Maintenance Of Therapeutic Relationship Research Articles

Youths' Perceived Impact of Invalidation and Validation on Their Mental Health Treatment Journeys.

Youths' experiences in seeking and accessing help for mental health problems can have pervasive and lasting effects on personal and interpersonal functioning. In particular, youth who experience validating experiences presumably persevere in seeking help and generally have positive treatment outcomes, whereas youth who experience invalidation are also likely to experience, at least in the short term, ruptures in therapeutic relationships, shame, and reluctance to seek services. The goal of the current study was to expand on previous research assessing youths' interactions with mental health providers, allied professionals, family members, and peers, with a focus on subjective experiences of validation and invalidation. The current study investigated both validating and invalidating experiences in seeking, accessing, and maintaining professional services among 31 Canadian youth (n = 20 girls, n = 11 boys; 12 to 21years old [M = 16.97, SD = 2.01]) who were diagnosed or self-identified with at least one of five conditions: depression (n = 26), anxiety (n = 22), eating disorders (n = 9), autism spectrum disorder (n = 2), or conduct disorder or oppositional defiant disorder (n = 2). Youth were recruited using convenience (e.g., posted advertisements in mental health clinics) and snowball sampling methods. Journey mapping methodology (i.e., participants created visual representations of milestones of their mental health journeys) was employed accompanied by semi-structured interviews to prompt youth to expand on their experiences (e.g., "Could you describe what was happening in your life when you first felt you would need support for your mental health?"). Four themes emerged using inductive thematic analysis, marked by the presence (validation) or lack (invalidation) of: feeling heard, feeling seen, feeling understood, and receiving helpful actions. Participants also reported key consequences of validation and invalidation. Findings broaden a conceptualization of validation across supportive relationships and an understanding of factors that enhance or impede the formation or maintenance of therapeutic relationships with youth. Clinical implications and limitations are discussed.

Exploring the development and maintenance of therapeutic relationships through e-Health support: A narrative analysis of therapist experiences.

Objective:Amid COVID-19 disruptions, e-therapy has become even more essential and has rapidly expanded across statutory, private and third sectors to meet growing demands for digital mental health support. A challenge in digital therapeutic care is how to develop and maintain a supportive, collaborative therapeutic relationship, built upon mutual trust and respect; intrinsic values of relationships that are often implied through complex non-verbal cues. Online practitioners are eager to learn how to adapt to online delivery, although platform-specific training is limited. The aim of the current study was to focus upon the therapist experience of online therapeutic relationships with young people, exploring a range of factors through their perspectives, including the impact of anonymity.Methods:Eight e-therapy practitioners were recruited from Kooth, an online mental health service. Narrative interviews undertaken via Skype facilitated reflective conversational one-to-one discussions, based upon the practitioners’ individual experiences, led by the interviewee. Following transcription and anonymisation, a narrative analysis was undertaken to explore participants’ experiences, perspectives and reflections.Results:Four analytic layers arose from the narratives, which explored the challenging learning experience of translating existing therapeutic skills to online working, rapidly building therapeutic relationships, managing risk in the online therapeutic relationship, and techniques for maintaining a digital therapeutic relationship.Conclusion:The study provides novel insights into the flexibility and adjustments therapists can make to improve online interventions and delivery through the development and maintenance of positive therapeutic relationships. Recommendations are also made in relation to platform-specific training, communicative adaptations, risk management and practitioner support.

Forensic Mental Health Nurses' Perceptions of Clinical Supervision: A Qualitative Descriptive Study

Mental health nursing in the forensic services is perceived as stressful as there is often a tension between therapeutic and custodial processes. Clinical supervision has been discussed as a support strategy for nurses. The aim of this paper is to explore forensic mental health nurses understanding of clinical supervision and their perception of its utility within their practice. A qualitative descriptive method was used and 10 mental health nurses were interviewed with the aid of an interview guide. Qualitative data was analysed using a thematic approach culminating in the emergence of three themes. Participants talked about the tension between caring and custodial roles within the forensic services which was stressful and created difficulties in the maintenance of a therapeutic relationship. Clinical supervision was seen as a necessary support to assist nurses working in the forensic services. The findings support the premise that there is a tension between therapeutic and custodial practices. Acknowledgement of the complexities of working within the forensic services and the provision of clinical supervision within a confidential, non-judgemental relationship may assist nurses in the provision of care and the maintenance of therapeutic relationships.

Nurses' Perspectives of Factors That Influence Therapeutic Relationships in Secure Inpatient Forensic Hospitals.

The therapeutic relationship is synonymous with mental health nursing and fundamental to the provision of nursing care, regardless of the setting in which care is provided. This literature review examines, from a nursing perspective, factors influencing the formation and maintenance of therapeutic relationships in forensic mental health settings. A systematic search of the literature, using a range of electronic databases, focusing on nurse-patient therapeutic relationships in forensic settings was conducted. Articles were Critical Appraisal Skills Programme quality appraised, followed by a meta-aggregative thematic approach to data analysis and synthesis to identify themes and, finally, a production of an "action" policy statement. Eight articles met the criteria for review inclusion. Nine themes were identified; seven were categorized as internal/interpersonal factors, and two were categorized as external/environmental factors (with some themes interconnected). Synthesis of findings resulted in the production of a policy statement encouraging forensic mental health nurses to be aware of intrapersonal influences on therapeutic relationships and the need to provide a safe and supportive clinical environment for these relationships to form.

A study to assess the effectiveness of planned teaching programme (PTP) on knowledge regarding selected psychiatric emergencies among staff nurses at selected hospitals of Sangli District

Mental health nurse has many of significant role in caring of psychiatric emergencies in emergency department of the hospital. The nurses carry various functions like support, reassurance, provision of medications as prescribed, involving in provision of therapies directly or indirectly, maintenance of therapeutic relationship, development of self-confidence, etc.1

Empathic processes during nurse-consumer conflict situations in psychiatric inpatient units: A qualitative study.

Empathy is a central component of nurse-consumer relationships. In the present study, we investigated how empathy is developed and maintained when there is conflict between nurses and consumers, and the ways in which empathy can be used to achieve positive outcomes. Through semistructured interviews, mental health nurses (n=13) and consumers in recovery (n=7) reflected on a specific conflict situation where they had experienced empathy, as well as how empathy contributed more generally to working with nurses/consumers. Thematic analysis was used to analyse the data, utilizing a framework that conceptualizes empathy experiences as involving antecedents, processes, and outcomes. The central theme identified was 'my role as a nurse - the role of my nurse'. Within this theme, nurses focussed on how their role in managing risk and safety determined empathy experienced towards consumers; consumers saw the importance of nurse empathy both in conflict situations and for their general hospitalization experience. Empathy involved nurses trying to understand the consumer's perspective and feeling for the consumer, and was perceived by consumers to involve nurses 'being there'. Empathic relationships built on trust and rapport could withstand a conflict situation, with empathy a core component in consumer satisfaction regarding conflict resolution and care. Empathy allows the maintenance of therapeutic relationships during conflict, and influences the satisfaction of nurses and consumers, even in problematic situations. Nurse education and mentoring should focus on nurse self-reflection and building empathy skills in managing conflict.

Therapeutic relationships. Evolution of the Children's Hospital of Philadelphia model.

The evolution of family-centered pediatric care coupled with the increasing complexity of healthcare environments has had a tremendous impact on the nature of relationships between nursing staff and the children and families they serve. In order to address this, in 1988 the Nursing Department at the Children's Hospital of Philadelphia (CHOP) identified parameters for the development and maintenance of therapeutic relationships. A therapeutic relationship is an interactive relationship with a child and family that is caring, clear, boundaried, positive, and professional. It encompasses the philosophy of the institution, empowerment of the caregivers, and empowerment for families. Utilizing family-centered care as a framework for the delivery of care, this article describes the evolution of therapeutic relationships as a standard of practice including the articulation of principles, clinical examples, implications for practice, and strategies for assessment, management, and evaluation.

Smoking with patients: policy us therapy.

While it is largely accepted that smoking is injurious to physical health, there is no general consensus on the value, or otherwise, of mental health nurses smoking in the company of their patients in the creation and maintenance of therapeutic relationships. This survey of key opinion-formers within medium- and high-security mental health-care facilities was designed to ascertain whether a consensus exists.

A qualitative analysis of adult incest survivors' responses to sexual involvement with therapists

Six women who had histories of incest and had been sexually involved with therapists participated in qualitative research employing semi-structured, open-ended interviews. Transcribed interviews were content analyzed for recurrent regularities in toplcs, themes, events, and dynamics. Following content and cluster analyses of interviews, three overall themes emerged that appeared most salient in attempting to understand the development and maintenance of therapeutic relationships in which incest survivors experienced additional abuse. The themes were (1) early environment that prohibited the development of a sense of “personhood” in incest survivors, (2) repeated experiences of depersonalization inside and outside of therapy that reinforced a state of non-personhood, and (3) adoption of a “surrender pattern” to cope with violations, including therapist violations.