Studies in family-oriented crisis intervention with hemodialysis patients

This article describes a family-oriented crisis intervention approach to help patients with chronic renal failure adjust to the unique demands of home dialysis. In particular, home dialysis necessitates a working patient-dialysis partner relationship that has very adaptive problem solving skills. A couple whose permorbid relationship is dysfunctional will soon manifest this under the stress of home dialysis. The family-oriented therapist initiates only the minimal change necessary in the relationship to achieve successful dialysis. In the home training stage the premorbidly dysfunctional couple seems best treated in individual interviews, whereas premorbidly functional couples respond more favorably to conjoint interviews which capitalize on their underlying strengths. Couples in crisis who are dialyzing at home may require a highly structured, behaviorally-oriented contractual approach which includes all relevant family members. This "band-aid" approach temporarily reinstitutes successful dialysis while purchasing more time for the couple to develop new coping mechanisms. Finally, four case studies are presented, including one in which crisis intervention efforts failed.