Many Negative Impacts of Restraints and Legal Coercion on Therapeutic Relationships

Rob Wipond
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One study identified a number of key factors in how the use of restraints affected the “therapeutic relationship” between patients and carers, and another identified similar factors with respect to involuntary committal.

In a study published in The Journal of Forensic Psychiatry & Psychology, interviews with patients on a UK psychiatric ward about physical restraint led researchers to identify five key issues that negatively affect therapeutic relationships. These were, “power imbalance, the experience as traumatic, the importance of justification, the negative attributes and motives of some staff and the impact of coping with powerlessness.”

In PLOS One, Swiss researchers surveyed 113 adult male psychiatric patients of different legal statuses and 32 attending physicians. “On average, self-referred patients rated the quality of the therapeutic relationship significantly more positive than did involuntarily admitted patients in general psychiatry wards,” the authors wrote. They also found that patients’ “symptoms of hostility” were more strongly correlated with negative effects on the therapeutic relationship than involuntary status per se.

Overall, the researchers also found that there was “no association” between how patients rated the quality of their therapeutic relationships with their physicians, and how the physicians rated those same relationships.

Knowles, Susan Frances, Joanna Hearne, and Ian Smith. “Physical Restraint and the Therapeutic Relationship.” The Journal of Forensic Psychiatry & Psychology 0, no. 0 (April 23, 2015): 1–15. doi:10.1080/14789949.2015.1034752. (Abstract)

Höfer, Friederike X. E., Elmar Habermeyer, Andreas Mokros, Steffen Lau, and Stefanie K. Gairing. “The Impact of Legal Coercion on the Therapeutic Relationship in Adult Schizophrenia Patients.” PLoS ONE 10, no. 4 (April 24, 2015): e0124043. doi:10.1371/journal.pone.0124043. (Full text)

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Rob Wipond
Rob Wipond is a Victoria, British Columbia-based freelance journalist who has been writing on mental health issues for fifteen years. His research has particularly focused on the interfaces between psychiatry, the justice system, and civil rights. His articles have been nominated for three Canadian National Magazine Awards, six Western Magazine Awards, and four Jack Webster Awards for journalism. He can be contacted through his website.

6 COMMENTS

  1. This study correlates to studies done on the therapeutic relationship between Nazi Gestapo guards and Jewish prisoners in concentration camps. The therapeutic relationship between southern slave owners and their slaves is also being explored, as is the therapeutic relationship between the Pharoah and those who built the pyramids.

  2. Could someone explain to me what this means,

    “Patients’ ratings of the quality of the therapeutic relationship were inversely related to symptom severity in general and hostility in particular.”

    Does it mean patients with less severe symptoms report worse therapeutic relationships?

    And when they discuss hostility, is it the hostility on the part of those strapping the patients to beds against their will, or hostility on the part of patients?

    • They are abusing the people more when they resist. That’s all it is. If you accept your role as a crazy person in need of “treatment” you get more of a pass.

      “They also found that patients’ “symptoms of hostility” were more strongly correlated with negative effects on the therapeutic relationship than involuntary status per se.”

      Also known as Stockholm syndrome. Apparently some folks don’t fight back but start to love their abusers. Sweet.

    • S. E. I think it is more simply just what inverse means, as in when you talk about gravity or light getting more or less intense according to the “inverse” significance of the distance relations between the light or gravity “source” (since it takes two to gravitate, or to get light to shed light upon something actually gotten seen in the light) and the “object” receiving the illumination or getting attracted (more than the “main” gravity source gets attracted by it). Let’s see what B says back in clarification, if he does, and figure more of your question out though for what it means for your theories of what couldn’t be right about what you were told by doctors, and what you understand is right to believe. I can’t immediately see what B is bringing in about Stockholm sybdrome that bears upon your question relative to the inverse relationships that qualify the survey reported on here. At least, I can’t see right off the bat what experiences he means it to account for that are “inversely”effective on perceived outcomes intended to be “good work” done on mental patients.

      Very simply, the statement you offered in quotes means what you would guess by thinking in analogy with the mathematical terms for force and light dispersion getting Weaker with More distance, and Stronger with Less distance. The inverses in the equations are about the Weaker effects corresponding to the More distant conditions in the respective physical systems, and the Stronger effects to the Less distant conditions.

      So, the good “high” quality of therapeutic relationships meant simultaneously Less hostility or symptom severity factored in the determination. When the judgment reflected More hostility and/or Greater symptom severity, then the reported therapeutic relationship quality was “low” and therefore bad… in correspondence to how the symptoms that were present were bad ones and the hostile feelings meant “No dice if Ihave to keep talking to this jerk.”

  3. “Overall, the researchers also found that there was “no association” between how patients rated the quality of their therapeutic relationships with their physicians, and how the physicians rated those same relationships. ”

    Maybe because when you torture people then they say anything they hope will make you stop? No sh*t Sherlock. I mean hove deprived of empathy do you have to be not to see it as a common sense consequence of using violence?