or challenge. These people, it is thought, are at points where growth or breakdo^11 may occur, and where short-term intervention is likely to have maximum impact. Th'j theory is central to the book, and has much to teach us, but offers such a convenieI1 framework for community planning that it could be accepted too uncritically. Of.. may doubt if these external crises are always the relevant ones, if the effect of cris'j intervention will not pass with the crisis, if we do not risk making some development3 stages more critical by anticipating difficulties. Although the author repudiates any idea of "government by psychiatrist", he sef

Principles of Preventive Psychiatry

The effectiveness of telephone crisis services/hotlines, examining proximal outcomes as measured by changes in callers' crisis state from the beginning to the end of their calls to eight centers in the U.S. and intermediate outcomes within 3 weeks of their calls, was evaluated. Between March 2003 and July 2004, 1,617 crisis callers were assessed during their calls and 801 (49.5%) participated in the follow-up assessment. Significant decreases in callers' crisis states and hopelessness were found during the course of the telephone session, with continuing decreases in crisis states and hopelessness in the following weeks. A majority of callers were provided with referrals and/or plans of actions for their concerns and approximately one third of those provided with mental health referrals had followed up with the referral by the time of the follow-up assessment. While crisis service staff coded these callers as nonsuicidal, at follow-up nearly 12% of them reported having suicidal thoughts either during or since their call to the center. The need to conduct suicide risk assessments with crisis callers and to identify strategies to improve referral follow-up is highlighted.

An evaluation of crisis hotline outcomes. Part 1: nonsuicidal crisis callers

This study investigates the experiences and processes that characterise crisis episodes occurring between the ages of 25 and 40. The methodology is a composite of Interpretative Phenomenological Analysis (Smith & Eatough 2006) and Miles and Huberman's Interactive Model (1994). Analysis of interview data found a four-phase pattern in all the crisis episodes sampled, starting with a precrisis description of an externally controlled identity and being stuck in a domestic and/or vocational role that is no longer wanted but is maintained out of passivity or obligation. This is followed by the peak of the crisis, which is characterised by an emotional separation from that role and/or relationship and by a confused and undefined identity. The third phase involves exploration of new intrinsically motivated activities and an experimental search through alternative self-conceptions and activities. The fourth postcrisis phase brings a new commitment to a life structure in which identity, life roles, and social contexts are in equilibrium, and an enhanced sense of consent and control. The study demonstrates that the careful hybridisation of qualitative approaches is a fruitful enterprise, while the resultant four-phase model is proposed for further validation with other samples and demographics.

Investigating the Form and Dynamics of Crisis Episodes in Early Adulthood: The Application of a Composite Qualitative Method

The course and duration of crisis.

Differences in crisis reactions among cancer and surgery patients.

A cognitive model of crisis theory and data validating the theory are presented. The research is structured in terms of construct validation of a test of crisis behavior. Two hypotheses regarding the crisis test were tested. Hypothesis One states that individuals in situations that typically produce crisis will have a higher crisis score on the test, and Hypothesis Two states that there will be a negative correlation between crisis and defensiveness. Both hypotheses were validated and the meaning of the results and significance for future research are discussed.

Crisis theory: a definitional study.

The present paper consists of a factor analytic study of the Crisis Test and a revision of the test based on this analysis. Two factor analyses are presented: the first, the 10 initial subtests; and the second, the 60 individual items. In both analyses the first factor accounts for a large proportion of the variance. This is interpreted as a demonstration of the unitary nature of the crisis syndrome. The revised test, based on the factor analysis of the individual items, consists of 36 items in two subtests: the first, crisis feelings; and the second, social behaviors. Implications for future research and potential clinical application are discussed.

Howard A. Halpern

Papers

Crisis theory: a definitional study.

The crisis scale: a factor analysis and revision.