Perceived Coercion and the Therapeutic Relationship: A Neglected Association?

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 05/2011; 62(5):471-6. DOI: 10.1176/
Source: PubMed


Increasing patient autonomy and decreasing coercion are frequently cited goals in mental health care. Research suggests that the therapeutic relationship and patients' experiences of coercion may be associated. This study investigated the association between the therapeutic relationship and perceived coercion in psychiatric admissions.
Associations between perceived coercion and the therapeutic relationship and sociodemographic and clinical variables were examined by using data from structured interviews with 164 patients consecutively admitted to two psychiatric hospitals in Oxford, England.
High levels of coercion were experienced by 48% of voluntarily and 89% of involuntarily admitted patients. A high perceived coercion score was significantly associated with involuntary admission and a poor rating of the therapeutic relationship. The therapeutic relationship confounded legal status as a predictor of perceived coercion.
Similar factors may influence patients' experience of both coercion and the therapeutic relationship during psychiatric hospital admission. Hospitalization, even when voluntary, was viewed as more coercive when patients rated their relationship with the admitting clinician negatively. Interventions to improve the therapeutic relationship may reduce perceptions of coercion.

Download full-text


Available from: Tom Patrick Burns
  • Source
    • "This would be an interesting avenue for further research. Contrary to previous literature (Angell et al., 2007; Sheehan and Burns, 2011) we found that service user ratings were not associated in multivariate analyses with their ratings of perceived coercion at 18 month follow-up. Univariate analyses comparing weakest and strongest TRs did show an effect. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Therapeutic relationships are considered a key component of good psychiatric care, yet its association with outcomes for individuals with psychosis remains unclear. 569 service users with psychotic disorders and care coordinators in community settings rated their therapeutic relationship; outcomes were assessed 18 months later. In multivariate analyses, a small but significant association was found between service user ratings and instances of psychiatric hospital admissions, self harm and suicide attempts over an 18 month period. Care coordinator ratings were associated with instances of psychiatric hospital admissions and harm to others over the 18 months and level of functioning at 18 months. The differential findings and small effect size suggests that the therapeutic relationship needs further definition for this patient group in this setting. Nevertheless, clinicians should prioritise interactions that strengthen therapeutic relationships.
    Full-text · Article · Dec 2014 · Psychiatry Research
  • Source
    • "In taking a step forward, it will be fruitful to also include clinical paternalism and responsibility on the research agenda when looking at the effects of psychiatric institutionalization. For example, Sheehan and Burns’ findings [57] indicated that high levels of perceived coercion are significantly associated with involuntary admission and a poor rating of therapeutic relationship. Voluntary hospitalization was seen as more coercive when patients rated their relationship with the admitting clinician negatively. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day. Method A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings. Results Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care. Conclusions The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how psychiatric care should develop and on the role of institutional care in psychiatry.
    Full-text · Article · Jun 2013 · BMC Psychiatry
  • Source

    Preview · Article · Jul 2011 · Psychiatric services (Washington, D.C.)
Show more