The effects of diagnosis and non‐compliance attributions on therapeutic alliance processes in adult acute psychiatric settings

Abstract

To investigate the effects of the diagnoses of borderline personality disorder (BPD) and major depressive disorder (MDD), together with reasons for client non-compliance with therapy tasks, on mental health workers' helping, empathy and anger reactions. Utilizing a 2 x 2 x 2 factorial design, mental health nurses were asked to read a series of vignettes and complete a 15-item rating scale for helping, empathy and anger reactions to each of the vignettes. Eight clinical vignettes were constructed and contained a combination of controllable/uncontrollable and stable/unstable attributional dimensions for service users who failed to complete a therapy task. The diagnoses of BPD and MDD were added to the vignettes to determine whether diagnoses affected alliance factors. A total of 26 mental health workers participated in the study and there were main effects for those workers to be angrier when causes were perceived as due to controllable factors; to be more helpful to service users' with a diagnosis of MDD; and less helpful when causes were perceived to be due to stable factors. Results show some support for Weiner's model of helping behaviour. It is suggested that there is an important role to explore the attributions of mental health workers working with service users with BPD. A role for case conceptualization is discussed to facilitate therapeutic engagement with service users with a diagnosis of BPD.