Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-16T02:32:37.078Z Has data issue: false hasContentIssue false
  • English
  • Français

Therapist-patient relationship as a predictor of the course of schizophrenic illness

Published online by Cambridge University Press:  16 April 2020

FM Stark ,
L Lewandowski  and
G Buchkremer
FM Stark
Affiliation:
Psychiatrische und Nervenklinik, Universitätskrankenhaus Eppendorf, Martinistrasse 52, 2000, Hamburg
L Lewandowski
Affiliation:
Psychiatrische Universitätsklinik Göttingen
G Buchkremer
Affiliation:
Psychiatrische Universitätsklinik Tübingen, Germany
Get access

Summary

Schizophrenic patients seem to react sensitively to expressed affect. Expressed emotion research has shown the negative impact of specific family communication styles on the course of illness. Further studies have discussed its relation to gender. This study examines the dyadic aspects of the therapist-patient relationship, the interaction between therapist's ratings and patient's psychopathology, and the predictive value concerning the course of illness. Results show a significant association with gender. Male therapists were inclined to reduce their therapeutic commitment when being confronted with patients who suffered from disturbances Of ego-function, attention, or perception. Female therapists felt rejected by patients with delusions and with formal thought disorders, but perceived themselves as competent when dealing with anergic patients. Furthermore, patients with a less favorable course of illness at the 2-year follow-up could be discriminated by the quality of the therapist-patient relationship at the end of the primary therapeutic intervention.

Keywords

schizophreniaexpressed emotiontherapist-patient relationshipgenderlong-term outcome
Type
Original article
Information
European Psychiatry , Volume 7 , Issue 4 , 1992 , pp. 161 - 169
Copyright
Copyright © Elsevier, Paris 1992

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

Andres, KBrenner, HD (1989) Die Verarbeitung von Aufmerksamkeitsstörungen durch schizophrene Patienten als systemischer ProzeßIn: Schizophrenie als systemische Störung. Die Bedeutung intermediörer Prozesse für Theorie und Praxis (Böker, WBrenner, HD eds) Huber, Bern, 129–142Google Scholar
Barrett-Lennard, G (1962) Dimensions of therapist response as causal factors in therapeutic change. Psychol Monogr 76, 43CrossRefGoogle Scholar
Berkowitz, RLeff, J (1984) Clinical teams reflect family dysfunction. J Fam Ther 6, 79–89CrossRefGoogle Scholar
Buchkremer, GFiedler, PA (1987) Kognitive versus handlungsorientierte Therapie. Ein Vergleich zweier psychotherapeutischer Methoden zur Rezidivprophylaxe bei schizophrenen Patienten. Nervenarzt 58, 481–488Google Scholar
Buchkremer, GRath, N (eds) (1989) Therapeutische Arbeit mil Angehörigen schizophrener Patienten. Meβinstrumente, Methoden, Konzepte. Huber Verlag, BernGoogle Scholar
Buchkremer, GStricker, KRook, ASchulze-Mönking, H (1988) Der ätiologische Zusammenhang zwischen emotionaler Familienatmosphäre und Rezidivraten bei schizophrenen Patienten. In: Aktuelle Kernfragen in der Psychiatrie (Böcker, FWeig, W eds) Springer, Berlin, HeidelbergGoogle Scholar
Buchkremer, GWindgassen, K (1987) Leitlinien des psychotherapeutischen Umgangs mit schizophrenen Patienten. Was ist den verschiedenen Schulen und Methoden gemeinsam? Psychother Med Psychol 37, 407–412Google Scholar
Ciompi, L (1981) Wie können wir die Schizophrenen besser behandeln? Eine Synthese neuer Krankheits- und Therapickonzepte. Nervenarzt 52, 505–515Google Scholar
Compi, L (1986) Auf dem Weg zu einem kohärenten multidimensionalen Krankheits- und Therapieverständnis der Schizophrenie: Konvergierende neue Konzepte. In: Bewältigung der Schizophrenie: Multidimensionale Konzepte, psychosoziale und Kognitive Therapien, Angehörigenarbeit und autoprotektive Anstrengungcn (Böker, WBrenner, HD eds) Huber, BernGoogle Scholar
Cournos, F (1987) The impact of environmental factors on outcome in residential programs. Hosp Community Psychiatry 8, 848–852Google Scholar
Falloon, IRH (1988) Expressed emotion: current status. Psychol Med 18, 269–274CrossRefGoogle ScholarPubMed
Falloon, IRHBoyd, JLMcGill, CWWilliamson, MRazani, JMoss, HBGildermann, AMSimpson, GM (1985) Family management in the prevention of morbidity in schizophrenia: Clinical outcome of a two-year longitudinal study. Arch Gen Psychiatry 42, 887–896CrossRefGoogle ScholarPubMed
Frank, AFGunderson, JG (1990) The role of the therapeutic alliance in the treatment of schizophrenia. Arch Gen Psychiatry 41, 228–236CrossRefGoogle Scholar
Frank, AFGunderson, JGGomes-Schwartz, B (1987) The psychotherapy of schizophrenia: Patient and therapist factors related to continuance. Psychotherapy 24, 392–403CrossRefGoogle Scholar
Frosch, JPGunderson, JGWeiss, RFrank, A (1985) Die Therapeuten schizophrener Patienten: Eine Charakterisierung. In: Psychotherapie und Sozialtherapie der Schizophre (Stierlin, HWynne, LCWirsching, M eds) Springer, BerlinGoogle Scholar
Goering, PNStylianos, SK (1988) Exploring the helping relationship between the schizophrenic client and the rehabilitation therapist. Am J Orthopsychiatry 58, 271–280CrossRefGoogle ScholarPubMed
Hartley, DE (1985) Research on the therapeutic alliance in psychotherapy. In: Psychiatry Update (Hales, RFrances, A eds) American Psychiatric Association Annu Rev, Vol 4, APA, WashingtonGoogle Scholar
Hogarty, GEAnderson, CMReiss, DJKornblith, SJGreenwald, PJavan, CDManonia, MJ (1986) Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. Arch Gen Psychiatry 43, 633–642CrossRefGoogle ScholarPubMed
Koenigsberg, HNHandley, R (1986) Expressed emotion: From predictive index to clinical construct. Am J Psychiatry 143, 1361–1373Google ScholarPubMed
Kuipers, LBebbington, P (1988) Expressed emotion research in schizophrenia: theoretical and clinical implications. Psychol Med 18, 893–909CrossRefGoogle ScholarPubMed
Leff, JVaughn, C (1985) Expressed Emotion in Families: Its Significance for Mental Illness, Guilford Press, New YorkGoogle Scholar
Liberman, RP (1982) Social factors in schizophrenia. In: Psychiatry Annual Review (Greenspoon, L ed) American Association of Psychiatry, WashingtonGoogle Scholar
Liberman, RPWallace, CJVaughn, CESnyder, KSRust, C (1980) Social and family factors in the course of schizophrenia: Toward an interpersonal problem-solving therapy for schizophrenics and their relatives. In: Psychotherapy of Schizophrenia: Current Status and New Directions (Strauss, JFleck, SBowers, MB Jr eds) Plenum Publ Corp, New YorkGoogle Scholar
Lorr, M (1965) Client perceptions of therapists: A study of therapeutic relation. J Consult Psychol 29, 146–149CrossRefGoogle ScholarPubMed
Matussek, P (1976) Psychothcrapie schizophrener Psychosen. Hoffmann und Campe, HamburgGoogle Scholar
Milgram, NA (1960) Cognitive and empathic factors in role-taking by schizophrenic and brain-damaged patients. J Abnorm Soc Psychol 60, 219–224CrossRefGoogle Scholar
Nuechterlein, KHGoldstein, MJVentura, JDawson, MEDoane, JA (1989) Beziehungen zwischen Patient und Umwelt in der Schizophrenie: Informationsverarbeitung, Komnninikationsstörung, autonomes Arousal und belastende Lebenscreignisse. In: Schizophrenie als systemische Störung. Die Bedeutung intermediärer Prozesse für Theorie und Praxis (Böker, WBrenner, HD), eds) Huber, BernGoogle Scholar
Parker, GHadzi-Pavlovic, D (1990) Expressed emotion as a predictor of schizophrenic relapse: An analysis of aggregated data. Psychol Med 20, 961–965CrossRefGoogle ScholarPubMed
Siol, TStark, FM (1992) Expressed Emotion und die Therapeut-Patient Beziehung mit Schizophrenen, submittedGoogle Scholar
Soldz, S (1990) The therapeutic interaction - research perspectives. In: Handbook of the Brief Psychotherapies (Wells, RAGianetti, VJ eds) Plenum Press, New YorkGoogle Scholar
Stark, FM (1992a) Schizophrene Patienten und ihre Familiären und therapeutischen Kommunikationspartner (S 250-263). In: Mensch - Psychiatrie - Umwelt. Ökologische Perspektiven für die soziale Praxis (Andresen, BStark, FMGross, J eds) Psychiatrie Verlag, BonnGoogle Scholar
Stark, FM (1992b) The development of the therapistpatient relationship scales with schizophrenic patients (TPSS). Behav Ther 15, 150–151Google Scholar
Stark, FMBuchkremer, G (1992) Die Therapeut/Patient - Beziehung in der Therapie schizophrener Patienten: Beurteilung durch Patienten und Therapeuten. Z Klin Psycho 21, 209–223Google Scholar
Stark, FMLiberman, RPCorrigan, PW (1992) Schizophrenic patients’ attitudes to therapists using behavioral and holistic-humanistic techniques. J Psychother Practice Res (in press)Google Scholar
Stark, FMSiol, TStolle, R (1990) Schizophrenic Patients caught between Family and Therapists. Paper presented at: International Family Therapy Conference, September, 2–7, 1990, Krakòw, PolandGoogle Scholar
Truax, CBCarkhoff, RR (1967) Toward Effective Counseling and Psychotherapy.Aldine, ChicagoGoogle Scholar
Truax, CB (1970) Effects of client-centered psychotherapy with schizophrenic patients: Nine years posttherapy hospitalization. J Consult Clin Psychol 35, 417–422CrossRefGoogle ScholarPubMed
Vaughn, CELeff, JP (1976) The influence of family and social factors in the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. Br J Psychiatry 123, 125–137CrossRefGoogle Scholar
Vaughn, CELeff, JP (1981) Patterns of emotional response in relatives of schizophrenic patients. Schizophr Bull 7, 43–44CrossRefGoogle ScholarPubMed
Whitehorn, JCBetz, BJ (1954) A study of psychotherapeutic relationships between physicians and schizophrenic patients. Am J Psychiatry 3, 321–331CrossRefGoogle Scholar
Zimmer, D (1983) Methodische Fragen bei der empirischen Erforschung der Therapeut-Klient-Beziehung. In: Die therapeutische Beziehung. Texte zur klinischen Psychologie (S. 5-11) (Zimmer, D ed) Edition Psychologie, WeinheimGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.