Some factors influencing the treatment expectations of anxious neurotic outpatients

What do patients expect of psychiatric services? A systematic and critical review of empirical studies

The article reviews literature concerning patients' expectations of psychiatric care. Early research (pre-1980) is outlined, followed by a systematic review of 21 studies fulfilling specific inclusion criteria from 1980 onwards. Overall, patients expected to improve as a result of psychiatric treatment, and had higher expectations of the helpfulness of psychological and combined treatments than other interventions. Few studies considered expectations of the process of psychiatric care or determinants of expectations. The majority of studies focused on examining the relation between expectations and outcomes. There were indications that expectations of improvement were linked to clinical outcomes, although the relationship appeared to be complex. There was also some evidence that when expectations of the process of care were incongruent with the service provided, outcomes were poorer. The findings of studies in the systematic review were generally congruent with earlier work (pre-1980), although expectations of improvement appeared to be higher in the later studies. Interventions to prepare patients for what to expect were found to have beneficial effects on attendance, satisfaction and the accuracy of expectations about the process of psychiatric care. Future research should focus on developing valid and reliable measures for use in different settings, and on determining the mechanism by which expectations may relate to outcomes, including clinical outcomes, attendance and satisfaction.

Anxious symptomatic volunteers in the Twin Cities: sociodemographic description and MMPI psychodiagnosis

This paper underscores the need for true sample selection before statistical inference of any value can be made. Its findings suggest that the sample selection strategy of symptomatic volunteers can produce samples of anxious subjects with remarkable demographic similarity across the country. Anxiety as a constitutional rather than pathognomonic symptom is illustrated by the heterogeneity of its psychometric evaluation in our volunteers. Expecting a drug to safely relieve the anxiety of all anxious symptomatic volunteers is akin to expecting a drug to safely relieve the headaches of all headache sufferers. We feel that careful psychodiagnosis remains the best sample selection strategy.

Outpatient requests, initial sessions and attrition

Treatment attrition in a psychiatric outpatient department was evaluated. Of eighty-two consecutive new patients, fifty-three (65%) showed up for a second appointment while twenty-nine (35%) failed to return. None of the demographic variables or specific categories of patient requests differentiated continuers from non-continuers; nor was attrition significantly influenced by feeling one's problems were understood, symptomatic improvement or receiving the kind of intervention originally desired. Treatment continuers were more likely to have been referred by other hospital clinics or psychiatric care facilities, and more often had previous outpatient contact, but these differences did not reach statistical significance. The only outcome measures significantly related to continuation were: perceiving one's feelings understood in the initial session, feeling satisfied with the interview, and planning to return for the next appointment. Theoretical and practical implications of these findings are discussed.

Correlates of initial client disturbance: expectations for therapy, dropout, resistance, and demographic description

Relationships were investigated between initial levels of client disturbance in each of 10 problem areas and client drop-out, lateness to, and absence from therapy, expectations with regard to therapy, and various demographic variables. Data were obtained from 154 outpatients at a university psychological clinic. Correlations computed between initial disturbance scores and all other variables revealed many significant relationships. Most noteworthy were the significant relationships betwee initial disturbance levels in the areas of future goals and self-satisfaction and expectations in a psychodynamically oriented therapist. Results were discussed in terms of client's awareness of the need to deal with the psychological factors that underlie their problems and their desire for the therapist to focus on such material.

Replication Of Symptom Distress Factors In Anxious Neurotic Outpatients

In an attempt to replicate the factor structure of symptom distress re- ported by Mattsson et al. in their study of 404 anxious neurotic outpatients, the same 68-item pretreatment self-report Symptom Check List was administered to an independent but clinically similar sample of 1,116 patients. Using an identical factor-analytic procedure, five useful factors were extracted: Neurotic Feelings, Somatization, Performance Difficulty, Fear-Anxiety, and Depression. Four of these factors were almost identical to those reported by Mattsson e t al. while the fifth factor, Depression, seemed to represent a composite of the two small Depression factors (Anxious and Somatic) found in the earlier study. This minor discrepancy was discussed and the future research potential of these factors was indicated.