scholarly journals Court-Mandated Patients’ Perspectives on the Psychotherapist’s Dual Loyalty Conflict – Between Ally and Enemy

2021 ◽  
Vol 11 ◽  
Author(s):  
Helene Merkt ◽  
Tenzin Wangmo ◽  
Félix Pageau ◽  
Michael Liebrenz ◽  
Corinne Devaud Cornaz ◽  
...  
Keyword(s):  
Therapeutic Alliance ◽  
Mental Health Professionals ◽  
Qualitative Interview ◽  
Interview Study ◽  
Dual Role ◽  
Therapist Characteristics ◽  
High Quality ◽  
Dual Loyalty ◽  
Qualitative Interview Study ◽  
Court Mandated

BackgroundMental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma.MethodsThis qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis.ResultsWe first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: (1) respecting the patient’s pace and perceived coercion; (2) patient health needs to be first priority; (3) clarity in roles and responsibilities; and (4) the art of communication – between transparency and unchecked information sharing.DiscussionDeveloping a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings.

scholarly journals What characterizes a good mental health professional in court-mandated treatment settings?: Findings from a qualitative study with older patients and mental health care professionals

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Helene Seaward ◽  
Tenzin Wangmo ◽  
Tobias Vogel ◽  
Marc Graf ◽  
Monika Egli-Alge ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Care Professionals ◽  
Service Providers ◽  
Interview Study ◽  
Therapist Characteristics ◽  
Good Mental Health ◽  
Qualitative Interview Study ◽  
Court Mandated ◽  
Treatment Settings

Abstract Background Therapist-related activities and characteristics such as empathy and genuineness are factors that significantly contribute to psychotherapy outcome. As they play a role in psychotherapy more generally, it can be expected that they are equally important in the treatment of court-mandated patients more specifically. At the same time, these treatment settings come with specific challenges—e.g. due to coercion and control—and it could thus be that some therapist-related characteristics might have a different empathy on the therapy. This interview study sought to investigate service providers’ and users’ perspectives on therapist-related characteristics in the context of detention. Methods We conducted a qualitative interview study with 41 older incarcerated persons mandated to treatment, and 63 mental health professionals (MHP). The data analysis followed thematic analysis. Results Patients and experts both emphasized the importance of treating patients with respect by taking a humanistic approach, that is, condemn the deeds but embrace the person and display genuine interest in supporting patients with any issue or concern that is of relevance to them. Furthermore, interviewees underscored that the coerciveness of the therapy context required to incorporate patients’ wishes into treatment planning, recognize and respond to the patients’ needs, and allow some choice within the given framework. Such inclusive attitude was deemed critical to engage and motivate patients to participate in treatment. In addition, it was emphasized that feedback and advice by the therapists need to be concrete, detailed and applied to each person’s current situation. Lastly, patients questioned MHP’s qualification when they did not progress in therapy. Discussion Our findings indicate that some therapist-related activities and characteristics are of particular importance in court-mandated settings. These include genuine interest in the patient, a respectful and positive attitude, as well as the capacity to target sensitive issues in a directive but non-confrontational manner. Further research needs to identify specific expressions and behaviors that are linked to the aforementioned characteristics in the forensic context. Our study therefore contributes to much-needed empirical research on clinician and patient perspectives on therapist characteristics and activities in the treatment of court-mandated patients.

scholarly journals Negotiating styles adopted by consultant psychiatrists when prescribing antipsychotics

2007 ◽  
Vol 13 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Robert Chaplin ◽  
Paul Lelliott ◽  
Alan Quirk ◽  
Clive Seale
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Therapeutic Alliance ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Qualitative Interview ◽  
Shared Decision ◽  
Adherence To Medication ◽  
Qualitative Interview Study ◽  
Improve Clinical Outcome

A good therapeutic alliance between mental health professionals and patients with psychosis can enhance adherence to medication regimens and improve clinical outcome. This article explores how the therapeutic alliance might be developed with respect to decisions to prescribe antipsychotic medication. It does this by presenting the implications for practice that arise from a recent qualitative interview study with consultant psychiatrists. We consider strategies for strengthening the therapeutic alliance, occasions when it might be appropriate to suspend shared decision-making temporarily, techniques used to enable discussion of symptoms and side-effects, and how issues of adherence are uncovered and addressed. Psychiatrists already possess considerable skills in these areas. The dissemination of these to colleagues forms an important opportunity for CPD.

scholarly journals Forensic mental health professionals’ perceptions of their dual loyalty conflict: findings from a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Helene Merkt ◽  
Sophie Haesen ◽  
Ariel Eytan ◽  
Elmar Habermeyer ◽  
Marcelo F. Aebi ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Justice System ◽  
Mandated Treatment ◽  
Dual Loyalty ◽  
Qualitative Interview Study ◽  
Ethical Conflicts ◽  
Court Mandated ◽  
Treatment Settings

Abstract Background Mental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods 31 MHPs working in court-mandated treatment settings were interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach. Results We first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. Conclusions Even though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system.

scholarly journals ‘I’m not Sherlock Holmes’: Suspicions, secrecy and silence of transplant professionals in the human organ trade

2019 ◽  
Vol 17 (6) ◽  
pp. 764-783
Author(s):  
Frederike Ambagtsheer ◽  
Linde Van Balen
Keyword(s):  
Qualitative Interview ◽  
Interview Study ◽  
Safe Distance ◽  
Sherlock Holmes ◽  
Human Organ ◽  
Qualitative Interview Study ◽  
Organ Trade ◽  
The Subject

This article presents the results of a qualitative interview study amongst 41 Dutch transplant professionals. The overarching aim was to acquire in-depth understanding of transplant professionals’ experiences with and attitudes towards patients who purchase kidneys. We found that transplant professionals occasionally treat patients who are suspected of kidney purchases abroad. However, they turn a blind eye to their patients’ suspected purchases. Secrecy and silence function as a tacit agreement between patients and their caregivers that keeps the subject of kidney purchase at a safe distance and allows transplant professionals to ignore its suspected occurrence. They thus participate in the building of walls of secrecy and silence in the organ trade.

scholarly journals Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045469
Author(s):  
Rachel Stocker ◽  
Siân Russell ◽  
Jennifer Liddle ◽  
Robert O Barker ◽  
Adam Remmer ◽  
...  
Keyword(s):  
Early Warning ◽  
Healthcare Professionals ◽  
Care Home ◽  
Qualitative Interview ◽  
Interview Study ◽  
Care Homes ◽  
Early Warning Score ◽  
Service Utilisation ◽  
Qualitative Interview Study ◽  
National Early Warning Score

BackgroundThe COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016. Implementation of a NEWS intervention (including equipment, training and support) was accelerated early in the pandemic, despite limited evidence for its use in the care home setting.ObjectivesTo understand how a NEWS intervention has been used in care homes in one area of North-East England during the COVID-19 pandemic, and how it has influenced resident care, from the perspective of stakeholders involved in care delivery and commissioning.MethodsA qualitative interview study with care home (n=10) and National Health Service (n=7) staff. Data were analysed using thematic analysis.ResultsUse of the NEWS intervention in care homes in this area accelerated during the COVID-19 pandemic. Stakeholders felt that NEWS, and its associated education and support package, improved the response of care homes and healthcare professionals to deterioration in residents’ health during the pandemic. Healthcare professionals valued the ability to remotely monitor resident observations, which facilitated triage and treatment decisions. Care home staff felt empowered by NEWS, providing a common clinical language to communicate concerns with external services, acting as an adjunct to staff intuition of resident deterioration.ConclusionsThe NEWS intervention formed an important part of the care home response to COVID-19 in the study area. Positive staff perceptions now need to be supplemented with data on the impact on resident health and well-being, workload, and service utilisation, during the pandemic and beyond.

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