effective for the prevention of PTSD, but early identification of the stress-related disorder and intensive treatment of individual patients is recently considered to be more necessary. Both of the 2 patients presented here showed good outcome, and early crisis intervention in individual patients is suggested to be effective for the treatment of stress-related disorders and prevention of PTSD.
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Crisis intervention is based upon crisis theory and is defined as a short-term active mode of therapy that focuses on solving the client's immediate problem and reestablishing psychological equilibrium. The crisis intervention program was the first phase in the development of a broader mental health program with advancement decisions being based upon evaluation results of this initial phase. An evaluation methodology using the Stufflebeam Goal-Stakeholder Model (1980) was designed and implemented. A satisfaction survey was conducted to develop a database relative to the program's process. The Mental Health Category Measure, and the Crisis Call Outcome Rating Scale were used to capture outcome data. Analysis of the qualitative and quantitative data indicate that stakeholders are satisfied with the program. outcome data demonstrates that the program produces the intended outcomes. Triangulation, a method of comparing the qualitative and quantitative findings revealed consistency, and thus provides confidence in the accuracy of the findings.
The goal of this survey was to evaluate the patients and their relatives' satisfaction with a home-based crisis intervention provided by a psychiatric mobile crisis team (Equipe Rapide d'Intervention de Crise, hôpital Charcot, Plaisir). We were particularly interested in measuring satisfaction with telephone response time, team mobility, patient welcome, family consultations, information given to patients and the number of caregivers. We designed a questionnaire that included 24 closed questions and 2 open-ended questions. Replies were collected over the telephone by an outside psychologist with no prior knowledge of the patients. The inclusion criteria were the following: the patient had to have received a home-based crisis intervention from the mobile crisis team and to have received at least two follow-up consultations. The response rate was 95%, from 81 relatives and 73 patients. The results show a high level of overall satisfaction, with satisfaction levels at over 90% for some of the questions. High satisfaction was due to the human and professional approach of staff - their listening skills and competence - the 24-hour availability of the telephone service, the fast intervention of the team, the team mobility, and the systematic involvement of relatives as part of the program. Low satisfaction was due to the high number of caregivers, the short length of programs, the patient referral process to outpatient services, the lack of information on medication and patients' illness and the sad appearance of the building. These results lead us to improve some aspects of our service or at least to explain our services more fully to clients. More generally, these results encourage us to listen more attentively to patients' opinions on how they experience their psychiatric care.
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Telephone crisis intervention services are growing at a very rapid rate. A review of the literature reveals that there are very few references to this new phenomenon and even fewer that deal with evaluating the effectiveness of telephone crisis training. Herein 7 articles are reviewed which deal with volunteer selection and training. These articles demonstrate that no consistent rationale for volunteer selection or training exists. Selection of volunteers typically consists of a gross screening to eliminate any obviously unsuitable persons, with training serving as a further sorting procedure where volunteers who are uncomfortable with the role of a crisis interventionist can be encouraged to drop out. The authors suggest that a training model be built around crisis intervention theory using principles of social learning as the methodology for training.
This article presents a vision of crisis intervention for seropositive persons following an approach inspired by existential psychology. Persons who intervene must view crisis intervention for HIV-positive persons as an exploration of the close relation that exists between life and death. They must investigate the interrelations with the dimensions who intervene must view crisis intervention for HIV-positive persons as an exploration of the close relation that exists between life and death. They must investigate the interrelations with the dimensions of time, space, world and body. They must also examine the characteristics of the seropositive experience that are specific to the different infected clienteles. The welcoming process, the urgency of the situation and the therapeutic complementarity must be considered as the main guidelines for this type of crisis intervention which, in addition, must take into account the various life experiences that are particular to each of the HIV-positive persons. This approach requires that the person who intervenes and plays a supporting role must put into question their own attitudes toward the phenomenon at hand. Finally, life with the infection can also bring certain intervenors and clients to discover and profit from a number of unsuspected benefits.
A crisis situation, because it engenders feelings of helplessness, promotes regression in the patient and thus makes the patient susceptible to the rapid formation of an intense positive relationship between himself and the therapist. While this type of patient-therapist relationship is useful for the treatment, it requires constant monitoring on the part of the therapist lest dependency and regression be furthered. Cases are presented which illustrate some of the problems that may be encountered as a result of the patient's feelings about the therapist, and techniques for avoiding these problems are discussed.
Pastoral crisis intervention may be thought of as the functional integration of crisis intervention and pastoral support. In effect, the practice of pastoral crisis intervention largely represents the use of faith-based interventions refined and augmented through the use of an emergency mental health delivery context. The value of pastoral crisis intervention seems apparent in situations involving death, serious injury, mass disasters, and cataclysmic events such as war. Nowhere, however, is pastoral crisis intervention potentially more useful than in response to real or threatened terrorism.
Pastoral crisis intervention may be thought of as the functional integration of crisis intervention and pastoral support. In effect, the practice of pastoral crisis intervention largely represents the use of faith-based interventions refined and augmented through the use of an emergency mental health delivery context. The value of pastoral crisis intervention seems apparent in situations involving death, serious injury, mass disasters, and cataclysmic events such as war. However, as with any form of crisis intervention, or even psychotherapy, there is a potential for harm. This paper explores this notion.