[Treatment of acute crisis in child and adolescent psychiatry].
Crises from the child and adolescent psychiatric point of view must be considered as unique or repeated moments of basic questioning of self-focused and relational perception. Hospitalisation if necessary depends on a well prepared social, legal, physical and cooperative framework. Patients, their family or social environment are in need of clarity, structure, and a professional counterpart willing to engage responsibly within an inpatient or--mostly--outpatient framework. He must adapt his diagnostic or therapeutic action to the patient's experience of fear, loss of orientation and insecurity. Then a crisis may be experienced like a bonding experience. Concerning the capacity of action confronted to psychiatric crisis the authors stress the importance of the scenic understanding, expressed symptoms and the acted-out crisis dynamics more than diagnostic classification. The diagnostic and decisive process of atunement to the patient in crisis is being described. A model for psychodynamic understanding of perception of and action towards crisis is proposed, which allows describing the interference between relational dynamics and intra-psychic conflicts leading to crisis. This can then be used as therapeutical focus for the crisis intervention or a consecutive psychotherapeutic treatment.
Walter
Joachim
J
Luisenklinik, Kinder- und jugendpsychiatrische und -psychotherapeutische Abteilung, Dürrheim. drjoachimwalter@t-online.de
Hoffmann
Sascha
S
Romer
Georg
G
D000223:Adaptation, Psychological; D000293:Adolescent; D000553:Ambulatory Care; D002648:Child; D002669:Child Welfare; D003299:Cooperative Behavior; D003419:Crisis Intervention; D004213:Dissociative Disorders / Q000523:psychology; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D009769:Object Attachment; D010343:Patient Admission; D010348:Patient Care Team; D011613:Psychotherapy; D012059:Rejection, Psychology; D020377:Self Efficacy; D013406:Suicide, Attempted / Q000523:psychology