ABSTRACT
The differences between outpatient sessions in the therapist's consulting rooms and therapy conducted at the bedside of inpatients in crisis are extreme. The former can be likened to a planned procedure in a wellprepared and equipped operating theatre. The surroundings and context have been designed for a specific purpose. The latter is like the task of the army field surgeon, operating under fire with minimal facilities, no control over the environment, and relying heavily on the creative use of anything that comes to hand. One is working "where the patient is," not only in the psychological sense, but physically. Patients may be attached to life support machinery, lying in a noisy public ward, or undergoing painful or frightening procedures. There is seldom opportunity for extensive history taking, and even less chance for detailed planning of an intervention. The situation is usually noisy, lacking in privacy, and far removed from the conventional comforts of therapy. In this setting, therapy is a matter of thinking on one's feet, often literally, since even a chair is inappropriate when working with a patient who is undergoing a kidney biopsy or surgery to create access for a dialysis machine. In the setting of a large
Address reprint requests to Juliet Auer, C.Q.S.W., Wychwood 23, Church Green Witney, Oxon, OX8 6A2 England.
