Exploring therapeutic endings and the role of therapeutic relationships in promoting recovery for secure inpatients; an interpretative phenomenological analysis study and a systematic review and narrative synthesis

Abstract

Research suggests that Therapeutic Relationships (TRs) are important across disciplines and can improve outcomes. This is also true for secure care, where there is an increased risk of attachment difficulties and experience of trauma. Yet there is little research on the role of TRs in promoting recovery. Secure inpatients may also experience several therapeutic endings, such as ending therapy, moving wards, staff leaving or a change in care team. Given the importance of TRs and the attachment difficulties experienced by secure inpatients, and the volume of endings experienced, it is important to understand the experience of therapeutic endings for this population.
Chapter 1 is a systematic review of the qualitative literature around patient perspectives of recovery and TRs in secure care, to understand the role of TRs in promoting recovery. 11 papers were quality assessed and analyzed using thematic synthesis. This produced two overarching themes of Promoters, highlighting how positive TRs can promote recovery and Barriers, highlighting how difficult TRs can become a barrier to recovery. Results aligned with previous reviews regarding recovery in secure care.
Chapter 2 is an empirical paper exploring low secure inpatient experiences of therapeutic endings, using Interpretative Phenomenological Analysis (IPA). Three Group Experiential Themes were identified from an IPA of interviews with eight participants: The Flow of Power, Endings Through Time and Coming to Terms with the Loss of Connection.
Results of both chapters are discussed in line with the current literature and clinical implications, strengths and limitations, and directions for future research are considered.

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Identifiers

ORCID for Pete Lawrence: orcid.org/0000-0001-6181-433X

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