Summary
Analysis of the content of 61 interviews with keyworkers supporting chronically disabled patients in long-term care settings revealed a range of EE ratings and associated characteristics. Low-EE interviews were prevalent (n=46), a finding not unlikely given the experience and training of the staff group sampled. High-EE (n=15) relationships were characterised by less tolerance, inappropriate expectations of patient progress and frustration in the key worker. Criticism in both high- and low-EE interviews was most frequently focused on socially embarrassing or difficult behaviour and, to a slightly lesser extent, the clinical poverty syndrome. It was rarely directed at positive symptomatology. High levels of criticism were significantly related to regarding the patient's difficulties as within their control and having negative rather than positive expectations of their ability to manage on their own. The factors identified by the EE interview that influence the nature of the staff-patient relationship are discussed, and the clinical implications of the findings briefly considered.
Similar content being viewed by others
References
Ball RA, Moore E, Kuipers L (1992) Expressed Emotion in community care facilities: a comparison of patient outcome in a ninemonth follow-up of two residential hostels. Soc Psychiatry Psychiatr Epidemiol 27:35–39
Berkowitz R, Eberlein-Fries R, Kuipers L, Leff J (1984) Educating relatives about schizophrenia. Schizophr Bull 10:418–429
Brown GW, Monck EM, Carstairs GM, Wing JK (1962) Influence of family life on the course of schizophrenic illness. Br J Prev Soc Med 16:55–68
Brown GW, Birley JLT, Wing JK (1972) Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry 121:241–258
Garety PA, Morris I (1984) A new unit for long-stay psychiatric patients: organisation, attitudes and quality of care. Psychol Med 14: 183–192
Gelfand DM, Gelfand S, Dobson WR (1967) Unprogrammed reinforcement of patients' behaviour in a mental hospital. Behav Res Ther 5:201–207
Goldberg DP, Bridges K, Cooper W, Hyde C, Sterling C, Wyatt R (1985) Douglas House: a new type of hostel ward for chronic psychotic patients. Br J Psychiatry 147:383–388
Golstein MJ, Hand I, Hahlweg I (eds) (1986) Treatment of schizophrenia: family assessment and intervention. Springer, Berlin Heidelberg New York
Hall JN (1990) Towards a psychology of caring. Br J Clin Psychol 29: 129–144
Hegerl U, Priebe S, Wilgrube C, Muller-Oerlinghausen B (1990) Expressed emotion and auditory evoked potentials. Pschiatry 53: 108–115
Hooley JM (1985) Expressed emotion: a review of the critical literature. Clin Psychol Rev 5:119–139
Hooley JM, Richters JE, Weintraub S, Neale JM (1987) Psychopathology and marital distress: the positive side of positive symptoms. J Abnorm Psychol 96:27–33
Isaacs AD, Bebbington PE (1991) Strategies for the management of severe psychiatric illness in the community. Int Rev Psychiatry 3: 71–82
Kingsley S, Towell D (1988) Planning for high-quality local services. In: Lavender A, Holloway F (eds) Community care in Practice. Wiley, New York
Kuipers L (1991) Schizophrenia and the family. Int Rev Psychiatry 3: 105–117
Kuipers L, Bebbington P (1988) Expressed emotion research in schizophrenia: theoretical and clinical implications. Psychol Med 18: 893–909
Kuipers L, Bebbington P (1990) Working in partnership: clinicians and carers in the management of longstanding mental illness. Heinemann, London
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Lavender A (1985) Quality of care and staff practices in long-stay settings. In: Watts FN (ed) New developments in clinical psychology. Wiley, New York
Lavender A, Sperlinger A (1988) Staff training. In: Lavender A, Holloway F (eds) Community care in practice. Wiley, New York
Light RJ (1971) Measures of response agreement for qualitative data: some generalisations and alternatives. Psychol Bull 76:365–377
Leff J (1989) Controversial issues and growing points in research on relatives' expressed emotion. Int J Soc Psychiatry 35:133–145
Leff J, Kuipers L, Berkowitz R, Eberlein-Fries R, Sturgeon D (1982) A controlled trial of social intervention in the families of schizophrenic patients. Br J Psychiatry 141:121–134
Leff J, Vaughn C (1985) Expressed emotion in families: its significance for mental illness. Guilford, New York
Miklowitz DJ, Goldstein MJ, Falloon IRH, Doane JA (1984) Interactional correlates of expressed emotion in the families of schizophrenics. Br J Psychiatry 144:482–487
Moore E, Ball RA, Kuipers L (1992) Expressed emotion in staff working with the long-term adult mentally ill. (submitted for publication)
Nolan PW (1991) The founding of psychiatric nurse training and its aftermath. Br J Psychiatry 159:46–52
Shepherd G (1984) Institutional Care and Rehabilitation. Longman, London New York
Shepherd G, Richardson A (1979) Organization and interaction in psychiatric day centres. Psychol Med 9:573–579
Smith J, Birchwood M (1987) Specific and non-specific effects of educational intervention with families living with a schizophrenic relative. Br J Psychiatry 150:645–652
Smith J, Birchwood M (1990) Relatives and patients as partners in the management of schizophrenia: the development of a service model. Br J Psychiatry 156:654–600
Strachan AM, Leff JP, Goldstein MJ, Doane JA, Burtt C (1986) Emotional attitudes and direct communication in the families of schizophrenics: a cross-national replication. Br J Psychiatry 149: 279–287
Strachan AM, Feingold D, Goldstein MJ, Miklowitz DJ, Nuechterlein KH (1989) Is expressed emotion an index of transactional process? II. Patient's coping style. Fam Process 28:169–181
Sturgeon D, Turpin G, Kuipers L, Berkowitz R, Leff J (1984) Psychophysiological responses of schizophrenic patients to high and low expressed emotion relatives: a follow-up study. Br J Psychiatry 138:40–45
Tarrier N, Barrowclough C (1986) Providing information to relatives about schizophrenia: some comments. Br J Pschiatry 149:458–463
Tarrier N, Barrowclough C, Porceddu K, Watts S (1988) The assessment of psychophysiological reactivity to the expressed emotion of the relatives sof schizophrenic patients. Br J Psychiatry 152: 618–624
Thornicroft G (1991) The concept of case management for long-term mental illness. Int Rev Psychiatry 3:125–132
Vaughn CE, Leff JP (1981) Patterns of emotional response in relatives of schizophrenic patients. Schizophr Bull 7:43–44
Watts FN, Bennett D (1983) Management of the staff team. In: Watts FN, Bennett D (eds) Theory and practice of psychiatric rehabilitation. Wiley, New York
Wing JK, Furlong R (1986) A haven for the severely disabled within the context of a comprehensive psychiatric community service. Br J Psychiatry 149:449–457
Wing JK, Cooper JE, Sartorius N (1974) The measurement and classification of psychiatric symptoms: an instruction manual for the PSE and CATEGO system. Cambridge University Press, Cambridge London
Wykes T (1982) A hostel ward for ‘new’ long-stay patients: an evaluative study of ‘a ward in house’. In: Wing JK (ed) Long term community care. Psychol Med Monogr Suppl 2: 59–97
Wykes T, Sturt E (1986) The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the SBS. Br J Psychiatry 148:1–11
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Moore, E., Kuipers, L. & Ball, R. Staff-patient relationships in the care of the long-term adult mentally ill. Soc Psychiatry Psychiatr Epidemiol 27, 28–34 (1992). https://doi.org/10.1007/BF00788953
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00788953