Behavioural correlates of expressed emotion in staff-patient interactions

Staff members working in community facilities for patients with long-standing mental illness were assessed using a modification of the Camberwell Family Interview designed to measure their attitudes towards their key patients. This enabled an evaluation of their levels of expressed emotion (EE). Staff members and their patients took part in a direct interaction task 2-4 weeks later. This was deliberately focused on low-conflict issues, and each interaction was audiotaped. The presence of the nuclear symptoms of schizophrenia in the mixed diagnosis sample was the only patient attribute associated with high-EE attitudes. Staff rated high in EE were more likely than low-EE staff to make negative statments during the interaction, and less likely to make supportive ones. Patients with low-EE keyworkers were more likely to volunteer statements of self-affirmation during the interaction. Low-EE staff tended to focus on positive aspects of the patient's life. During interviews and interactions, low-EE keyworkers did not dwell on their own negative feelings (if any) or on those expressed by the patient. This characteristic is probably a salient feature of successful therapeutic relations with clients suffering from long-term mental illness.