Occupational group therapy in a psychiatric day care unit for long-term mentally ill patients: ward atmosphere, treatment process, and outcome

Abstract: The outcomes of 20 patients participating in occupational group therapy at a psychiatric outpatient unit were explored and related to perceptions of the ward atmosphere and the treatment process. The outcome variables - psychiatric symptoms, global mental health, quality of life, and occupational functioning - were measured at admission, at discharge, and 1 year after discharge. The ward atmosphere was rated twice a year and the treatment process once a month. The study used a combined within-group and between-groups design. The ward atmosphere showed stability over a period of 5 years and was rated by patients and staff as beneficial for both psychosis and nonpsychosis patients. Low levels of anger and aggression and staff control and high levels of support and order and organization were the most prominent features of the unit. Several characteristics of the ward atmosphere were related to outcome, e.g., an optimal level of anger and aggression as perceived by the patients initially in treatment was significantly related to improvement in global mental health and occupational functioning. The patients improved from admission to discharge on all the outcome variables except for quality of life. Contrasted with a matched comparison group, the patients’ improvement was significantly higher regarding a measure of global functioning. Thirteen of the 20 patients were judged as having attained clinically significant change. With respect to the treatment process, patient ratings of a better working relationship vis à vis the main therapist compared to the other occupational therapists were significantly related to improvement in global mental health and occupational functioning, as well as to a principal component accounting for a large proportion of the variance in the outcome measures used. Furthermore, patient participation, especially in a psychological sense, was related to a better performance in everyday occupations and to the principal component reflecting outcome. Indepth analyses of three representative case studies illustrated the relationships that were established at a group level and mediated specific patient experiences. A percept-genetic test (PORT) revealed that the patients’ external life situations and psychiatric problems were reflected in their internal object representations and vice versa. A more benign picture from the testing at a 1-year follow-up indicated that the therapy had influenced the patients’ internal object representations.