Abstract
It has long been recognised that relationships are key to good mental health service delivery and yet the quality of the relational context remains poorly understood. This article brings together three studies that utilize very different methodologies to explore the various ways in which a process of therapeutic change can be aided or prevented by relational factors. All three studies took place within the context of therapeutic communities. The first study uses narrative ethnography and interaction ritual theory to explain how the mechanisms of everyday encounters in two therapeutic communities transform negative feeling into a sense of belonging and positive emotions such as confidence. The second study uses grounded theory to explore how the relational setting and the altered context of the researcher in a therapeutic faith community environment induces either a positive or negative quality of relationships. The final study uses a novel autoethnographic methodology to inform understanding of the relational experience of mental health treatment by comparing and contrasting multiple perspectives of different treatment environments. The paper concludes by identifying the expression and containment of affect in a congruent environment, belonging and hope, and fluid hierarchies of relational structures as key aspects of the relational context informing change.
Highlights
Relationships are implicated in both “the creation and amelioration of mental health problems” (Pilgrim, Rogers & Bentall, 2009, p. 235)
At the six-month interviews, all of the participants disclosed they had viewed Brown as someone with power to detain them under the UK Mental Health Act due to her status as a mental health pharmacist, and had provided inaccurate responses to the baseline outcome measures
Participants began to tell their stories of experiences with mental health services and professionals, and their experiences of being part of Church Deal (CCD)
Summary
Relationships are implicated in both “the creation and amelioration of mental health problems” (Pilgrim, Rogers & Bentall, 2009, p. 235). As one member of a therapeutic community put it, “it is people that hurt us and people that heal us” These statements have found strong support in the research literature: from the role of attachment as both a significant predictor of psychological difficulties and as a resilience factor against stress (Ma, 2006), to the quality of the therapeutic alliance as the most consistently reliable predictor of psychotherapeutic outcome (Lambert & Barley, 2001). In these terms, relationships are not just an important aspect of any mental health intervention – they are the intervention (Middleton, 2015). Rogers’ theories have been highly influential in psychotherapy and have been supported by numerous empirical studies (Joseph & Murphy, 2013)
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