Sells Dave, Black Ryan, Davidson Larry, Rowe Michael
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06513, USA.
Psychiatr Serv. 2008 Nov;59(11):1322-7. doi: 10.1176/ps.2008.59.11.1322.
This study explored experiences of validation and invalidation among clients with severe mental illness in treatment with either peer providers or traditional providers. Associations between six- and 12-month outcomes and validating and invalidating provider communications were also examined.
A total of 137 adults with severe mental illness were randomly assigned to either peer-based or traditional intensive case management. At six and 12 months participants completed self-report questionnaires on their quality of life, obstacles to recovery, and perceived invalidating and validating qualities (positive regard, empathy, and unconditional acceptance) of relationships with their providers.
Mixed analysis of variance showed that communications from and interactions with providers were perceived to be more validating than invalidating by clients in treatment with peer providers than by those in treatment with traditional providers. Regression analyses showed an association at six months, but not at 12 months, between favorable outcomes and the experience of invalidation from peer providers; invalidation from peer providers was linked to improved quality of life and fewer obstacles to recovery, an association that was not found for clients who experienced invalidation from traditional providers.
Peer providers, who reveal their experiences of mental illness to their clients, were perceived to be more validating, and their invalidating communications were linked with favorable short-term outcomes. Both peer and traditional providers sometimes express disapproval of clients' attitudes, values, or behaviors-a form of invalidation. This study found that early in the course of treatment peer providers may be effective in fostering progress by challenging clients' attitudes, values, or behaviors.
本研究探讨了患有严重精神疾病的患者在接受同伴服务提供者或传统服务提供者治疗时的被认可和不被认可的经历。同时还考察了6个月和12个月的治疗结果与服务提供者认可性和非认可性沟通之间的关联。
总共137名患有严重精神疾病的成年人被随机分配到同伴支持或传统强化个案管理组。在6个月和12个月时，参与者完成了关于他们生活质量、康复障碍以及与服务提供者关系中感知到的非认可性和认可性特质（积极关注、同理心和无条件接纳）的自我报告问卷。
混合方差分析表明，与接受传统服务提供者治疗的患者相比，接受同伴服务提供者治疗的患者认为来自服务提供者的沟通和与服务提供者的互动更具认可性而非非认可性。回归分析显示，在6个月时，同伴服务提供者的非认可经历与良好治疗结果之间存在关联，但在12个月时不存在这种关联；同伴服务提供者的非认可与生活质量提高和康复障碍减少有关，而接受传统服务提供者非认可的患者未发现这种关联。
向患者透露自己精神疾病经历的同伴服务提供者被认为更具认可性，他们的非认可性沟通与良好的短期治疗结果相关。同伴服务提供者和传统服务提供者有时都会对患者的态度、价值观或行为表示不赞同——这是一种非认可形式。本研究发现，在治疗过程早期，同伴服务提供者可能通过挑战患者的态度、价值观或行为来有效地促进治疗进展。
