INTERACTIONAL STYLES OF OUT-PATIENTS WITH POOR ADJUSTMENT TO CHRONIC ILLNESS RECEIVING PROBLEM-SOLVING COUNSELING

A sample of subjects with poor to fair adjustment to chronic illness i s described according to three interactional styles distinguished by p atterns of beliefs about the self in relation to others along an axis of purpose, dependency and self-concept. Further, the question of whet her differences in style are related to quantitative measures of adjus tment, purpose in life, and health and social service consumption is a ddressed. A randomized controlled trial was set up involving adult sub jects (Roberts et al. 1995a), who were not adjusting well to their ill ness as determined by the Psychosocial Adjustment to Illness Scale-Sel f Report (PAIS-SR; Derogatis & Lopez 1983), and who were referred to o ne of nine specialty out-patient clinics in a large urban health care centre in southern Ontario. The subjects received a problem-solving in tervention (experimental group) by random assignment to help improve p sychosocial adjustment to chronic illness and reduce health care utili zation. The nurse counsellors, using grounded theory, compiled descrip tive formulations for 96 experimental subjects who were receiving prob lem-solving counselling intervention. In this group, three core intera ctional styles emerged. According to descriptions predominating in the formulations written by nurses, subjects were placed along a continuu m from least to most effective in fostering social relationships and h aving needs met. The subjects were respectivley labelled 'resigned', ' survivors' and 'resourceful'. When these categories were compared for improvement in psychosocial adjustment, 'resourceful' individuals had a clinically important ( defined as greater than or equal to 10 points ) gain in their adjustment immediately following counselling. 'Resourc eful' individuals were able to maintain their gains in adjustment even 6 months after counselling (P=0.03). In contrast 'resigned' individua ls despite a slight gain with counselling continued in a trend toward their baseline poor adjustment status when counselling ended. 'Resourc eful' individuals were higher in their purpose-in-life score (PIL) at the outset and maintained that high purpose after counselling compared with 'Resigned' individuals (P=0.03) who improved somewhat and then r eturned to low levels of purpose. All types of subjects with chronic i llness were similar at the outset in their consumption of all health s ervices. However, during the period of counselling, although not stati stically significant an administratively important higher per person a nnual expenditure for services was generated by 'Resourceful' individu als (P=0.11) followed by a marked reduction in their service consumpti on 6 months after counselling compared to consumption trends exhibited by 'Resigned' and 'Survivor' individuals.