The Relationship Between Locus Of Therapy And Treatment Outcome In Chronic Psychiatric Outpatients

Abstract

The problem of this study was: to what extent will chronic psychiatric outpatients receiving treatment in neighborhood based settings experience lessening of rehospitalization, crises, symptomatology and improved attendance and affiliative behavior as compared to patients treated in a mental health center setting? The importance of this study derives from the need to decrease institutional transference and modify patient identity in order to enhance community adjustment, interrelatedness and socialization. All data were secured from 64 adult psychiatric outpatients currently receiving treatment at the Connecticut Mental Health Center. Subject groups were formed by matching an available sample of 32 patients receiving group psychotherapy and medication maintenance in neighborhood based groups with 32 patients receiving the same treatment in mental health center based groups. A multi-dimensional assessment approach was used to evaluate the effectiveness of the treatment conditions. Rehospitalization, crises and attendance data were secured from the patients' records to include the previous 24 months of treatment. Measure of symptom status was the Symptom Check List (SCL-90) a self report; affiliative behavior was assessed by the Affiliation Self Report Questionnaire, developed by the writer. The hypotheses of the study were: Hypothesis I. The neighborhood based group will demonstrate better attendance than the mental health center group. The experimental prediction that the neighborhood group would attend more regularly was not supported. Hypothesis II. The neighborhood based group would have significantly fewer crises than the mental health center based group. The results did not support this prediction. Hypothesis III. There would be a significant difference in the number of rehospitalizations between the two groups. The experimental prediction that the neighborhood based group would have an impact on reducing recidivism was not supported. Hypothesis IV. The neighborhood based group would have lower mean scores on all subscales of the SCL-90 than the mental health center based group. The differences obtained were not significant on all subscales except the Paranoid Subscale where the mental health center based group showed higher mean scores than the neighborhood based group. Hypothesis V. There would be a significant difference on all item scores on the Affiliation Self Report Questionnaire between the two groups. The differences obtained were significant on six of the 12 variables in the predicted direction. This supports the position that locus of therapy is significantly related to increased affiliative behavior. From the results, the conclusions were drawn that: (1) neither setting was superior to the other in reducing recidivism, crises, symptomatology or in increasing attendance, (2) neighborhood based treatment is significantly related to an increase in affiliative behavior. Results were discussed in terms of factors which may have influence in the experimental findings. Implications for future research of this type was discussed and the hope was expressed that investigation aimed at determining and demonstrating cause-effect relationships to locus of therapy will receive further expirical emphasis.