The content of interactions: Naturally occurring contingencies within a short-stay psychiatric unit

Abstract

The rate and content of naturally occurring interaction patterns between twenty target psychiatric patients, their peers and staff, were observed within a short-stay psychiatric unit. A seven category behaviour scale, shown to have both content and concurrent validity, was used to rate subjects' behaviour. Responses to the target patients' behaviour were coded as positive attention, negative attention or ignore. It was found that more than half the time (56.7%) that the subjects were observed, they were engaged in solitary activities. Staff interacted with them for 15.9% of the total observation periods and responded with positive attention, to both inappropriate and appropriate subject behaviour during 98.1% of that time. Patients were also found to be indiscriminate in the manner in which they responded to their peers. They interacted with the target subjects 15.4% of the time and applied positive attention for 98.4% of that interaction period. A comparison of the rate and style of both staff and peer interaction with patients diagnosed as neurotic or psychotic revealed no significant differences. However, the amount of inappropriate behaviour exhibited by subjects was positively correlated with the amount of time they were observed in solitary activities. A social learning framework suggests that, given the low rate of interaction, potential therapeutic opportunities are being missed and that the style of those interactions which do occur may be anti-therapeutic.