Abstract
BackgroundTherapist-related activities and characteristics such as empathy and genuineness are factors that significantly contribute to psychotherapy outcome. As they play a role in psychotherapy more generally, it can be expected that they are equally important in the treatment of court-mandated patients more specifically. At the same time, these treatment settings come with specific challenges—e.g. due to coercion and control—and it could thus be that some therapist-related characteristics might have a different empathy on the therapy. This interview study sought to investigate service providers’ and users’ perspectives on therapist-related characteristics in the context of detention.MethodsWe conducted a qualitative interview study with 41 older incarcerated persons mandated to treatment, and 63 mental health professionals (MHP). The data analysis followed thematic analysis.ResultsPatients and experts both emphasized the importance of treating patients with respect by taking a humanistic approach, that is, condemn the deeds but embrace the person and display genuine interest in supporting patients with any issue or concern that is of relevance to them. Furthermore, interviewees underscored that the coerciveness of the therapy context required to incorporate patients’ wishes into treatment planning, recognize and respond to the patients’ needs, and allow some choice within the given framework. Such inclusive attitude was deemed critical to engage and motivate patients to participate in treatment. In addition, it was emphasized that feedback and advice by the therapists need to be concrete, detailed and applied to each person’s current situation. Lastly, patients questioned MHP’s qualification when they did not progress in therapy.DiscussionOur findings indicate that some therapist-related activities and characteristics are of particular importance in court-mandated settings. These include genuine interest in the patient, a respectful and positive attitude, as well as the capacity to target sensitive issues in a directive but non-confrontational manner. Further research needs to identify specific expressions and behaviors that are linked to the aforementioned characteristics in the forensic context. Our study therefore contributes to much-needed empirical research on clinician and patient perspectives on therapist characteristics and activities in the treatment of court-mandated patients.
Highlights
Therapist-related activities and characteristics such as empathy and genuineness are factors that signif‐ icantly contribute to psychotherapy outcome
All authors agreed to the results presented in this paper and its interpretation. Using data from both older incarcerated persons undergoing court-mandated treatments and experts MHPs, we grouped the results into five themes that all relate to techniques and activities that mental health professionals applied in their work with patients
MHPs who were described as being genuinely motivated to help patients were pictured as persons who provided support that exceeded expectations: “She is a really good woman, she has helped me a lot here, is overly involved, so she really does something, she helps me with problems that come up.” (P554) This notion of support was prominent in several expert-interviews, as outlined by C41: “We would often see patients that were admitted here that were in very poor physical condition and when we provided them that physical and mental health care we have seen drastic and marked improvements in their presentation and their quality of life. (...) they um sort of thrive in the supportive environment that we provide and that is very rewarding as well.”
Summary
Therapist-related activities and characteristics such as empathy and genuineness are factors that signif‐ icantly contribute to psychotherapy outcome As they play a role in psychotherapy more generally, it can be expected that they are important in the treatment of court-mandated patients . These treatment settings come with specific challenges—e.g. due to coercion and control—and it could be that some therapist-related characteristics might have a different empathy on the therapy. The precise impact of these aspects on psychotherapy process and outcome factors is unclear, but it is important to understand their influence in court-mandated treatments [34] This is because studies assessing the effectiveness of court-mandated treatments showed positive, negative, or equivocal effects on outcome measures such as criminal recidivism and psychiatric symptoms [34, 35]. These inconsistencies suggest that other intermediary factors—such as therapist characteristics— might play a role
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