The relevance of professionals’ attachment style, expectations and job attitudes for therapeutic relationships with young people who experience psychosis
Abstract:BackgroundTherapeutic 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 rel… Show more
“…Figure 1 summarises the progress of papers through different stages of the review. Thirteen papers [13][14][15][16][17][18][19][20][21][22][23][24][25] met criteria for inclusion, and were included in the final analysis ( Table 3 and 4). No randomised controlled trials or cohort studies were found.…”
It is unclear whether or not there is a relationship between attachment style of health workers and patients' health outcomes. Further research using consistent data collection tools, especially in relation to the attachment measurement construct selected, and analysis methods across studies is required to draw recommendations for clinical practice.
“…Figure 1 summarises the progress of papers through different stages of the review. Thirteen papers [13][14][15][16][17][18][19][20][21][22][23][24][25] met criteria for inclusion, and were included in the final analysis ( Table 3 and 4). No randomised controlled trials or cohort studies were found.…”
It is unclear whether or not there is a relationship between attachment style of health workers and patients' health outcomes. Further research using consistent data collection tools, especially in relation to the attachment measurement construct selected, and analysis methods across studies is required to draw recommendations for clinical practice.
“…To measure clinicians’ attitudes relating to working with people with distressing voices, a 35-item modified version ( McLeod et al, 2002 ) of the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ; Cartwright, 1980 ) was used. The original AAPPQ had been designed to capture therapists’ attitudes toward working with patients who abuse alcohol, and it has been modified ( McLeod et al, 2002 ; Berry and Greenwood, 2016 ) to capture attitudes of mental health professionals to working with people with psychosis. For the purpose of this study, the questionnaire items were amended to refer specifically to voice-hearing.…”
IntroductionDue to the general psychopathological vulnerability of young people who hear distressing voices, research has stressed the importance for clinicians to assess this experience in youth. Nonetheless, the limited literature on the topic comes from studies with clinicians in adult health services and it primarily reports that clinicians do not feel confident in systematically assessing voice-hearing and doubt the appropriateness of doing so. We applied the Theory of Planned Behavior and identified clinicians’ job attitudes, perceived behavioral control, and perceived subjective norms as putative predictors of their intent to assess voice-hearing in youth.MethodNine hundred and ninety-six clinicians from adult mental health services, 467 from Child and Adolescent Mental Health (CAMHS) and Early Intervention in Psychosis (EIP) services and 318 primary care clinicians across the UK completed an online survey. The survey gathered data on attitudes toward working with people who hear voices, stigmatizing beliefs, and self-perceived confidence in voice-related practices (screening for, discussing and providing psychoeducation material about voice-hearing). Responses from youth mental health clinicians were compared with professionals working in adult mental health and primary care settings. This study also aimed to identify what youth mental health clinicians believe about assessing distressing voices in adolescents and how beliefs predict assessment intention.ResultsCompared to other clinicians, EIP clinicians reported the most positive job attitudes toward working with young voice-hearers, the highest self-efficacy in voice-hearing practices, and similar levels of stigma. Job attitudes, perceived behavioral control and subjective norms explained a large part of the influences on clinician’s intention to assess voice-hearing across all service groups. In both CAMHS and EIP services, specific beliefs relating to the usefulness of assessing voice-hearing, and perceived social pressure from specialist mental health professionals regarding assessment practices predicted clinician intention.DiscussionClinicians’ intention to assess distressing voices in young people was moderately high, with attitudes, subjective norms and perceived behavioral control explaining a large part of its variance. Specifically in youth mental health services, promoting a working culture that encourages opening and engaging in discussions about voice-hearing between clinicians, and with young people, and introducing supportive assessment and psychoeducation material about voice-hearing could encourage conversations about voices.
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