PREDICTION AND EVALUATION OF OUTCOME IN AN EMERGENCY BRIEF PSYCHOTHERAPY CLINIC

Abstract

This is a report of a pilot (N = 20) and replication (N = 33) study seeking predictors for and examining the effectiveness of short-term focal psychotherapy, accompanied by minimal or no psycho-active drugs, in the treatment of acutely disturbed psychiatric patients. The goals of this psychotherapy were to alleviate symptoms and return the patient to premorbid levels of vocational, domestic, and physiological functioning. Several newly developed evaluative measures were used: a Psychiatric Morbidity Scale (PMS), which provides a score of the relative severity of and functional disability produced by the psychiatric disorder, based on a standardized interview; a Therapist Attitude Inventory (TAI), a self-rating system which gives an index of conscious (and presumably unconscious) therapist attitudes toward each patient; verbal behavior scales of anxiety, hostility, social alienation-personal disorganization, and interest in human relations, all objective scores derived from the content analysis of 5 minutes of the patient''s speech; and social-class ratings based on the Hollingshead-Redlich 2-factor ratings. The above measures showed this type of psychotherapy to be associated with symptomatic and functional improvement among a high percentage of these psychiatric patients, a change in psychiatric status that was maintained for at least several months. Whether or not the therapist liked or disliked the patient had no relationship with the degree of improvement of the patient. Also, though therapists liked higher-social-class patients better than lower-social-class patients, lower-social-class patients who remained in treatment showed more improvement than upper-social-class patients. The predictive measures of outcome in this type of short-term psychotherapy clinic revealed the following characteristics of the "good responder": facility and positive interest in interpersonal object relationships (high human relations score[long dash]HRS); no signs of a disorder in thinking or of social alienation, typical of the schizophrenic individual (low social alienation-personal disorganization score); experiencing acutely distressing and disabling psychological symptoms (high scores on the Psychiatric Morbidity Scale, the anxiety scale, and the hostility inward scale; coming from a lower socioec momic background (social classes IV and V of the Hollingshead-Redlich Scale).