The use of psychoanalytic concepts in crisis intervention.

Crises have a dynamic structure. Repressed neurotic conflicts and defects in ego organization determine vulnerability to specific stresses. Selection of focus in crisis intervention follows from the recognition of those rigid defensive patterns and adaptive incapacities which have either partially failed or been overwhelmed by the current stress. Aiming at the old problem in the new situation allows crisis work to go beyond symptom relief to improved conflict resolution and coping abilities. Therapeutic activity, rather than passivity, is the hallmark of crisis intervention and involves suggestion, abreaction, manipulation, clarification, and dynamic interpretation. Individuals in crisis are characteristically in a partially regressed state of transference readiness and availability, particularly as this involves intensified dependence wishes. Management of the transference requires recognition of negative, as well as positive, responses and the limitation of further regression that might lead to continual adaptive failure. A variety of specific countertransference responses are commonly evoked in crisis work. These must be recognized for effective treatment to proceed.