Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Greater Manchester Mental Health NHS Trust, Rawnsley Building, Oxford Road, Manchester, UK.
J Ment Health. 2022 Oct;31(5):716-723. doi: 10.1080/09638237.2021.2022613. Epub 2022 Jan 11.
Compared to other ethnic groups in the UK, Black people have the highest rates of psychosis. This may partly be explained by both assessment bias and structural racism. Mental health services often find it difficult to develop therapeutic relationships with Black people with psychosis. Attachment theory posits that the quality of previous caregiving experiences influence current interpersonal functioning and emotional regulation. In this study, we applied the theory to improve the understanding of therapeutic relationships with people with psychosis.
This is the first study to examine associations between attachment difficulties, therapeutic alliance, and service engagement in a Black sample with psychosis.
Fifty-one participants completed self-report measures of attachment and alliance. Staff completed measures of alliance and service engagement.
Higher attachment avoidance was related to poorer alliance ratings. These significant findings were not upheld in a regression model controlling for total symptom scores and perceived ethnic/racial discrimination in services. Attachment anxiety was generally not associated with alliance ratings. Neither attachment anxiety nor attachment avoidance was significantly associated with service engagement.
Staff should be supported to better understand the needs of service users with avoidant attachment behaviours and to develop mutually-agreed treatment goals and therapeutic bonds.
与英国其他族裔相比，黑人的精神病发病率最高。这在一定程度上可以通过评估偏差和结构性种族主义来解释。精神卫生服务机构往往难以与患有精神病的黑人建立治疗关系。依恋理论假设，先前的照顾经历的质量会影响当前的人际关系功能和情绪调节。在这项研究中，我们应用该理论来增进对与精神病患者建立治疗关系的理解。
这是第一项研究，旨在检验黑人精神病患者中依恋困难、治疗联盟和服务参与之间的关联。
51 名参与者完成了依恋和联盟的自我报告测量。工作人员完成了联盟和服务参与的测量。
较高的依恋回避与较差的联盟评分相关。这些显著的发现并没有在控制总症状评分和服务中感知到的种族/族裔歧视的回归模型中得到支持。依恋焦虑通常与联盟评分无关。依恋焦虑和回避都与服务参与度没有显著关联。
应该支持工作人员更好地了解具有回避依恋行为的服务使用者的需求，并制定双方同意的治疗目标和治疗关系。
