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.

"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.

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.

"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.

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.

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.

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.

"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.

Contradictory experiences of safety and shame in inpatient mental health practice - a qualitative study.

This study explores the lived experience of hospitalisation from the perspective of people with a mental health disorder. This hermeneutic-phenomenological study, which forms part of a larger qualitative serial inquiry, uses a participatory research design, with analysis inspired by interpretative phenomenological analysis. Fourteen participants were interviewed twice: first during hospitalisation and then again 3 months following hospital discharge. Findings are reported from the entire interview data set. Our findings suggest that mental health hospitalisation is a contradictory experience for patients. On one hand, our study participants experienced the hospital as a place where it is alright to be vulnerable, while on the other hand participants experienced hospitalisation as a burden of everyday stigma and signs of depersonalisation. We conclude that it is important to recognise that patients in need of inpatient treatment for mental illnesses are, in fact, people first and foremost. More reflective practice can be developed by shifting the focus to recovery-oriented practices to and open dialogue-based approaches.

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.

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.

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.

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.

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.

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.

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.

'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.

"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.