Telehealth: EMAIL AS A MODALITY FOR CRISIS INTERVENTION
by: Joseph Polauf, MSSW, MPA
jcp@nyreferrals.com
September, 1997
The success of both e-mail and crisis intervention brief therapy are
due to similiar motivations: a need for rapid response, very low cost,
easy accessibility, and effectiveness towards modest goals. When combined
together, e-mail based crisis intervention can be an important
tool for mental health practitioners. The theory and technique of crisis
intervention does not require extensive modifications if conducted through
a series of e-mail communications between therapist and client, unlike
cognitive or psychodynamic therapies. It is important not to confuse crisis
intervention with trauma services, however, as trauma services usually
require hospital settings or immediate referral-response hotlines. Crisis
intervention is time limited counseling that is structured into distinct
stages, with concrete goals and problem solving exercises, and the overall
mission is to return the individual to pre-crisis, stabilized behavior.
E-mail based crisis intervention is a practical and efficient
innovation that can bring mental health interventions to the homes of
millions of people today.
Comparison between E-mail Crisis Intervention
and Agency-Based Crisis Intervention
|
Aspect
|
E-mail Crisis Intervention
|
Traditional Agency-Based Crisis Intervention
|
Presenting Problem |
Problem is framed during initial messages as a disruption in
otherwise steady state
|
Problem is defined in everyday terms. Problem is conceptualized
as a time-limited phenomena with either adaptive or dysfunctional
outcomes
|
|
Referral Source
|
Self-referral
|
Primarily allied health professionals: MDs, clergy, hospitals,
human service agencies, EAPs
|
|
Underlying Theory and Therapeutic Orientation
|
Primarily personality theory (psychoanalytic, ego psychology,
cognitive and learning theory)
|
Same
|
|
DSM IV Diagnosis
|
Important, but not used due to need to accomplish problem-solving
tasks
|
Same
|
|
Psychosocial assessment
|
Same as traditional approach, but slightly more difficult due
to nature of medium
|
Systematic but brief assessment of the nature of problem, individual's
coping skills and general adaptive abilities, availability of
family, friends and community resources. Extensive history-taking
is not part of treatment principles
|
|
Initial Phase
|
Explore problem and reframe in cognitive terms, instill hope,
allow ventilation. Therapist will usually offer tentative hypothesis
on the nature of the problem and the client's dynamics. Treatment
plan is constructed early with emphasis on time-limits
|
Same
|
|
Treatment Principles
|
Client is encouraged to maintain a sense of autonomy, contract
of goals is established, time frame for treatment is discussed
and agreed upon. Clients are helped to find solutions based on
their own internal skills, directive advice and coaching are not
used
|
Same
|
|
Treatment Goal
|
Relief of symptoms, restoration of functioning, insight into
stressors, increased repertoire of problem solving skills
|
Same
|
|
Termination
|
Part of Treatment Contract. New problems involve new treatment
contract. Termination is seen as critical component to promoting
client autonomy
|
Same
|
|
Follow-up
|
Must be client initiated
|
Usually client initiated
|
|
Appointment times
|
Usually, therapist is available more than once a week. Often
several sessions per week until problem is resolved
|
Several per week, tapering off towards termination
|
|
Self-disclosure
|
Varies, but web sites often include the therapist's treatment
philosophies, resumes, and professional interests
|
Usually limited by agency rules
|
|
Setting
|
Almost entirely private practice
|
Almost entirely agency based
|
|
Professional Qualifications
|
Unregulated
|
Usually agency-based state licensure and certification. Therapists
comply with state and local regulations. Usually practice is supervised
|
|
Payment
|
Self-pay, some therapists offer free services
|
Usually free to clients by third-party, grant, local assistance,
host agency (i.e., hospital, university), sometimes self-pay
|
|
External referrals
|
Difficult due to medium
|
Occasional, given geographic closeness of agency to clients
|
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|
