This study was designed to examine the effects of anxiety levels, as measured by the Gottschalk & Gleser (1969) and the Viney & Westbrook (1976) content analysis scales, of a brief period of supportive counselling of relatives who arrived at a hospital emergency admitting ward with a seriously ill or injured patient. Verbal samples were taken for analysis from the subjects before and after a period of counselling (or a period of no counselling for the control group). The results showed that the initial anxiety levels for subjects in both groups was very high. For both the psychoanalytically oriented Gottschalk & Gleser anxiety scale and the Viney & Westbrook scale of cognitive anxiety there was a decrease in the level of anxiety for the counselled group compared with the non-counselled group. The results showed that such crisis intervention in hospitals for relatives who accompany patients to the hospital can reduce their very high levels of diffuse and generalized anxiety.

Crisis-intervention counseling was implemented with hospitalized patients for whom illness or injury and hospitalization constituted the crisis. Its longterm as well as short-term psychological effects were monitored. When compared with a biographically and psychologically similar sample who were not counseled, counseled patients on discharge from the hospital showed the hypothesized short-term reductions in anxiety and in indirectly expressed anger. Their self-perceptions of helplessness were fewer, whereas their statements of competence increased. On follow-up 12 months later, reductions in their levels of anxiety were found to be even more notable, and more expressions of direct anger were observed. Reductions in depression proved statistically significant only on follow-up. Significant effects for self-perceptions were not apparent on follow-up. Although the findings for short-term effects provided some support for the use of crisis-intervention counseling to achieve immediate goals, the long-term effects suggested that it may have potential for achiev-" ing primary prevention goals.People in crisis are passing through a phase of disturbed psychological equilibrium on the way to a new equilibrium (Caplan, 1955(Caplan, ,1961. This disturbance lasts only for a short period of days or weeks. It usually occurs as a reaction to a change in their world and so requires changes in the assumptions they make about themselves in that world (Kelly, 1955;Parkes, 1971). People in crisis suddenly face different circumstances that demand different coping responses from them. The crisis is, therefore, a time of cognitive disorganization and emotional disturbance, and also a time of increased vulnerability to external influences (Pasewark & Albers, 1972;. For this reason, and because the extent to which crises are effectively resolved seems to be largely a function of the interpersonal sup-This work was supported by a grant from the Commonwealth Department of Health, Australia. We wish to thank Ms. Rosemary Caruana and the part-time members of the research team for their help with data collection and analysis. We also wish to thank the crisis-intervention counselors.

Three crisis intervention programmes were implemented on the basis of prior research and observation with patients in a general hospital. Programme 1 had been designed to decrease their anxiety and depression, programme 2 to decrease their indirectly expressed anger and increase anger which was directly expressed, and programme 3 to decrease the feelings of helplessness and increase their levels of competence. Examination of the psychological states of the sample of ill and injured patients on admission showed that those who were judged to have a poor counselling prognosis were found, as hypothesized, to be highly anxious, depressed and helpless, and to be expressing their anger only indirectly. The goals of the programmes therefore seem to have been appropriately selected to meet the psychological needs of the patients. After crisis intervention counselling, these differences on admission were no longer apparent on discharge or on follow-up 12 months later. Programme 1 did not prove differentially effective on discharge or follow-up. Programme 2 was not found to be more effective than the other programmes on discharge but, as hypothesized, was associated with direct expression of anger and decreased anxiety and depression more at follow-up. Programme 3 increased patients' expressions of competence and decreased their anxiety more on discharge; but on follow-up it proved more liable to maintain their depression than to have beneficial effects.

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