The influence of patient diagnosis and self-image on clinicians' feelings.

Abstract

This paper presents an analysis of the relations between the patients' psychiatric diagnoses, their self-image, and the staffs feelings toward the patients. At 17 treatment units for severely disturbed psychiatric patients, the staff rated their feelings toward the patients on a feeling checklist twice a year for 5 years. The patients were diagnosed on DSM-III-R (axis I and II) and rated their self-image on a self-rating instrument, the Structural Analysis of Social Behavior. First, comparisons between reactions toward patients with different axis I diagnoses, toward patients with different axis II diagnoses, and toward patients with either axis I or axis II diagnoses were made with one-way ANOVAs. No significant differences were found in any of these comparisons. The amount of variance in feelings explained by these groupings was between 2% and 4% (mean = 3%) for axis I, between 3% and 14% (mean = 8%) for axis II, and between 4% and 17% (mean = 9%) for the combined comparison. Differences between axis II diagnoses had the largest influence on the staffs feeling reactions. Second, comparisons between the influence of the patients' diagnoses and of their self-image on the therapists' feelings were made by way of blockwise multiple regression analyses. The results showed that the patient's self-image was more important in influencing the staffs feelings than the diagnosis but that diagnosis and self-image were virtually independent in this respect.