The Therapeutic Relationship After Psychiatric Admission

Abstract

The therapeutic relationship is one of the most central and important factors in the treatment of mental health disorders. A better therapeutic relationship is associated with service engagement, medication adherence, and satisfaction with services. This study aimed to compare the demographic and clinical factors associated with the therapeutic relationship in voluntarily and involuntarily admitted psychiatric service users. We found that individuals who had been admitted involuntarily, who had a diagnosis of a psychotic disorder, and who reported higher levels of perceived pressures on admission were more likely to have a poorer therapeutic relationship with their consultant psychiatrist. Greater levels of insight and treatment satisfaction, together with higher levels of procedural justice experienced on admission, were associated with a better therapeutic relationship. We found that the level of perceived coercion on admission was not related to the therapeutic relationship. Targeted interventions to improve the therapeutic relationship, particularly for involuntarily admitted service users, are discussed.

Satisfaction guaranteed? Forensic consumer satisfaction survey

“…Other studies have demonstrated that patients who experienced perceived coercion during their inpatient stay had lower satisfaction with their care (Svensson & Hansson ), yet still other studies have demonstrated an inconsistent result with regard to the therapeutic relationship and perceived coercion (Roche et al . ). Given that coercion could perhaps be considered a marker of negative therapeutic relationship, this merits further exploration.…”

“…The impact of a restrictive forensic environment and how this impacts satisfaction were seen in a New York study which identified medications, physical environment, telephone access, and unit rules and procedures as critical factors in satisfaction (Shiva et al 2009a,b). Other studies have demonstrated that patients who experienced perceived coercion during their inpatient stay had lower satisfaction with their care (Svensson & Hansson 1994), yet still other studies have demonstrated an inconsistent result with regard to the therapeutic relationship and perceived coercion (Roche et al 2014). Given that coercion could perhaps be considered a marker of negative therapeutic relationship, this merits further exploration.…”

Les conditions favorables à la relation infirmière-patient : le contexte de l’hospitalisation involontaire lors d’un premier épisode psychotique

“…Pour les professionnels, la relation semble plus difficile à établir avec les personnes vivant une psychose qu'avec celles vivant un autre problème de santé mentale (McCabe & Priebe, 2003;Roche, Madigan, Lyne, Feeney, & O'Donoghue, 2014). L'altération de l'autocritique (Kvrgic, Cavelti, Beck, Rusch, & Vauth, 2013), la dangerosité (Wahl & Aroesty-Cohen, 2010) et la symptomatologie qui accompagnent souvent la psychose constituent des obstacles au développement de la relation (Davis, Eicher, & Lysaker, 2011;Jung, Wiesjahn, & Lincoln, 2013;Lawlor, Hall, & Ellett, 2015).…”

“…L'approche orientée vers le rétablissement suggère de favoriser le pouvoir d'agir de la personne soignée (Barker & Buchanan-Barker, 2005). La relation est donc plus difficile à instaurer avec les patients sous OGE, comparativement à ceux hospitalisés de leur plein gré (Roche et al, 2014;Sheehan & Burns, 2011;Theodoridou et al, 2012). Malgré tout, les défis inhérents à la psychose et à l'OGE peuvent être surpassés.…”

A randomized study of a smartphone application compared with booklet to improve service user’s knowledge of their legal rights

“…Providing service users with information on the process of involuntary admission could lead to an improvement in the level of procedural justice perceived and this in turn, could improve the therapeutic relationship and reduce the perception of coercion (Roche et al 2014). As such, the Mental Health Commission produced an information booklet entitled 'Your guide to the Mental Health Act 2001' which is provided to individuals who are detained involuntarily.…”