Relationships among patient hostility, anger expression, depression, and the working alliance in a work hardening program

Hostility anger expression, and depression may adversely affect the respons e of chronic pain patients to pain or functional restoration programs by ha mpering the development of good working alliances between patients and phys ical or occupational therapists. Measures of hostility: anger expression, a nd depression and the Working Alliance Inventory (WAI) were completed by 71 patients with chronic pain (stemming from work-related injuries) prior to starting a "work hardening" program. The physical or occupational therapist acting as any given patient's "program manager" completed the WAI, as well . Hostility and anger expression were correlated negatively only with patie nt ratings of the working alliance. Therapist ratings were predicted by the interaction of patient angel expression and depression, such that therapis ts reported their poorest alliances with patients who were both depressed a nd expressed angel: Results imply that hostility and the propensity to expr ess anger mag, diminish a pain patient's capacity to foster a collaborative relationship with physical or occupational therapists, while therapists ma y readily become alienated from depressed and irritable patients.