Psychotherapeutic intervention in acute medical situations.

Psychotherapy in the extreme medical situation is an extension of the interviewing process. The interviewer must expeditiously and sometimes briefly assist the patient in elaborating his complaint, obtain information about the development of the complaint, and assess the patient's reactions to it. Past history, developmental patterns, reactions to previous illness and crises, the patient's present life situation, and past and present relationships may all be relevant and require evaluation. The interactive process requires that the therapist call upon specific knowledge as he engages with the patient, facilitates the expression of concern, appropriately reassures, instructs, and prepares, clarifies, and leads the patient to some insight about his altered state. Attention to the affective correlates of acute illness can enhance convalescence and the rehabilitative process.