Staff-patient relationships in the care of the long-term adult mentally ill. A content analysis of Expressed Emotion interviews.

Analysis of the content of 61 interviews with keyworkers supporting chronically disabled patients in long-term care settings revealed a range of EE ratings and associated characteristics. Low-EE interviews were prevalent (n = 46), a finding not unlikely given the experience and training of the staff group sampled. High-EE (n = 15) relationships were characterised by less tolerance, inappropriate expectations of patient progress and frustration in the key worker. Criticism in both high- and low-EE interviews was most frequently focused on socially embarrassing or difficult behaviour and, to a slightly lesser extent, the clinical poverty syndrome. It was rarely directed at positive symptomatology. High levels of criticism were significantly related to regarding the patient's difficulties as within their control and having negative rather than positive expectations of their ability to manage on their own. The factors identified by the EE interview that influence the nature of the staff-patient relationship are discussed, and the clinical implications of the findings briefly considered.