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Addressing The Needs of Frequent Flyers

Anne M. Ryan LCSW, ACSW and Sara L.B. Ryerson, BS

Mt. Sinai Hospital Medical Center

Chicago, IL

We are often placed in the situation of networking with other professionals when assisting clients who use crisis presentation as their Primary few of interface with service providers. Whether the setting is a crisis line, an outpatient clinic, an emergency room or community agency, crisis interventionists invariably encounter those clients whose names and reputations are well known to all involved - clinical as well as administrative staff. The frequent crisis presentation made by these clients often evokes a contemptuous and impatient response from staff. Despite the disdain these clients elicit, they need and deserve empathic care. To understand these clients from die biopsychosocial and psychodynamic perspectives can serve to broaden crisis staff perceptions and foster a therapeutic alliance. A portion of this presentation will explore the meaning of crisis, individual and institutional transference issues for frequency presenting clients and how to assist staff in better understanding these significant points.

Additionally, demographic, psychosocial and diagnostic profiles of frequent presenters will be reviewed. Studies have demonstrated that patients who repeatedly present in crisis may be identified by demographic and diagnostic characteristics. Such identification may allow for the implementation of more assertive treatmcnt planning. Strategies for networking with other clinical and community professionals to ensure successful referral, and coordination and continuity of care will be discussed.

The management of countertransference issues will also be explored. Clients can evoke derision. They are often masterful at splitting staff and impeding response to their presentation. The savvy crisis interventionist is aware of those coping techniques and is able to respond to both client and colleagues in an empathic and effective manner. The savvy worker is also adept at identifying his/her issues and monitoring his/her responses to further ensure empathic client response.

Last, suggestions for record keeping will be made. Timely and readily accessible documentation is essential to the identification and management of these problematic presenters.

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