Outpatient Medical Crisis Intervention: Goal Setting

There are significant challenges inherent in living with chronic illness, including “medically managing the illness; controlling symptoms; carrying out prescribed regimens; coping with social isolation; adjusting to physical changes; normalizing a new lifestyle; and dealing with financial consequences” (Pollin, 1995, p. 2). The Medical Crisis Counseling (MCC) model was designed as a short-term therapy intervention for individuals dealing with medical illnesses, and the variety of adjustment and emotional issues that accompany such diagnoses.

The goal of therapy is not to attempt to force a re-creation of the patient’s or family’s life before the illness, which is essentially an impossible and unsatisfying task, but to encourage the patient and family to adapt, to modify their lives to include the illness without allowing it to hinder their ability to live a “normal” and meaningful life (Klein, 1995). Recent research suggests that psychosocial intervention is an essential component of treating chronic medical illness, as mental and emotional factors are shown to significantly influence the body’s own natural healing mechanism (Roberts, Kiselica, & Frederickson, 2002).

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Additionally, the very nature of chronic illness implies its far-reaching effects on the family members and other close relationships of the patient, even if death is not an immediate fear or concern, and many patients experience problems in previously stable and healthy relationships (Shapiro & Koocher, 1996). Although originally intended for use with adults, it has been successfully modified for the pediatric and adolescent population, and carries the same four basic assumptions:

a) The focus of therapy is the medical condition – any coexisting problems are only addressed to the extent that they interfere with adjustment b) Regardless of the chronic nature of the illness or impairment, the actual time of crisis is only temporary and is represented as a time of learning c) The majority of adjustment issues that individuals with chronic illness or impairment will face are predictable, and thus can be prepared for in advance d) Individuals can draw upon strengths and abilities that they already have in order to help them cope (Pollin, 1995; Klein, 1995).

The focus of this paper will be a 16-year-old male with insulin-dependent diabetes mellitus (IDDM), or Type I diabetes, who we will call Jeff. The MCC model will provide the framework for therapy, which will focus on holistic interventions and treatment. Appropriate goal setting will be addressed, taking into consideration the developmental needs of a 16-year-old male. For the purposes of discussion, we will assume that the diagnosis is fairly recent.

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