Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-30T20:08:05.347Z Has data issue: false hasContentIssue false
  • English
  • Français

The relevance of professionals’ attachment style, expectations and job attitudes for therapeutic relationships with young people who experience psychosis

Published online by Cambridge University Press:  23 March 2020

C. Berry  and
K. Greenwood
C. Berry*
Affiliation:
University of Sussex and Sussex Partnership NHS Foundation Trust, UK
K. Greenwood
Affiliation:
University of Sussex and Sussex Partnership NHS Foundation Trust, UK
*
*Corresponding author. School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, UK. Tel.: +44 1273 265896. E-mail address:[email protected](C. Berry).
Get access

Abstract

Background

Therapeutic relationships are a central component of community treatment for psychosis and thought to influence clinical and social outcomes, yet there is limited research regarding the potential influence of professional characteristics on positive therapeutic relationships in community care. It was hypothesised that professionals’ relating style and attitudes toward their work might be important, and thus this exploratory study modelled associations between these characteristics and therapeutic relationships developed in community psychosis treatment.

Methods

Dyads of professionals and young patients with psychosis rated their therapeutic relationships with each other. Professionals also completed measures of attachment style, therapeutic optimism, outcome expectancy, and job attitudes regarding working with psychosis.

Results

Professionals’ anxious attachment predicted less positive professional therapeutic relationship ratings. In exploratory directed path analysis, data also supported indirect effects, whereby anxious professional attachment predicts less positive therapeutic relationships through reduced professional therapeutic optimism and less positive job attitudes.

Conclusions

Professional anxious attachment style is directly associated with the therapeutic relationship in psychosis, and indirectly associated through therapeutic optimism and job attitudes. Thus, intervening in professional characteristics could offer an opportunity to limit the impact of insecure attachment on therapeutic relationships in psychosis.

Keywords

Schizophrenia and psychosisSocial and cross-cultural psychiatryPsychometry and assessments in psychiatryPsychotherapyQuality of care
Type
Original article
Information
European Psychiatry , Volume 34 , April 2016 , pp. 1 - 8
Copyright
Copyright © European Psychiatry 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lester, HMarshall, MJones, PFowler, DAmos, TKhan, Net al.Views of young people in early intervention services for first-episode psychosis in England. Psychiatric Serv 2011;62(8):882–887.CrossRefGoogle ScholarPubMed
O’Toole, MSOhlsen, RITaylor, TMPurvis, RWalters, JPilowsky, LSTreating first episode psychosis–the patients’ perspective: a focus group evaluation. J Psychiatric Ment Health Nurs 2004;11(3):319–326.CrossRefGoogle Scholar
Topor, ABorg, MDi Girolamo, SDavidson, LNot just an individual journey: social aspects of recovery. Int J Soc Psychiatry 2009:90–99.Google Scholar
Goldsmith, LLewis, SDunn, GBentall, RPsychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis. Psychol Med 2015;45;1–9.CrossRefGoogle ScholarPubMed
Berry, CGreenwood, KHope-inspiring therapeutic relationships, professional expectations and social inclusion for young people with psychosis. Schiz Res 2015;168(1–2):153–160.CrossRefGoogle ScholarPubMed
Kirsh, BTate, EDeveloping a comprehensive understanding of the working alliance in community mental health. Qual Health Res 2006;16(8):1054–1074.CrossRefGoogle ScholarPubMed
McCabe, RPriebe, SThe therapeutic relationship in the treatment of severe mental illness: a review of methods and findings. Eur Psychiatry 2004;18(5):220–225.CrossRefGoogle Scholar
Chadwick, PBirchwood, MTrower, PCognitive therapy for delusions, voices and paranoia: towards a person model Chichester, UK: John Wiley & Sons, Inc; 1996.Google Scholar
Frank, AFGunderson, JGThe role of the therapeutic alliance in the treatment of schizophrenia: Relationship to course and outcome. Arch Gen Psychiatry 1996;47(3):228–236.CrossRefGoogle Scholar
Lincoln, CVMcGorry, PWho cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis. Psychiatric Serv 1995;1166–1171.Google ScholarPubMed
Birchwood, MEarly intervention and sustaining the management of vulnerability. Aust Z J Psychiatry 2000;34(Suppl. 2):S181–S184.CrossRefGoogle Scholar
Fowler, DHodgekins, JHowells, LMillward, MIvins, ATaylor, Get al.Can targeted early intervention improve functional recovery in psychosis? A historical control evaluation of the effectiveness of different models of early intervention service provision in Norfolk 1998-2007. Early Interv Psychiatry 2009;3(4):282–288.CrossRefGoogle ScholarPubMed
Department of, Health No health without mental health: A cross-government mental health outcomes strategy for people of all ages London: Department of Health; 2011.Google Scholar
Priebe, SRichardson, MCooney, MAdedeji, OMcCabe, RDoes the therapeutic relationship predict outcomes of psychiatric treatment in patients with psychosis? A systematic review. Psychother Psychosom 2011;80(2):70–77.CrossRefGoogle ScholarPubMed
Van Humbeeck, GVan Audenhove, CStorms, GDe Hert, MPieters, GVertommen, Het al.Expressed emotion in the client-professional dyad. Eur J Psychol Assess 2004;20(4):237–246.CrossRefGoogle Scholar
Skeem, JLLouden, JEPolaschek, DCamp, JAssessing relationship quality in mandated community treatment: blending care with control. Psychol Assess 2007;19(4):397–410.CrossRefGoogle ScholarPubMed
Bordin, ESThe generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice 1979;16(3):252–260.CrossRefGoogle Scholar
Safran, JDSegal, ZVInterpersonal process in cognitive therapy New York: Basic Books; 1990.Google Scholar
King, SDixon, MJThe influence of expressed emotion, family dynamics, and symptom type on the social adjustment of schizophrenic young adults. Arch Gen Psychiatry 1996;53(12):1098–1104.CrossRefGoogle ScholarPubMed
Moore, EKuipers, LBehavioural correlates of expressed emotion in staff-patient interactions. Soc Psych Psychiatr Epidemiol 1992;27(6):298–303.Google ScholarPubMed
Berry, KBarrowclough, CWearden, AAttachment theory: a framework for understanding symptoms and interpersonal relationships in psychosis. Behav Res Ther 2008;46(12):1275–1282.CrossRefGoogle ScholarPubMed
Bowlby, JAttachment and loss: Volume I. Attachment New York: Basic Books; 1969.Google Scholar
Brennan, KAClark, CLShaver, PRSelf-report measurement of adult attachmentSimpson, JARholes, WSAttachment theory and close relationships New York: The Guildford Press; 1998. p. 46–76.Google Scholar
Dozier, MCue, KLBarnett, LClinicians as caregivers: role of attachment organization in treatment. J Consult Clin Psychol 1994;62(4):793–800.CrossRefGoogle ScholarPubMed
Black, SHardy, GTurpin, GParry, GSelf-reported attachment styles and therapeutic orientation of therapists and their relationship with reported general alliance quality and problems in therapy. Psychol Psychother 2005;78(3):363–377.CrossRefGoogle ScholarPubMed
Rosenthal, RBaratz, SSHall, CMTeacher behavior, teacher expectations, and gains in pupils’ rated creativity. J Genet Psychol 1974;124(1):115–121.CrossRefGoogle ScholarPubMed
Cutcliffe, JRThe inspiration of hope in bereavement counseling. Issues Ment Health Nurs 2004;25(2):165–190.CrossRefGoogle ScholarPubMed
O’Connell, MJStein, CHThe relationship between case manager expectations and outcomes of persons diagnosed with schizophrenia. Community Ment Health J 2011;47(4):424–435.CrossRefGoogle ScholarPubMed
Borg, MKristiansen, KRecovery-oriented professionals: helping relationships in mental health services. J Ment Health 2004;13(5):493–505.CrossRefGoogle Scholar
Snyder, CRTaylor, JDHope as a common factor across psychotherapy approaches: a lesson from the dodo’s verdict . In: Snyder, CRHandbook of hope: Theory, measures, and applications San Diego, CA: Academic Press; 2000. p.89–108.CrossRefGoogle Scholar
Lauder, WReynolds, WSmith, ASharkey, SA comparison of therapeutic commitment, role support, role competency and empathy in three cohorts of nursing students. J Psychiatric Ment Health Nurs 2002;9(4):483–491.CrossRefGoogle ScholarPubMed
Shaw, SCartwright, ASpratley, THarwin, JResponding to drinking problems London, UK: Croom-Helm; 1978.Google Scholar
Roche, MDuffield, CWhite, EFactors in the practice environment of nurses working in inpatient mental health: a partial least squares path modeling approach. Int J Nurs Stud 2011;48(12):1475–1486.CrossRefGoogle ScholarPubMed
Johansson, HEklund, MPatients’ opinion on what constitutes good psychiatric care. Scandinavian J Caring Sciences 2003;17(4):339–346.CrossRefGoogle ScholarPubMed
Svedberg, PJormfeldt, HArvidsson, BPatients’ conceptions of how health processes are promoted in mental health nursing. A qualitative study. J Psychiatric Ment Health Nurs 2003;10(4):448–456.CrossRefGoogle ScholarPubMed
Kohut, HGoldberg, AStepansky, PEHow does analysis cure? Chicago, IL: University of Chicago Press; 1984.CrossRefGoogle Scholar
Watson, JCGeller, SMThe relation among the relationship conditions, working alliance, and outcome in both process–experiential and cognitive–behavioral psychotherapy. Psychother Res 2005;15(1–2):25–33.CrossRefGoogle Scholar
Zuroff, DCBlatt, SJSotsky, SMKrupnick, JLMartin, DJSanislow, CA IIIet al.Relation of therapeutic alliance and perfectionism to outcome in brief outpatient treatment of depression. J Consult Clin Psychol 2000;68(1):114–124.CrossRefGoogle ScholarPubMed
Rogers, CRThe necessary and sufficient conditions of therapeutic personality change. J Consult Psychol 1957;21: 95–103.CrossRefGoogle ScholarPubMed
Evans-Jones, CPeters, EBarker, CThe therapeutic relationship in CBT for psychosis: client, therapist and therapy factors. Behav Cog Psychother 2009;37(05):527–540.CrossRefGoogle ScholarPubMed
Mikulincer, MShaver, PRCassidy, JBerant, EAttachment-related defensive processes. In: Obegi, JHBerant, EAttachment theory and research in clinical work with adults New York: The Guildford Press; 2009. p. 293–327.Google Scholar
Leiper, RCasares, PAn investigation of the attachment organization of clinical psychologists and its relationship to clinical practice. Br J Med Psychol 2000;73(4):449–464.CrossRefGoogle ScholarPubMed
Ronen, SMikulincer, MAttachment orientations and job burnout: the mediating roles of team cohesion and organizational fairness. J Soc Pers Relat 2009;26(4):549–567.CrossRefGoogle Scholar
Khodabakhsh, MAttachment styles as predictors of empathy in nursing students. J Med Ethics Hist Med 2012;5: 8–15.Google ScholarPubMed
Rubino, GBarker, CRoth, TFearon, PTherapist empathy and depth of interpretation in response to potential alliance ruptures: The role of therapist and patient attachment styles. Psychother Res 2000;10(4):408–420.CrossRefGoogle ScholarPubMed
Gumley, AIStaying well after psychosis: a cognitive interpersonal approach to emotional recovery and relapse prevention. Tiddskrift For Norsk Psykologorening 2007;5: 667–676.Google Scholar
Tracey, TJKokotovic, AMFactor structure of the working alliance inventory. J Consult Clin Psychol 1989;1(3):207–210.Google Scholar
Calsyn, RJKlinkenberg, WDMorse, GALemming, MRPredictors of the working alliance in assertive community treatment. Community Ment Health J 2006;42(2):161–175.CrossRefGoogle ScholarPubMed
Forster, JFinlayson, SBentall, RDay, JRandall, FWood, Pet al.The perceived expressed emotion in staff scale. J Psychiatric Ment Health Nurs 2003;10(1):109–117.CrossRefGoogle ScholarPubMed
Friedmann, MSGoldstein, MJRelatives’ awareness of their own expressed emotion as measured by a self-report Adjective Checklist. Family Process 1993;32(4):459–471.CrossRefGoogle ScholarPubMed
Friedmann, MSGoldstein, MJRelatives’ perceptions of their interactional behavior with a schizophrenic family member. Family Process 1994;33(4):377–387.CrossRefGoogle ScholarPubMed
Berry, KWearden, ABarrowclough, CLiversidge, TAttachment styles, interpersonal relationships and psychotic phenomena in a non-clinical student sample. Person Indiv Differ 2006;41(4):707–718.CrossRefGoogle Scholar
Byrne, MKDeane, FPLambert, GCoombs, TEnhancing medication adherence: clinician outcomes from the Medication Alliance training program. Aust N Z J Psychiatry 2004;38(4):246–253.CrossRefGoogle ScholarPubMed
Bruckner, FTherapeutic optimism: Its components and correlates among clinical social workers. New York: Adelphi University School of Social Work; 1979.Google Scholar
O’Connell, MJThe development of case manager expectations about the abilities of clients with schizophrenia: The case manager expectancy inventory Bowling Green State University; 2000.Google Scholar
Macleod, HJDeane, FPHogbin, BChanging staff attitudes and empathy for people with psychosis. Behav Cog Psychother 2002;30(4):459–470.CrossRefGoogle Scholar
Cartwright, AThe attitudes of helping agents towards the alcoholic client: the influence of experience, support, training, and self-esteem. Br J Addiction 1980;75(4):413–431.CrossRefGoogle Scholar
Johansen, RIversen, VCMelle, IHestad, KATherapeutic alliance in early schizophrenia spectrum disorders: a cross-sectional study. Annals Gen Psychiatry 2013;12(14):1–10.CrossRefGoogle ScholarPubMed
Nelson, HENational adult reading test: Test manual Windsor, Berkshire: NFER-Nelson; 1982.Google Scholar
Wechsler, DWechsler Memory Scale: Revised manual San Antonio, TX: Psychological Corporation; 1981.Google Scholar
Benton, ALHamsher, KMultilingual aphasia examination Iowa City, IA: AJA Associates; 1983.Google Scholar
Tombaugh, TNKozak, JRees, LNormative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol 1999;14(2):167–177.Google ScholarPubMed
Nelson, HEWillison, JRThe revised National Adult Reading Test: Test manual Windsor, Berkshire: NFER-Nelson; 1991.Google Scholar
Kay, SRFlszbein, AOpfer, LAThe positive and negative syndrome scale (PANSS) for schizophrenia. Schiz Bull 1987;13(2):261–276.CrossRefGoogle Scholar
Muthén, LKMuthén, BMplus user’s guide. Los Angeles, CA; 1998-2010.Google Scholar
Johnson, DRYoung, RToward best practices in analyzing datasets with missing data: Comparisons and recommendations. J Marriage Fam 2011;73(5):926–945.CrossRefGoogle Scholar
Holmqvist, RArmelius, B.Å.Sources of psychiatric staff members’ feelings towards patients and treatment outcome. Psycho Psychother 2006;79(4):571–584.CrossRefGoogle ScholarPubMed
Nezlek, JBMultilevel modeling for social and personality psychology London: SAGE Publications Ltd; 2011.CrossRefGoogle Scholar
Kline, RBPrinciples and practices of structural equation modeling New York: The Guildford Press; 2011.Google Scholar
Bentler, PMChou, C.-P.Practical issues in structural modeling. Sociolog Methods Res 1987;16(1):78–117.CrossRefGoogle Scholar
Cohen, JStatistical power analysis for the behavioral sciences Hillsdale, NJ: Lawrence Erlbaum Associates Publishers; 1988.Google Scholar
Cohen, JA power primer. Psychol Bull 1992;112(1):155–159.CrossRefGoogle ScholarPubMed
Berry, KBand, RCorcoran, RBarrowclough, CWearden, AAttachment styles, earlier interpersonal relationships and schizotypye in a non-clinical sample. Psychol Psychother 2007;80(4):563–576.CrossRefGoogle Scholar
Bertram, GStickley, TMental health nurses, promoters of inclusion or perpetuators of exclusion?. J Psychiatric Ment Health Nurs 2005;12(4):387–395.CrossRefGoogle ScholarPubMed
Borkin, JSteffen, JKrzton, EWishnick, HWilder, KYangarber, NRecovery Attitudes Questionnaire: development and evaluation. Psychiatric Rehab J 2000;24: 95–102.CrossRefGoogle Scholar
Bedregal, LEO’Connell, MDavidson, LThe Recovery Knowledge Inventory: assessment of mental health staff knowledge and attitudes about recovery. Psychiatric Rehab J 2006;30: 96–103.CrossRefGoogle ScholarPubMed
Salgado, JDDeane, FPCrowe, TPOades, LGHope and improvements in mental health service providers’ recovery attitudes following training. J Ment Health 2010;19(3):243–248.CrossRefGoogle ScholarPubMed
Reynolds, WThe measurement and development of empathy in nursing Aldershot, UK: Ashgate Publishing Limited; 2000.Google Scholar
Submit a response

Comments

No Comments have been published for this article.