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
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
and Agency-Based Crisis Intervention
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