Psychotherapeutically Informed Assessment in Acute Care and Emergency Setting

The psychiatrist’s assessment of patients in the emergency department (ED) is a complex and critical part of a psychiatrist’s work. Developing a therapeutic connection with an individual in the acute care setting can be described as “psychotherapy in a pressure cooker”. Clinicians are often left to their best judgment and expertise to provide patient care in this setting, with limited guidance from evidence-based research.

Therapy is an integral part of being a psychiatrist. However, when psychiatrists work in consult and emergency services, therapy does not occur in the traditional pathways. Therapy techniques can be utilized in a variety of ways that draws from the traditional therapeutic modalities but in acute care settings. Applying the basic therapeutic skills can make a better and more enriching experience even with limited allotted time with patients. Therapeutic modalities can be applied from cognitive behavioral therapy and dialectal behavioral therapy, parent-child interaction therapy (PCIT), psychodynamic therapy, and interpersonal psychotherapy.

This workshop has been developed by the Emergency Psychiatry SIG. It will offer an overview of the evidence-base in the field, followed by a roadmap of the different therapeutic models that can be developed in the psychiatric ED. The crux of the workshop will focus on a discussion of shared clinical experience in the field and applications of different therapeutic models in acute care.

Dr Bossé Chartier will provide a summary of the research in the field, with a particular focus on interventions for suicidal individuals. A systematic review on the impact of therapeutic interventions in the ED and a thematic analysis from the interview of nine psychiatrists discussing the therapeutic nature of their work in the ED with suicidal individuals will be presented.

Dr Hook will review models of psychotherapy delivery to patients in urgency and emergency settings, including an in-depth discussion of the emPATH unit model (emergency psychiatric assessment, treatment, and healing unit) which has emerged as an innovative and effective approach to caring for patients who present to the hospital with an acute mental health crisis.

Drs Schott and Stiebel will review therapeutic modalities and how they can be utilized in emergency and inpatient consult liaison settings. They will provide clinical examples on how to apply therapeutic modalities in unique ways utilizing aspects of psychodynamic, parent-child interaction therapy, cognitive behavioral therapy and interpersonal psychotherapy techniques. Clinical vignettes will be employed to show examples on how to utilize these techniques in acute care settings. Time will be allotted for clinically informed discussion, and questions from the audience.