Introduction
Methods
Study design
Study participants
Setting
Interview procedure
Patients | Health professionals | |
---|---|---|
(1) Experience of a good treatment in general | “When you think about your stay at the clinic – can you tell me how a good treatment is characterized for you?” | “When you think about your patients – can you tell me how a good treatment is characterized for you?” |
(2) Example of a good treatment | “Can you give me an example or describe a key moment of a good treatment?” | “Can you give me an example or describe a key moment of a good treatment?” |
(3) Ideal case | “For you personally, how would an ideal treatment look like?” | “What would you wish for yourself and your patient in an ideal treatment?” |
(4) Open question | “Would you like to add anything we didn’t cover today?” | “Would you like to add anything we didn’t cover today?” |
Qualitative analysis
Results
Sample characteristics
Patients (N = 5) | Psychiatrist (N = 5) | Other health professionals (N = 5) | |
---|---|---|---|
Sex (female:male) | 2:3 | 3:2 | 4:1 |
Age (mean; SD) | 53.0y; 5.8y | 54.4y; 10.3y | 51.8y; 1.6y |
Interview duration | 35 min | 34 min | 35 min |
Diagnosis | 2 x F33.1 (Major depressive disorder, recurrent, moderate) 2 x F32.1 (Major depressive disorder, single episode, moderate) 1 x F32.2 (Major depressive disorder, single episode, severe without psychotic features) | ||
Practice experience (mean; SD) | 23y; 8y | 18y; 5y |
Qualitative analysis
Superordinate Categories | Main Categories |
---|---|
1. Specific therapy methods and expertise. | Specific components of the therapy |
Animal assisted therapy | |
Physical movement in therapy | |
Group therapy settings | |
Learning new strategies in therapy | |
Expertise and experience of the therapist in his method | |
2. The setting and the organization of the clinic. | Organization of the clinic |
Possibility to switch the therapist and health professional | |
Inpatient setting | |
Transfer phase / preparation for everyday life | |
3. Inpatients’ new insights. | Insights |
Goals | |
Development process | |
Resources | |
Changed behavior | |
Implementation of what has been learned in therapy | |
Trust in oneself | |
4. Treatment success. | Treatment success |
Experiences of success | |
5. Inpatients’ basic attitudes. | Willingness / motivation |
Hope | |
Expectations | |
Patience | |
6. Code of Conduct: The atmosphere and general attitudes. | To support and care for the patient |
To accept and respect the patient | |
To encounter the patient at “eye level” and to form a team | |
To guide and accompany the patient | |
To welcome and to feel welcomed | |
To provide a safe space | |
To be on-time | |
To not feel alone | |
Humor | |
Curiosity | |
7. Communication and feedback. | Good and transparent communication style between the health professional and the patient |
Good communication style within a group of patients | |
Non-verbal communication | |
Good communication style in the professional team | |
Feedback | |
8. Relationships within the clinical setting. | The importance of other patients |
Someone is here 24/7 | |
Practical interactions | |
To have a good relationship in the clinical setting | |
9. Individual face-to-face therapy setting. | Feeling understood in the therapy |
Non-judgmental acceptance in therapy | |
To have a balance between emotional closeness and distance in the therapy | |
To resonate with the therapist or to have a good match | |
To have an (initial) bond in the therapy | |
To have a therapeutic relationship that is based on trust | |
To have a therapeutic relationship that is constant | |
To train how relationships work | |
To find a good balance between autonomy and care | |
Self-disclosure of the therapist | |
10. Overcoming challenges and hurdles. | To overcome resistance: Uncomfortable moments are part of every treatment |
To confront and endure difficult moments | |
To talk openly about difficulties in the therapeutic relationship | |
To learn something as a psychiatrist from difficult situations |
-
Patient: And so, I notice clearly how it helps me to learn to consciously relax the body. What I find very important is that I notice early if I am in a stressful situation (B131).
-
Psychiatrist: For example, disorder-specific knowledge is required so that I know how to treat anxiety disorders. That I know what is evidence-based, which is very likely to lead to improvement. Or that I know, for example, whether I have to do exposure exercises, leading to a habituation (B116).
-
Nursing Staff: That they [the patients] have a structure. This can be a professional-therapeutic structure or a structure of their own (B105).
-
Patient: There are different people here, with different backgrounds, different interests and that is why it is good that there are different therapists. And you always have the possibility to say: Sorry, that is not true for me, I would like to change [the psychiatrist] (B299).
-
Occupational therapist: So, what I also think is nice, and what I really think is good in a treatment is when the patient understands something about himself and his situation (B46).
-
Psychiatrist: Therapeutic success could be, for example, symptom reduction. This is a good therapy for both patients and therapists when the symptoms are decreasing (B56).
-
Nursing Staff: A good treatment is guaranteed if the patient can get involved, if s/he is motivated, if s/he can be won and if s/he can also work on herself/himself (B92).
-
Occupational therapist: I think it is important to make room for stagnation, and to not just focus on a methodological goal. It is about responding to the person at this specific moment (B310).
-
Nursing Staff: So, from a patient’s perspective, the most important thing is that I want to be cared for (B260).
-
Patient: And conversely, one can say that these people and the health professionals, the nurses and the physicians, who encounter one at eye level, these are the ones that one really feels are doing good for oneself and that there are good conversations and this also means a successful treatment (B291).
-
Psychiatrist: I always say, compare psychotherapy to a mountain hike together. That I’m accompanying a patient. I can’t take the backpack, but I’m accompanying, maybe one can say, here is a short-cut, this is a different path, a different perspective (B114).
-
Occupational therapist: So, the setting we work in needs to be safe for the patient. So that s/he is not in danger, has no fear of consequences, that s/he takes me for granted, that s/he knows I’m sticking around (B39).
-
Occupational therapist: I always ask patients when they say goodbye, i.e., in the last session, if they received what they needed. Or if they achieved what they needed; I find it very exciting, what they say then (B351).
-
Nursing Staff: Well, if it’s something that concerns many people or the whole group, then for me this is something that I address in the patients’ morning round (B272).
-
Psychiatrist: This is exactly the moment of the first encounter, eye contact, body posture, mimic. And sometimes the nonverbal message of the patient is, yes, I’m looking forward to seeing you again (B228).
-
Patient: Then, what I have experienced very positively here is of course the community of the patients. It has been really wonderful here and that has helped a lot (B207).
-
Nursing Staff: And as a patient I want to have the possibility that someone is present 24 h a day (B281).
-
Nursing Staff: For example, at the barbecue evening, where at the end you stand together in the kitchen doing the dishes and washing up. That’s something that somehow connects (B324).
-
Psychiatrist: But perhaps also a certain expression of the emotional understanding of the patient, of his concern, of his problem, so empathy belongs to the good treatment, feeling oneself in, putting oneself in, understanding, not only cognitively (B223).
-
Occupational therapist: And I have to be separated from patients to a certain degree, but I also have to be tangible for the patient, for his world (B347).
-
Occupational therapist: With a few patients it is quite clear that they are very needy or need structure – I am certainly more supportive and suggest something that would give them some structure. And for a critical patient, who is able to structure himself well, yes, then I can ask him/her what would be of interest now (B394).
-
Patient: That he [the therapist] also often brings an example from his life. (…) He then tells me how he reacts and that it was difficult for him as well in the beginning, but that it is possible to implement it differently than I do at the moment. I then realize that this is very ‘human’ – and this feels good (B217).
-
Psychiatrist: As soon as something is activated, these are also important moments. That is, where it might be unpleasant for the patient, maybe for me, those are probably also the most important moments for the therapeutic process (B75).
-
Psychiatrist: Yes, she [the patient] just had some kind of crisis on Monday after talking to me. And then we talked about it on Tuesday and yes, somehow this crisis was also helpful. It wasn’t my intention, but it did cause something (B237).
-
Psychiatrist: Sometimes I gain self-awareness and sometimes it also affects the relationship, which can be difficult. This is also important, not always pleasant but still good. Yes, that I can then also expand my potential for improvement – that is good therapy (B353).