Collaborative/Therapeutic Assessment with Psychiatric Inpatients Diagnosed with Bipolar Disorder

Abstract

This quantitative dissertation investigates the effectiveness of a four-session Collaborative/Therapeutic Assessment (C/TA) with four adult inpatients diagnosed with bipolar disorder admitted to a psychiatric inpatient unit. The C/TA intervention was considered an adjunct therapy occurring alongside other treatments offered in the inpatient unit (e.g., medication management, group psychotherapy, etc.). A replicated Single-Case Experimental Time-Series Design (SCED) was used. Hypotheses 1 and 2 were partially supported. There was not a statistically significant change in reported levels of distress, hope, or session impact when data streams were compared to baseline. One participant, however, had a statistically significant increase in working alliance that was maintained to the post-intervention session. That said, measures of working alliance and session impact were high and positive for almost all participants. Exploratory analyses of patient-determined idiographic indices found a statistically significant decrease in levels of “anxiety”, “relationship with family”, and statistically significant increases in levels of “guilt”, “serenity”, and “silly” (i.e., humour and ability to take oneself lightly) variables. Hypothesis 3 was also partially supported, as the changes observed were largely maintained into the post-intervention session. Lastly, as Hypothesis 4 states, all participants indicated a high level of satisfaction with the intervention. Implications of these preliminary findings include the feasibility and potential clinical usefulness of using C/TA in an acute psychiatry setting with individuals diagnosed with bipolar disorder. Moreover, strong working alliances, session impact, and satisfaction scores contribute to the possibility of increased patient engagement in mental health services upon discharge from the hospital setting. Greater engagement in outpatient services may ultimately mitigate the need for repeat inpatient admissions, potentially saving substantial health care dollars. More longitudinal and large-scale research studies are needed to better understand the short and long term outcomes of C/TA processes. The findings of this study also hold implications for the underlying mechanisms of change, an area of study that is needed in the C/TA literature.