Aaron Lazare

Oral, obsessive and hysterical personality patterns: Replication of factor analysis in an independent sample

IN A previous study1 factor analysis was used to explore 3 personality patterns derived from psychoanalytic theory : oral, obsessive, and hysterical. The study demonstrated that the personality traits defining these 3 patterns could be reliably measured from items rated by patients; that the traits thus measured formed 3 clusters by factor analysis; and that the 3 clusters corresponded closely to the psychoanalytical descriptions of the oral, obsessive, and hysterical personality patterns. One limitation of the previous study lay in the patient sampling. These patients had been selected by resident psychiatrists as being typical of at least 1 of the 3 personality patterns. The question arose whether the results of the previous study would be replicated in a broader patient sample. The present paper reports a replication of the original study on a new sample. Using consecutive female admissions to a psychiatric hospital rather than preselected ‘typical’ patients, we investigated whether factor analysis would produce patterns with similar results.

Evaluation of the initial interview in a walk-in clinic. The patient's perspective on a "customer approach".

There have been different models on how to conduct the initial psychiatric interview in a walk-in clinic. A “customer approach” has been developed which stresses: a) eliciting and understanding the requests that patients have regarding how they hope to be helped; and b) negotiating a treatment plan with the patients. We evaluated this customer approach from the perspective of the patient. The first hypothesis was supported. The patients perception of the clinicians utilization of the customer approach correlated positively and substantially with measures of outcome, especially feeling satisfied and helped. The second hypothesis was also supported. Utilization of the customer approach continued to correlate positively and substantially with outcome even when patients did not get the disposition originally wanted. We discussed the clinical significance of the customer approach especially in regard to patient objectives in the initial interview—a treatment plan vs. symptom relief.

Patient requests in a walk-in clinic. Replication of factor analysis in an independent sample.

This study attempts to test the hypothesis that 14 categories of patient requests are relatively independent mathematically. The request categories were identified in the conduct of initial interviews in a walk-in clinic. To test the independence of the 14 request categories, we administered an 84-item Patient Request Form (PRF) to 296 patients coming to the walk-in clinic of a general hospital. In a previous study using a 75-item version of the PRF on a sample of 201 patients, only nine of the request categories were confirmed according to the criterion that three of the five items in the request category appear on the same factor with a loading of 0.4 or greater. The 84-item PRF is a revised form which contains 40 new items designed to capture more accurately the clinical meaning of the requests. Thirteen of the 14 request categories were confirmed in the present factor study using the same confirmation criterion as the earlier study. Three higher order request dimensions were identified by a factor analysis of each patients 14 request category scores. The request dimensions were for affective-dependence, cognitive understanding, and active intervention. Preferences among the requests are described. The results of this study are relevant in the following ways; 1) knowledge of the range and definition of patient requests enhances the clinicians ability to hear and respond to the patients request; 2) facilitating the patients expression of his request enhances the flow of the interview; 3) describing the distinct requests gives clinicians the opportunity to explore the efficacy of various treatment responses to each request; 4) knowing the request facilitates the negotiation process when clinician and patient are in conflict; 5) the PRF serves both as a clinical and a research tool; and 6) the methods used in this study are applicable to other settings, particularly in medical clinics.

Evaluation of the initial interview in a walk-in clinic. The clinician's perspective on a "negotiated approach".

A negotiated approach to the conduct of the initial interview has been developed from the need for a more flexible and active exchange between clinician and patient. The setting is the walk-in clinic of the psychiatry service in a large urban general hospital, staffed mostly by first-year residents and staff social workers. These clinicians [26] were asked to evaluate the utility of the negotiated approach. They rated the approach both from their perspective and from that of 136 patients they interviewed. Although the clinicians evaluated the approach positively, they associated their satisfaction much more with the aims of a diagnostic approach than a negotiated one. The clinicians do not perceive that patients share satisfaction in their instrumental objective of understanding (a diagnostic goal), and the clinicians do not perceive that they share satisfaction in the patients instrumental objective of participating in the treatment planning. The sharpest divergence between the clinicians and perceived patient satisfaction was over two evaluation/outcome measures: the treatment plan being wanted and attainment of symptom relief. These measures correlated much better with perceived patient than clinician satisfaction. Divergence in perspective between clinician and patient was discussed with regard to possible sources, the effect of settings, and the implication for the delivery of services

Specificity of Patients' Requests in the Initial Interview

The concept of the patients request is described in detail in relation to a negotiated approach to conduct an initial interview in a walk-in clinic and in relation to other related concepts such as patients goals. The verbalization of specific requests of 363 patients to the psychiatric walk-in clinic of a general hospital was investigated, using a structured pre-intake interview. Although a majority of the patients (69.5%) verbalized a specific request, it was significantly less than the percentage (93%) who endorsed at least one request on the Patient Request Form. Specificity was related to socialization in the mental patient role, conditions of entry into the mental health system, and presenting complaint, but not related to demographic measures. The nonspecific patient is likely to come to the clinic at the suggestion of someone else, to be new to the clinic, having no past treatment history, and having general or situational complaints. The implications of these results for the conduct of an initial interview using the negotiated approach were discussed.