Staff expressed emotion and causal attributions for client problems on a low security unit: an exploratory study

This is an exploratory study that sought to investigate a number of measures of staff-patient relationships on a continuing care, low security inpatient facility for patients with severe mental illness. Twenty staff members were assessed for expressed emotion (EE) using the Camberwell Family Interview (CFI) in regard to a client for whom they were a designated key worker. Their spontaneous attributions for the patient's problems were also assessed, along with self-report staff and patient ratings of their expressed and perceived feelings and thoughts about their staff or patient counterpart. The study found that although none of the staff were rated as fulfilling criteria for high EE, there was evidence of some variability in the quality of staff-patient relationships as assessed from the subjective self-report scales of staff and patients. Patients seemed to be sensitive to staff feelings for them: patient ratings of perceived feelings and thoughts from staff were significantly correlated with staff expressed feelings both from the CFI EE ratings and the direct self-report staff measures. Staff tended to view the behaviors of patients they felt less positively disposed toward as more controllable, and this association between less benign explanations of behavior and a more critical attitude is consistent with the attribution research for familial caregivers. The more negatively perceived patient group was found to be more likely to have behavioral disturbances in the 7 months after the relationship ratings were made. This article discusses measurement issues in the assessment of formal caregiver-patient relationships in the light of this and previous studies.