Faith Laura, Wiesepape Courtney, Kukla Marina, Lysaker Paul
Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA.
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
Neuropsychiatr Dis Treat. 2023 Oct 18;19:2179-2194. doi: 10.2147/NDT.S386004. eCollection 2023.
Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients' experience of recovery oriented approaches, there are less studies examining clinicians' perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis.
Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services.
Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work.
As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.
精神病康复是精神科康复中预期且期望达成的结果，这可能涉及与个人康复相关的主观结果。虽然大量定性研究考察了患者对以康复为导向方法的体验，但考察临床医生观点的研究较少。考察临床医生的观点对于在以康复为导向的实践中支持临床医生以及理解潜在治疗过程都很重要。本研究的目的是探索临床医生为患有精神病的个体提供不同精神科康复治疗的体验，并了解在康复重点方面工作不同的临床医生之间的异同。
对10位提供元认知反思与洞察疗法（MERIT）的心理治疗师进行了开放式访谈，MERIT是一种以康复为导向的综合心理治疗形式，侧重于康复的主观方面，同时对10位提供标准精神科康复服务的临床医生进行了访谈。
主题分析揭示了这两组提供者之间重要的异同。MERIT治疗师有七个主题：对不确定性感到自在、强调合作、成为治疗改变的一部分、与客户建立联系、强调患者自主性、体验成长以及治疗师运用自我意识。精神科康复临床医生有四个主题：结构化方法的价值、注重基于优势的方法、见证行为改变以及建立融洽关系以支持工作。
正如预期的那样，临床医生群体之间出现了异同。结果表明两组都关注治疗关系以及监测进展和结果。出乎意料的是，MERIT治疗师报告了成长以及对不确定性感到自在。这些发现表明MERIT是一种心理治疗方法，为创造性且灵活地探索意义和能动性提供了独特机会，这对临床医生来说既具有挑战性又有回报。讨论了对支持健康临床医生实践和服务发展的启示。
