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The following brief case study illustrates how one can work with a chronic psychiatric patient in a community mental health center using the crisis model
Assessment of the individual and his problem
Information was then obtained from his sister to determine what had happened (the precipitating event) when his symptoms had started and, specifically, what she meant by his "acting crazy again." His sister stated that he was "talking to the television set . . .muttering things that made no sense . . . staring into space . . . prowling around the apartment at night," and that "this behavior started about 3 days ago." When questioned about anything that was different in their lives before the start of his disruptive behavior, she denied any change. When asked about any changes that were contemplated in the near future, she replied that she was planning to be married in 2 months but that Jim did not know about it because she had not told him yet. When asked why she had not told him, she reluctantly answered that she wanted to wait until all of the arrangements had been made. She was asked if there was any way Jim could have found out about her plans. She remembered that she had discussed them on the telephone with a girl friend the week before.
She was asked what her plans for Jim were after she married. She said that her boyfriend had agreed, rather reluctantly, to let Jim live with them.
Since her boyfriend was reluctant about having Jim live with them, other alternatives were explored. She said that they had cousins living in a nearby suburb but that she did not know if they would want Jim to live with them.
Planning the intervention
He was asked if he had heard his sister talking about her wedding plans. He admitted that he had and that he knew her boyfriend would not want him around—"they would probably put him back in the hospital." As the session ended he still had not internalized the information he had heard. He was asked to continue in therapy for 5 more weeks and to take his medication as prescribed. He agreed to do so.
By the end of the sixth week he had visited his cousins, seen the apartment where he would be living, and had discussed his new "job." His disruptive behavior had ceased, and he was again functioning at his precrisis level.
Summation of paradigm
- Aguilera PhD, Donna C. and Janice M. Messick, M.S.; Crisis Intervention: Theory and methodology; The C.V. Mosby Company: St. Louis; 1982
Reflection Exercise #2
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