Facteurs sociodémographiques et construction de l'alliance thérapeutique aux urgences psychiatriques

Therapeutic alliance is a clinical concept considering the non-specific aspects and the common factors of the therapeutic relationship. In emergency, the therapeutic alliance seems to be one of the essential elements of crisis management, as the first stage of therapeutic framework. The aim of this study was to investigate the influence of sociodemographic factors in the constitution of the therapeutic alliance between patient and psychiatrist at the emergency psychiatric unit of a university general hospital. The study concerned 140 patients, requiring during workdays an urgent psychiatric intervention. Data were collected during four months. The exclusion criteria were the acute psychotic disorders, mania, delirium and dementia, situations interfering with the understanding of the study and with the patients' informed consent. The level of therapeutic alliance was estimated by means of the French translated questionnaire of “Helping Alliance” of Luborsky, completed separately by psychiatrists and patients. The results show a relatively limited influence of socio-demographic factors on the therapeutic alliance. The patients' age is a factor influencing alliance only for the psychiatrists, with a better alliance for the less than 25-year-old patients and more than 45 years. The patients with a lower instruction level have a better type I alliance. The scores of alliance with the French-speaking psychiatrists do not differ for the immigrant patients and the native French-speaking patients. Further than the epidemiological interest, this preliminary study suggests the interest of the consideration of the emergency time, in the construction of the therapeutic alliance.