1
|
Marchi M, Venturi G, Visentini C, Pinelli M, Priebe S, Galeazzi GM. The therapeutic relationship in community mental health services: a systematic review of the literature. Soc Psychiatry Psychiatr Epidemiol 2024; 59:731-743. [PMID: 37875610 DOI: 10.1007/s00127-023-02581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE This systematic review aimed to investigate the therapeutic relationship (TR) between mental health professionals (MHPs) and their patients in community mental health services (CMHS). METHODS PubMed (Medline), PsycINFO, CINAHL, CENTRAL, and Web of Science were searched for studies that assessed TR in CMHS using quantitative measures developed specifically for this setting (i.e., Helping Alliance Scale [HAS] and the Scale to Assess the Therapeutic Relationship [STAR]). Studies were included if they considered adult patients with a psychiatric disorder and/or any MHP working in CMHS. Meta-analysis and narrative synthesis assessed the association between patients' and MHPs' ratings and identified predictors of TR. RESULTS Of 1934 studies, 15 were included in the review, including 3004 patients. A total of 1127 patients and 963 MHPs were considered in the meta-analysis. The heterogeneity of the studies was high, and there was no significant difference between the patients' and MHPs' TR ratings in the random-effects model (standardized mean difference [SMD]: - 0.39 [95% CI: - 1.03; 0.24]). In the multivariable meta-regression, only duration of illness was significantly associated with TR ratings (unstandardized regression coefficient [B]: 0.388 [95% CI: 0.217; 0.558]). A recovery-oriented service, shared decision-making, and the recognition of patient needs contributed to more positive TR ratings. CONCLUSION Patients and MHPs converged in their TR ratings, although patients gave lower ratings. Routine assessment of TR in CMHS can inform reflective practice and service development, as TR can be assessed easily and early in the treatment process. Future research should focus on developing and testing interventions to improve TR in CMHS.
Collapse
Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | - Giulia Venturi
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | - Chiara Visentini
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Margherita Pinelli
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | | | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy.
| |
Collapse
|
2
|
Reinius M, Steinsaphir Å, Malmqvist Castillo M, Stenfors T. Patients' experiences of Daily Talks: a patient-driven intervention in inpatient mental healthcare. J Ment Health 2023:1-8. [PMID: 36840358 DOI: 10.1080/09638237.2023.2182420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Recovery is known to be enhanced by meaningful interactions between patients and mental health staff. However, nurses may become distanced from patients, and patients may spend most of their time in inpatient mental health care alone. AIMS This study aimed to explore how patients experience the intervention Daily Talks, a patient-driven innovation intended to enhance meaningful interactions between patients and staff. METHODS Fourteen in-depth interviews were performed with patients who participated in Daily Talks. The interviews were analysed using reflexive thematic analysis. RESULTS The results of the participants' experiences of Daily Talks are presented in four themes: 1.Interpersonal and active interaction where individual factors matter 2.A patient-controlled space 3.A multi-use intervention and 4.A part of the daily healthcare structure. Participants stated that Daily Talks improved the relationship between patients and their nursing staff, and they stressed the importance of patients having control over both time and content in the Daily Talks. Daily Talks was used to vent emotions and thoughts, handle situations and create strategies, and become part of a helpful structure. CONCLUSIONS The results support the value of Daily Talks, indicating that Daily Talks may facilitate helpful structures and meaningful relationships between patients and nursing staff.
Collapse
Affiliation(s)
- Maria Reinius
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
| | - Åsa Steinsaphir
- User Involvement Coordinator, North Stockholm Psychiatry, Health Care Services Stockholm County, Stockholm, Sweden
| | - Moa Malmqvist Castillo
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Terese Stenfors
- Division of Learning, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
Torres A, Diaz P, Freund R, Baker TN, Baker AZ, Peluso P. Therapeutic alliance in vocational rehabilitation counseling: Assessing client factors and functioning. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-211165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The therapeutic relationship is often acknowledged as one of the most significant factors in clinical process that influences client outcomes. OBJECTIVE: While considerable research has been conducted on the therapeutic relationship in psychotherapy, there is a paucity of research on the impact of the therapeutic relationship in vocational rehabilitation counseling settings. METHODS: This study explored the relationship between areas of client functioning (individual, interpersonal, social, and overall) and the therapeutic alliance among clients who receive services from the State vocational rehabilitation agency. RESULTS: In this study, younger clients (ages between 16 to 29) reported stronger therapeutic alliance. CONCLUSION: The findings of this study suggested that clients’ perceived individual, interpersonal and overall functioning have a significant positive relationship with the task and bond components of therapeutic relationship.
Collapse
Affiliation(s)
- Ayse Torres
- Florida Atlantic University, Boca Raton, FL, USA
| | | | - Robert Freund
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | | | - Paul Peluso
- Florida Atlantic University, Boca Raton, FL, USA
| |
Collapse
|
4
|
Harcourt E. Epistemic injustice, children and mental illness. JOURNAL OF MEDICAL ETHICS 2021; 47:729-735. [PMID: 34172522 DOI: 10.1136/medethics-2021-107329] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
The concept of epistemic (specifically testimonial) injustice is the latest philosophical tool with which to try to theorise what goes wrong when mental health service users are not listened to by clinicians, and what goes right when they are. Is the tool adequate to the task? It is argued that, to be applicable at all, the concept needs some adjustment so that being disbelieved as a result of prejudice is one of a family of alternative necessary conditions for its application, rather than a necessary condition all on its own. It is then argued that even once adjusted in this way, the concept does not fit well in the area where the biggest efforts have been made to apply it so far, namely the highly sensitive case of adult patients suffering from delusions. Indeed it does not serve the interests of service users struggling for recognition to try to apply it in this context, because there is so much more to being listened to than simply being believed. However, the concept is found to apply smoothly in many cases where the service users are children, for example, in relation to children's testimony on the efficacy of treatment. It is suggested that further research would demonstrate the usefulness of the concept in adult cases of a similar kind.
Collapse
Affiliation(s)
- Edward Harcourt
- Faculty of Philosophy, Humanities Division, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
McDowell C, Fossey E, Harvey C. Moving clients forward: a grounded theory of disability employment specialists' views and practices. Disabil Rehabil 2021; 44:5504-5512. [PMID: 34190004 DOI: 10.1080/09638288.2021.1937341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study sought to better understand the views and practices of disability employment specialists working with clients with mental illness. Specifically, it explored what helps and hinders employment specialists in their work. MATERIALS AND METHODS A constructivist grounded theory methodology was used. Semi-structured interviews with 16 disability employment specialists from four employment service providers in Victoria, Australia, were transcribed and analysed through initial coding, focused coding, and constant comparative methods. RESULTS Analysis led to the substantive grounded theory of "moving clients forward." The key themes included "taking a firm but fair approach," "meeting clients where they are at," "getting clients ready for work," "managing the interface between clients and employers," and as a consequence, "working under pressure." CONCLUSIONS These findings contribute the first grounded theory of how Australian disability employment specialists work with clients with mental illness and enhance understanding of employment specialists' notions of job readiness and their use of discretion in implementing seemingly contradictory employment-related policies. Practice tensions for these employment specialists could be reduced by modifying disability employment policies, and through training to deliver evidence-based practices that offer varied vocational services, pathways, and adjunct interventions tailored to clients' interests, needs and readiness for change.IMPLICATIONS FOR REHABILITATIONAustralian disability employment specialists experience tensions between meeting the needs of clients with mental illness and feeling pressured to adhere to performance-based funding and disability employment policies.Greater emphasis on evidence-based, individualised vocational interventions would better align with a recovery orientation and offer vocational options tailored to the needs and goals of job seekers with mental illnessFurther training and systemic support is needed for disability employment specialists to adopt evidence-based practices in their work with jobseekers with mental illness.Since Australian disability employment specialists describe considering the "job readiness" of clients in practice, the usefulness of this concept merits further investigation.
Collapse
Affiliation(s)
- Caitlin McDowell
- Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Melbourne Health, NorthWestern Mental Health, Melbourne, Australia.,Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Ellie Fossey
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Department of Occupational Therapy, Monash University, Frankston, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
6
|
Stengler K, Bechdolf A, Becker T, Döring A, Höhl W, Jäckel D, Kilian H, Theißing A, Torhorst A, Wirtz G, Zeidler R, Riedel-Heller S. [Implementation of the principle of supported employment in Germany : Position paper of a task force of the DGPPN]. DER NERVENARZT 2021; 92:955-962. [PMID: 33570685 DOI: 10.1007/s00115-020-01038-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.
Collapse
Affiliation(s)
- K Stengler
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Helios Park-Klinikum Leipzig, Leipzig, Deutschland
| | - A Bechdolf
- Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Akademische Lehrkrankenhäuser, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Becker
- Klinik für Psychiatrie und Psychotherapie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - A Döring
- Fachausschuss Psychiatrie, Deutscher Verband der Ergotherapeuten e. V., Karlsbad, Deutschland.,Referat "Gesundheitsfachberufe", DGPPN, Berlin, Deutschland
| | - W Höhl
- arbeit & integration e. V., Düsseldorf, Deutschland
| | - D Jäckel
- Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Akademische Lehrkrankenhäuser, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - H Kilian
- Bundesarbeitsgemeinschaft Beruflicher Trainingszentren e. V. (BAG BTZ), Berlin, Deutschland
| | - A Theißing
- beta89, Verein für betreuendes Wohnen und Tagesstrukturierung psychisch Gesundender e. V., Hannover, Deutschland
| | - A Torhorst
- RPK Bad Tölz und München, ReAL Holding AG, Bad Tölz, Deutschland
| | - G Wirtz
- SRH Rehabilitationseinrichtung für psychisch Kranke Karlsbad GmbH, Karlsbad, Deutschland
| | - R Zeidler
- DGPPN-Geschäftsstelle, Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V. (DGPPN), Reinhardtstraße 27 B I, 10117, Berlin, Deutschland.
| | - S Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| |
Collapse
|
7
|
Loughlin M, Bucci S, Brooks J, Berry K. Service users' and carers' experiences of engaging with early intervention services: A meta-synthesis review. Early Interv Psychiatry 2020; 14:26-36. [PMID: 30912274 DOI: 10.1111/eip.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 01/14/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIM The provision and implementation of early intervention for psychosis services (early intervention services [EIS]) has received increasing attention over recent years. Maximizing engagement with EIS is of clinical and economic importance, and exploring the experiences of those who access EIS is vital. Although research has been conducted exploring the experiences of engaging with EIS from both a service user and carer/family member point of view, these data have not been systematically collated to generate new understanding. The primary aim of this study is to review, critically appraise and synthesize qualitative findings relating to the experiences of service users and/or carers and family members engaging with EIS. METHODS Four databases were systematically searched. Studies were analysed using an inductive thematic analysis approach, within a critical realist epistemological framework. Studies were critically appraised using the critical appraisal skills programme tool. RESULTS Fourteen papers were identified for inclusion. Three main themes were identified: the importance of a personal relationship with an EIS staff member, the impact of this relationship and consideration of life after EIS. The importance of a strong relationship with EIS staff was the most prominent theme throughout the papers reviewed. CONCLUSIONS The quality of the therapeutic relationship with at least one EIS staff member was the single most important factor in determining whether the experience of accessing EIS was a positive or negative one. The majority of the studies reviewed were conducted in the United Kingdom or Australia. Therefore, more research across countries is needed to understand transferability of findings.
Collapse
Affiliation(s)
- Matthew Loughlin
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| |
Collapse
|
8
|
Loughlin M, Berry K, Brooks J, Bucci S. Moving on from early intervention for psychosis services: Service user perspectives on the facilitators and barriers of transition. Early Interv Psychiatry 2019; 13:1396-1403. [PMID: 30672143 DOI: 10.1111/eip.12780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/08/2018] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
AIM Early intervention for psychosis services (EIS) has been established worldwide and is offered to individuals experiencing a first episode of psychosis. Engagement with EIS typically lasts for 3 years, after which point, service users are either transferred to primary care or community mental health teams, according to perceived needs. Although UK National Institute for Clinical Excellence (NICE) guidelines recommend transfer of care should be arranged in conjunction with the receiving service, there exists little, if any, practical guidance as to how this should actually be managed. This study aims to investigate the barriers and facilitators of transition from EIS to both primary and secondary care services in the United Kingdom from the perspectives of service users. METHODS Fifteen EIS service users who had either been discharged to primary or secondary services were interviewed about their experience of discharge. Data were analysed using interpretive thematic analysis, adopting a critical realist stance. RESULTS Four themes were identified: feeling ready for discharge; relationships and trust; planning for discharge; life after EIS. CONCLUSIONS This is the first in-depth exploration of a sample of largely male service users' views on transition from EIS to primary and/or secondary care services. We highlight several practical steps that EIS and receiving services can take to facilitate a more optimal discharge and transition experience for EIS service users. Taking into account service pressures, the discharge process should be one that is gradual, allowing time for the service user to both process the news and gradually sever ties with keyworkers.
Collapse
Affiliation(s)
- Matthew Loughlin
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| |
Collapse
|
9
|
Browne J, Nagendra A, Kurtz M, Berry K, Penn DL. The relationship between the therapeutic alliance and client variables in individual treatment for schizophrenia spectrum disorders and early psychosis: Narrative review. Clin Psychol Rev 2019; 71:51-62. [PMID: 31146249 DOI: 10.1016/j.cpr.2019.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 03/30/2019] [Accepted: 05/19/2019] [Indexed: 12/31/2022]
Abstract
Given the high rates of treatment disengagement and medication nonadherence in individuals with schizophrenia spectrum disorders and early psychosis, fostering a strong alliance in treatment is critical. Moreover, the role of the therapeutic alliance extends beyond that in traditional psychotherapy because of the multifaceted nature of treatment. Thus, this review provides a comprehensive discussion of the relationship between the alliance and client variables across various provider types and individual treatments. This review summarizes existing research on (a) client correlates/predictors of the therapeutic alliance and on (b) the relationship between the alliance and client treatment outcomes in individual treatment for schizophrenia spectrum disorders and early psychosis. Parallel literature searches were conducted using PubMed and PsycINFO databases, which yielded 1202 potential studies with 84 studies meeting inclusion criteria. With regard to correlates/predictors, the existing evidence suggests that better insight, medication adherence, social support, and recovery variables were related to better client-rated alliance. Better medication adherence and recovery variables as well as less severe symptoms were related to better provider-rated alliance. In terms of alliance-outcome relationships, evidence suggests that a strong provider-rated alliance was predictive of improved functioning and medication and treatment adherence. There was some limited evidence that better client-rated alliance was related to improved recovery outcomes. Despite mixed results and heterogeneity among studies, this review suggests that a strong alliance can be beneficial in individual schizophrenia treatment. Thus, training and supervision of providers should emphasize developing a positive alliance, particularly with clients for whom developing an alliance may be difficult.
Collapse
Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Arundati Nagendra
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Kurtz
- Department of Psychology and Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA
| | - Katherine Berry
- School of Health Sciences, University of Manchester, Manchester, UK
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|
10
|
Doré-Gauthier V, Côté H, Jutras-Aswad D, Ouellet-Plamondon C, Abdel-Baki A. How to help homeless youth suffering from first episode psychosis and substance use disorders? The creation of a new intensive outreach intervention team. Psychiatry Res 2019; 273:603-612. [PMID: 30731429 DOI: 10.1016/j.psychres.2019.01.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 12/20/2018] [Accepted: 01/24/2019] [Indexed: 11/15/2022]
Abstract
In Canada, about 6,000 youth are homeless every night, many of whom suffer from addiction and psychotic disorders. To facilitate the exit out of homelessness, access to care and to improve psychosis and addiction outcomes, a new intensive outreach intervention team (EQIIP SOL) was created in Montreal (2012). It offers intensive outreach services dedicated to homeless youth suffering from first episode psychosis and addiction (HYFEPA) in addition to an early psychosis intervention service (EIS) in collaboration with the Addiction Psychiatry Unit. Our aim is to describe the characteristics, clinical, functional and housing outcomes of HYFEPA followed by EQIIP SOL. This two years long prospective longitudinal study with all HYFEPA (n = 42) admitted to EQIIP SOL between 2012-2015 reports at multiple time points, clinical (CGI, GAF), functional (SOFAS, work/study, housing autonomy) and substance use disorder (DUS, AUS) outcomes and acute services use (hospitalizations, emergency room visits). We observed that, at baseline, HYFEPA showed poor prognostic factors (eg. cluster B personality, substance use disorders, legal problems, childhood trauma and lower education level). The majority reached housing stability after 6 months and their functioning and illness severity improved with time. This suggests that HYFEPA improve with an intensive outreach intervention team integrated to an EIS.
Collapse
Affiliation(s)
- Virginie Doré-Gauthier
- Department of Psychiatry, Université de Montréal, 2900 Boulevard Edouard Montpetit, Montréal, QC, Canada, QC H3T 1J4
| | - Hubert Côté
- Department of Psychiatry, Université de Montréal, 2900 Boulevard Edouard Montpetit, Montréal, QC, Canada, QC H3T 1J4
| | - Didier Jutras-Aswad
- Department of Psychiatry, Université de Montréal, 2900 Boulevard Edouard Montpetit, Montréal, QC, Canada, QC H3T 1J4; Centre hospitalier de l'Université de Montréal (CHUM) - 1000, rue St-Denis, Montréal, QC, Canada, H2X 0C1; Centre de recherche du CHUM, 900, rue St-Denis, Montréal, QC, Canada, H2X 0A9
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry, Université de Montréal, 2900 Boulevard Edouard Montpetit, Montréal, QC, Canada, QC H3T 1J4; Centre hospitalier de l'Université de Montréal (CHUM) - 1000, rue St-Denis, Montréal, QC, Canada, H2X 0C1; Centre de recherche du CHUM, 900, rue St-Denis, Montréal, QC, Canada, H2X 0A9
| | - Amal Abdel-Baki
- Department of Psychiatry, Université de Montréal, 2900 Boulevard Edouard Montpetit, Montréal, QC, Canada, QC H3T 1J4; Centre hospitalier de l'Université de Montréal (CHUM) - 1000, rue St-Denis, Montréal, QC, Canada, H2X 0C1; Centre de recherche du CHUM, 900, rue St-Denis, Montréal, QC, Canada, H2X 0A9.
| |
Collapse
|
11
|
Lockett H, Waghorn G, Kydd R. A framework for improving the effectiveness of evidence-based practices in vocational rehabilitation. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Helen Lockett
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
- The Wise Group, Hamilton, New Zealand
| | - Geoffrey Waghorn
- The ORS Group, Brisbane, Queensland, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Rob Kydd
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
12
|
Shattock L, Berry K, Degnan A, Edge D. Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: A systematic review. Clin Psychol Psychother 2017; 25:e60-e85. [PMID: 28961352 DOI: 10.1002/cpp.2135] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 01/31/2023]
Abstract
Therapeutic alliance is a key predictor of therapy outcomes. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Databases were searched from inception up to April 2015. The search yielded 4,586 articles, resulting in 26 eligible studies, involving 18 independent samples. Weighted average client and therapist Working Alliance Inventory-Short Form total scores were 64.51 and 61.26, respectively. There was evidence that alliance predicts overall psychotic symptomatic outcomes and preliminary evidence for alliance predicting rehospitalization, medication use, and self-esteem outcomes. There was evidence for specific client-related factors being linked to different perspectives of alliance. For example, poorer insight and previous sexual abuse were associated with worse client-rated alliance, whereas baseline negative symptoms were associated with worse therapist-rated alliance. Therapist and therapy-related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client-rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist-rated alliance. Key clinical implications include the need to consider alliance from both client and therapist perspectives during therapy and training and supervision to enhance therapist qualities that foster good alliance. Future research requires longitudinal studies with larger samples that include pan-theoretical, well-validated alliance measures to determine causal predictor variables.
Collapse
Affiliation(s)
- Lucy Shattock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
13
|
Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
Collapse
Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | | |
Collapse
|
14
|
Kidd SA, Davidson L, McKenzie K. Common Factors in Community Mental Health Intervention: A Scoping Review. Community Ment Health J 2017; 53:627-637. [PMID: 28194599 DOI: 10.1007/s10597-017-0117-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
While there is considerable research and commentary devoted to common factors in psychotherapy, their implications for community mental health interventions are much less clear. In response, a scoping review was conducted to answer the question, 'What is the evidence base for common factors in community mental health intervention?' A comprehensive search of MEDLINE, PsycINFO, and Google Scholar was completed. A total of 60 publications were identified in this review with a focus primarily upon therapeutic alliance. Though methodologically diverse, this review supports the likely importance of alliance in the outcomes of community mental health interventions.
Collapse
Affiliation(s)
- Sean A Kidd
- Department of Psychiatry, University of Toronto, 1001 Queen St. W., Unit 2-1, #161, Toronto, ON, M6J 1H1, Canada.
| | - Larry Davidson
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, USA
| |
Collapse
|
15
|
Dahl K, Larivière N, Corbière M. Work participation of individuals with borderline personality disorder: A multiple case study. JOURNAL OF VOCATIONAL REHABILITATION 2017. [DOI: 10.3233/jvr-170874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kathy Dahl
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, QC, Canada
- Institut universitaire en santé mentale de Montréal, QC, Canada
| | - Nadine Larivière
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, QC, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, QC, Canada
| | - Marc Corbière
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, QC, Canada
- Department of Education and Pedagogy – Career Counseling, Université du Québec à Montréal, QC, Canada
| |
Collapse
|
16
|
Abstract
To describe the core elements of modern psychiatric rehabilitation. Based on selected examples we describe the discussion about values in mental health care with focus on Europe. We present outcome data from studies, which have tried to implement care structures based on this value discussion. In the second half of the 20th century, mental health care in all European and other high-income countries changed conceptually and structurally. Deinstitutionalisation reduced the number of psychiatric beds and transferred priority to outpatient care and community-based services, but community mental health programs developed differently across and within these countries. High-income countries in Europe continued to invest in costly traditional services that were neither evidence-based nor person-centered by emphasising inpatient services, sheltered group homes and sheltered workshops. We argue that evidence-based, person-centred, recovery-oriented psychiatric rehabilitation offers a parsimonious solution to developing a consensus plan for community-based care in Europe. The challenges to scaling up effective psychiatric rehabilitation services in high-income countries are not primarily a lack of resources, but rather a lack of political will and inefficient use and dysfunctional allocation of resources.
Collapse
Affiliation(s)
- W. Rössler
- Psychiatric University Hospital, Zürich University, Zürich, Switzerland
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - R. E. Drake
- Dartmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| |
Collapse
|
17
|
Topor A, Ljungberg A. “Everything is so relaxed and personal” – The construction of helpful relationships in individual placement and support. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1255276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alain Topor
- Department of Social Work, Stockholm University, Stockholm, Sweden
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | | |
Collapse
|
18
|
Feasibility and effectiveness of a combined individual and psychoeducational group intervention in psychiatric residential facilities: A controlled, non-randomized study. Psychiatry Res 2016; 235:19-28. [PMID: 26723137 DOI: 10.1016/j.psychres.2015.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/23/2015] [Accepted: 12/08/2015] [Indexed: 11/21/2022]
Abstract
This controlled, non-randomized study explored the feasibility of introducing a Combined Individual and Group Intervention (CIGI) for users with mental disorders in residential facilities, and tested whether users who received the CIGI had better functioning than users who received the Treatment-As-Usual (TAU), at two-year follow up. In the CIGI, a structured cognitivebehavioral approach called VADO (in English, Skills Assessment and Definition of Goals) was used to set specific goals with each user, while Falloon's psychoeducational treatment was applied with the users as a group. Thirty-one professionals attended a training course in CIGI, open to users' voluntary participation, and applied it for two years with all users living in 8 residential facilities of the Mental Health Department of Modena, Italy. In the same department, 5 other residential facilities providing TAU were used as controls. ANOVA for repeated measures showed a significant interaction effect between users' functioning at baseline and follow up assessments, and the intervention. In particular, change in global functioning was higher in the 55 CIGI users than in the 44 TAU users. These results suggest that CIGI can be successfully introduced in residential facilities and may be useful to improve functioning in users with severe mental disorders.
Collapse
|
19
|
Ljungberg A, Denhov A, Topor A. Non-helpful relationships with professionals - a literature review of the perspective of persons with severe mental illness. J Ment Health 2015; 25:267-77. [PMID: 27150468 DOI: 10.3109/09638237.2015.1101427] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relationship with professionals has proved to be important with regard to outcome for persons with severe mental illness (SMI). The understanding of non-helpful relationships is important complementary knowledge to that regarding helpful relationships. AIM To review the available qualitative research providing knowledge of non-helpful relationships from the perspective of persons with SMI. METHOD A review of qualitative studies, based on an earlier systematic search, analyzed through thematic analysis. RESULTS The main themes were "non-helpful professionals", "organization versus relation" and "the consequences of non-helpful relationships with professionals". Examples of professionals described as non-helpful were pessimistic and uncaring professionals who were paternalistic and disrespectful. Discontinuity, insufficient time and coercion were some of the contextual factors described as non-helpful. These sorts of relationships were non-helpful because they hindered helpful relationships from developing and contributed to further suffering, instilling hopelessness and hindering personal growth. CONCLUSIONS Non-helpful relationships with professionals can be understood as impersonal relationships that contain no space for negotiation of the relationship nor of the support and treatment provided through it. It is important that organizations provide professionals with favorable conditions to negotiate the organizational framework and to treat persons with SMI as whole human beings.
Collapse
Affiliation(s)
- Amanda Ljungberg
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden
| | - Anne Denhov
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden .,b Department of Social Work , Stockholm University , Stockholm , Sweden , and
| | - Alain Topor
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden .,b Department of Social Work , Stockholm University , Stockholm , Sweden , and.,c Faculty of Health and Sport Sciences , University of Agder , Grimstad , Norway
| |
Collapse
|
20
|
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 2015; 86:471-95. [PMID: 25631156 DOI: 10.1007/s11126-015-9347-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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.
Collapse
Affiliation(s)
- Amanda Ljungberg
- Research and Development Unit, Psychiatry South Stockholm, Box 5040, 121 05, Johanneshov, Stockholm, Sweden.
| | - Anne Denhov
- Research and Development Unit, Psychiatry South Stockholm, Box 5040, 121 05, Johanneshov, Stockholm, Sweden.
- Department of Social Work, Stockholm University, Stockholm, Sweden.
| | - Alain Topor
- Research and Development Unit, Psychiatry South Stockholm, Box 5040, 121 05, Johanneshov, Stockholm, Sweden.
- Department of Social Work, Stockholm University, Stockholm, Sweden.
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
| |
Collapse
|
21
|
Knaeps J, Neyens I, van Weeghel J, Van Audenhove C. Perspectives of hospitalized patients with mental disorders and their clinicians on vocational goals, barriers, and steps to overcome barriers. J Ment Health 2015. [PMID: 26207510 DOI: 10.3109/09638237.2015.1036972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND People with mental disorders experience difficulties with finding competitive jobs. In countries with longer psychiatric hospitalization periods, the vocational rehabilitation process can start during hospitalization. Yet, rehabilitation can be hindered by a lack of focus by clinicians on the patients' vocational goals and a lack of agreement between clinicians and patients. AIMS To compare (i) vocational goals, (ii) barriers to employment and (iii) support needed to overcome barriers faced by patients. METHOD The paired data-set comprised 733 hospitalized patients and their 279 clinicians. Patients selected their vocational goals and clinicians indicated options that seemed realistic. Patients and clinicians indicated how many barriers exist and what support is needed to overcome barriers. RESULTS Almost 45% of patients prefer competitive jobs, while 32% of clinicians find this realistic, indicating a moderate relationship between patients' goals and clinicians' perceptions. Patients and clinicians also differ in their perception of the level of barriers and types of support to overcome them. Patients perceive fewer vocational barriers than clinicians and prefer less intense vocational support options. CONCLUSIONS Patients and clinicians have different perspectives concerning vocational recovery. Improving vocational rehabilitation requires a stronger alignment between patients and clinicians' vocational goals and barriers.
Collapse
Affiliation(s)
- Jeroen Knaeps
- a LUCAS Centre for Care Research and Consultancy, University of Leuven , Leuven , Belgium
| | - Inge Neyens
- a LUCAS Centre for Care Research and Consultancy, University of Leuven , Leuven , Belgium
| | - Jaap van Weeghel
- b Department of Tranzo , Tilburg University , Tilburg , the Netherlands , and.,c Phrenos Centre of Expertise , Utrecht , the Netherlands
| | - Chantal Van Audenhove
- a LUCAS Centre for Care Research and Consultancy, University of Leuven , Leuven , Belgium
| |
Collapse
|
22
|
Viering S, Jäger M, Nordt C, Bühler F, Bärtsch B, Leimer H, Sommerfeld P, Rössler W, Kawohl W. Does "Individual Placement and Support" Satisfy the Users' Needs? Front Public Health 2015; 3:160. [PMID: 26137454 PMCID: PMC4468743 DOI: 10.3389/fpubh.2015.00160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
This study aims to investigate clients' satisfaction with individual placement and support (IPS) at the University Hospital for Psychiatry Zurich (PUK). Furthermore, this study aims to investigate if clients feel the approach of IPS as a useful approach to fulfill their needs. One hundred twenty-five people were recruited from one of the three IPS services of PUK and were asked to complete a structured questionnaire. The following IPS services were available: (i) randomized controlled trial (RCT) ZHEPP (www.zhepp.ch), (ii) RCT ZInEP (www.zinep.ch), and (iii) us clinical supported employment service of PUK (IPS-PUK). The clients mostly indicated that IPS was generally useful and fitted their needs. Overall satisfaction of the participants with the IPS services of the PUK was very high. Furthermore, client satisfaction and symptom severity are inversely associated. In conclusion, participants of the IPS services received the support they were looking for. This means that the approach of IPS fits the needs of different patient groups and can be used without any modifications. The most important limitation is the unequal group sizes. Therefore, the obtained results need to be strengthened by future research.
Collapse
Affiliation(s)
- Sandra Viering
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Carlos Nordt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Franziska Bühler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Bettina Bärtsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland
| | - Hansjörg Leimer
- Institute for Social Work and Health, School of Social Work and Health , Olten , Switzerland
| | - Peter Sommerfeld
- Institute for Social Work and Health, School of Social Work and Health , Olten , Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland ; Laboratory of Neuroscience, LIM 27, Institute of Psychiatry, University of São Paulo , São Paulo , Brazil ; University of Zurich , Zurich , Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Centre for Social Psychiatry, University Hospital for Psychiatry Zurich , Zurich , Switzerland ; University of Zurich , Zurich , Switzerland
| |
Collapse
|
23
|
Clarke E, Puschner B, Jordan H, Williams P, Konrad J, Kawohl W, Bär A, Rössler W, Del Vecchio V, Sampogna G, Nagy M, Süveges A, Krogsgaard Bording M, Slade M. Empowerment and satisfaction in a multinational study of routine clinical practice. Acta Psychiatr Scand 2015; 131:369-78. [PMID: 25471821 DOI: 10.1111/acps.12365] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Decision-making between mental health clinicians and patients is under-researched. We tested whether mental health patients are more satisfied with a decision made (i) using their preferred decision-making style and (ii) with a clinician with the same decision-making style preference. METHOD As part of the CEDAR Study (ISRCTN75841675), a convenience sample of 445 patients with severe mental illness from six European countries were assessed for desired clinical decision-making style (rated by patients and paired clinicians), decision-specific experienced style and satisfaction. RESULTS Patients who experienced more involvement in decision-making than they desired rated higher satisfaction (OR=2.47, P=0.005, 95% CI 1.32-4.63). Decisions made with clinicians whose decision-making style preference was for more active involvement than the patient preference were rated with higher satisfaction (OR=3.17, P=0.003, 95% CI 1.48-6.82). CONCLUSION More active involvement in decision-making than the patient stated as desired was associated with higher satisfaction. A clinical orientation towards empowering, rather than shared, decision-making may maximise satisfaction.
Collapse
Affiliation(s)
- E Clarke
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
The impact of legal coercion on the therapeutic relationship in adult schizophrenia patients. PLoS One 2015; 10:e0124043. [PMID: 25909589 PMCID: PMC4409206 DOI: 10.1371/journal.pone.0124043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 03/10/2015] [Indexed: 11/19/2022] Open
Abstract
The quality of the therapeutic relationship between psychiatric patients and their attending physicians plays a key role in treatment success. We hypothesize that mandatory treatment is negatively associated with the quality of the therapeutic relationship. In a cross-sectional study design, data on psychopathological symptom load (as captured with the Brief Psychiatric Rating Scale) and on the quality of the therapeutic relationship (as measured with the Scale to Assess the Therapeutic Relationship) were collected from 113 adult male psychiatric patients and 35 attending physicians. Patients belonged to one of three groups: self-referred or involuntarily admitted patients from general psychiatry wards or patients from medium secure forensic psychiatric units. On average, self-referred patients rated the quality of the therapeutic relationship significantly more positive than did involuntarily admitted patients in general psychiatry wards. Forensic psychiatric patients, on average, gave an intermediate rating of the quality of the therapeutic relationship. There was no association between patients' ratings and physicians' ratings of the quality of the therapeutic relationship. Patients' ratings of the quality of the therapeutic relationship were inversely related to symptom severity in general and hostility in particular. Ratings of the quality of the therapeutic relationship are not associated with patients' legal status but rather with patients' symptoms of hostility.
Collapse
|
25
|
Johansen R, Melle I, Iversen VC, Hestad K. Personality traits, interpersonal problems and therapeutic alliance in early schizophrenia spectrum disorders. Compr Psychiatry 2013; 54:1169-76. [PMID: 23856387 DOI: 10.1016/j.comppsych.2013.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 05/16/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The quality of the therapeutic alliance is associated with engagement in- and thus important to the outcome of- treatment in schizophrenia. In non-psychotic disorders, general personality traits and individual patterns of interpersonal problems have been linked to the formation and quality of the therapeutic alliance. The role of these factors in relation to therapeutic alliance has not previously been explored in schizophrenia spectrum disorders. AIM To investigate associations between personality traits, interpersonal problems and the quality of the therapeutic alliance in early schizophrenia spectrum disorders. METHODS Demographic and clinical characteristics including Positive and Negative Syndrome Scale (PANSS) scores were assessed in 42 patients. Personality traits and interpersonal problems were assessed with the NEO Five factor Inventory (NEO-FFI) and the circumplex model of the Inventory of Interpersonal Problems (IIP-64C). Therapeutic alliance was measured with the Working Alliance Inventory - short form (WAI-S). RESULTS Patient WAI-S scores were predicted by IIP-64C Submissive/Hostile interpersonal problems, age and PANSS excitative symptoms. Therapist WAI-S scores were predicted by NEO-FFI Agreeableness and the PANSS insight item. CONCLUSION Core traits of personality and dimensions of interpersonal problems are associated with both patients' and therapists' perceptions of the quality of the working alliance.
Collapse
Affiliation(s)
- Ragnhild Johansen
- St. Olav's Hospital, Trondheim University Hospital, Forensic department Brøset Centre for Research and Education in Forensic Psychiatry, 7440 Trondheim, Norway; Dept of Psychology, The Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | | | | | | |
Collapse
|
26
|
Tsai J, Lapidos A, Rosenheck RA, Harpaz-Rotem I. Longitudinal association of therapeutic alliance and clinical outcomes in supported housing for chronically homeless adults. Community Ment Health J 2013; 49:438-43. [PMID: 22820927 DOI: 10.1007/s10597-012-9518-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 07/02/2012] [Indexed: 11/26/2022]
Abstract
General psychotherapy research has underscored the importance of the therapeutic alliance in client outcomes. This study examined the association between therapeutic alliance and client outcomes specifically between chronically homeless clients in a supported housing program and their case managers. Using data from a federal supported housing initiative, participants were categorized into those who rated their therapeutic alliance with case managers at 3 months as relatively high (top 75th percentile; n = 123), relatively low (bottom 25th percentile; n = 128), or did not identify any primary mental health provider at 3 months (n = 205). Controlling for baseline differences, there were no group differences on any outcomes, except that participants who rated high therapeutic alliance at 3 months reported the highest subjective quality of life and perceived social support. Client outcomes in supported housing may rely more on practical assistance and access to other services than the quality of the therapeutic relationship with their primary mental health provider.
Collapse
Affiliation(s)
- Jack Tsai
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, 950 Campbell Ave., 151D, West Haven, CT 06511, USA.
| | | | | | | |
Collapse
|
27
|
Johansen R, Iversen VC, Melle I, Hestad KA. Therapeutic alliance in early schizophrenia spectrum disorders: a cross-sectional study. Ann Gen Psychiatry 2013; 12:14. [PMID: 23656747 PMCID: PMC3661357 DOI: 10.1186/1744-859x-12-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/30/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The therapeutic alliance is related to better course and outcome of treatment in schizophrenia. This study explores predictors and characteristics of the therapeutic alliance in recent-onset schizophrenia spectrum disorders including the agreement between patient and therapist alliance ratings. METHODS Forty-two patients were assessed with demographic, neurocognitive, and clinical measures including the Positive and Negative Syndrome Scale (PANSS). The therapeutic alliance was measured with the Working Alliance Inventory - Short Form (WAI-S). RESULTS Patient WAI-S total scores were predicted by age and PANSS excitative symptoms. Therapist WAI-S total scores were predicted by PANSS insight. Patient and therapist WAI-S total scores were moderately associated. Neurocognition was not associated with working alliance. CONCLUSION Working alliance is associated with specific demographic and symptom characteristics in patients with recent-onset schizophrenia spectrum disorders. There is moderate agreement between patients and therapists on the total quality of their working alliance. Findings highlight aspects that may increase therapists' specificity in the use of alliance-enhancing strategies.
Collapse
Affiliation(s)
- Ragnhild Johansen
- Forensic Department Brøset, Centre for Research and Education in Forensic Psychiatry, St, Olav's Hospital, Trondheim University Hospital, P, Box 3008 Lade, Trondheim, 7441, Norway.
| | | | | | | |
Collapse
|
28
|
Areberg C, Björkman T, Bejerholm U. Experiences of the individual placement and support approach in persons with severe mental illness. Scand J Caring Sci 2012; 27:589-96. [PMID: 22834791 DOI: 10.1111/j.1471-6712.2012.01056.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Across several research studies comparing the individual placement and support (IPS) approach to traditional vocational services, the approach has achieved employment outcomes superior to comparison conditions. However, to understand the efficacy of IPS, it is equally important to consider what is more or less effective as viewed by the IPS participants. AIM To investigate participants' experiences of IPS participation and their experiences of receiving support from an employment specialist (ES). METHOD Interviews were conducted with 17 persons with severe mental illness. The interviews were subjected to qualitative content analysis. The principles of informed consent and the voluntary nature of participation were included as ethical considerations. RESULTS Participation in IPS was associated with hope, meaning and an individualized support provided by the ES. The skills of the ES facilitated the relationship with the participant and the contact with the labour market. However, to make a change happen, everybody involved in IPS had to contribute. CONCLUSION These findings have endorsed the guiding principles of IPS and emphasized the ES's role and skills during IPS as well as the participant's motivation.
Collapse
Affiliation(s)
- Cecilia Areberg
- Department of Health Sciences, Division of Occupational Therapy and Gerontology, Lund University & The Swedish Institute for Health Sciences, Lund University, Lund, Sweden.
| | | | | |
Collapse
|
29
|
Therapeutic relationships: their specificity in predicting outcomes for people with psychosis using clinical and vocational services. Soc Psychiatry Psychiatr Epidemiol 2010; 45:1187-93. [PMID: 19915784 DOI: 10.1007/s00127-009-0163-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 10/27/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the distinctions between the client-keyworker relationship and the client-vocational worker relationship by assessing their impact on clinical outcomes and exploring the associations between the two. METHODS As part of an international randomised controlled trial of supported employment (n = 312), client-keyworker relationship and client-vocational worker relationship were each tested against clinical and social functioning 6 months later. Associations between the two relationships over time were explored. RESULTS Client-keyworker relationship predicted quality of life, while client-vocational worker relationship, as rated by the client, did not predict any clinical or social functioning outcomes. Vocational worker-rated relationship predicted reduced depression. The client-keyworker and client-vocational worker relationships were correlated, but this did not change over time. CONCLUSION The impact of the client-vocational worker is likely to be on the shared task of finding employment, rather than on clinical and social functioning. Good client-vocational worker relationships do not detract from client-keyworker relationships.
Collapse
|