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Erschienen in: Social Psychiatry and Psychiatric Epidemiology 2/2006

01.02.2006 | Original Paper

Helping alliance and early dropout from psychiatric out-patient care

The influence of patient factors

verfasst von: Håkan Johansson, MSc, Mona Eklund, PhD

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 2/2006

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Abstract

Background

The study examined client factors of relevance in the establishment of helping alliance and in the prediction of dropout from a routine psychiatric setting admitting a variety of diagnoses and staffed with a multiprofessional team.

Method

Newly admitted patients (n=122) and staff completed questionnaires regarding helping alliance, and the patients also completed questionnaires regarding motivation, symptoms and interpersonal problems. The patients were also diagnosed according to ICD-10 and were followed up concerning early dropout.

Results

Several variables correlated with helping alliance, and multivariate analyses showed that cold/distant factor, motivation and interpersonal sensitivity factor were the most important factors in establishing helping alliance. Moreover, it was the alliance as perceived by the patients (and not by the staff) that proved to be the most essential variable. A logistic regression analysis showed that early dropout was predicted by low helping alliance, low age and cold/distant factor.

Conclusion

The most important client factors for establishing helping alliance and for predicting early dropout seem to be those relevant to interpersonal processes. Furthermore, the therapists'/staff's responsiveness to these client factors seems to be of decisive importance.
Literatur
1.
Zurück zum Zitat Martin DJ, Garske JP, Davis MK (2000) Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 68(3):438–450PubMed Martin DJ, Garske JP, Davis MK (2000) Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 68(3):438–450PubMed
2.
Zurück zum Zitat Horvath AO, Bedi RP (2002) The alliance. In: Norcross JC (ed) Psychotherapy relationships that work: therapist contributions and responsiveness to patients. Oxford, New York, pp 37–69 Horvath AO, Bedi RP (2002) The alliance. In: Norcross JC (ed) Psychotherapy relationships that work: therapist contributions and responsiveness to patients. Oxford, New York, pp 37–69
3.
Zurück zum Zitat McGuire R, McCabe R, Priebe S (2001) Theoretical frameworks for understanding and investigating the therapeutic relationship in psychiatry. Soc Psychiatry Psychiatr Epidemiol 36(11):557–564CrossRefPubMed McGuire R, McCabe R, Priebe S (2001) Theoretical frameworks for understanding and investigating the therapeutic relationship in psychiatry. Soc Psychiatry Psychiatr Epidemiol 36(11):557–564CrossRefPubMed
4.
Zurück zum Zitat Eklund M, Hansson L (1996) The ward atmosphere of a psychiatric day care unit on the basis of occupational therapy: characteristics and development during a 5-year period. Nord J Psychiatry 50(2):117–125 Eklund M, Hansson L (1996) The ward atmosphere of a psychiatric day care unit on the basis of occupational therapy: characteristics and development during a 5-year period. Nord J Psychiatry 50(2):117–125
5.
Zurück zum Zitat Frank AF, Gunderson JG (1990) The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry 47(3):228–236PubMed Frank AF, Gunderson JG (1990) The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry 47(3):228–236PubMed
6.
Zurück zum Zitat Howgego IM, Yellowlees P, Owen C, Meldrum L, Dark F (2003) The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Aust N Z J Psychiatry 37(2):169–183CrossRefPubMed Howgego IM, Yellowlees P, Owen C, Meldrum L, Dark F (2003) The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Aust N Z J Psychiatry 37(2):169–183CrossRefPubMed
7.
Zurück zum Zitat Neale MS, Rosenheck RA (1995) Therapeutic alliance and outcome in a VA intensive case management program. Psychiatr Serv 46(7):719–721PubMed Neale MS, Rosenheck RA (1995) Therapeutic alliance and outcome in a VA intensive case management program. Psychiatr Serv 46(7):719–721PubMed
8.
Zurück zum Zitat Svensson B, Hansson L (1999) Therapeutic alliance in cognitive therapy for schizophrenic and other long-term mentally ill patients: development and relationship to outcome in an in-patient treatment programme. Acta Psychiatr Scand 99(4):281–287PubMed Svensson B, Hansson L (1999) Therapeutic alliance in cognitive therapy for schizophrenic and other long-term mentally ill patients: development and relationship to outcome in an in-patient treatment programme. Acta Psychiatr Scand 99(4):281–287PubMed
9.
Zurück zum Zitat Krupnick JL, Sotsky SM, Simmens S, Moyer J, Elkin I, Watkins J et al (1996) The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol 64(3):532–539PubMed Krupnick JL, Sotsky SM, Simmens S, Moyer J, Elkin I, Watkins J et al (1996) The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol 64(3):532–539PubMed
10.
Zurück zum Zitat Weiss M, Gaston L, Propst A, Wisebord S, Zicherman V (1997) The role of the alliance in the pharmacologic treatment of depression. J Clin Psychiatry 58(5):196–204PubMed Weiss M, Gaston L, Propst A, Wisebord S, Zicherman V (1997) The role of the alliance in the pharmacologic treatment of depression. J Clin Psychiatry 58(5):196–204PubMed
11.
Zurück zum Zitat Cruz M, Pincus HA (2002) Research on the influence that communication in psychiatric encounters has on treatment. Psychiatr Serv 53(10):1253–1265CrossRefPubMed Cruz M, Pincus HA (2002) Research on the influence that communication in psychiatric encounters has on treatment. Psychiatr Serv 53(10):1253–1265CrossRefPubMed
12.
Zurück zum Zitat Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV (2002) Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 63(10):892–909PubMed Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV (2002) Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 63(10):892–909PubMed
13.
Zurück zum Zitat Weiss KA, Smith TE, Hull JW, Piper AC, Huppert JD (2002) Predictors of risk of nonadherence in outpatients with schizophrenia and other psychotic disorders. Schizophr Bull 28(2):341–349PubMed Weiss KA, Smith TE, Hull JW, Piper AC, Huppert JD (2002) Predictors of risk of nonadherence in outpatients with schizophrenia and other psychotic disorders. Schizophr Bull 28(2):341–349PubMed
14.
Zurück zum Zitat McCabe R, Roder-Wanner UU, Hoffmann K, Priebe S (1999) Therapeutic relationships and quality of life: association of two subjective constructs in schizophrenia patients. Int J Soc Psychiatry 45(4):276–283PubMed McCabe R, Roder-Wanner UU, Hoffmann K, Priebe S (1999) Therapeutic relationships and quality of life: association of two subjective constructs in schizophrenia patients. Int J Soc Psychiatry 45(4):276–283PubMed
15.
Zurück zum Zitat Cape J (2000) Patient-rated therapeutic relationship and outcome in general practitioner treatment of psychological problems. Br J Clin Psychol 39(Pt 4):383–395PubMed Cape J (2000) Patient-rated therapeutic relationship and outcome in general practitioner treatment of psychological problems. Br J Clin Psychol 39(Pt 4):383–395PubMed
16.
Zurück zum Zitat Mallinckrodt B (1993) Session impact, working alliance, and treatment outcome in brief counseling. J Couns Psychol 40(1):25–32 Mallinckrodt B (1993) Session impact, working alliance, and treatment outcome in brief counseling. J Couns Psychol 40(1):25–32
17.
Zurück zum Zitat Clarkin JF, Levy KN (2004) The influence of client variables on psychotherapy. In: Lambert MJ (ed) Bergin and Garfield's handbook of psychotherapy and behaviour change, 5th edn. Wiley, New York, pp 194–226 Clarkin JF, Levy KN (2004) The influence of client variables on psychotherapy. In: Lambert MJ (ed) Bergin and Garfield's handbook of psychotherapy and behaviour change, 5th edn. Wiley, New York, pp 194–226
18.
Zurück zum Zitat Hersoug AG, Monsen JT, Havik OE, Hoglend P (2002) Quality of early working alliance in psychotherapy: diagnoses, relationship and intrapsychic variables as predictors. Psychother Psychosom 71(1):18–27CrossRefPubMed Hersoug AG, Monsen JT, Havik OE, Hoglend P (2002) Quality of early working alliance in psychotherapy: diagnoses, relationship and intrapsychic variables as predictors. Psychother Psychosom 71(1):18–27CrossRefPubMed
19.
Zurück zum Zitat Klein DN, Schwartz JE, Santiago NJ, Vivian D, Vocisano C, Castonguay LG et al (2003) Therapeutic alliance in depression treatment: controlling for prior change and patient characteristics. J Consult Clin Psychol 71(6):997–1006PubMed Klein DN, Schwartz JE, Santiago NJ, Vivian D, Vocisano C, Castonguay LG et al (2003) Therapeutic alliance in depression treatment: controlling for prior change and patient characteristics. J Consult Clin Psychol 71(6):997–1006PubMed
20.
Zurück zum Zitat Horvath AO, Greenberg LS (1994) The working alliance. Theory, research and practice. Wiley, New York Horvath AO, Greenberg LS (1994) The working alliance. Theory, research and practice. Wiley, New York
21.
Zurück zum Zitat Andreoli A, Frances A, Gex-Fabry M, Aapro N, Gerin P, Dazord A (1993) Crisis intervention in depressed patients with and without DSM-III-R personality disorders. J Nerv Ment Dis 181(12):732–737PubMed Andreoli A, Frances A, Gex-Fabry M, Aapro N, Gerin P, Dazord A (1993) Crisis intervention in depressed patients with and without DSM-III-R personality disorders. J Nerv Ment Dis 181(12):732–737PubMed
22.
Zurück zum Zitat Kokotovic AM, Tracey TJ (1990) Working alliance in the early phase of counseling. J Couns Psychol 37(1):16–21 Kokotovic AM, Tracey TJ (1990) Working alliance in the early phase of counseling. J Couns Psychol 37(1):16–21
23.
Zurück zum Zitat Piper WE, Azim HF, Joyce AS, McCallum M et al (1991) Quality of object relations versus interpersonal functioning as predictors of therapeutic alliance and psychotherapy outcome. J Nerv Ment Dis 179(7):432–438PubMed Piper WE, Azim HF, Joyce AS, McCallum M et al (1991) Quality of object relations versus interpersonal functioning as predictors of therapeutic alliance and psychotherapy outcome. J Nerv Ment Dis 179(7):432–438PubMed
24.
Zurück zum Zitat Mallinckrodt B (1996) Change in working alliance, social support, and psychological symptoms in brief therapy. J Couns Psychol 43(4):448–455 Mallinckrodt B (1996) Change in working alliance, social support, and psychological symptoms in brief therapy. J Couns Psychol 43(4):448–455
25.
Zurück zum Zitat Mallinckrodt B (1991) Clients' representations of childhood emotional bonds with parents, social support, and formation of the working alliance. J Couns Psychol 38(4):401–409 Mallinckrodt B (1991) Clients' representations of childhood emotional bonds with parents, social support, and formation of the working alliance. J Couns Psychol 38(4):401–409
26.
Zurück zum Zitat McCabe R, Priebe S (2003) Are therapeutic relationships in psychiatry explained by patients' symptoms? Factors influencing patient ratings. Eur Psychiatr 18(5):220–225 McCabe R, Priebe S (2003) Are therapeutic relationships in psychiatry explained by patients' symptoms? Factors influencing patient ratings. Eur Psychiatr 18(5):220–225
27.
Zurück zum Zitat Clarkin JF, Hurt SW, Crilly JL (1987) Therapeutic alliance and hospital treatment outcome. Hosp Community Psychiatry 38(8):871–875PubMed Clarkin JF, Hurt SW, Crilly JL (1987) Therapeutic alliance and hospital treatment outcome. Hosp Community Psychiatry 38(8):871–875PubMed
28.
Zurück zum Zitat Johansson H, Eklund M (2004) Helping alliance and ward atmosphere in psychiatric in-patient care. Psychol Psychother 77(Pt 4):511–523PubMed Johansson H, Eklund M (2004) Helping alliance and ward atmosphere in psychiatric in-patient care. Psychol Psychother 77(Pt 4):511–523PubMed
29.
Zurück zum Zitat Draine J, Solomon P (1996) Case manager alliance with clients in an older cohort. Community Ment Health J 32(2):125–134CrossRefPubMed Draine J, Solomon P (1996) Case manager alliance with clients in an older cohort. Community Ment Health J 32(2):125–134CrossRefPubMed
30.
Zurück zum Zitat Tryon GS, Kane AS (1993) Relationship of working alliance to mutual and unilateral termination. J Couns Psychol 40(1):33–36 Tryon GS, Kane AS (1993) Relationship of working alliance to mutual and unilateral termination. J Couns Psychol 40(1):33–36
31.
Zurück zum Zitat Mohl PC, Martinez D, Ticknor C, Huang M et al (1991) Early dropouts from psychotherapy. J Nerv Ment Dis 179(8):478–481PubMed Mohl PC, Martinez D, Ticknor C, Huang M et al (1991) Early dropouts from psychotherapy. J Nerv Ment Dis 179(8):478–481PubMed
32.
Zurück zum Zitat Reis BF, Brown LG (1999) Reducing psychotherapy dropouts: maximizing perspective convergence in the psychotherapy dyad. Psychotherapy: theory, research, practice. Training 36(2):123–136 Reis BF, Brown LG (1999) Reducing psychotherapy dropouts: maximizing perspective convergence in the psychotherapy dyad. Psychotherapy: theory, research, practice. Training 36(2):123–136
33.
Zurück zum Zitat Garfield SL (1994) Research on client variables in psychotherapy. In: Bergin AE, Garfield SL (eds) Handbook of psychotherapy and behavior change, 4th edn. Wiley, Oxford, England, pp 190–228 Garfield SL (1994) Research on client variables in psychotherapy. In: Bergin AE, Garfield SL (eds) Handbook of psychotherapy and behavior change, 4th edn. Wiley, Oxford, England, pp 190–228
34.
Zurück zum Zitat Wierzbicki M, Pekarik G (1993) A meta-analysis of psychotherapy dropout. Prof Psychol Res Pract 24(2):190–195 Wierzbicki M, Pekarik G (1993) A meta-analysis of psychotherapy dropout. Prof Psychol Res Pract 24(2):190–195
35.
Zurück zum Zitat Edlund MJ, Wang PS, Berglund PA, Katz SJ, Lin E, Kessler RC (2002) Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry 159(5):845–851CrossRefPubMed Edlund MJ, Wang PS, Berglund PA, Katz SJ, Lin E, Kessler RC (2002) Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry 159(5):845–851CrossRefPubMed
36.
Zurück zum Zitat Glyngdal P, Sorensen P, Kistrup K (2002) Non-compliance in community psychiatry: failed appointments in the referral system to psychiatric outpatient treatment. Nord J Psychiatry 56(2):151–156CrossRefPubMed Glyngdal P, Sorensen P, Kistrup K (2002) Non-compliance in community psychiatry: failed appointments in the referral system to psychiatric outpatient treatment. Nord J Psychiatry 56(2):151–156CrossRefPubMed
37.
Zurück zum Zitat Rossi A, Amaddeo F, Bisoffi G, Ruggeri M, Thornicroft G, Tansella M (2002) Dropping out of care: inappropriate terminations of contact with community-based psychiatric services. Br J Psychiatry 181:331–338CrossRefPubMed Rossi A, Amaddeo F, Bisoffi G, Ruggeri M, Thornicroft G, Tansella M (2002) Dropping out of care: inappropriate terminations of contact with community-based psychiatric services. Br J Psychiatry 181:331–338CrossRefPubMed
38.
Zurück zum Zitat Tehrani E, Krussel J, Borg L, Munk-Jorgensen P (1996) Dropping out of psychiatric treatment: a prospective study of a first-admission cohort. Acta Psychiatr Scand 94(4):266–271PubMed Tehrani E, Krussel J, Borg L, Munk-Jorgensen P (1996) Dropping out of psychiatric treatment: a prospective study of a first-admission cohort. Acta Psychiatr Scand 94(4):266–271PubMed
39.
Zurück zum Zitat Grunebaum M, Luber P, Callahan M, Leon AC et al (1996) Predictors of missed appointments for psychiatric consultations in a primary care clinic. Psychiatr Serv 47(8):848–852PubMed Grunebaum M, Luber P, Callahan M, Leon AC et al (1996) Predictors of missed appointments for psychiatric consultations in a primary care clinic. Psychiatr Serv 47(8):848–852PubMed
40.
Zurück zum Zitat Pelkonen M, Marttunen M, Laippala P, Lonnqvist J (2000) Factors associated with early dropout from adolescent psychiatric outpatient treatment. J Am Acad Child Adolesc Psychiatry 39(3):329–336PubMed Pelkonen M, Marttunen M, Laippala P, Lonnqvist J (2000) Factors associated with early dropout from adolescent psychiatric outpatient treatment. J Am Acad Child Adolesc Psychiatry 39(3):329–336PubMed
41.
Zurück zum Zitat Luborsky L, Barber JP, Siqueland L, Johnson S et al (1996) The revised Helping Alliance questionnaire (HAq-II): psychometric properties. J Psychother Pract Res 5(3):260–271 Luborsky L, Barber JP, Siqueland L, Johnson S et al (1996) The revised Helping Alliance questionnaire (HAq-II): psychometric properties. J Psychother Pract Res 5(3):260–271
42.
Zurück zum Zitat Derogatis LR (1993) BSI: Brief Symptom Inventory. Administration, scoring, and procedures manual, 4th edn. National Computer Systems, Inc., Minneapolis Derogatis LR (1993) BSI: Brief Symptom Inventory. Administration, scoring, and procedures manual, 4th edn. National Computer Systems, Inc., Minneapolis
43.
Zurück zum Zitat Horowitz LM, Alden LE, Wiggins JS, Pincus AL (2000) IIP: Inventory of Interpersonal Problems. Manual. The Psychological Corporation, San Antonio Horowitz LM, Alden LE, Wiggins JS, Pincus AL (2000) IIP: Inventory of Interpersonal Problems. Manual. The Psychological Corporation, San Antonio
44.
Zurück zum Zitat Weinryb RM, Gustavsson JP, Hellstroem C, Anderson E et al (1996) Interpersonal problems and personality characteristics: psychometric studies of the Swedish version of the IIP. Pers Individ Differ 20(1):13–23CrossRef Weinryb RM, Gustavsson JP, Hellstroem C, Anderson E et al (1996) Interpersonal problems and personality characteristics: psychometric studies of the Swedish version of the IIP. Pers Individ Differ 20(1):13–23CrossRef
45.
Zurück zum Zitat Licht M (1995) Multiple regression and correlation. In: Grimm L, Yarnold P (eds) Reading and understanding multivariate statistics. American Psychological Association, Washington, DC, pp 19–64 Licht M (1995) Multiple regression and correlation. In: Grimm L, Yarnold P (eds) Reading and understanding multivariate statistics. American Psychological Association, Washington, DC, pp 19–64
46.
Zurück zum Zitat Hosmer DW, Lemeshow S (2000) Applied logistic regression. Wiley, New York Hosmer DW, Lemeshow S (2000) Applied logistic regression. Wiley, New York
47.
Zurück zum Zitat Horvath AO, Symonds BD (1991) Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Couns Psychol 38(2):139–149 Horvath AO, Symonds BD (1991) Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Couns Psychol 38(2):139–149
48.
Zurück zum Zitat Hersoug AG, Hoglend P, Monsen JT, Havik OE (2001) Quality of working alliance in psychotherapy: therapist variables and patient/therapist similarity as predictors. J Psychother Pract Res 10(4):205–216PubMed Hersoug AG, Hoglend P, Monsen JT, Havik OE (2001) Quality of working alliance in psychotherapy: therapist variables and patient/therapist similarity as predictors. J Psychother Pract Res 10(4):205–216PubMed
49.
Zurück zum Zitat Thormahlen B, Weinryb RM, Noren K, Vinnars B, Bagedahl-Strindlund M, Barber JP (2003) Patient factors predicting dropout from supportive–expressive psychotherapy for patients with personality disorders. Psychother Res 13(4):493–509CrossRef Thormahlen B, Weinryb RM, Noren K, Vinnars B, Bagedahl-Strindlund M, Barber JP (2003) Patient factors predicting dropout from supportive–expressive psychotherapy for patients with personality disorders. Psychother Res 13(4):493–509CrossRef
50.
Zurück zum Zitat Holmbeck GN (1998) Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child–clinical and pediatric psychology literatures. In: Kazdin AE (ed) Methodological issues and strategies in clinical research, 2nd edn. American Psychological Association, Washington, DC, pp 83–111 Holmbeck GN (1998) Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child–clinical and pediatric psychology literatures. In: Kazdin AE (ed) Methodological issues and strategies in clinical research, 2nd edn. American Psychological Association, Washington, DC, pp 83–111
51.
Zurück zum Zitat Loehlin JC (2004) Latent variable models. An introduction to factor, path, and structural equation analysis, 4th edn. Lawrence Erlbaum Associates, New Jersey Loehlin JC (2004) Latent variable models. An introduction to factor, path, and structural equation analysis, 4th edn. Lawrence Erlbaum Associates, New Jersey
52.
Zurück zum Zitat Altman DG (1991) Practical statistics for medical research. Chapman & Hall, London, UK Altman DG (1991) Practical statistics for medical research. Chapman & Hall, London, UK
Metadaten
Titel
Helping alliance and early dropout from psychiatric out-patient care
The influence of patient factors
verfasst von
Håkan Johansson, MSc
Mona Eklund, PhD
Publikationsdatum
01.02.2006
Erschienen in
Social Psychiatry and Psychiatric Epidemiology / Ausgabe 2/2006
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-005-0009-z

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