Jw. Burns et al., Relationships among patient hostility, anger expression, depression, and the working alliance in a work hardening program, ANN BEHAV M, 21(1), 1999, pp. 77-82
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.