The present study examined consumer satisfaction with services provided in a Psychiatric Walk-In Clinic in order to determine not only general levels of satisfaction but also whether or not differences in satisfaction exist between different user groups. Although levels of reported satisfaction were generally high, group psychotherapy patients reported being significantly less satisfied than patients who had been assessed at the clinic or who were in individual psychotherapy. None of the demographic variables including previous psychiatric experience, diagnosis and patient visits were related to satisfaction. These data were discussed in terms of program development.
The purpose was to compare the psychosocial outcome in two groups of schizophrenic patients who were treated by different methods but were in other respects unselected, and to consider factors predictive of the outcome. The first sample, consisting of a total of 100 patients, had received hospital and outpatient care, here called traditional; only 12 of them had received sustained psychotherapy. Of the second sample, comprising 75 patients, 66 were treated in a psychotherapeutic community and 25 also received sustained psychotherapy. All patients were interviewed by the author on an average of 8 years after the first hospitalization. The patients treated in the psychotherapeutic community had remained longer under hospital care, particularly at first, and at the end of follow-up their functional capacity was lower, but they were more satisfied with the treatment received compared with the patients treated traditionally. The samples did not differ in terms of clinical status. The severity of the schizophrenic disorder, including diagnostic category, and a tendency toward grandiose thinking emerged as the most important factors predictive of psychosocial outcome. Premorbid psychosocial development and social support were also relevant to the outcome. After taking the predictor variables into account, extensive hospital care was still associated with a poor outcome. This may in part explain why, despite the greater amount of psychotherapy provided, the functional capacity of the patients who received psychotherapeutic community treatment had poorer outcome than those treated traditionally.
The article describes the development of the Norwegian systems for treatment and care of persons with alcohol-related problems during the last 90 years. The first institutions were run by religious organizations. Public interest was low, and the social framework consisted of compulsory regulations and a focus on clients with severe problems. Following World War II the disease concept of alcoholism was developed. This provided the system with new optimism, and more differentiated and medically oriented treatment. In 1970 the forced labour institutions were closed down, and new institutions were established which provided care. However, the inadequately staffed treatment centres, had a difficult time. Towards the end of the decade scientists started attacking the old myths about alcohol and "alcoholism". During the 1980s all programmes of treatment and care were regionalized, and the systems for treatment and care of persons with alcohol-related problems have become more closely linked to other health and social welfare services in society. Less severely handicapped clients are approached, and the focus is on out-patient treatment. It has become more usual to involve clients' families/social networks. A new system of private institutions is developing. These function in accordance with the Minnesota-model, which again highlights the concept of alcoholism as a disease.
Some 7950 patients have been treated at the traditional medicine department of the Consulting and Diagnostic Center N52, 2/3rds of them came after long and unsuccessful medicamental treatment. Psychotherapy, manual therapy and acupuncture-reflex methods were successful in 86-93% of cases. They are recommended for local clinics provided that the latter are properly equipped and stuffed.
The aim of the study was the prediction of the quality of early working alliance, using possible predictors among patient pretreatment variables: diagnoses, current and past relationships and intrapsychic ones. Data are from the ongoing, naturalistic Norwegian Multisite Project on Process and Outcome of Psychotherapy (NMSPOP).
The sample, n = 270, is recruited from 15 outpatient clinics; 61.1% of the patients have personality disorders. Alliance was assessed with the Working Alliance Inventory (WAI), and predictors include independent clinicians' evaluations of diagnostic/interpersonal/intrapsychic characteristics and the patients' self-reports on similar and additional variables.
Four of 6 hypotheses were supported: Quality of working alliance is difficult to predict, early alliance is better predicted than later, diagnostic variables do not predict quality of working alliance, but quality of both current and past relationships is associated with working alliance. In a hierarchical multiple-regression analysis, 7% variance of working alliance in the 3rd session was explained from current relationship variables, whereas alliance in the 12th session was not predicted by the same model. Intrapsychic variables predicted the therapists' ratings of alliance, but not the patients' ratings.
The results are in line with previous research, and also with the theoretical model for working alliance.
Insufficient evidence exists about the effect of different therapies on work ability for patients with psychiatric disorders. The present study compares improvements in work ability in two short-term therapies and one long-term therapy.
In the Helsinki Psychotherapy Study, 326 outpatients with depressive or anxiety disorder were randomly assigned to long-term and short-term psychodynamic psychotherapy, and solution-focused therapy. The patients were followed for 3 years from the start of treatment. Primary outcome measures were the Work Ability Index (WAI), the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR), Perceived Psychological Functioning Scale, the prevalence of patients employed or studying, and the number of sick-leave days.
Work ability was statistically significantly improved according to WAI (15%), SAS-Work (17%), and Perceived Psychological Functioning Scale (21%) during the 3-year follow-up. No differences in the work ability scores were found between two short-term therapies. The short-term therapies showed 4-11% more improved work ability scores than long-term therapy at the 7 month follow-up point. During the second year of follow-up, no significant differences were found between therapies. After 3 years of follow-up, long-term therapy was more effective than the short-term therapies with 5-12% more improved scores. No differences in the prevalence of individuals employed or studying or in the number of sick-leave days were found between therapies during follow-up.
Short-term therapies give benefits more quickly than long-term therapy on work ability but in the long run long-term therapy is more effective than short-term therapies. More research is needed to confirm these findings.
Comment In: Evid Based Ment Health. 2008 Nov;11(4):10918952958
The nature of the alliance-outcome relationship is still emerging. This study examined the reciprocal influence of change in alliance to the group and change in urge to restrict in eating-disordered individuals attending a group-based day treatment. Participants (N = 238) were a transdiagnostic or mixed diagnostic sample of eating-disordered individuals consecutively admitted to a day treatment program. On a weekly basis, participants completed a measure of alliance to the group of patients with whom they attended multiple group therapies each week. After each meal, they rated the intensity of their urge to restrict food intake, and the intensity ratings were averaged per week. Latent change score analysis was used to assess the reciprocal relationship between prior change in alliance to the group with subsequent change in urge to restrict, and prior change in urge to restrict with subsequent change in alliance to the group across each participant's first 9 weeks in the program. A reciprocal causal model was a good fit to the data. Prior growth in alliance to the group was significantly associated with subsequent reduction in urge to restrict, and concurrently, prior reduction in urge to restrict was significantly associated with subsequent growth in alliance to the group. Alliance to the group and individual outcomes are dynamically related and changing constructs represented by a reciprocal causal model. Clinicians may improve group treatment by assessing alliance to the group and outcomes repeatedly, being aware of their interplay, and structuring interventions based on the mutual causal effects of change in each.
The author's discuss their experience using nurses as therapists on a small unit at St. Joseph's Hospital, a general hospital in Hamilton, Ontario. They describe the training of the first nurse-therapists and the three-level training system established to make the program self-sustaining. The nurse-therapist system is now used on several psychiatric units in the hospital. Problems in role relationships and schedules occurred, but the authors, noting the patient-care, economic, and staff benefits, believe that the system would be especially useful in small inpatient units.