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A clinical portrait of a patient in crisis

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  1. Origin of the crisis
  2. Response to the crisis
  3. Coping mechanisms
  4. Interventions

In the spring of 2009 this author had the privilege to participate in the care of a twenty-seven year old woman who was recovering from a motor vehicle accident in which she had suffered multiple fractures of both her upper and lower extremities, as well as internal soft tissue injuries. This patient's medical history included polysubstance abuse and various psychiatric diagnoses, including attention deficit disorder, depression, post-traumatic stress disorder, panic disorder and clinical depression. This patient was acutely distressed about multiple aspects of her situation. Most pressingly, she was concerned about requiring a lengthy rehabilitation period to achieve her historic level of functioning, and that her prescribed pain medication might impair her recent and hard-won sobriety.

[...] Finally, the patient displayed a classic example of maladaptive devaluation, described by Fortinash and Holoday Worret (2008) as finding ?fault in every aspect of the hospitalization experience? (p. 176), which served to move the focus of her attention from her situation onto her perception of the poor quality of the care that she was receiving. While this behavior reduced her psychological distress in the moment, it also prevented her from addressing her situation constructively and fully taking advantage of the resources available to her during hospitalization. [...]

[...] Coping Mechanisms This author observed a number of coping strategies exhibited by this patient, including isolating herself consciously by refusing to attend group meals and unconsciously by an increase in physiological complaints (primarily abdominal pain) when leaving her room. This behavior limited the services and therapeutic interventions she received. Related to this isolation was a strong thread of avoidance. By frequently expressing inability to participate in ADLs, this patient both isolated herself from the population of the unit and met her need for attention, without focusing on the crisis at hand. [...]

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