Helping alliance and early dropout from psychiatric out-patient care

Abstract

This is an author produced version of a paper published in Social Psychiatry Psychiatric Epidemiology. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination. Abstract:Background: The study examined client factors of relevance for the establishment of the helping alliance and for dropout in a routine psychiatric setting, admitting a variety of diagnoses and staffed with a multi-professional team. Method: Newly-admitted patients (n= 122) and staff completed questionnaires regarding the helping alliance, and the patients also regarding motivation, symptoms and interpersonal problems. The patients were also diagnosed according to the ICD-10 and followed up concerning early dropout. Results: Several variables correlated with the helping alliance and multivariate analyses showed that the cold/distant factor, motivation and the interpersonal sensitivity factor were the most important factors in establishing the helping alliance. Moreover, it was the alliance as perceived by the patients and not 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. Conclusion:The most important client factors for establishing the helping alliance and for predicting early dropout seem to be those relevant to interpersonal processes. Further, the therapists'/staff's responsiveness to these client factors seems to be of decisive importance.

Client perceptions of a work rehabilitation programme for women: The Redesigning Daily Occupations (ReDO) project

“…has given us an understanding of how some of the participants perceived and experienced the ReDO programme. Since the ReDO is a manualised intervention, the findings might to some extent be transferable to future ReDO groups; however, the outcome also depends on the unique group-leaders" ability to establish a therapeutic and helping alliance with the participants (43,44), as well as cohesion within the group (45).…”

Why don't patients attend their appointments? Maintaining engagement with psychiatric services

“…Perhaps the most important interpersonal variable in predicting attendance is the quality of the therapeutic alliance and, more specifically, the degree of 'helpfulness' of the health professional as perceived by the patient (Johansson & Eklund, 2006) (Box 2). That said, in some studies clinician-rated alliance is a…”

Preditores de abandono de tratamento na psicoterapia psicanalítica de crianças

“…Na maior parte das vezes, os pacientes não verbalizam nenhuma razão para o abandono do tratamento ou, quando a referem, informam difi culdades fi nanceiras 6 . Em pacientes adultos, muitos estudos encontraram características clínicas associadas ao abandono, tais como: aliança terapêutica; troca de psicoterapeutas; número de faltas durante o tratamento 7 ; características psicopatológicas, especifi camente "psicoticismo" e "sentimentalismo" 8 ; motivação e sensibilidade interpessoal 9 ; sintomas psicossomáticos; sexualidade insatisfatória; abuso de álcool e substâncias farmacêuticas; e exposição na infância à violência e ao abuso sexual 10 . Ainda em estudos concentrados em adultos, dados sociodemográfi cos também mostraram associações com abandono, dentre eles: local de residência do paciente (fora da área do serviço), falta de vale transporte, o fato de o paciente ter procurado espontaneamente o serviço, o paciente ser do sexo masculino 11 , a idade do paciente e o fato de este ter fi lhos 7 .…”