Coercion and the Inpatient Treatment Alliance.

Area of Science:

• Psychiatry
• Clinical Psychology
• Mental Health Services Research

Background:

• A strong treatment alliance is crucial in psychiatric care.
• Quantitative studies indicate coercion negatively impacts the treatment alliance.
• Qualitative insights into how coercion affects patient-clinician relationships are limited.

Purpose of the Study:

• To explore how coercive experiences influence the treatment alliance in psychiatric inpatients.
• To understand patient perspectives on navigating treatment relationships under coercion.
• To examine the impact of coercive experiences on future treatment adherence.

Main Methods:

• Qualitative analysis of open-ended interviews with 50 psychiatric inpatients.
• Exploration of the relationship between coercive experiences (e.g., involuntary hospitalization) and the treatment alliance.
• Assessment of the perceived impact of hospital experiences on future adherence.

Main Results:

• Coercion often hinders the formation of a treatment alliance due to power imbalances and lack of patient participation.
• Some patients maintained their alliance through clear communication and trust in the clinician's intentions.
• Patient-reported experiences varied, with some alliances negatively impacted and others preserved.

Conclusions:

• Coercive experiences are generally detrimental to the treatment alliance but not insurmountable.
• Maintaining a strong therapeutic alliance is important even when coercive elements are present in treatment.
• Strategies like improved communication, explaining treatment rationale, and demonstrating patient-centered care can preserve the alliance.