Therapeutic factors in partial hospitalization

In recent years, partial hospitalization programs have become an accepted major component of community-based care for psychiatric patients. Studies have shown that partial hospitalization is at least as effective as inpatient hospitalization in treating a spectrum of psychiatric disorders and is substantially more cost effective than standard inpatient care (Guillette et al. 1978; Herz et al. 1971; Washburn et al. 1976; Wilder et al. 1966). Despite these positive findings, the therapeutic factors that contribute to the effectiveness of partial hospitalization continue to be a subject of speculation (e.g., Goldberg 1982; Vannicelli et al. 1978; Washburn 1983). In a recent review of the literature on the efficacy of partial hospitalization, Mason et al. (1982) emphasize that the "active ingredient" in this treatment modality remains unclear. In an outcome study by Dunn et al. (1982, p. 297), hope was expressed that "future studies might best explore which nonspecific factors are most powerful therapeutically." The current study is part of a larger effort to develop from an empirical base a comprehensive model of partial hospitalization. The comprehensive model provides a framework for understanding partial hospitalization by examining: 1) the functions of a partial hospital admission, 2) the types of patient changes that occur in these programs, 3) the processes of change, and 4) the therapeutic factors that appear to facilitate change. Findings regarding the first three elements of the model are described in a companion paper. This report focuses on the findings regarding the fourth element of the model, the therapeutic factors that appear to facilitate change in a short-term partial hospitalization program. It also examines how specific program components contribute to these therapeutic factors.