Interpersonal Considerations and Judgements in a Day Hospital

Abstract

There is a body of opinion which regards psychiatrically ill individuals, or at least one great class or subdivision of them, as suffering primarily from disturbances in personal relationships and social interaction processes generally. Sullivan, Horney and Fromm have made the most significant theoretical contributions to this subject, and empirical applications have been reported by Balint (1957), Maxwell Jones (1968), Rapoport (1960) and Laing (1961). These writers have at least this in common, that they take the point of view that since the pathology of the illness lies in social relationships the fundamental treatment process must lie there also—must, in fact, consist of re-experiencing social interaction within a therapeutic re-educative framework. In the past attention has been directed principally to the doctor-patient relationship as a heuristic model of social interaction, but Rapoport has extended the operational range of significant interaction to include all staff-patient, staff-staff and patient-patient encounters. As the recent Subcommittee of the Central Health Services Council has pointed out (1968), little has been written of the nurse as therapist, but a considerable literature has accumulated concerning the role of the social worker or caseworker or counsellor (e.g. Halmos, 1965). Halmos investigates the nature of such relationships, and finds therapeutic utility to be unrelated to intellectual skills. The therapeutic process is adjudged to lie in the relationship, true enough, but the essential qualities have more to do with the interpersonal styles of the therapist, than with his analytical expertise. Such is his conclusion. Apparently social skills are necessary for the professional worker, but intellectual skills for the problems to be unravelled are of little importance, and are largely irrelevant.

Patient satisfaction with community psychiatric nursing: a prospective controlled study

“…The mean therapeutic relationship score indicates that generally satisfaction with both agents is high -a common result in health care studies, but is significantly greater among nursing group patients. These results support the observations made in other investigations that have compared patient satisfaction with psychiatric nurses, social workers and psychiatrists (Ferguson & Camey 1970), Turner-Smith & Thomson 1979), They are also in accord with the studies of nurse practitioners renewed by MacFarlane (1980), Of particular interest are the elements of the therapeutic relationship revealing significant divergences between the two patient groups. These confirm the importance patients attach to the expressive role ofthe nurse.…”

Psychiatric Treatment: the Question of Attitudes

“…Daily ward routine and physical care are major parts of hospital nursing duties but a substantial part of patient-nurse interaction is concerned with discussion or tackling of psychological problems (18). It is not surprising, therefore, that a majority of psychiatric hospital patients report that they derive a greater benefit from their interaction with nurses than with doctors or social workers (19,20). Similarly there is a greater agreement between nurses and patients regarding the value of particular psychiatric treatments than there is between patients and doctors or social workers.…”

“…Studies of group psychotherapy for instance show that an 'enthusiastic attitude' as well as the patient's 'degree of sophistication' in using such a treatment facility are important predictors of good outcome (20,30). But social attitudes are also relevant to the patient's acceptance of group therapy, since conservative subjects have been shown to be less favourable towards this 'democratic' method of treatment (31).…”