This study attempted to identify and explore those therapist attributes which might be related to low socioeconomic class patients dropping out of psychiatric drug treatment, a widely recognized problem. Six experienced psychiatrists were observed during their initial treatment sessions with approximately 225 neurotic outpatients participating in a double blind, placebo-controlled psychiatric drug evaluation study. Patients were primarily of low socioeconomic class, female, and Negro. The observers rated items related to therapists' behavioral activity, characteristics, reactions, general style, and therapeutic activity on either 4-or 7-point scales. The data were approached in two ways. One set of analyses compared three therapists with relatively low dropout rates with three therapists with relatively high dropout rates, using only patients who completed the study. In a second set of analyses, patients were divided into two groups, completers and dropouts; therapists were pooled; and styles of treatment with these two patient groups were compared. Low dropout therapists were rated as more active, as more positive in dealing with and reacting toward their patients, and as providing greater and more personalized interview structure and focus. Low dropout therapists reported greater liking for their patients, although less comfort with them. They also were judged by the observers to be less enthusiastic about the medication and, in turn, saw their patients as less eager about taking the drugs. Finally, low dropout therapists rated their patients higher in pathology but with a better prognosis. All therapists were rated as somewhat more active and involved in therapeutic activity and as having a warmer relationship with completers than with dropouts. It was suggested that the therapists' approach to treatment might fruitfully be described in terms of a bipolar continuum, ranging from activity to passivity. It was further suggested that more active involvement of therapists and greater attempts to involve patients actively in the treatment process seem to decrease dropout rates even in situations where drugs are considered to be the central treatment agent and the population consists of low socioeconomic class patients.
ASJC Scopus subject areas
- Psychiatry and Mental health