School of Health Sciences, Nursing Science, University of Tampere and Finnish Doctoral Programme in Nursing Science, Tampere, Finland.
Int J Qual Stud Health Well-being. 2013 Aug 20;8:20316. doi: 10.3402/qhw.v8i0.20316.
Mothers with a co-occurring mental illness and substance abuse (dual diagnosis) use numerous different services. Help-seeking and engagement are complex processes which have not yet been sufficiently conceptualized. A descriptive phenomenological approach was used to explore these experiences from different service contexts and to describe the decisions in and structure of help-seeking over a 13-year period. Four in-depth interviews were conducted and data were analysed with a descriptive phenomenological method developed by Giorgi. The essential meaning structure is an inner conflict within the client, including a realization that change starts from within. The essential meaning structure combines the other meaning structures: disbelief of receiving help and admitting the need for help, keeping up the perfect façade and the risk of total collapse, being given and making own choices regarding care and being forced to use services and inner emptiness and search for contentment in life. It is possible that clients in the help-seeking process do not always recognize they have a need for care. If the client experiences inner powerlessness as emptiness and resistance to being helped, it is probably not possible to create relationships with care providers. Clients may have several ambiguous inner processes which prevent them from accepting the need for care. Theoretically and empirically a long-term approach is crucial, since the inner transformative processes take time. The services can contribute new experiences to the personal level of understanding and decision-making, if they consider the experiential level of their clients.
患有精神疾病和物质滥用共病（双重诊断）的母亲会使用许多不同的服务。寻求帮助和参与是一个复杂的过程，尚未得到充分的概念化。本研究采用描述现象学方法，从不同的服务背景中探索这些经历，并描述在 13 年内寻求帮助的决策和结构。进行了四次深入访谈，并使用 Giorgi 开发的描述现象学方法对数据进行了分析。基本的意义结构是客户内心的冲突，包括认识到改变始于内心。基本的意义结构结合了其他意义结构：不相信会得到帮助和承认需要帮助、保持完美的表象和完全崩溃的风险、接受和自己做出关于护理的选择、被迫使用服务以及内心的空虚和对生活的满足感的寻找。在寻求帮助的过程中，客户可能并不总是意识到自己需要护理。如果客户感到内心无力，感到空虚和抗拒被帮助，那么与护理提供者建立关系可能是不可能的。客户可能有几个模糊的内在过程，阻止他们接受护理的需要。从理论和经验上讲，长期的方法是至关重要的，因为内在的变革过程需要时间。如果服务能够考虑到客户的体验层面，那么它们可以为个人的理解和决策层面提供新的经验。
