Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-26T21:47:06.168Z Has data issue: false hasContentIssue false
  • English
  • Français

Are therapeutic relationships in psychiatry explained by patients’ symptoms? Factors influencing patient ratings

Published online by Cambridge University Press:  16 April 2020

R. McCabe  and
S. Priebe
R. McCabe*
Affiliation:
Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, LondonE13 8SP, UK
S. Priebe
Affiliation:
Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, LondonE13 8SP, UK
*
2Corresponding author. r.mccabe@qmul.ac.uk
Get access

Abstract

Objective

To investigate the therapeutic relationship and how it is influenced by sociodemographic and clinical factors.

Method

This study analysed self-ratings of the therapeutic relationship in 90 first-admitted, 72 long-term hospitalised and 41 out-patients with schizophrenia along with 249 alcoholic and 42 depressive in-patients and their association with sociodemographic and clinical variables. In all the patients, the therapeutic relationship was assessed using a simple scale based on three items.

Results

The therapeutic relationship differed significantly across groups. It was rated most positively by alcoholic patients and least positively by long-term hospitalised schizophrenia patients. Increased observer-rated psychopathology was significantly associated with a poorer therapeutic relationship in all groups except the hospitalised schizophrenia patients. In this group, increased self-rated symptoms were associated with a poorer relationship. In multiple regression analyses, 3–28% of the relationship variance was explained by psychopathology.

Conclusions

Patient ratings of the therapeutic relationship were partially explained by psychopathology, leaving the greater part of the variance to be explained by factors other than sociodemographic and clinical characteristics.

Keywords

Professional patient relationsAssessmentPsychiatryPsychopathologyTherapeutic relationship
Type
Original article
Information
European Psychiatry , Volume 18 , Issue 5 , August 2003 , pp. 220 - 225
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Clarkin, JF, Hurt, SW, Crilly, JL.Therapeutic alliance and hospital treatment outcome. Hos Community Psychiatry 1987;38:871–5.Google ScholarPubMed
Cohen, J. Statistical power analysis for the behavioral sciences. Hillsdale: NJ: Lawrence Erlbaum Associates; 1988.Google Scholar
Draine, J, Solomon, P.Case manager alliance with clients in an older cohort. Community Ment Health J 1996;32:125–34.CrossRefGoogle Scholar
Frank, AF, Gunderson, JG.The role of the therapeutic alliance in the treatment of schizophrenia. Arch Gen Psychiatry 1990;47:228–36.CrossRefGoogle ScholarPubMed
Gaston, L, Thompson, L, Gallagher, D, Cournoyer, L, Gagnon, R.Alliance, technique, and their interactions in predicting outcome of behavioural, cognitive, and brief dynamic therapy. Psychother Res 1998;8:190–209.Google Scholar
Hansson, L, Berglund, M.Stability of therapeutic alliance and its relationship to outcome in short-term inpatient psychiatric care. Scand J Soc Med 1992;20:45–50.Google ScholarPubMed
Hoffmann, K, Isermann, M, Kaiser, W, Priebe, S.Quality of life in the course of deinstitutionalisation—Part IV of the Berlin Deinstitutionalisation study [in German]. Psychiatr Prax 2000;27:183–8.Google Scholar
Hoffmann, K, Priebe, S.Needs for help and support in the view of schizophrenic long-term patients and of their therapists [in German]. Fortschritte Neurologie und Psychiatrie 1996;64:473–81.CrossRefGoogle Scholar
Horvath, O, Greenberg, LS.The working alliance: theory, research and practice. New York: Wiley; 1994.Google Scholar
Klinkenberg, WD, Calsyn, RJ, Morse, GA.The helping alliance in case management for homeless persons with severe mental illness. Community Ment Health J 1998;34:569–78.Google ScholarPubMed
Krupnick, JL, Sotsky, SM, Simmens, S, Moyer, J, Elkin, I, Watkins, J, et al. The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National programme. J Consult Clin Psychol 1996;64:532–9.CrossRefGoogle Scholar
Lehman, AF. Measures of quality of life among persons with severe and persistent mental disorders. Soc Psychiatry Psychiatr Epidemiol 1996;31:78–88.CrossRefGoogle ScholarPubMed
McCabe, R, Priebe, S.The therapeutic relationship in psychiatric settings: concepts and methods of assessment. Int J Soc Psychiatry 2003 (in press).Google Scholar
McCabe, R, Röder-Wanner, UU, Hoffmann, K, Priebe, S.Therapeutic relationships and quality of life: association of two subjective constructs in schizophrenia patients. Int J Soc Psychiatry 1999;45: 276–83.CrossRefGoogle ScholarPubMed
McGuire, R, McCabe, R, Priebe, S.Theoretical frameworks for understanding and investigating the therapeutic relationship in psychiatry. Social Psychiatry Psychiatr Epidemiol 2001;36:557–64.CrossRefGoogle Scholar
Neale, MS, Rosenheck, RA.Therapeutic alliance and outcome in a VA intensive case management programme. Psychiatr Serv 1995;46: 719–21.Google Scholar
Overall, J, Gorham, DR.The brief psychiatric rating scale. Psychol Rep 1962;10:799–812.Google Scholar
Priebe, S, Röder-Wanner, UU, Kaiser, W.Quality of life in first-admitted schizophrenia patients: a follow-up study. Psychol Med 2000;30:225–30.CrossRefGoogle ScholarPubMed
Priebe, S, Bröker, M.Prediction of hospitalisations by schizophrenia patients’ assessment of treatment: an expanded study. J Psychiatr Res 1999;33:113–9.CrossRefGoogle ScholarPubMed
Priebe, S, Oliver, JP, Kaiser, W.Quality of life and mental health care. Petersfield, UK: Wrightson Biomedical Publishing; 1999.Google Scholar
Priebe, S, Kaiser, W, Huxley, P, Röder-Wanner, UU, Rudolf, H.Do different subjective evaluation criteria reflect distinct constructs? J Nerv Ment Dis 1998;186:385–92.CrossRefGoogle ScholarPubMed
Priebe, S, Gruyters, T.Patients’ assessment of treatment predicting outcome. Schizophr Bull 1995;21:87–94.CrossRefGoogle ScholarPubMed
Priebe, S, Gruyters, T.Patients’ and caregivers’ initial assessments of day hospital treatment and course of symptoms. Compr Psychiatry 1994;35:234–8.CrossRefGoogle ScholarPubMed
Priebe, S, Gruyters, T.The role of the helping alliance in psychiatric community care: a prospective study. J Nerv Mental Dis 1993;181: 552–7.CrossRefGoogle ScholarPubMed
Röder-Wanner, UU, Oliver, JPJ, Priebe, S.Does quality of life differ in schizophrenic women and men? An empirical study. Int J Soc Psychiatry 1997;43:129–41.CrossRefGoogle ScholarPubMed
Rudolf, H, Priebe, S.Subjective quality of life in female in-patients with depression: a longitudinal study. Int J Soc Psychiatry 1999;45: 238–46.CrossRefGoogle ScholarPubMed
Solomon, P, Draine, J, Delaney, MA.The working alliance and consumer case management. J Ment Health Adm 1995;22:126–34.CrossRefGoogle ScholarPubMed
Tattan, T, Tarrier, N.The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes. Psychol Med 2000;30:195–204.CrossRefGoogle ScholarPubMed
Von Zerssen, D.Clinical self-rating scales (CSr-S) of the Munich Psychiatric Information System (Psych IS, Munich). In: Sartorius, N, Ban, TA, editors. Assessment of depression. Berlin: Springer; 1986. p. 270–303.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.