Examining the concept of patient satisfaction in patients with a diagnosis of schizophrenia: a qualitative study AIMS AND METHODTen people with a diagnosis of schizophrenia were interviewed. The interviews were analysed qualitatively with the aim of examining the concept of patient satisfaction in the context of a recent in-patient admission. RESULTSThe analysis identified two themes that influenced the expression of patient satisfaction: external factors and internal factors. The theme of external factors contained four categories: fear of violence, communication with staff, lack of autonomy and ward routines. The theme of internal factors comprised participants' conceptions and expectations. CLINICAL IMPLICATIONSThis small study suggests the complexity of the concept of patient satisfaction should be respected in assessing experiences of people with a diagnosis of schizophrenia.

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Beyond medication brings together psychotherapists and recovered patients from the United States to explore what helps recovery from psychosis. The book comes from a broadly psychodynamic perspective, and is not anti-medication, but makes it clear that to achieve effective and sustained recovery, clinicians and services need to go "beyond medication". A uniting feature of the chapters is a wish to understand the complexity of the human experiences that lead a person to develop psychosis, and emerging from this perspective comes a recognition that the single most important factor in a successful recovery from psychosis is a deep and meaningful therapeutic engagement.The structure of the book reflects its clinical grounding, with three main parts titled: "Engaging the patient", "The elements of change" and "Listening to the patient: Stories of what really works". The first part starts with David Garfield and Daniel Dorman presenting three case reports demonstrating clearly the importance of the therapeutic relationship in helping patients rediscover a sense of themselves following a psychotic breakdown. In the following chapter, Elizabeth Faulconer and Ann-Louise Silver present three more case reports illustrating how a flexible approach is essential in working successfully with people with psychosis. Garry Prouty in an inspiring chapter describes his Pre-Therapy Method for engaging with chronically regressed patients, and his detailed transcripts from sessions form a practical master class in approaching engagement with difficult to reach patients. Warren Schwartz and Frank Summers provide an immensely helpful chapter stressing the therapeutic importance of forming a deep emotional engagement with the patient; demonstrating that the most transforming therapeutic encounters occur when a patient can truly feel their therapist taking-in their deepest emotions, including negative ones.A highlight of the second part of the book is a chapter by Brian Koehler, in which he offers an in-depth account of his successful therapy with a very disturbed man with psychosis and uses his work to illustrate key theories by psychoanalysts such as Benedetti, Searles, Bion and Rosenfeld. Another high point is Daniel Mackler's description of his personal experience of sustaining his work as a psychotherapist despite the pressure from his employing organization only to value medication and throughput. Julie Kipp also provides a well-written and clear account of the benefits of milieu therapy for people with psychotic difficulties. Frank Summers and Patricia Gibbs both present chapters based around case reports that are beautifully written and psychoanalytically very helpful; however, I think these chapters could have had more impact on everyday psychiatric practice if the patients chosen were more typical of

The book concludes that teams such as The book concludes that teams such as the authors' own Critical Incident Stress the authors' own Critical Incident Stress Team, which can support traumatised Team, which can support traumatised front-line emergency staff, their families front-line emergency staff, their families and locally affected communities, have a and locally affected communities, have a valuable role to play-either directly or by valuable role to play-either directly or by ensuring referral of staff for mental health ensuring referral of staff for mental health specialist input. The authors openly ac-specialist input. The authors openly acknowledge the need for careful evaluation knowledge the need for careful evaluation of the impact of trauma response teams. of the impact of trauma response teams.

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