INDIVIDUAL PSYCHOTHERAPY AND PERSONS WITH SERIOUS MENTAL-ILLNESS - THE CLIENTS PERSPECTIVE

The perspectives of persons with serious mental illness about their ex periences with individual psychotherapy were obtained from a stratifie d random sample of 12 psychosocial rehabilitation centers from all cen ters in Maryland. Response and completion rates, test-retest reliabili ty, and generalization data were positive. Eight areas were explored: (1) Utilization and duration: of the 212 respondents, 90 percent had b een in therapy for a median of 12 months (mean = 3 years); only a thir d expected to end their therapy within 5 years. (2) Therapeutic effect iveness: most of the respondents (72%) reported that individual psycho therapy had brought positive changes to their lives, 14 percent report ed negative changes, and 14 percent reported that therapy had had no e ffect. (3) Preferred interventions and parameters: sixteen percent fel t that medication was most useful, 25 percent felt that talking therap y was most useful, and 60 percent endorsed a combination of the two. W ith respect to diagnosis and psychotherapy, 84 percent of respondents with schizophrenia preferred brief, less frequent sessions of reality- oriented therapy over longer, more frequent sessions of insight therap y. Respondents with bipolar and major depression were equally split be tween the two. (4) Therapeutic issues: human concerns were more freque ntly rated as important and were rated higher in importance than illne ss-specific symptoms. (5) Clients' view of illness: Only 8 percent tho ught their illness was a brain disease, a third thought it was a psych ological problem, and a quarter thought it was a combination of both; a third answered, ''I don't know.'' Almost half did not know what thei r therapists thought. (6) Therapeutic relationship: Friendliness was t he quality most desired in a therapist. (7) Confidentiality: Most felt that therapists generally kept the clients' confidences. (8) Empowerm ent: Persons who felt empowered in therapy spent less time in hospital s, expected a shorter stay in therapy, and knew more about their probl ems. Suggestions are made about a more client-responsive model of indi vidual psychotherapy for persons with serious mental illness.