Therapeutic relationship in the context of perceived coercion in a psychiatric population

Theodoridou, Anastasia; Schlatter, Fenissa; Ajdacic, Vladeta; Rössler, Wulf; Jäger, Matthias

doi:10.1016/j.psychres.2012.04.012

Cited by 118 publications

(97 citation statements)

References 35 publications

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“…Interestingly, the therapeutic relationship appeared to be a stronger predictor than the level of coercion experienced by the service user. However, this finding is not fully consistent with the international literature, as two previous studies found that the level of perceived coercion was associated with the therapeutic relationship (Sheehan & Burns, 2011;Theodoridou et al 2012). It could be argued that these are more conceivable results, as it is understandable that exposure to practices that are perceived as coercive could negatively impact the longer term therapeutic relationship.…”

Section: Comparison Of Findings With Previous Literaturecontrasting

confidence: 64%

Service users’ perspective of their admission: a report of study findings

O’Donoghue

Roche²,

Lyne

et al. 2016

Ir. j. psychol. Med.

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Objectives. The 'Service Users' Perspective of their Admission' study examined voluntarily and involuntarily admitted services users' perception of coercion during the admission process and whether this was associated with factors such as the therapeutic alliance, satisfaction with services, functioning and quality of life. This report aims to collate the findings of the study.Methods. The study was undertaken across three community mental health services in Ireland. Participants were interviewed before discharge and at 1 year using the MacArthur Admission Experience. Caregivers of participants were interviewed about their perception of coercion during the admission.Results. A total of 161 service users were interviewed and of those admitted involuntarily, 42% experienced at least one form of physical coercion. Service users admitted involuntarily reported higher levels of perceived coercion and less procedural justice than those admitted voluntarily. A total of 22% of voluntarily admitted service users reported levels of perceived coercion comparable with involuntarily admitted service users and this was associated with treatment in a secure ward or being brought to hospital initially under mental health legislation. In comparison with the service user, caregivers tended to underestimate the level of perceived coercion. The level of procedural justice was moderately associated with the therapeutic relationship and satisfaction with services. After 1 year, 70% experienced an improvement in functioning and this was not associated with the accumulated level of coercive events, when controlled for confounders.Conclusions. This study has provided valuable insights into the perceptions of coercion and can help inform future interventional studies aimed at reducing coercion in mental health services.

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Section: Comparison Of Findings With Previous Literaturecontrasting

confidence: 64%

Service users’ perspective of their admission: a report of study findings

O’Donoghue

Roche²,

Lyne

et al. 2016

Ir. j. psychol. Med.

View full text Add to dashboard Cite

show abstract

“…Unfortunately, we did not directly assess the number of patients who were committed initially and consented to treatment during their stay. As perceived coercion is harmful for therapeutic alliance [22], a voluntary treatment status may be beneficial.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it has been shown to be associated with craving and with the outcome of substance use treatment, for example, relapse [20,21]. Furthermore, locked doors may have effects on therapeutic alliance [22], ward atmosphere [23] and psychiatric symptoms, which are also closely related to stressful experiences.…”

Section: Introductionmentioning

confidence: 99%

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

et al. 2017

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Objective: Substance use treatment is often performed inside locked wards. We investigate the effects of adopting a policy of open-door treatment for a substance use treatment and dual diagnosis ward. Methods: This is a prospective open-label study investigating 3-month study periods before opening (P1), immediately after (P2), and 1 year after the first period (P3). Data on committed patients, coercion (seclusion, forced medication, absconding events with subsequent police search), violence, and substance use was collected daily. We applied generalised estimating equation models. Results: The mean daily number of patients with ongoing commitment changed from 2.64 (P1) to 2.12 (P2) to 0.96 (P3), corresponding to a reduction of relative risk (RR) for having an ongoing commitment by 20% in P2 (RR 0.80; 95% CI 0.66-0.98) and 67% in P3 (RR 0.33; 95% CI 0.25-0.42). The mean daily number of coercive events was 0.29, 0.13, and 0.05, corresponding to a risk for undergoing coercive measures reduced by 56% (RR 0.44; 95% CI 0.22-0.90) and 85% (RR 0.15; 95% CI 0.05-0.45). Substance use, violence or ward atmosphere did not differ significantly. Conclusions: Our results support findings from general psychiatric wards of reduced coercion after adopting a primarily open-door policy. However, coercive events were rare during all periods. The widespread practice of restricting the freedom of inpatients with substance use disorders by locking ward doors is highly questionable.

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“…It has been demonstrated that the level of perceived coercion reduces over time (Fiorillo et al, 2012) and this might indicate an opportunity to engage the individual in further care. The relationship between the perception of coercion and the subsequent therapeutic relationship is unclear, with some studies indicating that they are inherently associated (Sheehan and Burns, 2011;Theodoridou et al, 2012) and others indicating that they are independent of one another . The therapeutic relationship is of utmost importance in mental health services and recently it has been found that an improved therapeutic relationship is associated with a better outcome in terms of admission rates and suicide attempts for individuals with psychotic disorders (Farrelly et al, 2014).…”

Section: Clinical Implications and Future Researchmentioning

confidence: 99%