Therapeutic working relationships with people with schizophrenia: literature review

Hewitt, Jeanette; Coffey, Michael

doi:10.1111/j.1365-2648.2005.03623.x

Cited by 110 publications

(135 citation statements)

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“…The researchers found no marked difference in outcome between the two treatment modes; there were, however, significant findings in relation to the therapeutic alliance which led the researchers to conclude that "the therapeutic alliance is not only a prerequisite for therapeutic work, but often may be the main vehicle of change" (Horwitz, 1974, p. 254-255). Moreover, the findings of an early review (Horvath & Symonds, 1991), which provided significant empirical support for the power of the therapeutic relationship, has been replicated in more recent reviews (Hewitt & Coffey, 2005;Horvath et al, 2011;Martin et al, 2000).…”

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confidence: 82%

The Experience of Forming a Therapeutic Relationship from the Client’s Perspective: A Metasynthesis

Noyce

Simpson

2016

Psychotherapy Research

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Objective: This review aimed to synthesise qualitative research exploring clients' perspectives of forming a therapeutic relationship with their therapist or counsellor. Method:Noblit and Hare's meta-ethnographic approach was used to guide the synthesis of 13 studies meeting inclusion criteria. The quality of each study was rated using the CASP quality rating checklist. Results: Findings demonstrated that clients create a hierarchy of desired therapist characteristics to assess how well the therapy can meet their needs (theme 1: assessing clienttherapist match). The formation of the therapeutic relationship is facilitated by an openness from both the therapist and client (theme 2: facilitating openness) and helps to develop a connection through which the client can be fundamentally understood (theme 3: connecting on a deeper level). Displays of disrespectful or disempowering behaviour generate barriers in the formation of a therapeutic relationship (theme 4: empowerment through respect). Conclusions:The meta-ethnographic approach extended the findings from each individual study to highlight some significant discoveries, including that clients across different settings created a hierarchy of therapist characteristics which were of varying importance to them depending on their perceived needs. Additionally, clients reported that they preferred their therapists to disclose information in order to facilitate the therapeutic relationship.

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The Experience of Forming a Therapeutic Relationship from the Client’s Perspective: A Metasynthesis

Noyce

Simpson

2016

Psychotherapy Research

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“…The therapeutic relationship is a reliable predictor of patient outcomes in mainstream psychiatric care. 23,24 Strong, collaborative, working alliances between case managers and people with long-term mental health difficulties have been shown to reduce symptoms, improve levels of functioning and social skills, promote quality of life, enhance medication compliance and raise levels of satisfaction with care received. 25 Yamashita et al 26 describe negotiating care within a trusting relationship as key in case management and this relationship may influence users' perceptions of stigma.…”

Section: Objective(s)mentioning

confidence: 99%

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

Simpson

Hannigan

Coffey

et al. 2016

Health Serv Deliv Res

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BackgroundConcerns about fragmented community mental health care have led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require those people receiving mental health services to have a care co-ordinator, a written care plan and regular reviews of their care. Care planning and co-ordination should be recovery-focused and personalised, with people taking more control over their own support and treatment.Objective(s)We aimed to obtain the views and experiences of various stakeholders involved in community mental health care; to identify factors that facilitated, or acted as barriers to, personalised, collaborative and recovery-focused care planning and co-ordination; and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving six NHS sites in England and Wales, including a meta-narrative synthesis of relevant policies and literature; a survey of recovery, empowerment and therapeutic relationships in service users (n = 449) and recovery in care co-ordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117); and a review of care plans (n = 33).Review methodsA meta-narrative mapping method.ResultsQuantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and the framework method. Our study found significant differences for scores on therapeutic relationships related to positive collaboration and clinician input. We also found significant differences between sites on recovery scores for care co-ordinators related to diversity of treatment options and life goals. This suggests that perceptions relating to how recovery-focused care planning works in practice are variable across sites. Interviews found great variance in the experiences of care planning and the understanding of recovery and personalisation within and across sites, with some differences between England and Wales. Care plans were seen as largely irrelevant by service users, who rarely consulted them. Care co-ordinators saw them as both useful records and also an inflexible administrative burden that restricted time with service users. Service users valued their relationships with care co-ordinators and saw this as being central to their recovery. Carers reported varying levels of involvement in care planning. Risk was a significant concern for workers but this appeared to be rarely discussed with service users, who were often unaware of the content of risk assessments.LimitationsLimitations include a relatively low response rate of between 9% and 19% for the survey and a moderate level of missing data on one measure. For the interviews, there may have been an element of self-selection or inherent biases that were not immediately apparent to the researchers.ConclusionsThe administrative elements of care co-ordination reduce opportunities for recovery-focused and personalised work. There were few shared understandings of recovery, which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work.Future workResearch should be commissioned to investigate innovative approaches to maximising staff contact time with service users and carers; enabling shared decision-making in risk assessments; and promoting training designed to enable personalised, recovery-focused care co-ordination.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Services of support and treatment that is directed toward persons with SMI take place within a wealth of organizational contexts such as psychiatric inpatient care, community mental health services and support provided in people's homes [4]. Despite of these differences in context, it has been indicated that the relationship to professionals can be associated with a more positive outcome also within these kinds of services [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The Art of Helpful Relationships with Professionals: A Meta-ethnography of the Perspective of Persons with Severe Mental Illness

2015

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Relationships with professionals have been shown to be helpful to persons with severe mental illness (SMI) in relation to a variety of services. In this article, we aimed to synthesize the available qualitative research to acquire a deepened understanding of what helpful relationships with professionals consists of, from the perspective of persons with SMI. To do this, we created a meta-ethnography of 21 studies, through which ten themes and an overarching interpretation were created. The findings show that helpful relationships with professionals are relationships where the persons with SMI get to spend time with professionals that they know and trust, who gives them access to resources, support, collaboration and valued interpersonal processes, which are allowed to transgress the boundaries of the professional relationship. The overarching interpretation shows that the relationship that persons with SMI form with professionals is a professional relationship as well as an interpersonal relationship. Both these dimensions entail actions and processes that can be helpful to persons with SMI. Therefore, it is important to recognize and acknowledge both the functional roles of service user and service provider, as well as the roles of two persons interacting with each other, in a manner that may go beyond the purview of the traditional professionalism. Furthermore, the helpful components of this DOI 10.1007/s11126-015-9347-5 relationship are determined by the individual preferences, needs and wishes of persons with SMI.

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Therapeutic working relationships with people with schizophrenia: literature review

Abstract: Therapeutic relationships are necessary but not sufficient to enable change when working with people with schizophrenia.

Cited by 110 publications

References 54 publications

The Experience of Forming a Therapeutic Relationship from the Client’s Perspective: A Metasynthesis

The Experience of Forming a Therapeutic Relationship from the Client’s Perspective: A Metasynthesis

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

The Art of Helpful Relationships with Professionals: A Meta-ethnography of the Perspective of Persons with Severe Mental Illness

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