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)