Patient-appraised beneficial moments during inpatient psychiatric treatment

Cosima Locher,Stefan Büchi,Ramin Mansour,Helen Koechlin

doi:10.1186/s12913-020-05617-4

Abstract

BackgroundPsychiatric inpatients receive a multidisciplinary treatment approach, covering psychiatry, nursing, occupational therapy, and psychology. Research findings reveal that the effectiveness of any treatment is associated with three types of factors: specific (e.g., treatment techniques), common (e.g., clinician-patient relationship, patients’ expectations) and extra-therapeutic. However, there is little published research on the factors and events which inpatients themselves consider to be beneficial (‘beneficial moments’).MethodsInpatients (N = 107) of a psychiatric clinic completed a questionnaire to elicit their appraisal of beneficial moments. A qualitative content analysis was applied. The coding procedure was conducted independently by two authors.ResultsSelf-appraised beneficial moments were found in five areas: therapy-specific components (number of quotations, N = 204), positive relationships (N = 140), clinical setting and environment (N = 52), inpatients’ new insights (N = 36), and factors unrelated to either therapy or the clinic (N = 30). In total, 44% of the quotations were related to specific factors, 49% to common factors, and 7% to extra-therapeutic factors.ConclusionsInpatients judge both specific and common factors as crucial for the therapeutic benefit they gain during their stay at the clinic. Our results differ from meta-analytical findings, where the impact of specific factors on symptom improvement has shown to be much smaller (i.e., 17%) than appraised by patients in our study (i.e., 44%). Our study underlines the importance of a patient-centred care approach as well as shared decision making and patient-clinician communication. For clinical practice, knowledge of inpatients’ perspectives on beneficial moments is crucial in order to reinforce precisely these therapeutic components.

Highlights

Psychiatric inpatients receive a multidisciplinary treatment approach, covering psychiatry, nursing, occupational therapy, and psychology
Psychiatric inpatients participate in a wide array of multidisciplinary treatments: inpatient care usually involves psychiatry, nursing, occupational therapy, and psychology [1]
A meta-analysis evaluating the efficacy of non-directive supportive therapy in adult patients suffering from depression reported that common factors are responsible for about half (49.6%) of the symptom improvement, whereas extra-therapeutic factors are responsible for about 33.3% and specific factors for about 17.1% of the improvement [13]

Summary

Introduction

Psychiatric inpatients receive a multidisciplinary treatment approach, covering psychiatry, nursing, occupational therapy, and psychology. Research findings reveal that the effectiveness of any treatment is associated with three types of factors: specific (e.g., treatment techniques), common (e.g., clinician-patient relationship, patients’ expectations) and extra-therapeutic. Since the late 1940s, psychotherapy research aimed to uncover the effect of ‘specific factors’ (e.g., treatment techniques and methods such as exposure, free association, skills training) which rely on a specific psychotherapy theory (e.g., CBT). Beyond their specific components, different psychotherapy approaches typically share a variety of socalled ‘common factors’ [4], including the interpersonal clinician-patient relationship [6] patients’ expectations [7], as well as the provision of a convincing rationale [8]. The variety of common factors that are indispensable to practising psychotherapy effectively have been summarized in the contextual model [14, 15]

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