Anne Denhov

Social relationships as a decisive factor in recovering from severe mental illness

Background: Recovery research often describes recovery from mental illness as a complex individual process. In this article a social perspective on recovery is developed. Aims: To ascertain which factors people regard as decisive to their own recovery and what makes them beneficial. Methods: In-depth interviews were conducted with 58 persons in Sweden who had recovered from severe mental illness. Interviews were qualitatively analyzed using grounded theory. Results: Three dimensions of contributing recovery factors were identified. Social relationships emerged as the core category throughout these dimensions. Conclusions: The results show that recovery processes are social processes in which social relationships play a key role.

The components of helping relationships with professionals in psychiatry: Users’ perspective

Background: The quality of the relationship between professional and user is one of the important factors in the recovery process. However, more knowledge is needed concerning the components of helping relationships and characteristics of the helping professional. The aim of this study was to explore users’ experiences of helping relationships with professionals. Data and methods: This was a grounded theory analysis of 71 qualitative interviews to explore users’ experience of helping relationships and their components, in psychiatric care in Sweden. Discussion: Within the three main categories – interpersonal continuity, emotional climate and social interaction – two core themes were found that described vital components of helping relationships: a non-stigmatizing attitude on the part of the professionals and their willingness to do something beyond established routines. Conclusions: The focus in psychiatric treatment research needs to be broadened. In addition to research on the outcome of particular methods and interventions, the common factors also need to be investigated, above all, what is the effect of the quality of the relationship between user and professional. Greater attention needs to be paid, as well, to how helping respective obstructive relationships in psychiatric services arise, are maintained or are modified.

The Art of Helpful Relationships with Professionals: A Meta-ethnography of the Perspective of Persons with Severe Mental Illness

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.

Psychosis and poverty : coping with poverty and severe mental illness in everyday life

In psychiatry, it is assumed that the social conditions of everyday life do not in themselves affect the severity of an individual’s mental ill health. Rather, the illness is the cause of problems that the individual meets in daily life. However, recent studies indicate that social factors can explain behavior that has ordinarily been regarded as symptoms of mental illness. The aim of the present study is to investigate how people with a psychosis diagnosis manage their economic difficulties. Nineteen persons with a psychosis diagnosis were interviewed on several occasions in the course of a follow-up study. The interviews were analyzed according to Grounded Theory. The present study shows that the persons had developed different rational ways of coping with economic strain: reducing their expenses, increasing their incomes or borrowing money and acquiring debts. Living under poverty negatively affects their possibility to acquire and maintain a social network and their sense of the self. The study contributes to our knowledge of the nature of psychosis and its relationship to the social context.

Helping Relationships and Time: Inside the Black Box of the Working Alliance

Research has shown the importance of the relationship between professionals and users for the outcome of interventions in psychiatry. The aim of this study is to analyze time as one factor in the development of working alliances. Fifty-eight persons in recovery from diagnosis of severe mental illness were interviewed about helping factors in their recovery process. Two aspects of time were considered to be of importance for the construction of working alliances: the quantity of time, that is, getting more time than expected during, between, and after the sessions; and the quality of time, that is, having undisturbed and focused time, the experience of being in the professional thoughts between the sessions and timing in ones life. Those experiences give the person a sense of being a real-life person and not an abstract patient, and this lays the groundwork for establishing a working alliance. The management of time is an important factor in the creation of a working alliance and should be given greater attention in the development of experience- and evidence-based practice.

Non-helpful relationships with professionals – a literature review of the perspective of persons with severe mental illness*

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.

After the Asylum? The New Institutional Landscape

AbstractDuring the last decades services to people with severe mental health problems have gone through important changes. Terms as de-, trans-, reinstitutionalisation and dehospitalisation has been used. The objective of the study was to collected data about the changes in a welfare society about the new institutional landscape after the mental hospital area. Data about interventions from social welfare agencies, psychiatric care, and prisons were collected from local and national register as well as data about cause of death and socio-economic status for 1355 persons treated with a diagnosis of psychosis in a Stockholm area 2004–2008. Psychiatric in-patient care and prisons are marginalized. Different interventions in open care touched a very large number of persons. Social welfare agencies play an increasing role in this context. The total institutions have been replaced by a network of micro-institutions sometimes offering help but also control.

Going beyond: Users’ experiences of helping professionals

Background: Establishing a working alliance has been found to be of great importance for the outcome of professional interventions for people diagnosed with severe mental illnesses. Aim: The aim of the present study was to analyse the concrete actions of helpful professionals in establishing a working alliance. Method: Interviews with 58 persons diagnosed with severe mental illness who were in a recovery process or had recovered were analysed using Grounded Theory. Results: The core category that emerged from the analysis was termed ‘going beyond’. It was constituted on three subcategories: challenging the rationality of the institutions, restoring the professional as a person and restoring the user as a person. Conclusion: Users’ experience-based knowledge about helpful professionals calls into question the traditional view of professional roles.

Aloneness and loneliness – persons with severe mental illness and experiences of being alone

People with severe mental illness (SMI) are often described as lonely and socially incapable – an inability resulting from the mental illness. The aim of this article is to explore experiences of b ...

A Balancing Act—How Mental Health Professionals Experience Being Personal in Their Relationships with Service Users

ABSTRACT Background: Although being personal in relationships with service users is commonly described as an important aspect of the way that professionals help people with severe mental problems, this has also been described to bring with it a need to keep a distance and set boundaries. Aims: This study aims to explore how professionals working in psychiatric care view being personal in their relationships with users. Method: Qualitative interviews with 21 professionals working in three outpatient psychiatric units, analyzed through thematic analysis. Results: Being personal in their relationships with users was described as something that participants regarded to be helpful, but that also entails risks. Participants described how they balanced being personal by keeping a distance and maintaining boundaries in their relationships based on their “experience-based knowledge” to counter these risks. While these boundaries seemed to play an important part in the way that they act and behave, they were not seen as fixed, but rather as flexible and dynamic. Boundaries could sometimes be transgressed to the benefit of users. Conclusions: Being personal was viewed as something that may be helpful to users, but that also entails risks. Although boundaries may be a useful concept for use in balancing these risks, they should be understood as something complex and flexible.