Expressed Emotion in staff working with the long-term adult mentally ill

Institute of Psychiatry, London.
The British Journal of Psychiatry (Impact Factor: 7.99). 01/1993; 161(6):802-8. DOI: 10.1192/bjp.161.6.802
Source: PubMed


Staff-patient relationships in long-term settings were examined in 35 staff and 61 patients. Measures were also taken of the staff's general health, their coping style in relation to work events, and job satisfaction. A range of ratings of EE was evident in staff descriptions of patients under their care. Strain and criticism in the relationship were not associated with identified stressors in the workplace, or the general health of the carer. When patients were grouped according to high-EE and low-EE interviews, there were no significant differences in their symptoms. Criticism was associated with other patient characteristics, including aggressive and attention-seeking behaviour, underactivity, and limited social interaction. The findings have implications for staff training and for the maintenance of optimal staff-patient relationships in services supporting severely disabled patients.

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Available from: Elizabeth Kuipers
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    • "Thereupon, Watts (cited in Kuipers & Moore, 1995) and Herzog (1992) succesfully used the EE construct to describe interaction patterns between professional caregivers and clients. Although the EE-research in professional caregiverclient dyads still is in its infancy, there is evidence for high-EE attitudes towards clients with a broad range of psychiatric problems and even towards clients with learning disabilities (Ball et al., 1992; Barrowclough et al., 2001; Cottle et al., 1995; Finnema et al., 1996; Hansen et al., 1991; Moore & Kuipers, 1992, 1999; Moore et al., 1992a; Oliver & Kuipers, 1996; Sabarese, 1999; Snyder et al., 1994; Stark & Siol, 1994; Tattan & Tarrier, 2000; Van Humbeeck et al., 2001; in press; Weigel & Collins, 2000; Willets & Leff, 1997). In these studies, high-EE varies from 0% (Barrowclough et al., 2001) to 62% (Herzog, 1992). "

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    • "Arguably, these interventions are predicated upon an understanding of psychopathology that privileges the role of stress within interpersonal relationships in the course of mental disorders such as schizophrenia and the genesis of problematic behaviours. Classically this is described in terms of high expressed emotion in family groups (Brown et al 1962, 1972) but has also been researched in staffpatient relationships (Moore et al 1992) and forensic environments (Forster 1999). It has been hypothesised that the high expressed emotion response is linked to misunderstanding what causes challenging behaviours and responding accordingly. "

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    • "After the CFI interviews were analyzed, it became clear that professional caregivers expressed varying reactions to the behavior of their residents. Critical remarks were most frequently related to the negative symptoms and socially embarrassing behavior and not to positive symptomatology (Moore et al. 1992; Oliver and Kuipers 1996). For example: "
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    ABSTRACT: Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staff-patient dyad as measured by the concept of EE. EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS, residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders. Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI. The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship.
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