Interactional styles of out-patients with poor adjustment to chronic illness receiving problem-solving counselling

Abstract

A sample of subjects with poor to fair adjustment to chronic illness is described according to three interactional styles distinguished by patterns of beliefs about the self in relation to others along an axis of purpose, dependency and self-concept. Further, the question of whether differences in style are related to quantitative measures of adjustment, purpose in life, and health and social service consumption is addressed. A randomized controlled trial was set up involving adult subjects (Roberts et al. 1995a), who were not adjusting well to their illness as determined by the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR; Derogatis & Lopez 1983), and who were referred to one of nine specialty out-patient clinics in a large urban health care centre in southern Ontario. The subjects received a problem-solving intervention (experimental group) by random assignment to help improve psychosocial adjustment to chronic illness and reduce health care utilization. The nurse counsellors, using grounded theory, compiled descriptive formulations for 96 experimental subjects who were receiving problem-solving counselling intervention. In this group, three core interactional styles emerged. According to descriptions predominating in the formulations written by nurses, subjects were placed along a continuum from least to most effective in fostering social relationships and having needs met. The subjects were respectivley labelled “resigned”, “survivors” and “resourceful”. When these categories were compared for improvement in psychosocial adjustment, “resourceful” individuals had a clinically important (defined as 10 points) gain in their adjustment immediately following counselling. “Resourceful” individuals were able to maintain their gains in adjustment even 6 months after counselling (P=0.03). In contrast “resigned” individuals despite a slight gain with counselling continued in a trend toward their baseline poor adjustment status when counselling ended. “Resourceful” individuals were higher in their purpose-in-life score (PIL) at the outset and maintained that high purpose after counselling compared with “Resigned” individuals (P=0.03) who improved somewhat and then returned to low levels of purpose. All types of subjects with chronic illness were similar at the outset in their consumption of all health services. However, during the period of counselling, although not statistically significant an administratively important higher per person annual expenditure for services was generated by “Resourceful” individuals (P=0.11) followed by a marked reduction in their service consumption 6 months after counselling compared to consumption trends exhibited by “Resigned” and “Survivor” individuals.