This is what I need a clinical feedback system to do for me: A qualitative inquiry into perspectives of adolescents and their therapists

OBJECTIVE

Routine outcome monitoring and clinical feedback systems might be beneficial for adolescent psychotherapy processes.

METHODS

Clinicians (n = 34) and adolescent clients (n = 22) aged 14-19 from seven different outpatient clinics located in Norway participated in the study. Adolescents were interviewed in individual in-depth interviews (n = 7) or in four adolescent-only focus groups (n = 15), clinicians participated in seven clinician-only focus groups.

RESULTS

We report two core domains, (1) feedback about the therapeutic relationship and (2) feedback about the therapeutic work. Seven subthemes specify the functionality that participants need in a feedback system.

CONCLUSION

Adolescents and therapists requested a feedback system that was relationally oriented, supported collaborative action, and was personalized to the needs of the individual adolescent. The research indicates that a clinical feedback system should have idiographic, as well as nomothetic, components. A clinical feedback system for adolescents should monitor experiences of personal autonomy and the quality of the therapeutic relationship.

How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway

Background

Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment.

Methods

We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky’s theoretical framework on the role public health workers play in policy implementation.

Findings

Following Norway’s new policy was challenging for the therapists in our study, particularly balancing a patient’s needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients’ conditions worsening.

Conclusions

Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work.

Trial registration: N/A.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13033-022-00529-8.

"A mismatch between what is happening on the inside and going on, on the outside": a qualitative study of therapists' perspectives on student mental health

BACKGROUND

Although a growing number of studies indicates a high prevalence of reported mental health problems in students and that the problems are growing in number and severity, less is known about the experiences of students facing mental health problems and personnel who interact with students that seek help for these problems. The aim of this study is to examine the perspectives of therapists working with students seeking therapy for mental health problems.

METHODS

A qualitative study of 15 therapists' perspectives. Data are collected with in-depth, semistructured and open-ended interviews, and analyzed using a reflexive thematic analysis.

RESULTS

We developed four themes that summarize how the therapists viewed and understood the students' experiences of mental health problems: (1) an agonizing mismatch between the inside and the outside, (2) conflicting needs for closeness and distance, (3) no room for pain, and (4) a major potential for ripple effects.

CONCLUSIONS

We relate our findings to the existing theory and research, and we discuss the implications for clinical practice and the limitations of the study. We argue that our findings demonstrate the need to provide students room to explore and make meaning of their difficulties and pain related to mental health problems, in addition to offer some symptom-reducing tools and techniques that can enhance performance and academic achievements. More research is needed to understand what student mental health problems might be related to and what students need.

'Not at all what I had expected': Discontinuing treatment with extended-release naltrexone (XR-NTX): A qualitative study

BACKGROUND

Extended-release naltrexone (XR-NTX), an opioid antagonist, has demonstrated equal treatment outcomes, in terms of safety, opioid use, and retention, to the recommended OMT medication buprenorphine. However, premature discontinuation of XR-NTX treatment is still common and poorly understood. Research on patient experiences of XR-NTX treatment is limited. We sought to explore participants' experiences with discontinuation of treatment with XR-NTX, particularly motivation for XR-NTX, experiences of initiation and treatment, and rationale for leaving treatment.

METHODS

We conducted qualitative, semi-structured interviews with participants from a clinical trial of XR-NTX. The study participants (N = 13) included seven women and six men with opioid dependence, who had received a minimum of one and maximum of four injections of XR-NTX. The study team analyzed transcribed interviews, employing thematic analysis with a critical realist approach.

FINDINGS

The research team identified three themes, and we present them as a chronological narrative: theme 1: Entering treatment - I thought I knew what I was going into; theme 2: Life with XR-NTX - I had something in me that I didn't want; and theme 3: Leaving treatment - I want to go somewhere in life. Patients' unfulfilled expectations of how XR-NTX would lead to a better life were central to decisions about discontinuation, including unexpected physical, emotional, or mental reactions as well as a lack of expected effects, notably some described an opioid effect from buprenorphine. A few participants ended treatment because they had reached their treatment goal, but most expressed disappointment about not achieving this goal. Some also expressed renewed acceptance of OMT. The participants' motivation for abstinence from illegal substances generally remained.

CONCLUSION

Our findings emphasize that a dynamic understanding of discontinuation of treatment is necessary to achieve a long-term approach to recovery: the field should understand discontinuation as a feature of typical treatment trajectories, and discontinuation can be followed by re-initiation of treatment.

Like Taking a Magnifying Glass Into Everyday Life: Vulnerable Parents' Experiences With Video Guidance in an Infant Mental Health Clinic

Background: Parents are a central focus in clinical infant mental health interventions because of the key importance of the caregiver-infant relationship, especially when dyads are burdened by psychosocial and parental mental health problems. However, knowledge is scarce about the lived experience of vulnerable parents who undergo video-based guidance.

Aim: The study explores how parents in an infant-psychiatric outpatient clinic who struggled to mentalize and remain emotionally connected to their infant experienced helpful and challenging elements in video guidance.

Method: We analyzed the interviews of a strategic sample of 12 parents after undergoing Marte Meo video guidance, using a team-based, reflexive thematic analysis (TA).

Results: We identified four main themes: (a) Handling initial feelings of fear and loss of control; (b) Filming as a disturbing or agentic experience; (c) Feeling validated or devalued in the therapeutic relationship; and (d) Bringing insights from video guidance into everyday life. Therapeutic and existential factors became apparent in the main themes of adjustment to the guidance, experiences with filming, the therapeutic relationship and integration of new experiences.

Conclusion: The parents’ sense of agency, dignity, and shame may be important for their ability to integrate new ideas about themselves.

Implications: Video guidance for vulnerable parents in specialized clinical treatment should address relational challenges, parental mental health, and issues of recognition.

Learning to mentalize: Exploring vulnerable parents' experiences of change during video guidance in an infant mental health clinic

BACKGROUND

Interventions that promote infant mental health face challenges when applied for parents who struggle with psychosocial and psychological burdens. Video-based guidance using the Marte Meo method is used in specialized clinical settings with high-risk families to improve parent-child interaction, parental sensitivity and mentalizing. However, knowledge about the lifeworlds of these parents and their experiences of the therapeutic process during video guidance is limited.

AIM

This qualitative study explores how parents in an infant mental health outpatient clinic who had difficulties mentalizing and maintaining an emotional connection with their infants experienced the change process during Marte Meo video guidance.

METHODS

We identified a strategic sample of parents with difficulties mentalizing and maintaining an emotional connection with their infants through the Parent Development Interview. Twelve parents received video guidance and were afterwards interviewed in-depth. The research interviews were qualitatively analysed via a team-based reflexive thematic analysis.

RESULT

We identified four themes: a) feeling inadequate or disconnected as a parent; b) discovering the infant as a relating and intentional person; c) becoming more agentic and interconnected; and d) still feeling challenged by personal mental health issues.

CONCLUSION

Parents described positive changes in their interactions, in mentalizing their infants, the relationship and themselves as parents, in their experiences of self-efficacy and on a representational level. They also described increased confidence and improved coping despite ongoing personal mental health challenges. The findings suggest that video guidance using the Marte Meo method can be a critical intervention for vulnerable parents but should be coordinated with parents' primary treatments when complex parental mental health issues are involved.

"And then the rest happened"- A qualitative exploration of the role that meaningful activities play in recovery processes for people with a diagnosis of substance use disorder

Background: In this qualitative exploration, we report on a thematic analysis of the key role that engaging in meaningful activities may play in recovery processes for people with a diagnosis of substance use disorder (SUD). Methods: We conducted semi-structured, individual interviews with 30 participants and analyzed the parts of this material that were related to meaningful activities. Results: The findings are summarized through the development of three broad themes: (a) the central role of work-"The wages suck, but the job is gold"; (b) mastery and commitment-"I had to get up early, find my spot, I had to be present and fully functioning all day"; and (c) repairing the bridge to community life-"It's my job and working out that has made this possible, really, I see that now." Conclusion: We discuss these findings in relation to a recovery perspective and relevant empirical studies, highlight some important implications for research and practice, and consider the strengths and limitations of the present study.

How do Norwegian adolescents experience the role of social media in relation to mental health and well-being: a qualitative study

Background

During the last decade, social media has permeated most parts of society. Adolescents are particularly active users of social media, and their use has been suggested as a contributing factor to mental health issues in this group. Quantitative studies have found associations between the frequency and/or duration of social media use and more mental health issues. However, most studies are cross-sectional and the identified associations are weak and of questionable practical significance. The aim of this study was to investigate adolescents’ lived experiences of using social media, focusing on both negative and positive aspects, using a qualitative approach. Qualitative research enables in-depth explorations of the experiences of individuals, nuance quantitative findings, and offer the perspective of adolescents into policies regarding social media use.

Methods

Experiences and perspectives of 27 adolescents from two senior high schools in Norway were gathered using focus group interviews (mean age 16.8, range 15–18). The data were analysed using thematic analysis.

Results

According to the participants, social media use catalyse changes to how people communicate and relate to each other (theme 1). Some changes were positive, in terms of facilitating social connectedness, while others were negative, such as people behaving worse than in face-to-face interactions. Further, social media use affected the participants at the individual level (theme 2); positively in terms of a sense of belonging and social support, and negatively in terms of perceived stress, body pressure, and displacing other activities such as sleep and homework. The motivations for using, or not using, social media were multifaceted (theme 3), reflecting the positive and negative aspects of social media in terms of interpersonal and personal consequences.

Conclusion

Social media was described as an important part of the participants’ everyday life, with both a positive and negative impact on their mental health and well-being. Considering the compelling nature of social media and adolescents’ relatively limited self-regulatory capacities, efforts to modify social media use should avoid relying on self-regulation, while also recognizing the importance of social media as an arena for peer interaction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00582-x.

Finding focus in a difficult landscape: Therapists' experiences with challenging video guidance processes for parent-infant dyads

Marte Meo video guidance uses filmed interaction of the actual parent-infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent-infant dyads may illuminate important aspects of the method itself as well as the therapists' role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent-infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent-infant dyads where child protective issues arise, where caregivers' insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists' role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.

"It means so much for me to have a choice": a qualitative study providing first-person perspectives on medication-free treatment in mental health care

BACKGROUND

In 2016, the Western Norway Regional Health Authority started to integrate more evidence-based psychosocial interventions into the existing mental health care, emphasizing the right for persons with psychosis to choose medication-free treatment. This change emerged from the debate on the effectiveness and adverse effects of the use of antipsychotic medication. Aspects beyond symptom reduction, such as interpersonal relationships, increased understanding of one's own pattern of suffering, hope and motivation, are all considered important for the personal recovery process.

METHODS

This study explores whether these aspects were present in users' descriptions of their recovery processes within the medication-free treatment programme in Bergen, Western Norway. We interviewed ten patients diagnosed with psychosis who were eligible for medication-free services about their treatment experiences. Data were analysed using Attride-Stirling's thematic network approach.

RESULTS

The findings show a global theme relating to personal recovery processes facilitated by the provision of more psychosocial treatment options, with three organizing subthemes: interpersonal relationships between patients and therapists, the patient's understanding of personal patterns of suffering, and personal motivation for self-agency in the recovery process. Participants described an improved relationship with therapists compared to previous experiences. Integrating more evidence-based psychosocial interventions into existing mental health services facilitated learning experiences regarding the choice of treatment, particularly the discontinuation of medication, and appeared to support participants' increased self-agency and motivation in their personal recovery processes.

CONCLUSION

Health care in Norway is perhaps one step closer to optimizing care for people with psychosis, allowing for more patient choice and improving the dialogue and hence the interpersonal relationship between the patient and the therapist. Personal patterns of suffering can be explored within a system aiming to support and have a higher level of acceptance for the discontinuation of medication. Such a system requires personal agency in the treatment regimen, with more focus on personal coping strategies and more personal responsibility for the recovery process.

The nature of youth in the eyes of mental-health care workers: therapists' conceptualization of adolescents coming to therapy at others' initiative

Background

Adolescent clients often come to therapy at the initiative of others and show a higher drop-out rate compared to adult clients. Therapeutic relationships are critical for preventing drop-outs and attaining good outcomes, yet few empirical studies have investigated how therapists conceptualize and meet adolescent clients who come reluctantly to therapy.

Methods

We conducted ten focus-group interviews in this study with a total of 51 therapists at different Norwegian specialist outpatient clinics for children and adolescents with mental-health problems to explore how therapists view and understand adolescents who come to therapy at the initiative of someone else. We used a reflexive approach to thematic analysis to analyze the transcripts.

Results

We found five main themes, expressing variations in participants’ understanding: The hurt and distrustful adolescent; The adolescent lacking hope for the future; The adolescent engulfed in the burden of mental-health suffering; The adolescent as something more than a psychiatric patient; and The adolescent meeting a system with varying flexibility and space for engagement.

Conclusions

Several conceptualizations of the adolescent client coexist within and between clinics, resulting in variability of services for adolescents even within the frames of a strong welfare system.

Rethinking Social Interaction: Empirical Model Development

Background

Social media is an integral part of human social life. More than 90% of young people use social media daily. Current theories, models, and measures are primarily based on face-to-face conceptions, leaving research out of sync with current social trends. This may lead to imprecise diagnoses and predictions.

Objective

To develop a theoretically based empirical model of current social interfaces to inform relevant measures.

Methods

A three-stage, qualitative, data-collection approach included anonymous individual Post-it notes, three full-class discussions, and 10 focus groups to explore 82 adolescents’ relational practices. Data analysis followed a meaning-condensation procedure and a field-correspondence technique.

Results

We developed an empirical model that categorizes adolescents’ social interactions into five experiential positions. Four positions result from trajectories relating to social media and face-to-face social interaction. Positions are described by match or mismatch dynamics between preferred and actual social platforms used. In matched positions, individuals prefer and use both face-to-face and social media platforms (position 1), prefer and use face-to-face platforms (position 2), or prefer and use social media platforms (position 3). In mismatched positions, individuals prefer face-to-face interactions but use social media platforms (position 4) or prefer social media but use face-to-face platforms (position 5). We propose that matched positions indicate good social functioning while mismatched positions indicate serious social challenges.

Conclusions

We propose a model that will expand previous unidimensional social interaction constructs, and we hypothesize that the described match and mismatch analyses provide conceptual clarity for research and practical application. We discuss prediction value, implications, and model validation procedures.

"A Life More Ordinary" Processes of 5-Year Recovery From Substance Abuse. Experiences of 30 Recovered Service Users

Background: Studies investigating the subjective experiences of long-term recovery from substance use disorder are scarce. Particularly, functional and social factors have received little attention. Objectives: To investigate what long-term recovered service users found to build recovery from substance use disorder. Material and Methods: The study was designed as a phenomenological investigation subjected to thematic analysis. We interviewed 30 long-term recovered adult service users. Results: Our thematic analysis resulted in five themes and several subthemes: 1) paranoia, ambivalence and drug cravings: extreme barriers to ending use; 2) submitting to treatment: a struggle to balance rigid treatment structures with a need for autonomy; 3) surrendering to trust and love: building a whole person; 4) a life more ordinary: surrendering to mainstream social responsibilities; and 5) taking on personal responsibility and gaining autonomy: it has to be me, it cannot be you. Conclusions: Our study sample described long-term recovery as a developmental process from dependency and reactivity to personal autonomy and self-agency. The flux of surrendering to and differentiating from authority appeared to be a driving force in recovery progression. Participants called for treatment to focus on early social readjustment.

"We all have a responsibility": a narrative discourse analysis of an information campaign targeting help-seeking in first episode psychosis

BACKGROUND

Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are considered important tools within early detection and intervention strategies. In this study, we aimed to explore which discursive meaning content, including roles and actors, such information campaigns build on and construct. Our intention was not to provide objective answers, but to contribute to a discursive debate about potential conflicts in messages conveyed in such campaigns.

METHODS

A broad sample of information material utilized by TIPS Stavanger University Hospital (Norway) was examined. The material consisted of posters, booklets and brochures, newspaper ads, Facebook ads, and TIPS Info's website, representing various campaigns from 1996 to April 2018. A narrative discursive approach was applied at an epistemological level. At a practical level, a team-based thematic analysis was utilized to identify patterns across data.

RESULTS

Diversity and several changes in strategy were recognized throughout the information material. Furthermore, three main themes and four subthemes were found to constitute the meaning content built in the information campaigns: knowledge is key; (almost) an illness among illnesses; and we all have a responsibility (comprising of the subthemes; to respond quickly; to step in; to provide an answer; and to tag along).

CONCLUSION

Our findings pointed to common dilemmas in mental health services: How to combine professional expert knowledge with collaborative practices that emphasize shared decision-making and active roles on behalf of patients? How to combine a focus on symptoms and illness and simultaneously express the importance of addressing patients' recourses? And how can we ask for societal responsibility in help-seeking when professionals are placed in expert positions which may not be optimal for dialogue with potential patients or their network? We discuss whether highlighting practices with more weight on resources and active roles for patients and their surroundings in information campaigns could promote earlier help-seeking.

Moving Toward Connectedness - A Qualitative Study of Recovery Processes for People With Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health disorder estimated to affect 1–2% of the general population. As a group, people with BPD endure a high degree of suffering, often leading to suicide attempts, self-harm, and suicide. Comparatively few studies explore the first person perspective of the person suffering from any mental health disorder. This might be especially problematic for people diagnosed with BPD, as this particular diagnosis is followed by stigma potentially making help seeking harder and helping relationships more vulnerable. We interviewed 12 female participants recently diagnosed with BPD in-depth about their experiences with recovery and treatment, and used a stepwise reflective approach to rigorously analyze the data. Results show an overarching theme of working toward connectedness, with four constituent sub-themes. We discuss the findings with regard to empirical work, recovery and autonomy, and the risk of epistemic injustice that people with BPD risk facing.

Being recognised as a whole person: A qualitative study of inpatient experience in mental health

Few studies address the many challenges that are faced by staff and patients in the inpatient mental health context. In particular, there is a lack of research that explores first-hand patient experiences in order to establish what treatment practices best assist patient recovery and what are the barriers to these practices. This qualitative study, which utilises a user-involved research framework, collaborates with a co-researcher patient group throughout the study. Fourteen patients, all of whom had been in inpatient treatment for at least three weeks, were recruited to the study. Study participants were interviewed in-depth in the period September 2016 to March 2017. Data underwent a thematic analysis that was inspired by interpretative phenomenological analysis. A core theme of the findings was the importance of being recognised as a whole person, and the patient-professional relationship was regarded as a fundamental factor in fostering recovery, with two underlying themes: (i) a need to have one's self-identity recognised and supported, and (ii) an experience of ambivalence between needing closeness and distance. This study suggests ways nurses can give priority to interpersonal interactions and relationships with hospitalised patients over task-oriented duties, highlighting the need for nurses to balance patient competing needs for both closeness and distance.

"It's not a life of war and conflict": experienced therapists' views on negotiating a therapeutic alliance in involuntary treatment

BACKGROUND

Working alliances are considered to be essential to treatment, and they represent a robust predictor of positive treatment outcomes. In a working alliance, a patient and therapist agree upon treatment decisions, which can raise a series of challenges when patients are in involuntary treatment. The aim of this study was to research how therapists experience negotiating a working alliance with patients with serious mental illnesses who are subjected to coercive treatment.

METHODS

Using a qualitative approach, we conducted 10 semi-structured interviews with experienced therapists in a Norwegian mental health care setting. Transcripts were analysed using a team-based thematic analysis method.

RESULTS

Two interrelated major themes and five sub-themes were identified: (1) between coercion and care; (a) the ease of coercion, (b) the paradox of autonomy, and (c) the coercion as care; and (2) imperative treatment and interpersonal dilemmas; (a) this is happening between us and (b) when we do not meet in the middle.

CONCLUSION

We conclude that the therapists exhibited a will to consider their patients' goals and methods, but only when they were in agreement, and they ultimately made treatment decisions themselves. Further, patient autonomy seems to come second in therapist assessments of needs for care; consequently, we question to what degree the working alliance as a defined concept of mutual agreement is present in the involuntary treatment we investigated.

Psychotherapy in Psychosis: Experiences of Fully Recovered Service Users

Background: Despite the evidence of the importance of including service users' views on psychotherapy after psychosis, there is a paucity of research investigating impact on full recovery. Objectives: To explore what fully recovered service users found to be the working ingredients of psychotherapy in the recovery process after psychosis. Materials and Methods: The study was designed as a phenomenological investigation with thematic analysis as the practical tool for analysis. Twenty fully recovered service users were interviewed. Results: Themes: (1) Help with the basics, (2) Having a companion when moving through chaotic turf, (3) Creating a common language, (4) Putting psychosis in brackets and cultivate all that is healthy, and (5) Building a bridge from the psychotic state to the outside world. Conclusion: Therapeutic approaches sensitive to stage specific functional challenges seemed crucial for counteracting social isolation and achieving full recovery. Findings indicate that psychotherapy focusing on early readjustment to everyday activities, to what are perceived as meaningful and recovery-oriented, seems to be what is preferred and called for by service users.

What are "good outcomes" for adolescents in public mental health settings?

BACKGROUND

In line with the evidence-based paradigm, routine outcome monitoring and clinical feedback systems are now being recommended and implemented in youth mental health services. However, what constitutes a good outcome for young service users is not fully understood. In order to successfully monitor outcomes that are clinically and personally relevant for the service user that are to benefit from these systems, we need to gain more knowledge of what young service users value as meaningful outcomes of youth mental health services.

AIM

To contribute knowledge into what constitutes "good outcomes" from the experiences of adolescent service users in public mental health systems.

METHODS

A qualitative in-depth study of the experiences and reflections from 22 adolescents aged 14-19 years, currently or recently being in public mental health services. The data material was analyzed using a systematic step-wise consensual qualitative research framework for team-based analysis.

RESULTS

An overarching theme of outcome as having developed a stronger autonomy and safer identity emerged from the analysis, with the subsequent five constituent themes, named from the words of the adolescent clients: (1) I've discovered and given names to my emotions, (2) I've started to become the person that I truly am, (3) I've dared to open up and feel connected to others, (4) I've started saying yes where I used to say no, and, (5) I've learned how to cope with challenges in life.

CONCLUSION

"Good outcomes" in youth mental health services should be understood as recovery oriented, sensitive to developmental phases, and based on the personal goals and values of each adolescent client.

How Do People Experience Early Intervention Services for Psychosis? A Meta-Synthesis

We conducted a study to explore how people diagnosed with first-episode psychosis experienced their contact with early intervention services for psychosis and the way these experiences relate to their recovery processes. Our aim was to integrate and describe the service users' experiences in a rigorous and comprehensive way. A broad literature search was performed in June and July 2016. After screening, 17 qualitative studies were included. We analyzed the findings in two main steps: (a) translating studies into one another and (b) synthesizing the findings from the studies. Through these interpretative processes, we found five new and overarching themes: (a) something is wrong, (b) do for myself, (c) it's about people, (d) a price to pay, and (e) ongoing vulnerability. We describe these themes as a process that service users' maneuver through in their contact with the services. Our findings are discussed in light of relevant research.

"If there's no stability around them": experienced therapists' view on the role of patients' social world in recovery in bipolar disorder

BACKGROUND

Recovery in severe mental illness has traditionally been described as a deeply personal process. At the same time, researchers are increasingly attending to the social nature of such processes. In this article, we aim to supplement the growing knowledge base regarding these social aspects by exploring the perspectives of experienced therapists: how do they view the role of the social world in processes of healing and growth for people with bipolar disorder? And in what ways can the social world impede recovery?

METHODS

We conducted 12 semi-structured individual interviews and analyzed the resulting transcripts using a team-based thematic analysis method.

RESULTS

We identified three themes: (a) establishing a sense of belonging; (b) backing ongoing therapy; and (c) relational ripple effects.

CONCLUSIONS

We relate our findings to existing theory and research, discuss clinical implications, and highlight study limitations. We argue that our findings underscore the need to integrate an understanding of recovery as a personal and social process in the mental health care services that we provide.

Antipsychotic treatment: experiences of fully recovered service users

BACKGROUND

There is lack of long-term controlled studies evaluating treatment effects of antipsychotic medication. A complete investigation should include the service user perspective.

AIMS

To investigate experiences of clinically recovered service users of antipsychotic medications during and after a first episode of psychosis.

METHOD

We used a thematic analytic approach within an interpretative-phenomenological framework. 20 clinically recovered service users were interviewed.

RESULTS

Themes: (1) Antipsychotic drugs reduce mental chaos during the acute phase, (2) Non-stigmatizing environments were perceived to increase chances of successful use, (3) Antipsychotic drugs beyond the acute phase - considered to compromise the contribution of individual effort in recovery, (4) Prolonged use - perceived to reduce likelihood of functional recovery, (5) Antipsychotic medication was considered as a supplement to trustful relationships.

CONCLUSIONS

Acute phase antipsychotic treatment was mostly perceived as advantageous by this sample, who was in clinical recovery. However, costs were often seen as outweighing benefits beyond the acute stage. Findings clearly emphasize the need for a collaborative approach to be integrated across all phases of care. This study underscores the need to investigate sub-group differences with regard to long-term antipsychotic treatment.

What are "good outcomes" in public mental health settings? A qualitative exploration of clients' and therapists' experiences

BACKGROUND

The mental health field sees a surge of interest in Routine Outcome Monitoring, mandated by a wish to help better those not-on-track to recovery. What constitutes positive outcomes for these patients is not fully understood.

AIMS

To contribute knowledge into what constitutes meaningful outcome concepts in the experiences of patients with long and complex mental health suffering and treatment, and the clinicians who work to help them.

METHODS

A qualitative in-depth study of 50 participants' experiences. Data are collected through focus groups and individual interviews, and analyzed using a team based structured thematic analytic approach.

RESULTS

We found an overarching theme of outcome as an ongoing process of recovery, with the four constituent themes: (1) strengthening approach patterns for new coping; (2) embodying change reflected by others; (3) using new understandings developed in dialogue; and (4) integrating collaborative acceptance.

CONCLUSIONS

We discuss our findings in light of existing empirical studies and different recovery concepts, and suggest that if outcomes monitoring is to become an integral part of routine practice, it might be beneficial to integrate an understanding of outcomes as ongoing processes of recovery within mental health suffering into these systems.

"Everyone Needs a Friend Sometimes" - Social Predictors of Long-Term Remission In First Episode Psychosis

Background: Predictors of long-term symptomatic remission are crucial to the successful tailoring of treatment in first episode psychosis. There is lack of studies distinguishing the predictive effects of different social factors. This prevents a valid evaluating of their independent effects.

Objectives: To test specific social baseline predictors of long-term remission. We hypothesized that first, satisfaction with social relations predicts remission; second, that frequency of social interaction predicts remission; and third, that the effect of friend relationship satisfaction and frequency will be greater than that of family relations satisfaction and frequency.

Material and Methods: A sample of first episode psychosis (n = 186) completed baseline measures of social functioning, as well as clinical assessments. We compared groups of remitted and non-remitted individuals using generalized estimating equations analyses.

Results: Frequency of social interaction with friends was a significant positive predictor of remission over a two-year period. Neither global perceived social satisfaction nor frequency of family interaction showed significant effects.

Conclusions: The study findings are of particular clinical importance since frequency of friendship interaction is a possibly malleable factor. Frequency of interaction could be affected through behavioral modification and therapy already from an early stage in the course, and thus increase remission rates.

This is what I need a clinical feedback system to do for me: A qualitative inquiry into therapists' and patients' perspectives

Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of providing naturalistic research data and enhancing mental health care. However, implementation in routine care is challenging, and we need more knowledge about clinicians' and patients' needs from such systems.

OBJECTIVE

We aimed to study perspectives of clinicians and patients to explore how ROM/CFS can be helpful and acceptable to them.

METHOD

We interviewed 55 participants in focus groups and individual interviews and analyzed the data through rigorous team-based qualitative analyses.

RESULTS

We report 3 overarching domains: (a) Shared needs, (b) Specific patient needs, and (c) Specific therapist needs. Shared needs, in which perspectives of different stakeholders converge, was the dominant domain in the material. Under each domain, we report 3 specific themes: (a1) Degree of trust in therapy, (a2) Allowing for openness, (a3) Monitoring joint objectives; (b1) Life functioning, (b2) Canary in the coal mine, (b3) Holistic report; and (c1) Emotional presence and style, (c2) Monitoring risk and symptoms, and (c3) Agency and ownership of process.

CONCLUSIONS

In what should increase our confidence toward core aspects of ROM, we suggest that an integration of relational feedback concepts and stringent clinical dimension tracking into the ROM/CFS can be beneficial.

Negotiating the coresearcher mandate - service users' experiences of doing collaborative research on mental health

PURPOSE

Traditionally, the voices of service users have been silent in research into mental health issues. A Norwegian research network, however, recognizes the importance of involving service users as coresearchers and initiated a training program in research methodology and design intended to empower them as active participants in research projects. In this article, we explore how these coresearchers with a mental health service user background experience their participation in projects as well as in attending the training: What is it like being a service user coresearcher in collaborative studies on issues in mental health? How do coresearchers negotiate their roles and mandate?

METHOD

We used focus groups as our data collection method, transcribed the group discussions verbatim, and analyzed the transcriptions using qualitative methodology. We then took the preliminary analyses back to the participants for discussion, auditing, and reanalysis.

RESULTS

We identified themes that represent important social processes around which the participants developed a consensual understanding: self-definition, constructive differentiation and negotiations.

CONCLUSION

Our findings generate hypotheses on how participatory research into mental health issues can be fruitfully organized, in a way that empowers service users to active and constructive participation.

Toward caring for oneself in a life of intense ups and downs: a reflexive-collaborative exploration of recovery in bipolar disorder

In this article, we discuss processes of recovery in bipolar disorder. We utilized a hermeneutical-phenomenological approach developed within a reflexive-collaborative framework to examine what individuals do to promote improvement and positive change in their own lives. The study was designed and carried out in collaboration with an expert-by-experience group of 12 coresearchers with firsthand experiences of mental distress and recovery. In-depth interviews were conducted with 13 participants who acknowledged having lived and dealt with a bipolar disorder. Four core themes were drawn from our analysis: (a) handling ambivalence about letting go of manic states; (b) finding something to hang on to when the world is spinning around; (c) becoming aware of signals from self and others; and (d) finding ways of caring for oneself. Interrelationships between the four themes, along with limitations, strengths, and implications of the study are discussed.