Attachment theory‐based approaches to treatment and problem behaviour in a medium secure hospital: effects of staff gender on ratings
The Journal of Mental Health Training, Education and Practice
ISSN: 1755-6228
Article publication date: 30 November 2012
Abstract
Purpose
The aim is to determine whether staff ratings of service user attachment style are associated with service user misconduct during inpatient treatment in a medium secure mental health unit; also, to gauge whether staff can evaluate attachment style reliably.
Design/methodology/approach
Retrospective case note analysis on 55 inpatient treatment episodes were supplemented with staff ratings of service user attachment style. Records of untoward incidents were centrally retrieved. Kappa statistics were used to analyse levels of staff agreement regarding service user attachment style.
Findings
Attachment style was associated with hostile episodes, treatment non‐compliance and service user aggression. Post hoc analysis on a subset of data yielded poor overall agreement in ratings of attachment style (Kappa=0.2). Further analysis revealed a sex‐based asymmetry with high consistency in ratings of female service users (Kappa=0.79) and very low inter‐rater reliability for male service users (Kappa=−0.05). It is important to note that the staff included in the interrater reliability analysis were female.
Research limitations/implications
The sample was small, the observation period was short and staff conducting the ratings had no special training in the rating tool.
Practical implications
Attachment style per se played a significant part in the success and/or failure of service user treatment (when measured by misconduct). However, the validity of staffs' ratings of attachment style may interact systematically with the sex of staff and service users. These findings have important implications for the application of the concept of attachment in clinical settings.
Social implications
Mental health professionals place central importance on the establishment of therapeutic relationships between clinicians and service users. Service user attachment style is assumed to play a role in mediating the success, or failure, of relationships with clinicians.
Originality/value
This study makes a novel contribution to the application of attachment theory to secure mental health care, it also demonstrates that gender is an important factor in staff appraisals of service users' approach to treatment.
Keywords
Citation
Bagshaw, R., Lewis, R. and Watt, A. (2012), "Attachment theory‐based approaches to treatment and problem behaviour in a medium secure hospital: effects of staff gender on ratings", The Journal of Mental Health Training, Education and Practice, Vol. 7 No. 4, pp. 189-199. https://doi.org/10.1108/17556221211287208
Publisher
:Emerald Group Publishing Limited
Copyright © 2012, Emerald Group Publishing Limited