Interpersonal Change Following Intensive Inpatient Treatment

Abstract

Objective: Persons admitted for inpatient psychiatric care often present with interpersonal difficulties that disrupt adaptive social relations and complicate the provision of treatment. Whereas domains of psychosocial functioning in this population demonstrate clear growth in response to intervention, the impact of treatment on more complex patterns of interpersonal behavior has been largely overlooked within the existing literature. Interpersonal profiles characteristic of psychiatric inpatients were identified in the current study to determine rates of transition to adaptive functioning following hospitalization. Methods: Personality disturbance was assessed in 513 psychiatric inpatients using the Inventory of Interpersonal Problems. Scores were analyzed within a series of latent profile models to isolate unique interpersonal profiles at admission and at discharge. Longitudinal modeling was then employed to determine rates of transition from dysfunctional to adaptive profiles. Relationships with background characteristics, clinical presentation, and treatment response were explored. Results: Normative, Submissive, and Hostile/Withdrawn profiles emerged at both admission and discharge. Patients in the Normative profile demonstrated relatively moderate symptoms. Submissive and Hostile/Withdrawn profiles were related to known risk factors and elevated psychopathology. Approximately half of patients identified as Submissive or Hostile/Withdrawn transitioned to the Normative profile by discharge. Transition status evidenced modest associations with background characteristics and clinical presentation. Treatment engagement and reduction of clinical symptoms were strongly associated with adaptive transition. Conclusion: Maladaptive interpersonal profiles characteristic of psychiatric inpatients demonstrated categorical change following inpatient hospitalization. Enhanced therapeutic engagement and overall reductions in psychiatric symptoms appear to increase potential for interpersonal change.

Changes in interpersonal problems in the psychotherapeutic treatment of depression as measured by the Inventory of Interpersonal Problems: A systematic review and meta-analysis

“…One study reported IIP quadrant data (Puschner et al 2004) for treatment with either PD, CBT or PP. In the PD group only, the fastest rate of improvement was found for participants with problems in the hostile-submissive quadrant, and the slowest rate of improvement was found for participants with problems in the friendly-dominant quadrant, of the IIP-C. One additional study (Clapp et al 2014), in which the researchers had had determined their own study-specific IIP-C profiles, reported that 48% of participants with a pre-treatment submissive profile (elevations across the non-assertive, overly accommodating, and self-sacrificing scales) had transitioned to a normative profile at the end of treatment, compared with 57.1% of those with a hostile/withdrawn profile (elevations across the vindictive/self-centred, cold/distant, and socially inhibited subscales).…”