An empirical model of therapeutic process for psychiatric emergency room clients with dual disorders

Abstract

Many individuals with dual disorders of mental illness and substance abuse enter the mental health system through psychiatric emergency rooms (PERs), but may resist treatment and not follow through with referrals to services. This study examined the impact of therapeutic process on referral outcome. Raters used the Vanderbilt Psychotherapeutic Process Scales and Working Alliance Inventory to evaluate audiotapes and transcripts of 39 PER sessions. Outcome was successful if clients attended all referral appointments. The authors found that therapist warmth and friendliness had a positive association with working alliance, which, in turn, was associated with successful referral. Paradoxically, there was a negative relationship between warmth and friendliness and success. Analysis demonstrated that, for a given level of warmth and friendliness, there must be a correspondingly higher level of working alliance to be associated with success.