E-mail as a Modality for Crisis Intervention

by Joseph Polauf, MSSW, MPA

on 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

About the Author/s:

You can reach Mr. Joseph Polauf at his email: jcp@nyreferrals.com.