Outside of the ER, are there such things as "crisis" appointments? What do you define as "crisis"?

Before you answer...

My T and I were talking yesterday about "crisis" appointments because I mentioned some issues I was having with reaching my pdoc for urgent appointments. (They both work in the same office.) She said that the office does offer something called "crisis" appointments (which I hadn't heard of before), but she does not believe in crisis appointments for psychiatric help. She said she will fit you in if you want to see her sooner, but if you're in a legitimate crisis, you need to go to the ER. She said 95% of the time someone has come in for a "crisis" appointment, they were not in a legitimate crisis. "ER is for *real* crises."

Thoughts? I'm inclined to believe, but I think it'd be an interesting philosophical discussion

[DodgersMom]

i think every therapist is different on this, last week i had 2 appointments because he thought one was a crisis for me and suggested i come a second time. however i didn't feel it was a crisis, none the less i went.

hard to say really. i would personally say like death of loved one or trying to kill yourself but then again, you might wanna go elsewhere for the latter.

[Elio]

***my opinion***

Hmmm at first I thought I would agree with her, then I got thinking about the nature of "crisis" and what that means for different people.

Say I'm addicted to some chemical substance. I've been clean for x period of time. For whatever reason, I find myself sitting there with some of my drug of choice in front of me... say that drug has a high mortality rate for single usage especially for relapsing people. If I was still struggling with my decision on how to act on it. I wouldn't go to the ER for this. I would consider it a crisis and would look to reach out to whatever supports I feel would help me. In this case, maybe it's a sponsor, maybe it's a friend, and maybe it's my T. Just depends on the me in the story and what supports I do have in place.

If this was real scenario for me, my T is the only support I would have in this instance.

It sounds like your T maybe defining crisis as situations where one has lost touch with reality, is actively at risk for self termination, or violence against others. To me those seem to be past the point of the crisis moment and are now in the aftermath of the crisis, if you think of it as a cause and effect thing. The person has past the point where they are able or willing to be active in making different choices; cognitive thinking maybe too impaired, and such.

Possible trigger:

The times I have reached out to T in crisis have been times where I felt I had no emotional control and my world was collapsing around me. The times I have reached out to crisis lines have been times where I have been scared of the choices I was making in the concept of self termination. I was usually more emotionally stable in those moments, they were moments of realization that I was gathering the needed items, I was putting in motion the plan, ... and so on.

Personally, I would never go to ER voluntarily for crisis management. My T is on rotation with a group of T for emergency/crisis contacts. Even if she is not the one on-call, she can be paged. However, she might not be in pager range.

[anais_anais]

I guess it comes down to one's definition of crisis, but I think crisis appointments can have their place especially among clents who currently lack a strong support network of their own.

When I was sui, I went to ER and was placed in IP. That's one type of crisis where going to an appointment probably would not have helped much. I had a terrible experience at the hospital but it did keep me alive. I'm not sure a "crisis" appointment would have been at all helpful.

On the other hand, when my apartment burnt down, I was in a different type of crisis, not an SH crisis, of being in extreme distress with no relatives or friends around to privide support. I asked for a crisis appointment-- my T never had experienced what I was going through but was there for me to talk at and rage at and weigh my options at, which is what I needed. In addition to our appointments she called me daily. The ER would not have helped, but without the extra support from T I think I WOULD have ended up in what your T calls "a *real* crisis." If I had a robust support network of my own, though, it's true that I probably wouldn't have needed the crisis appointment at all.

I think there is a difference for most people in what types of support and intervention a therapist provides vs. what a pdoc provides. I can see where the distinction is made between a "crisis" in therapy as opposed to a crisis that a psychiatrist would intervene in. That might not be so clear in cases where the psychiatrist is also doing therapy with a client, but those situations aren't terribly common most of the time.

My therapist was my go-to person for most crisis situations, not my psychiatrist. I could get in for extra appointments fairly easily, process through whatever was going on, and hopefully get through the crisis without need for pdoc support or inpatient.

I never had "crisis" appointments with my psychiatrist, but we certainly had phone calls. (Due to distance, getting in a for a "crisis" appointment was not really feasible.) My pdoc handled my meds for the most part, and in the event my therapist's support in conjunction with meds was not working and I was in crisis (suicidal; manic, etc.), then we spoke on the phone for a med change if possible, but if that couldn't happen quickly enough or the level of intervention moved beyond what a med change could correct, then my pdoc would ask me to go inpatient where he could be sure I was safe and he could make more aggressive med adjustments under medical supervision.