Psychotherapy Research ( IF 4.117 ) Pub Date : 2021-05-05 , DOI: 10.1080/10503307.2021.1921304 Holly Alice Bear 1, 2, 3 , Kate Dalzell 4 , Julian Edbrooke-Childs 1, 2, 4 , Lauren Garland 2 , Miranda Wolpert 1, 5
ABSTRACT
Background: Approximately half of those who access child and adolescent mental health services do not show measurable improvement in symptoms. This study aimed to provide practice recommendations for managing treatment endings, particularly when outcomes have not improved. Method: Semi-structured interviews were carried out with 26 young people with a history of anxiety and/or depression along with 7 roundtable sessions with 52 mental health clinicians. Data were analyzed using Framework Analysis. Results: A common experience for young people when outcomes did not improve was a poor experience of the treatment ending, which often resulted in setbacks in their mental health and feelings of loss and abandonment. Clinicians agreed that ending was hard for young people and reported that they found managing ending hard on a personal and professional level. This was compounded by unrealistically high public expectations about the impact of therapy on outcomes and trying to strike a balance between fostering hope and managing expectations, within a context of inflexible service structures and resource constraint. Implications: Recommendations include establishing expectations from the outset and a shared understanding of what outcomes matter most to the young person. This can be achieved through communicating honestly about likely outcomes, while also providing hope.
中文翻译:
如何管理不成功治疗的结局:青年和临床医生观点的定性比较
摘要
背景:大约一半获得儿童和青少年心理健康服务的人的症状没有明显改善。本研究旨在为管理治疗结束提供实践建议,特别是在结果没有改善的情况下。方法:对 26 名有焦虑和/或抑郁病史的年轻人进行半结构化访谈,并与 52 名心理健康临床医生进行 7 次圆桌会议。使用框架分析分析数据。结果:当结果没有改善时,年轻人的普遍经历是治疗结束的糟糕经历,这往往导致他们的心理健康受挫以及失去和被遗弃的感觉。临床医生一致认为,结束对年轻人来说很难,并报告说他们发现在个人和专业层面上很难管理结束。在不灵活的服务结构和资源限制的背景下,公众对治疗对结果的影响抱有不切实际的高期望,并试图在培养希望和管理期望之间取得平衡,这使情况更加复杂。影响:建议包括从一开始就建立期望,并就对年轻人最重要的结果达成共识。这可以通过诚实地交流可能的结果来实现,同时也提供希望。