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Therapeutic alliance in forensic mental health: coercion, consent and recovery

Published online by Cambridge University Press:  13 June 2014

Vidis Donnelly ,
Aideen Lynch ,
Conal Devlin ,
Leena Naughten ,
Olivia Gibbons ,
Damian Mohan  and
Harry G Kennedy
Vidis Donnelly
Affiliation:
National Forensic Mental Health Service Central Mental Hospital Dundrum Dublin 14, Ireland and clinical professor of forensic psychiatry, Trinity College Dublin, Dublin 2, Ireland
Aideen Lynch
Affiliation:
National Forensic Mental Health Service Central Mental Hospital Dundrum Dublin 14, Ireland and clinical professor of forensic psychiatry, Trinity College Dublin, Dublin 2, Ireland
Conal Devlin
Affiliation:
National Forensic Mental Health Service Central Mental Hospital Dundrum Dublin 14, Ireland and clinical professor of forensic psychiatry, Trinity College Dublin, Dublin 2, Ireland
Leena Naughten
Affiliation:
National Forensic Mental Health Service Central Mental Hospital Dundrum Dublin 14, Ireland and clinical professor of forensic psychiatry, Trinity College Dublin, Dublin 2, Ireland
Olivia Gibbons
Affiliation:
National Forensic Mental Health Service Central Mental Hospital Dundrum Dublin 14, Ireland and clinical professor of forensic psychiatry, Trinity College Dublin, Dublin 2, Ireland
Damian Mohan
Affiliation:
National Forensic Mental Health Service Central Mental Hospital Dundrum Dublin 14, Ireland and clinical professor of forensic psychiatry, Trinity College Dublin, Dublin 2, Ireland
Harry G Kennedy*
Affiliation:
National Forensic Mental Health Service Central Mental Hospital Dundrum Dublin 14, Ireland and clinical professor of forensic psychiatry, Trinity College Dublin, Dublin 2, Ireland
*
*Correspondence Email: [email protected]
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Abstract

Objective: We examined the Working Alliance Inventory (WAI) and Interpersonal Trust in Physician (ITP) in a forensic psychiatry hospital, where all patients were detained under mental health legislation for psychosis. We hypothesised that working alliance and trust are bilateral and can be measured.

Method: We adapted the WAI and ITP minimally so that patients rated both their treating psychiatrist and primary nurse. We also adapted them minimally so that clinicians could rate WAI and ITP with the patient. A total of 81 of 83 patients completed the assessments. The clinicians (seven consultant psychiatrists and 43 nurses) also completed a minimally altered version of the same questionnaires. All three (patient, nurse and psychiatrist) were blind to the ratings of the others.

Results: Cronbach's alpha was greater than 0.9 for both patient and clinician versions of the WAI and greater than 0.8 for the ITP. The WAI and ITP correlated with each other (Spearman r > 0.67 for patients, for psychiatrists and for nurses). Patients rated clinicians higher than clinicians rated patients. Ratings were higher in pre-discharge wards than in acute wards. Patients' ratings of WAI for their psychiatrist and nurse correlated r = 0.75, and patients rating of IPT for psychiatrist and nurse correlated 0.67. Psychiatrists correlated with nurses 0.38 for WAI, 0.53 for IPT. Psychiatrists and patients mutual ratings correlated r = 0.35 for WAI, 0.24 for IPT. Nurses and patients correlated r = 0.34 for WAI, 0.25 for IPT. All correlations were statistically significant. Mental state (PANSS) and global function (GAF) correlated with all ratings and confounded most patient-clinician correlations.

Conclusion: Working alliance and interpersonal trust can be measured reliably even in forensic settings. The extent to which they measure a mutual quality is unclear.

Keywords

Forensic psychiatryWorking Alliance InventoryPsychosis
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 28 , Issue 1 , March 2011 , pp. 21 - 28
Copyright
Copyright © Cambridge University Press 2011

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References

1.Kallert, TW. Coercion in psychiatry. Curr Op Psychiatry 2008; 21(5): 485–489.CrossRefGoogle ScholarPubMed
2.Becker, MA, Young, MS, Ochshorn, E, Diamond, RJ. The relationship of antipsychotic medication class and adherence with treatment outcomes and costs for Florida medicaid beneficiaries with schizophrenia. Administration and Policy in Mental Health and Mental Health Services Research 2007; 34(3): 307–314.CrossRefGoogle ScholarPubMed
3.Gianfrancesco, FD, Rajagopalan, K, Sajatovic, M, Wang, R. Treatment adherence among patients with schizophrenia treated with atypical and typical antipsychotics. Psychiatry Res 2006; 144(2-3): 177–189.CrossRefGoogle ScholarPubMed
4.Watts, D, Morgan, HG. Malignant alienation: Dangers for patients who are hard to like. Br J Psychiatry 1994; 164: 11–15.CrossRefGoogle Scholar
5.Szmukler, G, Appelbaum, PS. Treatment pressures, leverage, coercion, and compulsion in mental health care. J Mental Health 2008; 17(3): 233–244.CrossRefGoogle Scholar
6.Winick, BJ. A therapeutic jurisprudence approach to dealing with coercion in the mental health system. Psychiatry, Psychology and Law 2008; 15(1): 25–39.CrossRefGoogle Scholar
7.Hansson, L, Bjorkman, T, Priebe, S. Are important patient-rated outcomes in community mental health care explained by only one factor? Acta Psych Scand 2007; 116(2): 113–118.CrossRefGoogle ScholarPubMed
8.Sorgaard, KW. Satisfaction and coercion among voluntary, persuaded/pressured and committed patients in acute psychiatric treatment. Scand J Caring Sci 2007; 21(2): 214–219.CrossRefGoogle ScholarPubMed
9.Strack, KM, Deal, WP, Schulenberg, SE. Coercion and empowerment in the treatment of individuals with serious mental illness: A preliminary investigation. Psychological Services 2007; 4(2): 96–106.CrossRefGoogle Scholar
10.Cooper, D, Moisean, J, Gregoire, JP. Adherence to atypical antipsychotic treatment among newly treated patients: a population-based study in schizophrenia. J Clin Psychiatry 2007; 68(6): 818–825.CrossRefGoogle ScholarPubMed
11.McGuire, R, McCabe, R, Priebe, S. Theoretical frameworks for understanding and investigating the therapeutic relationship in psychiatry. Soc Psychiatry Psychiatric Epid 2001; 36(11): 557–564.CrossRefGoogle ScholarPubMed
12.Martin, DJ, Garske, JP, Davis, MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analylitic review. J Consult Clin Psychol 2000; 68(3): 438–450.CrossRefGoogle ScholarPubMed
13.Gray, R, Bressington, D, Lathlean, J, Mills, A. Relationship between adherence, symptoms, treatment attitudes, satisfaction, and side effects in prisoners taking antipsychotic medication. J Forensic Psychiat Psychol 2008; 19(3): 335–351.CrossRefGoogle Scholar
14.Kennedy, HG. Therapeutic Uses of Security: mapping forensic mental health services by stratifying risk. Adv Psychiatric Treat 2002; 8: 433–443CrossRefGoogle Scholar
15.Horvath, AO, Greenberg, LS. The development and validation of the Working Alliance Inventory. J Counselling Psychol 1989; 36(2): 223–233.CrossRefGoogle Scholar
16.Hall, MA, Zheng, B, Dugan, Eet al.Measuring Patients' Trust in Their Primary Care Providers. Med Care Res Rev 2002; 59(3): 293–318.CrossRefGoogle ScholarPubMed
17.McGuire-Snieckus, R, McCabe, R, Catty, J, Hansson, L, Priebe, S. A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychol Med 2007; 37(1): 85–95.CrossRefGoogle ScholarPubMed
18.Hatcher, RL, Barends, AW. Patients' views of the alliance in psychotherapy: exploratory factor analysis of three alliance measures. J Consult Clin Psychol 1996; 64: 1326–1336.CrossRefGoogle Scholar
19.Tracey, TJ, Kokotovic, AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A. J Consulti Clin Psychol 1989; 1: 207–210.CrossRefGoogle Scholar
20.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed). Washington DC: American Psychiatric Association, 1994.Google Scholar
21.Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schiz Bull 1987; 13: 261–276.CrossRefGoogle ScholarPubMed
22.Andreason, NC, Carpenter, WT, Kane, JM, Lasser, RA, Marder, SR, Weinberger, DR. Remission in schizophrenia: Proposed criteria and rationale for consensus. Am J Psychiatry 2005; 162(3): 441–9.CrossRefGoogle Scholar
23.Horvath, AO, Symonds, BD. Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Consult Psychol 1991; 38: 139–149.Google Scholar
24.Hansson, L, Bjorkman, T, Priebe, S. Are important patient-rated outcomes in community mental health care explained by only one factor? Acta Psych Scand 2007; 116(2): 113–118.CrossRefGoogle ScholarPubMed
25.Priebe, S, Gruyters, T. Patients' assessment of treatment predicting outcome. Schiz Bull 1995; 21(1): 87–94.CrossRefGoogle ScholarPubMed
25.Junghan, UM, Leese, M, Priebe, S, Slade, M. Staff and patient perspectives on unmet need and therapeutic alliance in community mental health services. Br J Psychiatry 2007; 191(6): 543–547.CrossRefGoogle ScholarPubMed