Sapiro Beth
Montclair State University.
Child Youth Serv Rev. 2020 Sep;116. doi: 10.1016/j.childyouth.2020.105178. Epub 2020 Jun 16.
Marginalized youth are at elevated risk for mental health difficulties, yet they encounter numerous barriers to engagement with mental health services. Past negative experiences with family, social workers, and systems of care contribute to distrust of service providers and ambivalence about engaging in trusting relationships with adults. This longitudinal qualitative study explored how marginalized youth living with mental health conditions make decisions about trust in their relationships with helping professionals. Semi-structured, open-ended in-depth interviews were conducted with 13 young women living with a mood or anxiety disorder, exploring trust, mutuality, and disconnection in relationships between marginalized youth and helping professionals. Eleven of the participants also participated in a second interview, 3 months later, that explored participants' relationships with friends and family. Transcripts were analyzed using thematic analysis and interpreted through the lens of relational-cultural theory. Results indicated that the majority of interview participants described feeling unseen, judged, or invalidated in their relationships with family members. Four themes emerged as factors in the assessment of the trustworthiness of service providers: genuine caring; understanding; non-judgmental acceptance; and adult respect for youth agency. Concerns about confidentiality and mandated reporting informed participants' decisions about disclosure in these relationships. Analysis of findings reveals evidence of the central relational paradox in these descriptions of helping relationships, reflecting the simultaneous appeal and peril of vulnerability in relationships, especially relationships characterized by power differentials. Findings suggest that practitioners working with marginalized youth can expect both openness and guardedness in the treatment relationship.
边缘化青年面临心理健康问题的风险更高，但他们在寻求心理健康服务时遇到了诸多障碍。过去与家庭、社会工作者及护理系统的负面经历导致他们对服务提供者不信任，也对与成年人建立信任关系持矛盾态度。这项纵向定性研究探讨了患有心理健康问题的边缘化青年如何在与帮助专业人员的关系中做出信任决策。对13名患有情绪或焦虑障碍的年轻女性进行了半结构化、开放式深度访谈，探讨边缘化青年与帮助专业人员之间关系中的信任、相互性和脱节问题。11名参与者还在3个月后参加了第二次访谈，此次访谈探讨了参与者与朋友和家人的关系。使用主题分析法对访谈记录进行了分析，并通过关系文化理论的视角进行了解读。结果表明，大多数参与访谈的人表示在与家庭成员的关系中感到被忽视、被评判或不被认可。出现了四个主题，成为评估服务提供者可信度的因素：真诚关怀；理解；不评判的接纳；以及成年人对青年自主性的尊重。对保密和强制报告的担忧影响了参与者在这些关系中关于披露信息的决策。对研究结果的分析揭示了这些帮助关系描述中核心关系悖论的证据，反映了关系中脆弱性同时具有的吸引力和危险性，尤其是在存在权力差异的关系中。研究结果表明，与边缘化青年打交道的从业者在治疗关系中可能会遇到既开放又有所保留的情况。
