Strong Therapeutic Alliance Research Articles

Suicide prevention via telemental health services: insights from a randomized control trial of crisis response plan and self-guided safety planning approaches.

Although telemental health can make suicide prevention treatments more scalable and accessible, limited evidence demonstrates successful reductions in suicidality when interventions are administered through telehealth platforms. To address this limitation, the current work investigated the effects of two suicide prevention treatments - a clinician-guided Crisis Response Plan and a self-guided Safety Planning approach. After completing the screening process, 82 participants with high suicide ideation and/or a lifetime history of suicidal behavior were randomly assigned across the two groups. Trained research clinicians administered the interventions using a videoconferencing platform. After the intervention delivery was complete, participants reported the therapeutic alliance they experienced with their clinician using an online survey. Participants also reported their overall suicidality 45 days after receiving the intervention. In addition, participants' perceived usefulness of the received intervention and actual use of the plan were recorded. Linear and logistic regression models predicted how suicidality, perceived utility, and actual use of their intervention protocols varied depending on the high (Crisis Response Plan) versus low (self-guided Safety Planning) level of clinician-led collaboration the two treatments entailed. Both Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services. At the same time, those who received the Crisis Response Plan (the more collaborative form of therapy) reported experiencing a stronger therapeutic alliance with the clinician, utilizing the plan more often and perceiving it as more useful. These findings demonstrate the additional benefits of adopting a more collaborative approach because of its effectiveness and perceived utility, which has implications for suicide-related distress reduction in the short and long term. Evidence from this randomized control trial suggests that Crisis Response Plan is a suitable candidate for delivering suicide prevention via telehealth platform because of its effectiveness in reducing suicidality and its collaborative approach to building a strong therapeutic alliance, perceived usefulness, and actual utility in everyday life. This paper was part of a registered RCT: https://clinicaltrials.gov/study/NCT04888845 . Registration date: Date: 2021-04-22.

Exploring the Impact of Stigma on Health and Wellbeing: Insights from Mothers with Lived Experience Accessing Recovery Services.

Stigmatisation is the process by which an individual is devalued based on their attributes, characteristics, and/or behaviour, with this often leading to prejudice, social and health-related harms, active discrimination, and microaggressions. The aim of this paper is to show how social harms can occur and how stigma is damaging to the health and wellbeing of a person in recovery. To do so, we focus on the harms that arise from the internalisation of labels that mothers who use drugs encounter in a treatment and recovery setting whilst in active recovery, and how this stigmatisation can manifest negative self-beliefs. Qualitative data was used from two semi-structured focus groups involving females with lived experience of substance use (n = 13). A reflexive thematic analysis approach was used to analyse the interview transcripts, and three themes were identified: (1) the enduring nature of stigma; (2) gender disparity and the need for mothers- and women-only spaces; and (3) stigma as a barrier to services and wellbeing. Findings revealed the enduring nature of stigma amongst mothers who were in active recovery, with women feeling judged more harshly than men and experiencing pressure to live up to a "good mother" ideal whilst in recovery. This paper demonstrates that mothers in recovery are still stigmatised and, as a consequence, approach services with increased sensitivity, with stigma often resulting in disengagement or reluctance to access healthcare settings. We conclude that staff in health, social, and primary care settings need to develop a strong therapeutic alliance with mothers in recovery and promote anti-stigma approaches in their practice, in order to mitigate stigma and reduce harms to health and wellbeing.

Understanding Pediatric Physical Therapists' Experiences With Middle Eastern Patients and Arabic Interpreters: A Qualitative Study.

The purpose of this study was to explore pediatric physical therapists' (PTs') experiences including successes, challenges, and barriers with cross-cultural communication with Arabic-speaking Middle Eastern children and their families who require interpreter services. Eight PTs consented to participate in qualitative dyadic interviews. Transcription and interviews were conducted virtually in Microsoft Teams. Quality criteria included member checking for validity and trustworthiness and bracketing to minimize investigator bias. Inductive thematic analysis was used to identify meaning units and major themes. The 6 themes that emerged were: fostering therapeutic relationships, practicing culturally sensitive care, communicating intentionally, experiencing successes, recognizing challenges, and tailoring a physical therapy plan of care. Representative quotations support each theme. Therapists perceive their experiences with Arabic-speaking children, families, and interpreters positively despite challenges related to cultural and language barriers. In sharing their experiences, therapists demonstrated self-reflection, openness to learning, and desire to build strong therapeutic alliances.

‘Leaving my comfort zone’. A qualitative study of physiotherapists' experiences blending an eHealth psychosocial intervention with face-to-face physiotherapy

BackgroundMany physiotherapists do not feel adequately equipped to address psychosocial risk factors in people with complex pain states. Hence, a biopsychosocial blended intervention (Back2Action) was developed to assist physiotherapists to manage people with persistent spinal pain and coexisting psychosocial risk factors associated with the development or maintenance of persistent pain. ObjectiveThis study aimed to gain insight into the experiences of physiotherapists with this blended psychosocial intervention. Designand methods: This was an interpretative qualitative study with a reflexive thematic analysis of semi-structured interviews with physiotherapists (N = 15) who delivered Back2Action. The interview started with the grand-tour question: “What was your experience in using Back2Action?” Physiotherapist were encouraged to provide examples, and follow-up questions were posed to ensure a deeper understanding could be reached. ResultsFour themes were constructed: Physiotherapists became increasingly aware of (1) their own implicit expectations, biases and skills, and underlying treatment paradigms, and (2) the implicit expectations from their patients towards them. This led to (3) creating a deeper and stronger therapeutic alliance with the patient, but also (4) an understanding that implementation of a true biopsychosocial intervention – even if offered in a blended form – requires more practice, confidence and resources. ConclusionsBack2Action is considered a valuable treatment to deliver a biopsychosocial intervention in primary care. Considering the high level of knowledge, skills and competency of the participating physiotherapists, the perceived barriers may be more difficult to overcome for more junior physiotherapists.

Qualitative study exploring the views of patients and healthcare providers on current rehabilitation practices after lumbar fusion surgery

ObjectivesTo explore the views of patients and healthcare providers on current rehabilitation after lumbar fusion surgery (LFS) to fuel the development of a novel rehabilitation care pathway.DesignA cross-sectional, qualitative study...

Adolescents' voices on self-engagement in mental health treatment: a scoping review.

According to the United Nations Convention on the Rights of the Child, adolescents' involvement in their healthcare is a fundamental right, and self-engagement in mental health treatment is vital for realizing their potential within person-centered care (PCC). Research exists that highlights barriers to involving adolescents in their care decisions. However, research on adolescents' own voices about self-engagement in mental health treatment has been scarce. This scoping review aimed to examine and summarize current knowledge on adolescents' voices regarding self-engagement in mental health treatment. The review followed the scoping methodology of Arksey and O'Malley from 2005, updated by Levac and colleagues in 2010, involving five stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing and reporting the results. Nineteen studies were included. The following themes on adolescents` voices regarding self-engagement in mental health treatment were identified: (1) the therapeutic alliance, (2) the need for active engagement in treatment, (3) different experiences due to time of data collection, (4) treatment context and healthcare system, and (5) adolescent-caregiver interaction. Adolescents' understanding of self-engagement was multilevel and comprehensive, including individual, contextual and relational factors. A strong therapeutic alliance with healthcare providers, and a need to be actively engaged in treatment were highlighted. To succeed in strengthening PCC in mental healthcare for adolescents, health professionals must take this complex understanding into consideration, as treatment without adolescents` self-engagement may worsen their clinical outcomes. Future research should explore specific PCC interventions and incorporate diverse methodologies in various clinical contexts. Additionally, insights from healthcare providers and caregivers on self-engagement in mental health treatment will complement these findings.

Point-of-care ultrasound (POCUS): Assessing patient satisfaction and socioemotional benefits in the hospital setting.

Point-of-care ultrasound (POCUS) is an imaging modality used to make expedient patient care decisions at bedside. Though its diagnostic utility has been extensively described, POCUS is not yet considered standard of care in inpatient settings. Data from emergency department settings suggest that POCUS may yield socioemotional benefits beyond its diagnostic utility; furthermore, elements of the POCUS experience are known to promote placebo effects. These elements likely contribute to a placebo-like "POCUS positive care effect" (PPCE) with socioemotional benefits for receptive patients. Our objective is to provide the first characterization of the PPCE and its facilitating factors in an inpatient setting. In this novel mixed-methods study, we recruited 30 adult patients admitted to internal medicine floors in an urban academic medical center, recorded observations during their routine POCUS encounters, and administered post-encounter surveys. We conducted complementary quantitative and qualitative analyses to define and assess the magnitude of the PPCE. We also aimed to identify factors associated with and facilitating receptiveness to the PPCE. The results indicated that POCUS improves patients' satisfaction with their hospital providers and care overall, as well as perceived care efficiency. Mutual engagement, strong therapeutic alliances, and interpreting POCUS images to provide reassurance are most closely associated with this PPCE. Patients who have lower anxiety levels, less severe illness, and received efficient care delivery during their hospitalizations are most receptive to the PPCE. We conclude that diagnostic POCUS has the potential to exert a positive care effect for hospitalized patients. This PPCE is associated with modifiable factors at the patient, provider, and environment levels. Together, our findings lay the groundwork for an optimized "therapeutic POCUS" that yields maximal socioemotional benefits for receptive patients.

The Dance of Empathy and Understanding: Nurturing Rapport in the Counselor-Client Connection

This article explores the analysis of individual counseling service strategies in relation to the counselor-client relationship. The research method employed in this study is a literature review analysis. The results reveal that counseling is a process of providing assistance through counseling interviews conducted by a professional counselor to individuals facing various problems. Individual counseling emerges as a core service within guidance and counseling, enabling clients to express their personal issues and find solutions. The counselor-client relationship is of utmost importance, requiring the counselor to establish rapport, trust, and effective communication with the client. Building a strong therapeutic alliance is crucial for successful counseling outcomes. The counselor-client relationship is dynamic and evolves over time, fostering trust, mutual understanding, and personal growth. Furthermore, maintaining appropriate boundaries and adhering to ethical standards are vital aspects of the counseling relationship.

Pain: The Silent Public Health Epidemic.

More than 50 million Americans suffer from chronic pain, costing our society an estimated 565 to 635 billion dollars annually. Its complexity and training deficits in healthcare providers result in many patients receiving ineffective care. Large health inequities also exist in access to effective pain care for vulnerable populations. The traumatic history of indigenous people and people of color in regards to the experience of pain care perpetuates a lack of trust in the healthcare system, causing many to hesitate to seek medical treatment for painful events and conditions. Other vulnerable populations include those with sickle cell disease or fibromyalgia, whose experience of pain has not been well-understood. There are both barriers to care and stigma for patients with pain, including those taking prescribed doses of long-term opioids, those with known substance use disorder, and those with mental health diagnoses. The suffering of patients with pain can be "invisible" to the clinician, and to one's community at large. Pain can affect all people; but those most vulnerable to not getting effective care may continue to suffer in silence because their voices are not heard. Since 1973, pain societies around the globe have worked tirelessly to bring clinicians together to advance pain and opioid education, research, and patient care. These improvements consist of pain education, integrative treatment, and the understanding that a therapeutic alliance is critical to effective pain management. Pain education for both pre and post-licensure health professionals has increased substantially over the last decade. In addition, integrative and interdisciplinary approaches for clinical pain management are now considered best practices in pain care for patients with moderate to severe pain in addition to the development of a strong therapeutic alliance.

The Ideal Physical Therapist from the Perspective of Individuals With Limb Loss.

Effective rehabilitation after limb loss is necessary to maximize function and promote independence. Physical therapists (PT) are one of the primary drivers of the rehabilitation process. While general physical therapy knowledge and abilities have been shown to be important to the rehabilitation process, it is unclear what individuals with limb loss value in their PT's. The purpose of this study was to understand the elements that define an ideal PT from the perspective of individuals with limb loss. Mixed-method design consisting of a 20-item web-based survey and semi-structured interviews that were administered to individuals 18 years or older, who spoke English, and had a history of lower limb loss. Individuals with limb loss describe an ideal PT as promoting a therapeutic alliance, having specialized knowledge, and collaborating with a prosthetist. Knowledge of the PT as it relates to limb loss was found to be both the greatest facilitator and barrier to the rehabilitation process. From the perspective of those with limb loss, an ideal PT promotes a strong therapeutic alliance through communication, has specialized knowledge when it comes to the limb loss rehabilitation process, and collaborates with the prosthetist to problem-solve throughout the rehabilitation process.

Access to therapy for child sexual abuse survivors: Preliminary dialogue of barriers and facilitators between caregivers.

Difficulties in access to therapy were highlighted by COVID-19 measures restricting in-person gatherings. Additional challenges arise when focusing on caregivers of child sexual abuse (CSA) survivors in particular, which are a population that has been historically difficult to engage with due to issues of stigma and confidentiality. To present preliminary qualitative results from caregivers of CSA survivors. This study was conducted with caregivers of CSA survivors. Two hybrid webinar/focus groups were conducted using a video conferencing platform in fall of 2021 with two groups of stakeholders (11 caregivers and 5 moderators/clinical staff at Little Warriors, an intensive episodic treatment facility). Sessions were recorded, transcribed, and thematically-analyzed using standard qualitative methodology. A total of 11 caregivers contributed to the data. Themes include: (1) Challenges of starting and maintaining treatment (i.e., emotional impact of intake day, challenges of enrolling), (2) Therapeutic benefits of specialized treatment (i.e., feeling safe and supported and the importance of trauma-informed care), and (3) Barriers and facilitators of treatment (i.e., avenues to scale-up and self-care). The importance of a strong therapeutic alliance was highlighted by both caregivers/clinical staff and further support is needed for families post-treatment. The present hybrid webinar/focus group also achieved engagement goals in a population that is typically difficult to reach. Overall, the response rate (12%) was equivalent to reported registrant attendance rates for general business to consumer webinars and the recommended focus group size. This preliminary approach warrants replication in other populations outside our clinical context.

Using expletives to enhance therapeutic outcomes: A case report.

Swearing deserves attention in the physical therapy setting due to its potential positive effects on pain, physical performance, and therapeutic alliance. The purpose of this case report is to describe the strategic use of swearing in the clinical setting. A 44-year-old female completed an episode of physical therapy after undergoing patellofemoral arthroplasty. Swearing was formally included into the plan of care, and the patient swore out loud during the most challenging and painful interventions. The patient reported that repeating a swear word was funny, distracted the patient, and made the patient feel more confident. The patient and physical therapist self-reported a strong therapeutic alliance. There is evidence repeating a swear word out loud can strengthen the therapeutic alliance, improve physical performance, and decrease pain. This is, to our knowledge, the first report of a patient swearing during an episode of physical therapy care.

MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations.

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.

DYNAMICS OF KINESIOPHOBIA AND PHYSICAL FUNCTIONING PARAMETERS IN THE ELDERLY ADULTS WITH SARCOPENIC OBESITY UNDER THE INFLUENCE OF THE PHYSICAL THERAPY PROGRAM

Aim: to determine the effectiveness of a physical therapy program for the elderly with sarcopenic obesity in terms of the kinesiophobia and physical functioning parameters.
 Materials and methods: We examined 106 elderly people, who were divided into 3 groups. The control group consisted of individuals with normal body weight and they had no sarcopenia. The main group 1 consisted of individuals with sarcopenic obesity and a weak therapeutic alliance; they were given general recommendations for modifying the diet and expanding physical activity. The main group 2 included patients with a strong therapeutic alliance. A one-year physical therapy program with the use of kinesitherapy, massage, dietary intervention, patient education, the elements of cognitive training and occupation therapy was developed for them. The dynamics were assessed by Tampa Kinesiophobia Scale, Fullerton Fitness Test, Edmonton Frail Scale.
 Results: Elderly people with sarcopenic obesity have a high level of kinesiophobia (Tampa Kinesiophobia Scale), their physical status (coordination, balance, strength, flexibility, endurance, agility) significantly lags behind that of their peers (Fullerton Fitness Test), they suffer from the frailty (Edmonton Frail Scale). After applying the developed physical therapy program, it was possible to state that the individuals of the main group 2 showed a statistically significant (p <0.05) improvement in their physical functioning parameters relative to the indicators of their peers and initial parameters, a reduction in the frailty, decreasing in the level of kinesiophobia. The low level of the therapeutic alliance, despite the awareness of the negative consequences for the health, led to unsatisfactory implementation or non-implementation of the recommendations provided for the elderly with sarcopenic obesity and was associated with no improvement in the physical status, signs of frailty, kinesiophobia.
 Conclusions: The developed physical therapy program for elderly patients with sarcopenic obesity against a background of a high level of the therapeutic alliance showed a statistically significant improvement in all studied indicators of kinesiophobia and physical functioning parameters compared to the initial level and the indicators of people with low levels of the therapeutic alliance.

Establishing an optimal working relationship with patients with an antisocial personality disorder. Aspects and processes in the therapeutic alliance.

Developing good interpersonal relationships is one of the main impediments for people with an antisocial personality disorder (ASPD). However, in treatment of psychiatric disorders, establishing a strong therapeutic alliance (TA) is important for effective treatment. Nevertheless, there is little knowledge on how to establish this TA with this challenging patient group. This study investigates which factors are important in TA development. For this study, a qualitative research methodology is applied. In-depth interviews with therapists experienced in treating ASPD were conducted and analysed through thematic analysis. The analysis revealed six themes important in alliance formation: the patient's needs, regulating interpersonal dynamics, connective attitude, connective skills, treatment process and treatment goals. Each theme is defined including aspects of the recommended therapeutic attitude and required skills for therapists working with patients with ASPD. This study determined that, for therapists working with patients with ASPD, several key factors are essential in establishing a strong TA. These factors include the ability to be firm, authentic, non-judgmental and genuinely involved. An attentive presence is crucial, in which the therapist takes initiative in establishing contact and makes the patient feel that he is truly seen as an autonomous and equal person. In doing so, the therapist needs to provide clarity and structure while remaining perceptive to boundary violations. The therapist must be able to set limits using a clear yet kind tone of voice. Furthermore, it was notable that an intensive appeal is made to the therapist's reflective capacity in these treatments.

Workshop (Clinical/Best Practice Implementation) ID 1984795

Background/Objectives Following an initial summit in March 2019, various Canadian stakeholders have collaborated within a Community of Practice (CoP) with a vision to increase the access to, and quality of activity-based therapies (ABT) for persons with spinal cord injury/disease (SCI/D). This workshop will describe key knowledge products and study findings emanating from working groups of the ABT CoP as well as a study initiated through the Canadian SCI Standing and Walking Module Group. Design/Methods Priority areas were identified by consensus across the ABT CoP, leading to several studies and development of specific knowledge products. Key challenges included defining and standardizing ABT, gaps in knowledge/training and practice variation with a focus on achieving optimal timing, dosage and intensity of ABT. Various knowledge products and study findings related to these challenges will be presented, with audience interaction encouraged through polls and open discussion. Results Presentation highlights include a framework for structured reporting of ABT and a series of videos, pod-casts and information cards promoting ABT. In addition, a mixed methods study of Canadian physiotherapists demonstrated that ABTs were a much desired, yet not fully available treatment option. Therapists identified needs for more fulsome research partnerships, improved and more creative staffing models, enhanced training methods and the importance of a strong therapeutic alliance. Conclusion The work of the ABT CoP will continue to focus on these and other priorities, with the ultimate goal of universal access and identification of approaches that will enhance outcomes for persons with SCI/D.

When therapists talk to voices: Perspectives from service-users who experience auditory hallucinations.

The purpose of the study was to investigate service-users' experiences of a therapist engaging with their voices (auditory hallucinations) using psychological formulation and direct dialogue. A nested qualitative study was conducted within a randomised controlled trial of a novel intervention for supporting voice hearers with a diagnosis of psychosis (Talking With Voices: TwV). Of 24 participants allocated to therapy, 13 (54%) consented to a semi-structured, in-depth interview which was audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Participants described their experiences of using the intervention to improve the relationship between themselves and their voice(s). The findings are organised within three themes and associated subthemes: (1) A desire for suitable help (Motivation to reduce voice-related distress, Limitation of other treatment options); (2) Engaging with voices (Challenges, Support and safety, Exploration and revelation); and (3) Contemplating the future (The aftermath of adversity, Living well with voices, Resources for moving forward). Despite the emotional challenges of the work, many participants experienced tangible gains in the ways they related to their voices post-intervention. For those who responded well, the development of safety strategies, including a strong therapeutic alliance, could facilitate a basis for developing new insights about the origin/nature of the voices which could then be applied in constructive ways. Further research is needed to understand which client characteristics indicate suitability for TwV as opposed to relational therapies that require less direct engagement with voices and/or the psychosocial conflicts with which they may be associated.

COVID-19, consequences on psychiatric care and access to mental health services: A patients’ opinions survey

Objective: The COVID-19 pandemic has (and will continue to have) quite a strong impact on patients whose mental conditions worsen due to isolation, disruption of usual routine, activities, and loss of community support, if not the infection itself. Therefore, exploring and evaluating existing ways and proposing new ways to communicate and maintain a strong therapeutic alliance between therapists and patients was important.Methods: A semi-structured interview based on a homemade grid designed to assess participants’ opinions on access to telehealth services and their efficiency. Period of study: March 2020 to June 2021.Results: Impact of COVID-19 on daily life: 70% experienced isolation due to the pandemic life-changing, 65% experienced anxiety, 42% depression, and 28% anger. Teleconsultations’ perceptions during the COVID-19 pandemic were perceived as a good solution for a pandemic era and no need for displacement (30%). 38% thought that video consultation is a better option than telephone consultations, with 60% stating a similar level of comfort in video/phone consultation compared to in-person. Recommendations to address Mental Health (MH) care delivery soon after this pandemic were: Patients (60%) are interested in accessing a website (or mobile application) on resources of MH services available in their city/region.Conclusions: Results show that isolation and anxiety were the factors most affecting the social life and conditions of participants, with some significant levels of depression and anger. Participants largely accepted the transition to virtual care with some improvements.

Therapeutic Communication in Schizophrenic Patients: A Systematic Literature Review

Introduction: Schizophrenia is a complex mental disorder that affects an individual's thoughts, perceptions, and behaviors. Therapeutic communication in schizophrenic patients refers to the communication approach used by health professionals or therapists to interact with schizophrenic patients with the aim of assisting them in recovery and improving their quality of life. This study aimed to explore forms of therapeutic communication that could be used to improve improvements in schizophrenia patients.
 Methods: The literature search process was carried out on various databases (PubMed, Web of Sciences, EMBASE, Cochrane Libraries, and Google Scholar) regarding therapeutic communication and schizophrenia. The search was performed using the terms "therapeutic communication" OR "psychoeducation" OR "psychotherapy" AND "schizophrenia”.
 Results: Among all studies included in the review, there were three qualitative studies and one observational study. In addition, the study did not provide information on whether there were deviations from the intervention data, bias in measuring outcomes, and bias in the selection of reported outcomes.
 Conclusion: Therapeutic communication can be adapted to the individual needs of schizophrenic patients. To build a strong therapeutic alliance, open conversation, trust, and respect play a fundamental role, with the ultimate goal of building a partnership to optimize patient outcomes.

First-hand reports of prolonged social withdrawal: contributing factors, experiences, and change processes

Purpose The purpose of this study is to gain deeper understanding of the experience of PSW and pathways to recover. Prolonged social withdrawal (PSW) among young people has been widely reported; however, the voice of those who withdraw is rarely heard. Illuminating these firsthand experiences is important as the phenomenon becomes widespread, calling for increased attention and creative solutions to promote recovery processes and re-inclusion in society. Design/methodology/approach This study conducted nine in-depth semi-structured interviews with young people who have been reclusive for 2–19 years and inquired about their perspectives and experiences around times of PSW and beyond. These data were analyzed and categorized according to three main areas: factors contributing to PSW, subjective experiences and general functioning during PSW and processes involved in coming out of PSW. This study presents the main findings and illustrates them using a case of a young man in PSW for 19 years. Findings The findings reveal that young people may turn to social withdrawal in response to varied personal and familial challenges, and often experience intense loneliness and psychic pain. Attempts to cope and recover from withdrawal involve inner motivation combined with support from significant others and a strong therapeutic alliance with professionals. Originality/value To the best of the authors’ knowledge, this is the first study to report findings from in-depth interviews with people who spent very long periods in PSW, and accordingly it contributes to the growing body of knowledge on this phenomenon. Based on this unique firsthand perspective, the authors propose potential guidelines for caregivers and mental health professionals trying to help people in PSW to reintegrate into society.