CRISIS ORIENTED THERAPY

CRISIS-ORIENTED THERAPY

Over 20 years ago, Don Jackson, in his now-classic article -The Question of Family Homeostasis,-7' noted that improvement of the identified patient was concomitant with changes in behavior among other family intimates. He cited examples of this, such as the treat-ment of a depressed woman whose improvement was followed by her husband's complaint that she was worsening. Continued improvement in the wife was accompanied by the husband's loss of employment and suicide. Jackson observed that -healthy- intimates of patients attempted to sabotage the patients' improvement to prevent their own downfall. Successful treatment of an individual in isolation of his intimates frequently evoked a crisis among these intimates to the magnitude of death:1. An important clinical considera tion, suggested by Jackson, is that the crisis experienced by the intimates may be worse than the problem presented by the identified patient (IP). Such phenomena underlie the rationale for conjoint family therapy, al-though there is little evidence that simply working with the whole family, per se, insures that the IP can get better without his intimates getting worse.' 6

Langsley and associates88' "4 attempted to keep acutely disturbed patients out of psychiatric hospitals by providing crisis therapy for the entire family. Pittman et al.'" describe the underlying assumption of this project: that the symptomatic member is a pressure point in a family in which crisis resolution has been faulty. Helping families to resolve crises more successfully was at least as helpful as hospitaliza-tion and had a preventive effect in avoiding subsequent hospitaliza-tion." By containing the problem within the family, the family's dysfunctional mechanisms for crisis resolution could emerge and be corrected, thus permitting the symptomatic member to improve.

Two of the authors (Mowatt and Heard) participated in a some-what similar project housed at the Philadelphia Child Guidance Clinic, under the direction of Jay Haley.* This program provided family therapy as an alternative to psychiatric hospitalization for severely disturbed young adults, focusing on the immediate problem as a family crisis and on contracting with the family around a goal of preventing future hospitalizations.

The treatment approach applied in the Schizophrenia Project has been described elsewhere by Haler) and is synopsized in Chapter 6 of this book. Basically, the parental dyad was strengthened by the therapist, who helped the parents to adopt a united course of action toward the patient. When this led to symptomatic improvement, parental conflict or some other interpersonal crisis would usually emerge. If the therapist was successful in helping the family through this crisis and avoiding a relapse and rehospitalization, therapy was extremely helpful. Haler) reports that 10 of the 14 cases (71% ) had not been rehospitalized at the point of follow-up, 2 to 4 years after treatment.