Abstract
Relationships with professionals have been shown to be helpful to persons with severe mental illness (SMI) in relation to a variety of services. In this article, we aimed to synthesize the available qualitative research to acquire a deepened understanding of what helpful relationships with professionals consists of, from the perspective of persons with SMI. To do this, we created a meta-ethnography of 21 studies, through which ten themes and an overarching interpretation were created. The findings show that helpful relationships with professionals are relationships where the persons with SMI get to spend time with professionals that they know and trust, who gives them access to resources, support, collaboration and valued interpersonal processes, which are allowed to transgress the boundaries of the professional relationship. The overarching interpretation shows that the relationship that persons with SMI form with professionals is a professional relationship as well as an interpersonal relationship. Both these dimensions entail actions and processes that can be helpful to persons with SMI. Therefore, it is important to recognize and acknowledge both the functional roles of service user and service provider, as well as the roles of two persons interacting with each other, in a manner that may go beyond the purview of the traditional professionalism. Furthermore, the helpful components of this relationship are determined by the individual preferences, needs and wishes of persons with SMI.
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Horvath AO, Del Re AC, Flückiger C, Symonds D: Alliance in individual psychotherapy. Psychotherapy 48:9–16, 2011.
Martin DJ, Garske JP, Davis M: Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology 68:438–450, 2000.
Wampold BE: The great psychotherapy debate: Models, methods and findings. Mahwah, Erlbaum, 2001.
McCabe R, Priebe S: The therapeutic relationship in the treatment of severe mental illness: A review of methods and findings. International Journal of Social Psychiatry 50:115–128, 2004.
DeLeeuw M, Van Meijel B, Grypdonck M, Kroon H: The quality of the working alliance between chronic psychiatric patients and their case managers: Process and outcomes. Journal of Psychiatric and Mental Health Nursing 19:1–7, 2012.
Catty J, White S, Koletsi M, Becker T, Fioritti A, Kalkan R, et al.: Therapeutic relationships in vocational rehabilitation: Predicting good relationships for people with psychosis. Psychiatry Research 187:68–73, 2011.
Hewitt J, Coffey M: Therapeutic working relationships with people with schizophrenia: Literature review. Journal of Advanced Nursing 52:561–570, 2005.
Howgego IM, Yellowlees P, Owen C, Meldrum L: The therapeutic alliance: The key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Australian and New Zealand Journal of Psychiatry 37:169–183, 2003.
Priebe S, Richardson M, Cooney M, Adedeji O, McCabe R: Does the therapeutic relationship predict outcomes of psychiatric treatment in patients with psychosis? A systematic review. Psychotherapy and Psychosomatics 80:70–77, 2011.
Gray GE, Pinson LA: Evidence-based medicine and psychiatric practice. Psychiatric Quarterly 74:387–399, 2003.
Norcross JC, Lambert MJ: The Therapy Relationship. In: Norcross JC, Beutler LE, Levant RF (Eds) Evidence-Based Practices in Mental Health–Debate and Dialogue on the Fundamental Questions, Washington, American Psychological Association, pp. 208–218, 2006.
Anthony W, Rogers ES, Farkas M: Research on evidence-based practices: Future directions in an era of recovery. Community Mental Health Journal 39:101–114, 2003.
Davidson L, Chan KKS: Common factors: Evidence-based practice and recovery. Psychiatric Services 65:675–677, 2014.
Finfgeld DL: Metasynthesis: The state of the art -so far. Qualitative Health Research 13:893–904, 2003.
Noblit GW, Hare RD: Meta-ethnography: Synthesizing qualitative studies, London, Sage Publications, 1988.
Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, et al.: Evaluating meta-ethnography: A synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social Science and Medicine 56:671–684, 2003.
Stige B, Malterud K, Midtgarden T: Toward an agenda for evaluation of qualitative research. Qualitative Health Research 19:1504–1516, 2009.
Sandelowski M, Docherty S, Emden C: Qualitative metasynthesis: Issues and techniques. Research in Nursing & Health 20:365–372, 1997.
Britten N, Pope C: Medicine Taking for Asthma: A Worked Example of Meta-ethnography. In: Synthesizing Qualitative Research. Choosing the Right Approach, New York, Wiley, 2012.
Waibel S, Henao D, Aller M-B, Vargas I, Vàzquez M-L: What do we know about patients’ perceptions of continuity of care? A meta-synthesis of qualitative studies. International Journal for Quality in Health Care 24:39–48, 2012.
Andreasson E, Skärsäter I: Patients treated for psychosis and their perceptions of care in compulsory treatment: Basis for an action plan. Journal of Psychiatric and Mental Health Nursing 19:15–22, 2012.
Borg M, Kristiansen K: Recovery-oriented professionals: Helping relationships in mental health services. Journal of Mental Health 13:493–505, 2004.
Buck PW, Alexander LB: Neglected voices: Consumers with serious mental illness speak about intensive case management. Administration and Policy in Mental Health 33:470–481, 2006.
Denhov A, Topor A: The components of helping relationships with professionals in psychiatry: Users’ perspective. International Journal of Social Psychiatry 58:417–424, 2012.
Galon P, Graor CH: Engagement in primary care treatment by persons with severe and persistent mental illness. Archives of Psychiatric Nursing 26:272–284, 2012.
Green CA, Polen MR, Janoff SL, Castleton DK, Wisdom JP, Vuckovic N, et al.: Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results. Psychiatric Rehabilitation Journal 32:9–22, 2008.
Langley GC, Klopper H: Trust as a foundation for the therapeutic intervention for patients with borderline personality disorder. Journal of Psychiatric and Mental Health Nursing 12:23–32, 2005.
Laugharne R, Priebe S, McCabe R, Garland N, Clifford D: Trust, choice and power in mental health care: Experiences of patients with psychosis. International Journal of Social Psychiatry 58:496–504, 2012.
Lester H, Tritter JQ, England E: Satisfaction with primary care: The perspectives of people with schizophrenia. Family Practice 20:508–513, 2003.
Nehls N: What is a case manager? The perspective of persons with borderline personality disorder. Journal of American Psychiatric Nurses Association 7:4–12, 2001.
O’Brien L: The relationship between community psychiatric nurses and clients with severe and persistent mental illness: The client’ s experience. Australian and New Zealand Journal of Mental Health Nursing 10:176–186, 2001.
Priebe S, Watts J, Chase M, Matanov A: Processes of disengagement and engagement in assertive outreach patients: Qualitative study. British Journal of Psychiatry 187:438–443, 2005.
Tidefors I, Olin E: A need for “good eyes”: Experiences told by patients diagnosed with psychosis. International Journal of Qualitative Studies on Health and Well-being 6:1–9, 2011.
Topor A, Denhov A: Helping relationships and time: Inside the black box of the working alliance. American Journal of Psychiatric Rehabilitation 15:239–254, 2012.
Topor A, Borg M, Mezzina R, Sells D, Marin I, Davidson L: Others: The role of family, friends, and professionals in the recovery process. American Journal of Psychiatric Rehabilitation 9:17–37, 2006.
Tunner TP, Salzer MS: Consumer perspectives on quality of care in the treatment of schizophrenia. Administration and Policy in Mental Health 33:674–681, 2006.
Ware N, Tugenberg T, Dickey B: Practitioner relationships and quality of care for low-income persons with serious mental illness. Psychiatric Services 55:555–559, 2004.
Williams CC, Tufford L: Professional competencies for promoting recovery in mental illness. Psychiatry 75:190–201, 2012.
Wright N, Callaghan P, Bartlett P: Mental health service users’ and practitioners’ experiences of engagement in assertive outreach: A qualitative study. Journal of Psychiatric and Mental Health Nursing 18:822–832, 2011.
Young AT, Green CA, Estroff SE: Personal growth in the recovery process: Findings from the STARS study. Psychiatric Services 59:1430–1436, 2008.
Berggren UJ, Gunnarsson E: User-oriented mental health reform in Sweden: Featuring “professional friendship.” Disability & Society. 25:565–577, 2010.
Kinn LG, Holgersen H, Ekeland T-J, Davidson L: Metasynthesis and bricolage: An artistic exercise of creating a collage of meaning. Qualitative Health Research 23:1285–1292, 2013.
Topor A: Managing the contradictions—Recovery from severe mental disorders. Stockholm University, 2001.
Parsons T: Illness and role of the physician: A sociological perspective. American Journal of Orthopsychiatry 21:452–460, 1951.
Hem MH, Heggen K: Being professional and being human: One nurse’s relationship with a psychiatric patient. Journal of Advanced Nursing 43:101–108, 2003.
Moyle W: Nurse–patient relationship: A dichotomy of expectations. International Journal of Mental Health Nursing 12:103–109, 2003.
Rogers A, Pilgrim D: Mental health and inequality. Basingstoke, Palgrave McMillan, 2002.
Foucault M: Two Lectures. In: Gordon C (Ed) Power/Knowledge: Selected Interviews and Other Writings 1972–1977. Brighton, Harvester P, pp. 78–108, 1980.
Morrow M, Weiser J: Towards a social justice framework of mental health recovery. Studies in Social Justice 6:27–43, 2012.
Sparks E: Depression and Schizophrenia in Women. The Intersection of Gender, Race/Ethnicity, and Class. In: Ballou M, Brown LS (Eds) Rethinking Mental Health and Disorder—Feminist Perspectives. New York, Guildford, pp. 279–305, 2002.
Schön U-K: Recovery from severe mental illness, a gender perspective. Scandinavian Journal of Caring Sciences 24:557–564, 2010.
Koekkoek B, Van Meijel B, Van Ommen J, Pennings R, Kaasenbrood A, Hutschemaekers G, et al.: Ambivalent connections: A qualitative study of the care experiences of non-psychotic chronic patients who are perceived as “difficult” by professionals. BMC Psychiatry 10:96, 2010.
Ådnøy Eriksen K, Arman M, Davidson L, Sundfør B, Karlsson B: Challenges in relating to mental health professionals: Perspectives of persons with severe mental illness. International Journal of Mental Health Nursing 23:110–117, 2014.
Frank JD, Frank JB: Persuasion and healing—A comparative study of psychotherapy. 3rd edn. Baltimore and London, The John Hopkins University Press, 1993.
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Ljungberg, A., Denhov, A. & Topor, A. The Art of Helpful Relationships with Professionals: A Meta-ethnography of the Perspective of Persons with Severe Mental Illness. Psychiatr Q 86, 471–495 (2015). https://doi.org/10.1007/s11126-015-9347-5
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DOI: https://doi.org/10.1007/s11126-015-9347-5