Carolyn Winget

Hope and discomfort as factors influencing treatment continuance

Abstract Many agencies, clinics, and hospitals have been increasingly concerned with the high percentage of people who seek help and subsequently discontinue contact during the early stages of diagnostic sessions, intake procedures, or actual treatment. Investigators who have approached the dropout problem by looking at the success of various treatment theories and methods of different schools have been almost unanimous in their findings that no one treatment modality has proven to be more successful than another. 2,12 Recently the emphasis seems to have shifted from studying methods or techniques of treatment, environmental and demographic factors, and personality characteristics to a focus on those attitudes and feelings aroused within the patient and/or doctor early in the treatment relationship which may affect continuance in treatment. 1,4,8 The purpose of this study was to explore the relationship between feelings of hope and discomfort in the potential psychiatric patient, and how this relationship influences the patients motivation and capacity to follow recommendations for psychiatric treatment. Hope and discomfort were viewed as polarized motivating forces within the individual. Hope was defined as verbal expressions of optimism regarding a favorable outcome in day-to-day activities as well as in more cosmic, spiritual or imaginary events. Discomfort involved painful affects and psychological distress in the form of anxiety, depression, feelings of inadequacy or inferiority, and self-dissatisfaction. To the extent that these forces exist in different amounts and proportions within the person seeking help, potential patients or clients can be viewed as having varying intensities and qualities of motivation. The present authors hypothesized that motivation to follow through with treatment recommendations would be characterized by high hope and high discomfort, existing in reasonably equal proportions to one another within the individual seeking help.

The measurement of emotional changes during a psychiatric interview: a working model toward quantifying the psychoanalytic concept of affect

The advantages to psychoanalysis as a science of some means of quantifying a few of the key psychoanalytic concepts have been referred to by many authors, including Fenichel (1945), Kubie (1952), Jacobson (1953), Rapaport (1953, 1960), Knapp (1957), and others. Rapaport (1960), for example, has reminded us that all sciences, in striving to make their assertions precise, move toward a mathematization of the relationships they establish by their procedures, and that “quantification may prove to be the mathematization appropriate to psychoanalysis” (p. 91). Eloquent pleas have been made for exploratory quantification, on even an a priori basis, of the concept of cathexis and other psychoanalytic constructs, but there have not been offered any practical methodologie solutions to attain these ends.