Therapeutic relationships in child and adolescent mental health services: A Delphi study with young people, carers and clinicians
Therapeutic relationships in child and adolescent mental health services: A Delphi study with young people, carers and clinicians
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DOI：
10.1111/inm.12857
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发表时间：
2021-03-25
影响因子：
5.6
通讯作者：
Hartley, Samantha
中科院分区：
文献类型：
--
作者：
Ryan, Rachael;Berry, Katherine;Hartley, Samantha
治疗关系已被广泛认为是心理治疗取得良好效果的关键。然而，在儿童和青少年心理健康服务（CAMHS）的背景下，什么构成和影响治疗关系的研究相对较少。CAMHS内部的关系本质上是复杂的，年轻人、父母或护理人员以及各个学科的工作人员之间存在多种关系。德尔菲法被用来获得共识的治疗关系的定义，什么有助于建立和什么阻碍了良好的关系，在CAMHS的背景下形成。邀请了三个专家组（青年、照料者和工作人员）共88名参与者完成三轮在线德尔菲调查。达成共识，将治疗关系定义为信任，可靠性和缺乏判断的态度（n = 19声明）。有助于建立良好关系的因素主要是指工作人员的行为，建立开放的沟通渠道，表现出接受年轻人的困难和一致（n = 88共识协议声明）。阻碍良好关系的因素是所有组之间的不一致和缺乏明确的沟通（n = 18共识协议声明）。有效的治疗关系需要临床医生的关键行为和方法。至关重要的是，工作人员在促进关于父母参与关系的讨论时必须开诚布公，工作人员必须向年轻人和家庭成员提供一贯和信任的支持。我们的调查结果表明，主要利益攸关方在重要方面达成了一致，这些方面可能是更新培训和支持结构的催化剂。
Therapeutic relationships have been widely recognized as crucial to good outcomes in psychotherapy. However, there is comparatively little research on what constitutes and impacts therapeutic relationships in the context of child and adolescent mental health services (CAMHS). Relationships within CAMHS are inherently complex, with multiple relationships taking place between young people, parents or carers and staff members of various disciplines. The Delphi method was used to gain consensus regarding the definition of therapeutic relationships, what helps to build and what hinders the formation of a good relationship in the context of CAMHS. Three expert groups (young people, carers and staff) totalling 88 participants were invited to complete an online Delphi survey across three rounds. Consensus was reached to define the therapeutic relationship as trust, reliability and absence of judgemental attitudes (n = 19 statements). Factors that help build good relationships predominantly referred to staff behaviours of setting up open communication channels, showing acceptance of the young person's difficulties and being consistent (n = 88 consensus agreement statements). Factors that hindered a good relationship were inconsistencies and lack of clear communication between all groups (n = 18 consensus agreement statements). Effective therapeutic relationships require key behaviours and approaches from clinicians. It is essential that staff members are open and honest in facilitating discussions about parental involvement within the relationship and that staff provide consistent and trusting support to young people and family members. Our findings demonstrate that key stakeholders agree on important aspects and that these could be a catalyst for renewed training and support structures.