The measurement of expressed emotion in relationships between staff and service users: The use of short speech samples

Objectives. Research on expressed emotion (EE) has demonstrated a remarkabl e consistency across cultures and over time; the psychosocial climate in re lationships is important in determining the course of problems in mental he alth. The rating of EE might be described as the least accessible aspect of this literature to those who have not undertaken a training course. The pu rpose of this study was twofold: first, to obtain EE ratings for staff-pati ent relationships via interview and speech sample methods, in order to esti mate the validity of the shorter method (the Five-Minute-Speech-Sample, FMS S); second, to examine the generalizability of the FMSS rating method to ra ters who were not previously trained to rate EE. Design and Method. Staff(N = 15) working in a day hospital service for peop le with enduring mental health problems were interviewed about their work w ith at least one patient (N = 32), and also asked to provide an FMSS on eac h relationship. Ratings of FMSS-EE were subsequently compared with the Camb erwell Family Interview-EE ratings. Following an hour-long training period, the FMSS-EE ratings of five postgraduate students were then compared with those of a criterion rater. Results. Correspondence between the two measures of EE was found to be good , with overall agreement achieved in 89.7% of cases. Raters with very limit ed training in the concept and rating of EE were accurate in identifying th e overall rating of the relationship in question, but less accurate in iden tifying specific critical comments. Conclusion. The FMSS technique can be used reliably to identify negative re lationships even by raters given very limited training. Clinical and resear ch applications are suggested.