Abstract
BackgroundWorking alliances are considered to be essential to treatment, and they represent a robust predictor of positive treatment outcomes. In a working alliance, a patient and therapist agree upon treatment decisions, which can raise a series of challenges when patients are in involuntary treatment. The aim of this study was to research how therapists experience negotiating a working alliance with patients with serious mental illnesses who are subjected to coercive treatment.MethodsUsing a qualitative approach, we conducted 10 semi-structured interviews with experienced therapists in a Norwegian mental health care setting. Transcripts were analysed using a team-based thematic analysis method.ResultsTwo interrelated major themes and five sub-themes were identified: (1) between coercion and care; (a) the ease of coercion, (b) the paradox of autonomy, and (c) the coercion as care; and (2) imperative treatment and interpersonal dilemmas; (a) this is happening between us and (b) when we do not meet in the middle.ConclusionWe conclude that the therapists exhibited a will to consider their patients’ goals and methods, but only when they were in agreement, and they ultimately made treatment decisions themselves. Further, patient autonomy seems to come second in therapist assessments of needs for care; consequently, we question to what degree the working alliance as a defined concept of mutual agreement is present in the involuntary treatment we investigated.
Highlights
How do you proceed to find goalsCan you describe what it is like with the person subjected to providing involuntary treatment coercive treatment?to people with serious mental How do you go about creating illnesses?agreement between you and the Possible follow-up questions person?What is it like executing coercive How do you include the patient’s treatment? goals?Do you experience any differ-Have you experienced any chalences from other ways of work- lenges in relation to agreeing on ing with patients in therapy? mutual goals?Establishing working alliance inIf yes, can you describe these?
Reflexivity The interpretative phenomenological approach taken by the authors implies that we aim to explore and describe the views on establishing working alliances in involuntary treatment settings, but by doing so, we need to acknowledge that we are informed by our own experiential horizons [33]
The analysis yielded two interrelated major themes and five sub-themes illustrating how the therapists experienced working alliances with patients subjected to involuntary treatment
Summary
How do you proceed to find goalsCan you describe what it is like with the person subjected to providing involuntary treatment coercive treatment?to people with serious mental How do you go about creating illnesses?agreement between you and the Possible follow-up questions person?What is it like executing coercive How do you include the patient’s treatment? goals?Do you experience any differ-Have you experienced any chalences from other ways of work- lenges in relation to agreeing on ing with patients in therapy? mutual goals?Establishing working alliance inIf yes, can you describe these?. The aim of this study was to research how therapists experience negotiating a working alliance with patients with serious mental illnesses who are subjected to coercive treatment. A working alliance is understood as a bond between a patient and therapist involving elements of trust and acceptance [2], active cooperation and mutual agreement on treatment goals and methods [3,4,5]. Working alliances with individuals with serious mental disorders, which represents the group most often admitted involuntarily, have been studied to a greater extent. Studies find it possible to develop and maintain a good
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