Helping alliance and ward atmosphere in psychiatric in-patient care

Objective. The study investigated how patients in a psychiatric in-patient ward perceived the therapeutic relationship and the ward atmosphere, the interrelationships between these phenomena, and whether demographic and clinical factors had an influence on the helping alliance. Design. This was an explorative study in a natural setting. A correlational and multiple regression design were adopted. Method. All discharged patients (N = 61) during a limited period completed questionnaires regarding the ward atmosphere and the helping alliance, were rated on psychosocial functioning, and diagnosed according to the ICD-10. Results. Several ward-atmosphere factors correlated with the helping alliance. A multivariate analysis suggested that support, programme clarity, and spontaneity were important ingredients and that support was the most important contributor. Patients with a high level of psychosocial functioning established a better helping alliance and patients with personality disorders tended to develop a weaker helping alliance. Conclusion. The findings emphasize that a holding environment is important in establishing a good helping alliance, which is consistent with results from the psychotherapy area. Since helping alliance is known to have a most important influence on therapy outcome, one conclusion must be that the staff, in their endeavour to strengthen the supportive element of the ward atmosphere, may improve the therapeutic outcome as well.