Individuals in nontraditional inpatient care settings such as residential care and virtual hospitalization can develop strong therapeutic alliances with their care providers, reports a study in Psychiatric Services in Advance.
“Although inpatient care is considered the standard approach for acute states, efforts have been made in recent years to develop alternatives to hospitalization,” wrote Avraham Friedlander, Ph.D., of Ariel University, Ariel, Israel, and colleagues.
“Because alternatives to psychiatric hospitalization ground their treatment approach in therapeutic principles that differ from those of traditional inpatient care, whether the alliance will develop in a similar manner remains unclear.”
Friedlander and colleagues recruited 188 patients from three treatment settings:
- A standard inpatient psychiatric ward at a medical center.
- A residential care center known as Soteria House, which has a full professional staff but aims to create “a nonhierarchical and nondiagnostic environment … with medication not considered a first-line treatment.”
- A telepsychiatry-based hospitalization in which patients recover at home but have ongoing monitoring and online access to psychiatrists, nurses, and other professionals 24/7.
Each patient and therapist (the psychologist, social worker, or psychiatric nurse who spent the most regular time with the patient) completed the Session Alliance Inventory following the first therapy session and again at discharge or treatment termination. The Session Alliance Inventory tracks how both participants in the therapeutic relationship feel on issues such as being appreciated, agreement on therapy goals, and development of a bond.
Patients in all three settings reported a strengthening of the therapeutic alliance over time, with no significant differences among the groups. Therapist responses, however, showed some differences, with therapists at the online hospital reporting a stronger therapeutic alliance at baseline compared with therapists in the other two settings. Friedlander and colleagues suggested that the novelty of online patient care and its nonstigmatizing nature may have helped therapists engage more rapidly with their patients, but more research is needed.
The Soteria therapists reported significant strengthening of bonds over time, however, and by the time of patients’ discharge, the therapist-reported therapeutic alliance at Soteria was almost as strong as for the online therapists.
“These findings suggest that alternatives to psychiatric hospitalization enable alliance to develop in a manner similar to that in traditional psychiatric hospitalization,” the researchers concluded. “To further advance research and clinical care, additional studies are needed to assess the effects of these dynamics on recovery, stigma, social inclusion, and therapeutic outcomes.”
To read more on this topic, see the Psychiatric News article “When Prescribing, Remember the Power of the Doctor-Patient Relationship.”
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