Volume 2, Issue 4, December 2000 pages 17-30
Factors influencing the evaluation of the relationship between schizophrenic patients and their therapists
in two different therapeutic contexts
Andrzej Cechnicki
*,
MałgorzataChechlińska
2, Michael Stork3
,Maria Wojnar1
1 Day Clinic and Family Therapy Unit of the Day Clinic, Department of Adult Psychiatry of the Medical College Jagiellonian University in Cracow
Department DirectorJProf. dr A. Szymusikl
2 Vocational Workshop Therapy Unit, University Hospital in Cracow
’Psychiatric Clinic, University Eppendorf, Hamburg
The aim of the present study was to research the influence of selected vari
ables connected with the psychopathological state of the patient and with the educational background of the therapist on the patient/therapist relationship (in the therapeutic process) as well as to identify the differences in the devel
opment of this relationship in two different groups of patients. The subjects of the research were a group of patients embraced by the long-term individual programme (Itip) and a group of patients embraced by the sheltered work
shops therapy (swt). All the patients were diagnosed as schizophrenics. In
cluded in the research were also the therapists working in both settings.
Keywords: therapist-patientrelationship,schizophrenia,therapeuticcontext The opinions
of outstanding
clinicistsconvince
usabout
theimportance
oftherela
tionshipbetween a
schizophrenic patientand his/her therapist and
encourageto study
thisrelationship
[27,12,20,7,17].All these researchers comprehensively describe
the therapist’s
attitude,which is indispensableto establish
thetherapeutic
contactand has
a positiveinfluenceon
thecourseof
theillness.However,theydonot present
anyspecific suggestions as tothemethodologyof
such research.Many
authorsthinkthat
in there
search
of
patient/therapists relationsit
is difficultto avoiderrors[16,15].Van
den Bosand
Karon [26]found out
that thesituation
in whichtherapists
con sciously
or unconsciouslyuse
the peoplewho are dependent
fromthem to satisfy
theirown personal
needsis
related tothe negativeoutcomeof schizophrenia
therapy.Karon
createdmeasurement instruments for
thischaracteristic,
which hecalled“
ma
ternalpathogenesis”. Gunderson
[14]created
arating
scalewhich
included tendi
mensions
measuringparticular characteristics of
therapistswho
workedwith
schizo
phrenic patients. The characteristics whichwere
thebest
predictors ofthe positive outcomeof
thetherapyamounted
to the therapist’s
satisfactionwith his/her
compo
sure
in the faceof strong emotions,
experienced both by himself/herselfand
thepa-18 Andrzej Cechnicki et al.
tient.
Witerhornand
Betz[22], onthe basisof
thetherapy outcome,
dividedthether
apists who took
careof schizophrenicpatients into
twogroups.In groupA
the thera pists
’ patientsdemonstrated
aremarkableor very
remarkableimprovement,while in
groupB
thetherapists
’patients
showedan
insignificantimprovement. The therapists
from groupAattachedmore attention
totheimportanceof a
patient’s
symptom inthe aspectof
his/herbiography.They were not
exclusively concentrated onthe reduction ofschizophrenia symptoms, but
theyactively co-operated with
thepatient
and,while providingsupport,
they formulated the goals ofthetherapy for
each individual pa tient. They
werealso more
active inestablishing
the relationship, which was morepersonal as
well.Torney [22]
stated that
thehyperactivity of
thetherapist
(i.e. frequentinterrup
tions, too
many
questionsand
interpretations,an
excessivelydomineeringstyle)
wascorrelated with
fearand hostility
ofschizophrenic patientsas wellas with
theirfeel
ing that
too
much wasrequired ofthem.On theother
hand,too
much withdrawalof
thetherapist (i. e. low
activity,little support,
lowempathyand understanding)
caused in schizophrenic patientsa
reductionof
verbalactivity,
mental disorders, hostility,and
depressiveness.The
quotedstudies concerned only
theperspectiveeitherof
thetherapist or
of the patient, measured one-sidedly.But
because the therapeutic processis based
on the relationship, whichis
adiadicsituation, one
canexpect interesting results
in the re search which
wouldestimate both
perspectives: the patient’s and
therapist’s.Stark [22, 23, 24,
25]constructed a diadic
testwhich evaluated
thetherapist-patient relation
ship. Cechnicki
and
Wojnar [10], following thismodel,
inorder
toexamine
this diadic relationship, created apolish version
of thequestionnaire, and
assessedits validity and
reliability.The
constructionof
thequestionnaire
whichresearches
the relationshipbetween atherapist and a
psychoticpatientand both questionnaires
werepresented
in theabove mentioned
study. Stark’s research
[22] clearly demonstrated the correlation between themutual
perceptionof
thepatient and
thetherapist. When
thetherapistassessedhimself/herself as
ratherrejecting, uncertain,and showing
little acceptancetowards
thepatient, and when he/she
wasmorecriticalabouthis/her
pro fessional competence,
then thepatient
assessed the therapist more negatively.Con
trariwise,
thepatients consider those
therapistsmore
supportive whofeel more self-
assuredand
competent. Intheir
subsequent researchWojnar
et al. [28] observed asimilar
regularity.Having
examined thecorrelationsbetweenthefactors intheques
tionnairefor patients and for
therapists, as wellas
thecorrelations
between the two questionnaires, it can besurmised
thatbothquestionnaires deal with correlated fac
tors whicharesituated along the acceptance-rejection continuum,
and
that thecorre
lations
betweenthequestionnaire for patients and for
therapistsarearrangedsymmet
rically in the
domains of
acceptance, professionalismand
uncertainty. This means that the patient’s and
thetherapist
’s
evaluationsof these
attitudesare identical.
Stark in hisresearch
observedthatpatients
ina worse
conditionevaluated their therapists as more rejecting,
incompetent, inscrutableand less supportive.
One can suppose that a diadic relationship
is also
subjectto
externalinfluences
(suchas
thetype
ofward or
thekindoftherapeutic
workshops)which are
conditionedby
thetherapeuticgoals and
theresulting selection of
patients.Therefore this attempt
wasmade toevaluate
thepatient-therapist
relationshipintwo outpatient wards whichdiffer
in the therapystyle.
Itseemed
importantto
investigate the influence ofthese variables which were
definedas
the therapeuticcontext.
Aim (of the research) and (research) hypotheses
This research
was conducted on the mutualrelationship
betweentherapists and patients in two
studygroups:
the sheltered workshopstherapy group and
the long
termindividual programme group.
Moreover,thisrelationshipwasresearched
incon nection
with thepatient’s
psychopathologyand with
thetherapist
’seducational back
ground. Sixresearch
hypotheses were
formulated:1. The
way inwhich thetherapistand
thepatient
perceiveeach otherdependson the attitudeof theother
party.2.
The
relation
between thetherapist and
theschizophrenic patient
depends on thetherapeutic context.
3. The
experienceof
the therapeutic relationship by thetherapist
is relatedto
thepatient
’s
psychopathologyas
well as tothe therapeuticcontext.
4. The
experienceof
thetherapeutic
relationshipby thepatient
is related to the pa
tient’s
psychopathologyas
wellas
tothe therapeuticcontext.
Description of groups and therapeutic context
Two
groups ofpatients
fromtwo different
therapeuticprogrammes
werestudied.Below
(table 1)
ispresentedageneral
description ofthe studied groups.Description of swt and ltip patients
Table 1
Group 1: sheltered workshopstherapy GroupII: long-termindividual programme Overall numberofpatients: 33 Overall number of patients: 24
Men:16 Women: 17 Men:9 Women: 15
Age:21-52 years Age: 30-56 years
Duration of the illness: 3-33 years Duration of the illness: 12-22 years Number of hospitalisations: 0-21 Numberof hospitalisations: 1-9 Therapy method: work therapy,
everyday contact, “co-existence”, self-reliance training andprofessional training.
Therapy method: regular, long-term supportive therapeutic contact (once ortwicea month).
All
the swtpatients were
diagnosedaccording
toICD-10
bypsychiatrists
very experienced inworking
with schizophrenics patients. They used amethod
of inde
pendentjudges.
Thecondition
of themajority of them
was good,and
theydid not
demonstrateacute
psychoticsymptoms. The
patientsremained
inconstant individual
care and
participated in worktherapy
(fivetimes a week).20 Andrzej Cechnicki el al.
The basic
therapymethod
in the swtis
occupational therapywhich
structures thepatient
’s daily
scheduleand its rhythm and
constitutes amotivatingfactor which
al
lowsfor
theactivation
of thispartof
thepatient’s potential that has not been affected by
theillness.
Thanksto
thismethod patients regain their sense of dignity and
their purpose in living.The
therapeutic relationshipwith these
patientsis chiefly based
on accompanyingand
supporting themin
theirfight
with theillness,
on the "co-exist-ence
’and assistance
insolving everyday
problemsaswell as
on teaching them self-reliance.
Thestrong
pointsof
thismethod are
agood mutual
contact, the patient’
strust
inthe therapist as
wellas
the possibilityof
obtainingadvice and
supportby
thepatient.
The patients who
participate in thelong-term individual
programme,when
their hospitalisationis over, remain
intheconstant,long-term contact with one therapist. In
themajority
ofthem remission is
observed,whilesomemayperiodicallyrelapse.
The researched patientsremained
inlong
therapeutic relationships (2-12 years)which were of
a supportivecharacter,
aimed atthe maintenanceof
the remissionstate,
the individual developmentand
assistancein the caseof
relapse.Below (table
2) generalinformation is gathered concerning
thetwenty therapists who
remained in the therapeutic relationshipwith
the patients in the twodiscussed
programmes.While thegender proportions are similar
inthetwo different therapeu
tic
contexts,a
majordifference
can benoticed as
to the length ofemployment
and educationalbackground. The
ltipstaffarehighly
qualifiedand
havea
moreextensiveclinical experience.
Table 2 Description of swt and ltip therapists
Group 1: shelteredworkshops therapy Group II: long-termindividualprogramme Overall numberof therapists:10 Overall numberoftherapists: 10
Men: 2 Women: 8 Men:2Women:8
Years ot employment: 3-17 Yearsof employment: minimum 10 Instruments and methodology
To
lest the subjectiveperception
ofrelationships the diadicquestionnaire
on the therapist-patientrelationshipwasused inits
polishversion
byCechnicki and Wojnar
[10],constructed
onthebasisof Stark
’s
questionnaire [22].Itconsists of
two separate questionnaires:for
thepatient and for
thetherapist. The factors in
bothquestionnaireswere selected
through factoranalysis.I.
Thequestionnaire for patients
includesquestionsconcerning five domains:
1. Acceptanceofthe therapist
’s personal
qualities;2.
Professionalismof
thetherapistas defined
by thepatient, expressed
inhis/her trust
in thetherapist
’s
knowledgeand
skills;3.
Uncertaintyof
thetherapist as perceived by thepatient;4. Dominationof thetherapistexperienced
by
thepatient;5. Rejection
ofthe therapist bythepatient.
II. The questionnaire for
therapistsconcernsthe followingfour areas:
1.
Acceptance of
thepatient
’s personal qualities;
2. Professionalism, i.e.The
therapist’s
senseofcompetence;3. Uncertainty
of
the therapist, bothpersonal and
professional;4. Rejection of
the patient bythetherapist.To
evaluate
the acutenessof
the psychopathological condition, thepositive and negative syndrome scale for schizophrenia
(pans) was usedin
thecase
of the swtpatients, and
overalland
Grohamm’s brief
psychiatricrating
scale intheltip group.
The correlations between the
results of
thequestionnaire for patients and for
thera pists were
investigatedwith
the useof
Pearson’s
correlation coefficient. Toinvesti
gatethe
differences
in theevaluationof therelationship,
in referencetothetherapist
’s educationalbackground, Duncan
’s
multiple interval test wasused.
Research results
The
results of the research weredescribed
on thebasis
of the analysis of the therapeuticrelationship,
thetherapeutic
context, aswell
as of the correlationbe
tween the
therapeutic
relationship, the patient’s psychopathology and
thetherapist’seducational background.
A. Therapeutic relationship and therapeutic context
Does
theway
inwhich
thetherapist and
thepatientperceive
eachotherdependon theattitude of
theother
party?This
partof
theresearch is
arepetitionofthelastyear’
sresearch carried out
in adifferent therapeuticcontext [28], whichembraced ex-out- patients
who, havingleft
theward,
remainedin intenseindividual
contact.Thistime
wewere interested
howthemutual therapist-patient relationship would
dependonthetherapeutic
context.For
thatpurpose theresearch
wasconducted in twovarious ther
apeutic programmes, different
from
the previous one.The swt group
The
correlationsbetween
the questionnairefor
patientsand for therapists were investigated
intheswtgroup. In
the mutual evaluationof
therelationship
thefactorsof
acceptanceand
professionalismproved to
beimportant.
Il turned
out
thatthere exists
a symmetricalcorrelation
in the domain of accep tance
inboth
questionnaires(table 3).
Thefeelingof sympathy, definedby the accep tance factor,
generallyseems to
bereciprocal.Simultaneously,
thetherapist
’s
experience ofhis/her professionalism
issignifi
cantly
related to
thepatient
’s
acceptanceand
perceptionof
thetherapist
asa profes
sional person,
whichamounts
to trust in his/hercompetence. For
thetherapist,
thepatient
’s high appreciation of
his/herprofessionalismand
thepatient
’s
sympathygohand
inhand with his/her own
sense ofprofessionalism and
areconnected with
the self-evaluationof
his/herown competence.
The
reciprocalityoftheattitudes does not
concernnegative
attitudes,e.g. There
is no correlationbetween
negativeand approving
attitudes.22
Andrzej Cechnicki et al.Correlations between the results of the questionnaire for patients and the results of the questionnaire for therapists in the swt group
Table 3
Patient Therapist
1 Acceptance
2 Professionalism
3 Uncertainty
4 Domination
5 Rejection 1
Acceptance *0.35 0.12 0.03 -0.14 -0.06
2
Professionalism *0.36 *0.39 -0.23 -0.23 -0.33
3
Uncertainty -0.12 -0.01 -0.06 -0.02 0.03
4
Rejection -0.26 -0.07 0.09 0.18 0.26
Pearson correlation coefficient * p<0.05
The Itip group
The same
correlationswere investigated in
the ltip group.Itturnedout
thattheltip
patients,who remain
inlong-term
individual contact, perceive those therapists who show no sympathy towards themas
domineering ones.This is
the onlystatistically
significantcorrelation.Thetherapist’s
dominance,as perceived
by thepatient,is neg
atively
correlated with the therapist’s personal
acceptanceof
thepatient. The
factor of mutual acceptance didnot prove
tobe significant. What is
puzzlingis
thelack of mutual correlation
inother attitudes, both
negativeand positive (see
table4).Correlation between the results of the questionnaire for patients and the results of the questionnaire for therapists in the ltip group
Table 4
Patient Therapist
1 Acceptance
2 Professionalism
3 Uncertainty
4 Domination
5 Rejection 1
Acceptance -0.13 0.05 -0.33 *-0.41 -0.19
2
Professionalism -0.09 0.05 -0.38 -0.38 -0.22
3
Uncertainty 0.07 0.02 0.35 0.35 0.15
4
Rejection 0.13 0.15 0.34 0.34 0.09
Pearson correlation coefficient * p<0.05
B. Therapeutic relationship versus psychopathology
The correlation
betweenthetherapist
’s
attitudesand
the patient’
spsychopatholo
gywasinvestigated in theswtgroupand
theltip
group,with
thedifferences between positive and negative
symptomstaken intoaccount.
The swt therapists
The
correlationsobtainedwiththeuseof
Pearson’s
testbetweentheresultsof
the questionnairefor
therapistsand
the results in thepans
scalerevealed
a connection between thepatient
’s
psychopathologyand
thetherapist
’sattitude
towardshim/her.
It turnedout that
the patient’s
psychopathologyis
significantlyrelated to all
the four investigatedattitudes of
thetherapist(seetable 5),
whichmakes
theresults
analogous to those obtained byStark.
The intensifiedgeneral psychopathology is
closely con nected
withthetherapist
’s lower
acceptanceof
thepatient. Moreover,in
suchasitu
ation
thetherapists perceive
themselvesas
less professional, uncertainand have
atendency
toreject
thepatient.
Next,more research
wascarriedout
onthe correlationbetween
thetherapist’s attitudes and
positiveand negative
symptomsseparately. It seems
thatpositivesymptoms are
connectedwith
thetherapist’s
lack ofacceptance, theuncertainty and
therejection of
thepatient,
whilethey haveno
influence on the therapist’ssense of
professionalism.Negativesymptoms
thenare connected with
thelack of
acceptancetowards
thepatient,
withthetherapist’s
senseof incompetence
andhis/her
senseofuncertainty
in thetherapy.In contrast to positive
symptoms,negative symptoms are not
connectedwith
the therapist’s
rejection ofthe patient.Correlations between the factors of the questionnaire for therapists and the patient’s psychopathology acc. To pans (swt group)
Table 5
Psychopathology
Therapists' attitudes Pans PositiveSymptoms NegativeSymptoms 1
Acceptance **•-0.59 **-0.41 **-0.53
2
Professionalism ‘-0.43 -0.25 **-0.51
3
Uncertainty "0.49 *0.48 *0.34
4
Rejection *0.35 *0.35 0.32
Pearson correlation coefficient * p<0.05, ** p<0,01, *** p<0,001 The swt patients
Similarly
aswith the swttherapists, thecorrelation between theswtpatients’
atti
tudesand
theirpsychopathology wasresearched.
In this groupthepatient
’s
psycho
pathology
wasinnoway related to his/herperception of
thetherapist (see
table6).
24 Andrzej Cechnicki et al.
Correlations between the factors of the questionnaire for patients and the patient’s psychopathology acc. To pans (swt group)
Table 6
Psychopathology Pans Positive Negative
Therapists’attitudes Symptoms Symptoms
1
Acceptance -0.20 -0.21 -0.18
2
Professionalism 0.19 0.22 -0.01
3
Uncertainty -0.12 -0.03 -0.01
4
Domination 0.09 0.08 0.22
5
Rejection -0.19 -0.10 -0.01
The ¡tip therapists
The correlations
between thefactors of
thequestionnaire for
therapistsand
thepatient
’s
psychopathology (accordingto BPRS)
in theltip
groupwereinvestigated.
There exists
acorrelationbetweentheltip
patient’s psychopathology and
thether
apist
’s attitude only
inthedomain of
acceptance(see
table7). The higher
thepatient’
s general psychopathologicallevel,
theless
he/she isaccepted
by the therapist.This
correlationis
statisticallyvery
significantand refers
chiefly to negativesymptoms.Factors
other
than acceptanceare not
significantlycorrelated with
the patient’s psychopathology.Table 7 Correlations between the factors of the questionnaire for therapists
and the patient’s psychopathology acc. To BPRS (ltip group)
Psychopathology Therapists’ attitudes
BPRS
General condition PositiveSymptoms NegativeSymptoms 1
Acceptance *‘‘-0.60 -0.24 *-0.42
2
Professionalism -0.26 0.02 -0.14
3
Uncertainty 0.28 -0.05 0.11
4
Rejection 0.24 -0.17 0.07
Pearson correlation coefficient * p<0.05, *** p<0,001
The ¡tip patients
The correlations between
thefactors of
thequestionnaire for
patientsand
thepa
tient’s psychopathology (accordingto
BPRS)
intheltip
groupwere
investigated.As compared with
the swtpatients,
theworse condition of
theltip
patientsaffects
theevaluation
oftherelationship. In particular
thetherapist
’s professionalism is
more negativelyevaluatedand
theacceptancetowards
thetherapist
is loweredwhilehe/she is
perceivedas
domineering(see
table 8).Table 8 Correlations between the factors of the questionnaire for patients
and the patient’s condition acc. To BPRS (ltip group) Psychopathology
Therapists’ attitudes
BPRS Generalcondition
Positive Symptoms
Negative Symptoms 1
Acceptance -0.37 -0.11 *-0.48
2
Professionalism ‘-0.38 -0.08 **-0.54
3
Uncertainty 0.38 0.04 0.16
4
Domination *0.46 0.07 0.35
5
Rejection 0.18 0.04 0.02
Pearson correlation coefficient * p<0.05, ** p<0,01
Therapeutic relationship versus educational background
This research
wascarried out
onlyamong
theswttherapistsbecause
theltip ther
apistsconstituted a
homogeneous
groupinrespect of educational
background. Onthe contrary,the swttherapistscould bedivided
intothree
professionalcategories: occu
pationaltherapists, psychiatric nurses
and staff with higher psychiatric or
psycholog
icaleducation.
Thecorrelationsbetweentheattitudesand
theeducational
background weresought with
theuse of Duncan
’s
multiple intervaltest. The
resultswere com
paredindependently
for
each factor.Significantdifferenceswere observed
inthether
apists’
grouponly
intheprofessionalismand
uncertaintyfactors. It
turnedout
thatthe three different professionalgroups providing therapy
within the swtprogramme dis
played
significant
divergences, the levelof
significance being0.01 intheprofession
alism
factor.The
most assured of their professionalismfelt
the occupational thera
pists
with no psychological education(see table 9).
26
Andrzej Cechnicki et al.The factor or professionalism versus the results of the questionnaire for therapists (swt group, therapists of different educational backgrounds)
Table 9
Education Size of the group Average results Standard deviation
Occupational therapists 3 20.66 1.15
Psychiatric nurse 9 18.11 3.55
Psychiatric and
psychological Education 21 16.04 2.87
Level of statistic significance pcO.Ol
Itwas alsopointed
out
thatthese
categoriesoftherapists significantly differ (the levelofsignificancebeing0.01 )as to
thefactor ofuncertainty.The least
uncertainare the psychiatricnurses,
whoseemployment period
is thelongest one
incomparison with
thatof other
swtemployees:
thenurseshave worked
at the ward sinceitsestab
lishment.Table 10 The factor of uncertainty versus the results of the questionnaire for therapists
(swt group, therapists of different educational backgrounds)
Education Size ofthe group Average results Standard deviation
Non-psychiatric 3 16.00 1.73
Psychiatric nurse 9 14.22 3.34
Psychologicaland psychiatric
education 21 17.56 2.29
Level of statistic significance p< 0,01
The
significanceof
thedifferences
in the patients’
attitudes towards their thera
pists was examined inrelation to
thetherapists
’ educational background.It appears
thatfor
theswtpatients
thefactor of
thetherapists’
educationalbackground is
inno way connectedwith
theevaluation of
the therapeuticrelationship.
Discussion
The
factor that bears the greatestimportance
in thetherapeutic relationship
ispersonal
acceptance. Thischaracteristic is pointed to as a significant one
inmost
bibliographical items referring toresearch
onpsychotherapy. The present
study cancontribute
tothe demonstrationofhowrelationship-based
thisphenomenon is.
The importance of
theacceptance
factor wasdisplayed particularly
in the swt group. Itseems thatthereexists a symmetrical correlation in acceptance.The
thera
pistlikes the patientdependingonwhetherhe/she is liked
by thepatient,
approvedof asaperson,
shownsympathy. Similarly with
thepatient,
themore he/she is liked
by thetherapist,
themore he/she requites
thefeeling.
At the
same time
thetherapists
’ sense ofprofessionalism issignificantly linked
withthepatients
’acceptance and perception of them
asprofessionals,which amounts
totrust
intheir
competence.For
thetherapists,thepatients
’high appreciation
of their professionalismand
thepatients’
sympathygo
hand inhandwith
theirown sense of
professionalismand are
connected withtheself-evaluation oftheir
owncompetence.The
reciprocalityof
the attitudesdoes not refer
tonegative
attitudes,e.g. There
is nocorrelationbetween
negativeand approving attitudes. It
may happen thatthepa tient
likes the therapisteven
whenperceiving
him/her as domineeringorevenwhen rejected
by thetherapist.
In the
long-term individual
programme,where
thetherapist-patient relationship
is along-term one,attitudes are perhaps
lessemotionally loaded, while the problemof dominance comesto
thefore.
Thesense of
being dominatedby thetherapist
may be thecause of
dependence,and it binds
thepatient
in therelationship.The
maintenanceof such a
relationshipentails thesubordination of
thepatient, which
inturn hinders
theseparation process,
socrucial
in thetherapy
ofschizophrenia.
Onthe
basis of
oursubsequentresearch
itmay be surmised thatthepatient
’s psy
chopathology
has a considerable impact
onthetherapist’s attitudes. For
thetherapist,
therelationshipwith
thepatient
in aworse
condition isamore difficult
one, especial ly
whennegativesymptoms
areintensified.
However,one
caneasily
noticethediffer
ences
in thetwo different
therapeuticcontexts,
which areconditioned
bytheir
special character. Itappearsthattheimpact of
thepatient’s
psychopathologyis
muchstronger in the swt group.This can
beexplained by the kind ofrelationship
whichrelies
on everyday,several hours long contact with
apsychoticpatient,
analogousas inparen tal relationships. This
makes the therapistsmore
sensitive to the patients’ psycho-pathological condition, more
tenseand
tired than in thecircumstances of
structuredand
lessfrequent therapeutic meetings
inthelong-term individual
programme.In the
case of
theswt
patientssuch results are not
observed: inthecircumstances of
frequent,close contacts their
psychopathologyhas
noinfluenceon their perception
of the therapist.This
may beconnectedwith
thefact
thatthe swttherapeutic relation ship relies
less ontreatment,
andmoreonaccompanying thepatient,who
regards theward
ratheras a
‘workplace’
thana
‘hospital’.
Theclose
tiesand
the familiarityhelp topreserve
the patients’
senseof
self-fulfilment,even
when the symptomsof
theillness
are intensified.On the
other
hand, thepatients
whoremain
in long-term,outpatient
therapeutic relation evaluatetheirrelationshipwith
thetherapist
inconnectionwith their
psycho pathology. Because
oftheir more serious condition,
they perceive theirtherapists as less professional, domineeringand
theiracceptance of them is
lower.The kind of
therapeuticcontact which is
typicalof
thisgroupofpatients
maycontribute
tothefact that
the patient, whenevaluating
his attitude towards thetherapist, attaches
more attention to his/herowncondition and
well-beingand makes
thetherapist
responsible for them.Of special
interestare
theresults
concerningthe impactof
thetherapists’ educa
tional
background
on theevaluationof
the therapeutic relationship as they manifest theimportance of
thetherapeuticcontext. In
the swtprogramme
themost
profession
28
Andrzej Cechnicki et al.ally
assuredare
theoccupational therapists, becausetheirskills
areexcellently
suited to thetask of
therehabilitation
programme.For
thepatients
then the educational backgroundfactor plays
norolesincetheyare
probablymoreinterestedinthekindof contact, in theassistance
theycangel in performingthetasks which resemble
profes sional
work,and
inothernon-specificfactorswhich
arecharacteristic of interperson
al
rather than therapeuticrelationships.
It
must
alsoberememberedthattheresearch
oninterpersonal relationships is
hard,almost
impossible,and
thatany generalisations lead
to reductionism. Inthesearch
of reliablestatistical
datawe
cancome closer to
the description ofreality
on condition that we take intoconsideration
several variableswhich
areconnected with
the spe
cial,unique
characterof eachtherapeuticrelationship.
Conclusions
The above described results of
theresearch confirm
theinfluence
ofthepsycho- pathological state,
thetherapeuticcontext and
the jobof
thetherapist
on thesubjec
tiveevaluation of
the therapeuticrelationship
by theinvolved parties.
It turnedout
that:1.
The personal
acceptancefactor
plays themostcrucial role inthetherapeuticrela
tionship regardlessofthetherapeuticcontext.2. The intensification of
psychopathologicalsymptoms
significantly underlines the importanceof thetherapeutic context.
Suchintensification taken
intoaccount,
the perceptionof
thepatient
by the therapistand
viceversa depends
on thecontextin which
thetherapyoccurs.3.
The
intensification ofnegative symptoms
significantlylowers
the acceptance of patients by therapists, regardlessofthe therapeuticcontext,but
in everyday,per
manent
contact it is
positivesymptoms thatare
connected with the rejection ten
dency.4.
For
the swtpatients
thefactor of
educational backgroundis
inno way
related totheir
evaluationoftheir
relationshipwith
thetherapist.5.
Workshop therapists feelto
be themost competent and
professional group in thesheltered workshops
therapy,while psychiatric nurses with
longpractice
inpsy
chiatry feel
to
betheleast
uncertain.References
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