Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Psychiatr Serv. 2011 May;62(5):471-6. doi: 10.1176/ps.62.5.pss6205_0471.
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.
提高患者自主性和减少强制是精神卫生保健中经常提到的目标。研究表明，治疗关系和患者的强制感受可能存在关联。本研究调查了精神科住院患者治疗关系与感知强制之间的关联。
利用英格兰牛津两所精神病院连续收治的 164 名患者的结构化访谈数据，考察了感知强制与治疗关系以及社会人口学和临床变量之间的关联。
自愿和非自愿入院患者分别有 48%和 89%的人经历了高度的强制。感知强制评分较高与非自愿入院和治疗关系评价较差显著相关。治疗关系使法律地位成为感知强制的预测因素变得复杂。
在精神科住院期间，类似的因素可能会影响患者对强制和治疗关系的体验。即使是自愿住院，如果患者对与收治医生的关系评价不佳，他们也会认为住院更具强制性。改善治疗关系的干预措施可能会减少对强制的感知。
