Social support, psychological distress and the consequences of psychotherapeutic intervention

Several questions about social support and its relation to mental health over the course of psychotherapeutic intervention are investigated. These include: how do different measures of social support relate to each other at entrance to therapy (time 1) and three months later (time 2), how does social support vary with mental health over time, and how do strategies of therapists affect social support of patients? Forty patients and their therapists (27) at two community mental health centers were interviewed. Four quantitative standardized measures of social support were used: Donald and Ware\u27s social integration measure (1982), McFarlane\u27s (1980) measure of social networks, Kaplan\u27s perception of social support (Turner and Noh 1983), and Instrumental/Expressive Support developed by Dean et al. (1981). Finally, Goldberg\u27s (1972) General Health Questionnaire measured psychological status. In addition, intensive qualitative interviews concerning the meaning of social support were conducted with patients and their therapists. The research design incorported several elements of triangulation (Denzin 1970a) including (a) collection of data at two time points, (b) the use of multiple indicators of social support, (c) systematic comparison between our patient sample and nonpatients studied by other researchers, (d) use of multiple informants on the same cases, and (e) quantitative standardized measures of the main variables combined with detailed qualitative interviews. Only some measures of support varied with psychological health: network multiplexity and instrumental-expressive support. Perception of social support was most consistently related with other social support measures at both time points. Social networks and social integration were unrelated to instrumental/expressive support. Support needs of patients varied with stage in treatment. New patients sought unreciprocated support but were unlikely to receive it. Patient\u27s psychological health after time in treatment was related to financial resources, having close friends, and fewer demands made on them. Financial help at intake to therapy was especially predictive of psychological health at time 2. Patients\u27 social support was also influenced by therapist\u27s orientations. Therapists who focused on relations with others helped patients reconnect with others who cared about them