title: Improving Therapeutic Relationships: Joint Crisis Planning for Individuals With Psychotic Disorders.
abstract: Outcomes for individuals with psychosis remain far from acceptable. Recently, prominent psychiatrists have called for an improved understanding of the impact of social contexts, and how social contexts might influence the development and maintenance of mental health problems. A key social context for individuals with psychosis is the therapeutic relationship. As part of a trial of joint crisis planning in England, this qualitative study aimed to determine the mechanism through which joint crisis planning might affect the therapeutic relationship. Results suggest that routine processes in mental health care are affected by policy and organizational requirements for risk mitigation-aspects that undermine person-centered approaches. In contrast, strong therapeutic relationships are characterized by individualized care and reliable and respectful treatment. The Joint Crisis Plan intervention partially succeeded in reducing contextual influences on routine role enactments, facilitating the demonstration of respect and improving the therapeutic relationship.
authors.affiliation: King's College London, London, United Kingdom simone.farrelly@kcl.ac.uk.
authors.forename: Simone
authors.initials: S
authors.lastname: Farrelly
authors.affiliation: The University of Birmingham, Birmingham, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Lester
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: Diana
authors.initials: D
authors.lastname: Rose
authors.affiliation: University of Warwick, Coventry, United Kingdom.
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.affiliation: University of Manchester, Manchester, United Kingdom.
authors.forename: Max
authors.initials: M
authors.lastname: Marshall
authors.affiliation: University of Manchester, Manchester, United Kingdom.
authors.forename: Waquas
authors.initials: W
authors.lastname: Waheed
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: R Claire
authors.initials: RC
authors.lastname: Henderson
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Szmukler
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019090:Case Management / Q000458:organization & administration / Q000592:standards; D003134:Commitment of Persons with Psychiatric Disorders / Q000592:standards; D003419:Crisis Intervention / Q000379:methods / Q000592:standards; D004739:England; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards*; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy; D036301:Qualitative Research; D012008:Recurrence; D013222:State Medicine / Q000458:organization & administration / Q000592:standards
keywords: communication, medical; crisis management; grounded theory; group interaction; mental health and illness; nursing, community; psychiatry; qualitative analysis; relationships, patient-provider; risk; schizophrenia; symbolic interactionism