Make me why don't you: understanding barriers to treatment engagement in coercive contexts

The high cost of mandated or coercive treatment in terms of time, money, and emotional distress highlights the importance of determining whether and how this kind of treatment can lead to positive outcomes. Findings suggest that even treatment resistant patients can benefit given the right circumstances. A recent Task Force concluded that there was evidence for the influence of three factors in treatment outcomes including relationship principles, non-diagnostic patient characteristics and the technical details of the treatment. The authors called for future research to further their stated aim, “to identify empirically based principles of change in psychotherapy …that provide guidelines about how to most effectively deal with clients that aren’t tied to particular approaches or theories” (Castongauy & Beutler, 2006, p. 632).The aim of the present study was to examine factors thought to influence relationship principles (patient perceptions of the hospital admission process and subsequent treatment) and patient characteristics associated with negative treatment outcomes (antisocial personality traits and negative emotionality) in an attempt to identify which variables are at play during the experience of treatment that prevent active participation (therapeutic alliance, treatment motivation and treatment compliance). The participants were 139 civil psychiatric patients recently discharged. Data was collected via semi-structured interview and record review at baseline and 5 prospective follow-ups to examine relationships between variables over time. Results indicated that patient perceptions are related to treatment indices at baseline and these relationships are stable over time. Further, antisocial personality traits were related to treatment compliance and dispositional anger. Findings hold implications for the impact of interventions designed to target treatment interfering perceptions and emotions at initial contact, on treatment engagement over time.