How people diagnosed with borderline personality disorder experience relationships to oneself and to others. A qualitative in-depth study.

BACKGROUND: The first-person experiences of people diagnosed with borderline personality disorder (BPD) is an important area of research. It can support clinical and ethical practice, and nuance and expand on insights offered by diagnostic and treatment-oriented research approaches. In this study, we aimed to develop knowledge about how persons who were recently diagnosed with BPD experience being in relationships with themselves and others. METHODS: We conducted in-depth life-world interviews with 12 women recently diagnosed with BPD. The interviews focused on their lived experiences of relationships to self and others. All participants gave their informed consents to participate. We analysed the data with a structured approach to reflexive thematic analysis, conducted as a team-based approach. RESULTS: We extracted an overarching theme, "Reaching for firm holdings", that is the most abstract interpretation of participants' experiences. The five subordinate themes ("Captive of emotions", "Keeping undeservedness at bay", "Distrusting oneself", "Dependence as stability" and "The uncertainty of reaching out") are specific constituents of the overarching theme, and provide detail and variations across individual accounts. CONCLUSIONS: The results suggest that the experience of relationship to self and others of people recently diagnosed with BPD entails feeling insecure, unsafe and frightened. We report five themes that describe ways participants seek to cope with this situation. The results indicate that their experiences encompass turning to others, or to objects, for feelings of safety. As such, the experience of relationship to self and others in the context of receiving a BPD diagnosis seemed to entail finding and evolving strategies to protect a vulnerable self. Self-harm, suicide attempts and addiction all seemed to be ways of handling and tolerating chaotic and frightful emotions. One major limitation of our study is that only people who identified as female were recruited to participate in the study.

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.

"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.

'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.

"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.

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.

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.

"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.

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.

La guía de video Marte Meo usa interacciones filmadas de las propias díadas. Explorar los retos que en la guía surgen de las díadas progenitor-infante pudiera dar luz al papel de los terapeutas y requisitos, así como a importantes aspectos del método mismo. Esto podría llevar al desarrollo del método y una práctica mejorada, sin embargo, hasta el presente ha sido poco estudiada. Exploramos cómo los hábiles terapeutas experimentan y manejan los retos o los fallos en los procesos de guía. Analizamos entrevistas con 13 terapeutas/supervisores de Marte Meo usando análisis temáticos de reflexión basados en el equipo de trabajo. Se identificaron cuatro temas principales: promover el crecimiento de la relación dentro de un contexto coercitivo; construir una alianza en la que los progenitores se sientan seguros; prestar atención a momentos positivos en vidas difíciles; y manejar sentimientos intensos como terapeuta. Nuestros resultados muestran que el terapeuta experimenta retos éticos y terapéuticos específicos con un vulnerable subgrupo de díadas progenitor-infante donde surgen asuntos de protección al niño, donde las inseguridades de los cuidadores impiden la relación terapéutica, y donde los cuidadores tienen problemas de relación o de salud mental no resueltos. El papel de los terapeutas se convierte en esencial y exigente con respecto a la alianza, a las intervenciones terapéuticas, así como a la propia necesidad de regulación, supervisión y estructura. La temprana identificación de estas díadas pudiera facilitar una mejor adaptación a la guía del video. Nuestros resultados sugieren la necesidad de estructuras de apoyo, supervisión clínica y entrenamiento para manejar estos retos.

La guidance interactive par vidéo Marte Meo ("Par mes propres forces") utilise une interaction filmée de vraies dyades. L'exploration des défis qui se posent dans la guidance de dyades parent-bébé peuvent illuminer le rôle des thérapeutes ainsi que les besoins et les aspects importants de la méthode en elle-même. Cela pourrait mener au développement de la méthode et à une pratique améliorée mais n'a jusque-là guère été abordé. Nous explorons ici comment des thérapeutes expérimentés vivent et gèrent les processus de guidance qui forment un défi ou qui échouent. Nous avons analysé des entretiens avec 13 thérapeutes/superviseurs Marte Meo utilisant une analyse thématique de réflexion et menée en équipe. Quatre thèmes principaux ont été identifiés: la promotion de la croissance relationnelle dans un context coercif; la construction d'une alliance que les parents trouvent sûre; le fait de voir des moments positifs dans des vies difficiles; et le fait d'avoir à faire à des sentiments intenses en tant que thérapeute. Nos résultats montrent que les thérapeutes font l'expérience de défis thérapeutiques spécifiques et de défis éthiques avec un sous-groupe vulnérable de dyades parent-bébé lorsque des problèmes de protection de l'enfant se posent, dans un contexte ou les insécurités des personnes prenant soin de l'enfant enfreignent la relation thérapeutique et où les personnes prenant soin de l'enfant peuvent avoir des problèmes relationnels ou de santé mentale qui n'ont pas été résolus. Le rôle des thérapeutes devient central et exigeant pour ce qui concerne l'alliance, les interventions thérapeutiques et son propre besoin de régulation, de supervision et de structure. Une identification précoce de ces dyades pourrait faciliter une meilleure adaptation de la guidance par vidéo. Nos résultats suggèrent qu'il est nécessaire d'avoir des structures de soutien, une supervision clinique et une formation afin de faire face à ces défis.

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.

"Becoming myself": how participants in a longitudinal substance use disorder recovery study experienced receiving continuous feedback on their results.

BACKGROUND: Being a participant in longitudinal follow-up studies is not commonly a factor considered when investigating useful self-change aspects for individuals attempting recovery from substance use disorder (SUD). This study reports on how ongoing monitoring, and feedback on data results in a longitudinal follow-up study of SUD recovery were perceived by individuals who had achieved long-term abstinence and social recovery. METHODS: Interviewers with first-hand experience with the topic conducted interviews with 30 participants and analysed the data using a thematic analytic approach within an interpretative-phenomenological framework. RESULTS: Analyses resulted in the following themes. 1) Ongoing short text messaging (SMS) monitoring: helped participants by offering recovery milestones and reminders of the past. 2) Feedback on data results helped participants track physical and cognitive recovery: "I am more like myself". 3) Using feedback in treatment: understanding the importance of a functional brain to participants may help with long-term retention in treatment. CONCLUSIONS: Self-changes that were challenging to detect on a day-to-day basis were available for reflection through longitudinal study participation, including ongoing monitoring and feedback on the results, allowing personal consolidation of change processes. Clinical services could benefit from continuing development and implementation of such technology for ongoing monitoring and feedback on assessments to motivate self-change in SUD recovery. The development of guidelines for providing the results of research assessments to individuals could help reduce attrition in research projects and support recovery and healthy choices for study participants.

Reports of the benefits of drug use from individuals with substance use disorders.

Background: The perceived benefits of drug use are not currently integrated into the treatment of substance use disorder. This omission appears paradoxical and is unsubstantiated by empirical research. As the perceived benefits of drug use are catalysts for drug initiation, relapse and continuous use, increased knowledge about these benefits seems crucial to efficacious treatment. Aims: To investigate the perceived benefits of drug use in substance use disorder. Method: The study is a phenomenological-hermeneutical investigation using thematic analysis of interviews with 30 long-term recovered adult service users. Results: Our thematic analysis resulted in three themes and several sub-themes: (1) Benefits of drug use; (2) Necessity of intense experiences; and (3) Importance of being unconventional. Conclusions: Findings indicate that the benefits of non-problematic and problematic drug use are motivated by similar individual and social needs. An absolute distinction between problematic and non-problematic drug use thus seems arbitrary and potentially counterproductive for clinical practice. The benefits of drug use should be researched as a possible add-on treatment module, as this knowledge may be of significant clinical value in treatment frameworks.

Antipsychotic treatment - a systematic literature review and meta-analysis of qualitative studies.

Background: The literature on antipsychotic medication in psychosis lack systematization of the empirical knowledge base on patients' subjective experiences of using antipsychotic drugs. Such investigations are pivotal to inform large-scale trials with clinically relevant hypotheses and to illuminate clinical implications for different sub-groups of individuals.Aims: To re-analyze and summarize existing qualitative research literature on patient perspectives of using antipsychotic medication.Method: A systematic literature search was performed in September 2018 (Protocol registration no. CRD42017074394). Using an existing framework of meta-analyzing qualitative research, full text evaluation was conducted for 41 articles. Thirty-two articles were included for the final synthesis.Results: Four meta-themes were identified: (1) short-term benefits; (2) adverse effects and coping processes; (3) surrender and autonomy; (4) long-term compromise of functional recovery.Conclusions: While largely positive about acute and short-term use, patients are more skeptical about using antipsychotic drugs in the longer term. The latter specifically relates to processes of functional and social recovery. The clinical conversations about antipsychotic medication need to include evaluations of contexts of patient experience level, patient autonomy processes, patient values and risk preferences, and patient knowledge and knowledge needs in addition to assessing the severity of symptoms of psychosis.

"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.

"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.

"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.