Background
Methods
Study design
Study sample
The concept of the evening clinic
Ethics
Development of the interview guidelines
Key question | Maintaining questions | Demands |
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First question: Expectations and hopes | ||
What expectations and hopes do you have concerning the evening clinic? | Can you describe this in more detail? Can you be a little more specific? Are there any more specific hopes or requests that you associate with the evening clinic? | – |
Second question: Advantages | ||
What advantages do you expect from treatment in the evening clinic? | Can you describe this in more detail? Can you be a little more specific? Are there any specific benefits that you associate with the evening clinic? | Do you expect advantages over other treatment settings (outpatient, day-care, inpatient therapy)? Do you expect any benefits by continuing to be in your everyday environment, such as integrating issues that have been discussed in therapy into your private life? Do you see any benefits in limiting and intensifying the therapeutic program? |
Third question: Problems and difficulties | ||
What problems and difficulties do you see in connection with treatment in the evening clinic? | Can you describe this in more detail? Can you be a little more specific? Are there any specific problems that you associate with the evening clinic? | Do you expect difficulties compared to other treatment settings (outpatient, day-care, inpatient therapy)? Are you experiencing difficulties in maintaining close ties to your everyday environment (work/study, family) during treatment in the evening clinic? Do you see any difficulties in limiting and intensifying the therapeutic program? |
Fourth question: Disadvantages | ||
Do you see specific disadvantages that could arise when you attend the evening clinic? | Can you describe this in more detail? Can you be a little more specific? Are there specific problems that you associate with the evening clinic? | Do you see disadvantages compared to other treatment settings (outpatient, day-care, inpatient therapy)? Do you expect disadvantages regarding the fact that during treatment in the evening clinic you have a close relation to your everyday environment (job/study, family)? Do you see any disadvantages in limiting and intensifying the therapeutic program? |
Key question | Maintaining questions | Demands |
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First question: Perception of the evening clinic | ||
How did you experience treatment in the evening clinic? | Can you describe this in more detail? Can you be a little more specific? | Are there special moments or experiences that remind you of the evening clinic? |
Second question: Positive effects of the evening clinic | ||
What did you profit from? | Can you describe this in more detail? Can you be a little more specific? | Are there any more specific positive effects that you associate with the evening clinic? Were there certain situations that you found particularly helpful? |
Third question: Difficult aspects of the evening clinic | ||
What did you find difficult? | Can you describe this in more detail? Can you be a little more specific? | Are there any more difficulties that you associate with the evening clinic? Were there certain situations that you found difficult or less helpful? |
Qualitative content analysis and quantitative descriptive statistics
Results
Quantitative study sample
Parameters | Number |
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Age (years) | 40.5 ± 13.3 |
Gender m:f (%) | 15:10 (60:40) |
Duration of treatment (days) | 70 ± 26.1 |
Diagnoses | |
Depression, n (%) | 22 (88) |
Anxiety disorder, n (%) | 7 (28) |
Eating disorder, n (%) | 5 (20) |
Somatoform disorder, n (%) | 2 (10) |
Personality disorder, n (%) | 4 (16) |
Professional situation | |
Continuing to work n (%) | 11 (44) |
Continuing to study n (%) | 3 (12) |
Reintegration initiated n (%) | 4 (16) |
Incapacity to work n (%) | 7 (28) |
Main categories and topics
1. The therapy process |
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T0.1.1 Tasks und goals (115) ”Concerning my depression, I had hoped that my mood would generally improve and that I would be less anxious and could start processing everything.”(G) ”It is about processing. How to deal with certain situations or things that happen and to understand why my body or I react in a certain way—it is something completely new.”(Y) “The regular sessions encourage you to leave your comfort zone and talk about things. Rather than pushing everything away you have to engage with certain topics, more or less.”(H) T0.1.2 Difficulties during the therapeutic process (36) ”That it may not work, that I will be disappointed and have to look for another way—that would be awful.”(R) “That I have to confront myself with my anxieties, problems and assessments in front of the group. That is what I find difficult, too.”(S) |
T1.1.1 Tasks and goals (59) “Yes, so, I’ve learned to cope better with thoughts or perhaps feelings, also in the moment.”(K) “And every time I was there I felt very safe, I always had this feeling: Nothing is going to happen to me here.”(U) T1.1.2 Difficulties during the therapeutic process (36) “I would have wished for more support in that direction.”(F) |
2. Group experience |
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T0.2.1 Interacting in the group (63) “It’s the exchange with other patients who have had a similar fate or have made similar experiences. You get to learn about new perspectives that you haven’t encountered or haven’t been able to encounter before.”(F) T0.2.2 Community experience and feelings of belonging (42) “When you are not feeling well mentally, you are stronger in a group setting, I think. The incentive and the motivation are greater. Also, you receive help outside of the therapy sessions. You don’t know what kind of people you will meet there, perhaps you will find new friends. People, who can support you. I think it is really intensive to do group therapy together with someone.”(U) T0.2.3 Learning through interactions in the group (28) ”[…] … and you can get into contact with other people. On the one hand, in order to differentiate, on the other hand to set your boundaries and to engage with others, telling them that here is my space, my boundary, and there is the other person’s boundary. This would help interacting with other people.”(Q) T0.2.4 The challenge of opening up in the group (79) “You would like to be strong and not show any weakness, because that would make you seem vulnerable and could lead to others hurting you. And the more people know about it, the more difficult it gets. This is a disadvantage of the evening clinic because there you have to open up to a group of 6 people as well as to the medical professionals.”(F) “That I won’t be accepted into the group or that I will have conflicts within the group.”(S) T0.2.5 Engaging with the topics of the other group members (11) ”[…] that I might find it difficult to open up and deal with the problems of others.”(K) |
T1.2.1 Interacting in the group (107) ”Yes, you may just see other courses of action or that people deal with them differently, other problem-solving possibilities are pointed out that you may not have thought of yourself yet.”(H) ”Yes, that several things have changed, that some things were different in the past, that I have become more open, that I am looking for more conversations, especially if something disturbs me, that I then speak about it, for example.”(F) T1.2.2 Community experience and feelings of belonging (215) ”And so it is good in this group that you see that everyone is struggling with these problems and that also creates the incentive to develop there.”(C) T1.2.3 Learning through interactions in the group (64) ”And then also the interaction in the group and with the other patients, that’s also something that I have a hard time with, with social things, social interaction and so that was actually such, yes, such a good test field for it.”(N) T1.2.4 The challenge of opening up in the group (74) ”Was it harder for me to open up, well, to talk about my problems because I thought the other -, the problems of the others are more important.”(R) T1.2.5 Engaging with the topics of the other group members (34) Because at that moment I pushed myself all, all the way back. And I didn’t know how to deal with other people’s problems either, so it must have taken me a week to even know how to deal with them.”(W) T1.2.6 The challenge of a semi-open group setting (36) “And that the group members were, uh, constantly changing, that made me really, uh, even harder.”(S) |
3. Staying involved in everyday life |
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T0.3.1 Maintaining autonomy and independence (38) “Yes, actually I don’t feel so sick that I have the feeling I would need comprehensive care. I manage to deal with everyday stuff and I’m also quite content that I’m able to keep my flat in order.” (O) T0.3.2 Promptly implementing therapeutic contents (24) “The problem of going to hospital is that you will be staying there, you get “full board” and perhaps you also learn a lot there, but when you leave you suddenly—boom—have to cope with your everyday life. This is not the same with the evening clinic. When you have learnt something there, you can immediately try to include it in your daily life.”(I) T0.3.3 Continuous contact with the social environment (37) “Yes, well, due to the fact that I’m at home with my family in the mornings and also at other times except for these 3 days, I can continue fulfilling my obligations in the family. It is not as restrictive as it would be if I were in a day-care clinic.”(C) “I’m fine there, even if there might be a lot of problems, but all the same I get the feeling of being safe and having a place to retreat to. And this is exactly what I wouldn’t have in inpatient therapy.”(F) |
T1.3.1 Maintaining autonomy and independence (10) ”Well, I wanted to stay in my life. It was important to me to be able to manage independently in my everyday life. So that was one of my goals and, um, I don’t know, I’ve never received inpatient therapy before, but I have the feeling that everything, like preparing food etc., is done for you.”(G) T1.3.2 Promptly implementing therapeutic contents (65) ”Yes, that I have the feeling that I am doing something for my daily routine and, um, I can practice, maybe reorganize my life, maybe a little bit. That was also a concern of mine—to get out of this old rut in which I was stuck” (O) T1.3.3 Continuous contact with the social environment (40) ”[….] in which you can basically keep on with your regular daily routine without being afraid of missing out on something or letting others hang.”(F) ”Yes, of course I simply had to put some people off and say: “sorry, I can’t do it at the moment, I can’t manage it”.(L) |
4. Supply needs |
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T0.4.1 Intensity of treatment (76) “As I have already said, the fact that my social contacts have decreased—I just don’t feel well, I have problems… I sleep too much, I’m constantly tired and listless, I can’t get my act together. And I think that it helps to be there 3 times a week and work on my problems intensively.”(V) T0.4.2 Multimodality of the treatment offer (32) “I think when you receive outpatient treatment, you just have your one-on-one therapy session once a week. Now, in the evening clinic, there are options that you basically don’t get in the usual outpatient setting: one-on-one sessions, group sessions, mindfulness training and consultations.”(Y) T0.4.3 Less waiting time (16) ”[…] the main thing was to get help quickly, and not have to wait for months to get therapy. This just was the option that was available for me at the time.”(W) |
T.1.4.1 Intensity of treatment (73) ”It wouldn’t have worked with outpatient therapy; I’m convinced that wouldn’t have been enough.”(E) T1.4.2 Multimodality of the treatment offer (31) ”[….] I just liked the mixture between the mindfulness training, the consultations with a doctor, the one-on-one therapy sessions with the therapists and the interaction in the group—just the whole package.”(U) |
5. Compatibility with professional life |
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T0.5.1 Avoiding being absent from work (51) ”But I’d feel pretty bad if I couldn’t work because of that at the moment. That would beat me up”(C) T0.5.2 Work as a stabilizing factor (11) “And when I work and when I have a job then I’m distracted. I’ve filled my time in a meaningful way. And it also gives me the feeling of independence and of not being helpless. If I’d just sit at home, I’d feel even sicker. Like this, at least I have the feeling of being a part of society.”(G) T0.5.3 Support in job-associated topics (10) “Of course I hope to find a new job relatively soon—one that is possible because of my treatment in the evening clinic. That this is possible at the same time and that I’ll have support here. That would also be an advantage of the evening clinic over in-patient therapy.”(F) T0.5.4 Time challenge (34) “Well, that you come here stressed out, your head is not free, you are still thinking of work or of your kids, that you might overtax yourself even though it is supposed to be a positive offer—but perhaps it will return as a boomerang?”(H) |
(G) Avoiding being absent from work (23) ”Well, um, I don’t think I would have come this far if I hadn’t been working.”(A) ”Of course, there’s also a certain fear of what could happen if it became known, yes, of course.”(D) T1.5.2 Support with professional topics (9) ”[….] and then I started vocational rehabilitation, but first I was working part-time and now, slowly, I am beginning to work full-time. And I realize how other aspects in the job are starting to surface again [….]”.(M) T1.5.3 Time challenge (30) ”Being here from 5:00 p.m. three times a week and to juggle this with the job wasn’t always easy.”(B) |