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We conducted a study to explore how people diagnosed with first-episode psychosis experienced their contact with early intervention services for psychosis and the way these experiences relate to their recovery processes. Our aim was to integrate and describe the service users' experiences in a rigorous and comprehensive way. A broad literature search was performed in June and July 2016. After screening, 17 qualitative studies were included. We analyzed the findings in two main steps: (a) translating studies into one another and (b) synthesizing the findings from the studies. Through these interpretative processes, we found five new and overarching themes: (a) something is wrong, (b) do for myself, (c) it's about people, (d) a price to pay, and (e) ongoing vulnerability. We describe these themes as a process that service users' maneuver through in their contact with the services. Our findings are discussed in light of relevant research.

Routine outcome monitoring (ROM) and clinical feedback (CF) systems have become important tools for psychological therapies, but there are challenges for their successful implementation.To overcome these challenges, a greater understanding is needed about how patients experience the use of ROM/CF.We conducted a systematic literature search of qualitative studies on patient experiences with the use of ROM/CF in mental health services.The findings from 16 studies were synthesized, resulting in four meta-themes: (1) Suspicion towards service providers, (2) Flexibility and support to capture complexity, (3) Empowering patients, and (4) Developing collaborative practice.We discuss the implications of these meta-themes for further development and implementation of ROM/CF into clinical practice, acknowledging the limitations of our review and suggesting avenues for further research. Clinical or methodological significance of this article: This article provides useful and actionable knowledge about the patient perspective on ROM/CF, an important discussion on the current state of research in this area, and useful and concrete suggestions for further avenues of research.

OBJECTIVE Routine outcome monitoring and clinical feedback systems might be beneficial for adolescent psychotherapy processes. METHODS Clinicians (n = 34) and adolescent clients (n = 22) aged 14-19 from seven different outpatient clinics located in Norway participated in the study. Adolescents were interviewed in individual in-depth interviews (n = 7) or in four adolescent-only focus groups (n = 15), clinicians participated in seven clinician-only focus groups. RESULTS We report two core domains, (1) feedback about the therapeutic relationship and (2) feedback about the therapeutic work. Seven subthemes specify the functionality that participants need in a feedback system. CONCLUSION Adolescents and therapists requested a feedback system that was relationally oriented, supported collaborative action, and was personalized to the needs of the individual adolescent. The research indicates that a clinical feedback system should have idiographic, as well as nomothetic, components. A clinical feedback system for adolescents should monitor experiences of personal autonomy and the quality of the therapeutic relationship.

BackgroundBeing a participant in longitudinal follow-up studies is not commonly a factor considered when investigating useful self-change aspects for individuals attempting recovery from substance use disorder (SUD). This study reports on how ongoing monitoring, and feedback on data results in a longitudinal follow-up study of SUD recovery were perceived by individuals who had achieved long-term abstinence and social recovery.MethodsInterviewers with first-hand experience with the topic conducted interviews with 30 participants and analysed the data using a thematic analytic approach within an interpretative–phenomenological framework.ResultsAnalyses resulted in the following themes. 1) Ongoing short text messaging (SMS) monitoring: helped participants by offering recovery milestones and reminders of the past. 2) Feedback on data results helped participants track physical and cognitive recovery: “I am more like myself”. 3) Using feedback in treatment: understanding the importance of a functional brain to participants may help with long-term retention in treatment.ConclusionsSelf-changes that were challenging to detect on a day-to-day basis were available for reflection through longitudinal study participation, including ongoing monitoring and feedback on the results, allowing personal consolidation of change processes. Clinical services could benefit from continuing development and implementation of such technology for ongoing monitoring and feedback on assessments to motivate self-change in SUD recovery. The development of guidelines for providing the results of research assessments to individuals could help reduce attrition in research projects and support recovery and healthy choices for study participants.

Purpose Routine outcome monitoring (ROM) and clinical feedback systems (CFS) are becoming increasingly prevalent in mental health services. Their overall efficacy is unclear, but quantitative evidence suggests they can be useful tools for preventing treatment failure and enhancing therapeutic outcomes, especially for patients who are not progressing in therapy. The body of qualitative material, however, is smaller and less refined. We need to know more about how ROM/CFS is used in psychotherapy, and why it is helpful for some patients, but not others. Methods We recorded therapy sessions of 12 patients who were using a CFS as part of their therapies at an outpatient clinic in Norway. We then conducted video-assisted interviews and follow-up interviews with patients. Data were analyzed with systematic text condensation. Results Analysis revealed three themes: (1) triggering reflections, emotions, and self-awareness, (2) Ambivalent and ambiguous self-presentation, and (3) potential for feeling understood and talking about what matters. Conclusion Answering questions in a CFS is an interpretative and intentional process of self-presentation and the results from ROM/CFS must be interpreted and explored in conversation to be clinically useful. When they are, they have potential for enhancing the therapeutic process by stimulating self-awareness, reflexivity, and allowing access to new therapeutic topics. Further research should explore this how-to aspect of ROM/CFS with different CFS and different types of patients. Integrating clinical feedback in therapeutic practice can be conceptualized as a clinical skill, which should be a part of training programs for therapists.

BackgroundConsultations before and after bariatric surgery should include structured assessments of patients’ health-related quality of life (HRQOL) and mental health. One way to conduct this assessment is to implement patient-reported outcome monitoring with a clinical feedback system (PRO/CFS).AimWe will explore patients’ and healthcare professionals’ experiences when a PRO/CFS is an integrated part of bariatric surgery care.Methods and analysesThis is a design paper in which a PRO/CFS will be implemented in two bariatric outpatient clinics. All patients who have an appointment with a healthcare professional prior to, and 3 and 12 months after surgery, will be asked to complete six digital questionnaires measuring HRQOL, mental health, bowel symptoms and eating self-efficacy prior to each consultation. A digital summary report generated from the patient’s responses will form the basis for the clinical consultation. A team of patient representatives, healthcare professionals and researchers will be involved in all phases of designing the PRO/CFS to ensure its relevance for clinical consultations. The patients’ experiences will be explored with a generic 12-item questionnaire, developed for use in outpatient clinics, prior to and 12 months after bariatric surgery. We will conduct focus-group interviews with patients and healthcare professionals to explore their experiences when PRO/CFS is integrated into the consultations.Ethics and disseminationWritten informed consent will be obtained for all participants in the study. The project is approved by the Norwegian Centre for Research Data, Department of Data Protection Services (ref. no. 282738). The project has also undergone Data Protection Impact Assessments, both at Førde Hospital Trust and at St. Olav Hospital (registration no. 2016/3912). Data from the qualitative and quantitative studies will be kept in de-identified form in a secured research database, and the findings will be published in international peer-reviewed journals and presented at scientific conferences.

This qualitative study investigated ways in which student participants in a three-session self-compassion course became more compassionate toward themselves and challenges related to this change. Ninety-four participants completed an online survey and 12 participants were interviewed face-to-face. First, a thematic analysis of the responses from the online survey was conducted, and then sorted by frequency, indicating their representativeness in the written responses. The following themes were identified: (1) being more supportive and friendlier toward self, (2) being more aware of being too hard on oneself, (3) feeling less alone when having painful feelings, (4) having more acceptance of painful feelings, and (5) feeling more stable and peaceful. These five most frequent themes served as a basis for a structured phenomenological analysis in the next analytic stage. They were used as a template for a content analysis of the interview material. Subsequently, a phenomenological analysis was conducted on the interview transcripts covering the five thematic areas publishedVersion

Background: The perceived benefits of drug use are not currently integrated into the treatment of substance use disorder. This omission appears paradoxical and is unsubstantiated by empirical research. As the perceived benefits of drug use are catalysts for drug initiation, relapse and continuous use, increased knowledge about these benefits seems crucial to efficacious treatment. Aims: To investigate the perceived benefits of drug use in substance use disorder. Method: The study is a phenomenological-hermeneutical investigation using thematic analysis of interviews with 30 long-term recovered adult service users. Results: Our thematic analysis resulted in three themes and several sub-themes: (1) Benefits of drug use; (2) Necessity of intense experiences; and (3) Importance of being unconventional. Conclusions: Findings indicate that the benefits of non-problematic and problematic drug use are motivated by similar individual and social needs. An absolute distinction between problematic and non-problematic drug use thus seems arbitrary and potentially counterproductive for clinical practice. The benefits of drug use should be researched as a possible add-on treatment module, as this knowledge may be of significant clinical value in treatment frameworks. publishedVersion

Background Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are considered important tools within early detection and intervention strategies. In this study, we aimed to explore which discursive meaning content, including roles and actors, such information campaigns build on and construct. Our intention was not to provide objective answers, but to contribute to a discursive debate about potential conflicts in messages conveyed in such campaigns. Methods A broad sample of information material utilized by TIPS Stavanger University Hospital (Norway) was examined. The material consisted of posters, booklets and brochures, newspaper ads, Facebook ads, and TIPS Info’s website, representing various campaigns from 1996 to April 2018. A narrative discursive approach was applied at an epistemological level. At a practical level, a team-based thematic analysis was utilized to identify patterns across data. Results Diversity and several changes in strategy were recognized throughout the information material. Furthermore, three main themes and four subthemes were found to constitute the meaning content built in the information campaigns: knowledge is key; (almost) an illness among illnesses; and we all have a responsibility (comprising of the subthemes; to respond quickly; to step in; to provide an answer; and to tag along). Conclusion Our findings pointed to common dilemmas in mental health services: How to combine professional expert knowledge with collaborative practices that emphasize shared decision-making and active roles on behalf of patients? How to combine a focus on symptoms and illness and simultaneously express the importance of addressing patients’ recourses? And how can we ask for societal responsibility in help-seeking when professionals are placed in expert positions which may not be optimal for dialogue with potential patients or their network? We discuss whether highlighting practices with more weight on resources and active roles for patients and their surroundings in information campaigns could promote earlier help-seeking. Electronic supplementary material The online version of this article (10.1186/s13033-019-0289-4) contains supplementary material, which is available to authorized users.

Objective The objective was to explore how a person-adaptive clinical feedback system (CFS) effects its users, and how meaning and relevance are negotiated. Methods We conducted a 10-month case-study of the implementation and practice of Norse Feedback, a personalized CFS. The data material consisted of 12 patient interviews, 22 clinician interviews, 23 field notes, and 16 archival documents. Results We identified four main categories or themes: (i) patients' use of clinical feedback for enhanced awareness and insight; (ii) patients work to make clinical feedback a communication mode; (iii) patients and clinicians negotiate clinical feedback as a way to influence treatment; and (iv) clinical feedback requires an interactive sense-making effort. Conclusion Patients and therapists produced the meaning and relevance of the CFS by interpreting the CFS measures to reflect the unique patient experience of the patient-therapist relationship. Patients regarded CFS as a tool to inform therapy with important issues. Patients became more self-aware and prepared for therapy.

Background: The literature on antipsychotic medication in psychosis lack systematization of the empirical knowledge base on patients’ subjective experiences of using antipsychotic drugs. Such investigations are pivotal to inform large-scale trials with clinically relevant hypotheses and to illuminate clinical implications for different sub-groups of individuals. Aims: To re-analyze and summarize existing qualitative research literature on patient perspectives of using antipsychotic medication. Method: A systematic literature search was performed in September 2018 (Protocol registration no. CRD42017074394). Using an existing framework of meta-analyzing qualitative research, full text evaluation was conducted for 41 articles. Thirty-two articles were included for the final synthesis. Results: Four meta-themes were identified: (1) short-term benefits; (2) adverse effects and coping processes; (3) surrender and autonomy; (4) long-term compromise of functional recovery. Conclusions: While largely positive about acute and short-term use, patients are more skeptical about using antipsychotic drugs in the longer term. The latter specifically relates to processes of functional and social recovery. The clinical conversations about antipsychotic medication need to include evaluations of contexts of patient experience level, patient autonomy processes, patient values and risk preferences, and patient knowledge and knowledge needs in addition to assessing the severity of symptoms of psychosis.

Social anxiety disorder typically manifests in young adulthood, but there is an absence of qualitative research on the actual experiences of young adults suffering with this disorder. The aim of the present study was to investigate the lived experiences of 29 Norwegian university students who were seeking professional help for symptoms of social anxiety. We conducted in-depth interviews prior to a clinical trial. The interviews were transcribed and analyzed using a team-based thematic analysis method based on a hermeneutic-phenomenological epistemology. We identified five themes: (a) from being shy to interpreting anxiety as a mental health problem, (b) experiencing emotions as threatening and uncontrollable, (c) encountering loneliness as relationships fall away, (d) hiding the vulnerable self from others, and (e) deciding to face social fears in the future. We relate our findings to existing theory and research, discuss our process of reflexivity, highlight study limitations, and suggest implications for future research.

Few studies address the many challenges that are faced by staff and patients in the inpatient mental health context. In particular, there is a lack of research that explores first-hand patient experiences in order to establish what treatment practices best assist patient recovery and what are the barriers to these practices. This qualitative study, which utilises a user-involved research framework, collaborates with a co-researcher patient group throughout the study. Fourteen patients, all of whom had been in inpatient treatment for at least three weeks, were recruited to the study. Study participants were interviewed in-depth in the period September 2016 to March 2017. Data underwent a thematic analysis that was inspired by interpretative phenomenological analysis. A core theme of the findings was the importance of being recognised as a whole person, and the patient–professional relationship was regarded as a fundamental factor in fostering recovery, with two underlying themes: (i) a need to have one‘s self-identity recognised and supported, and (ii) an experience of ambivalence between needing closeness and distance. This study suggests ways nurses can give priority to interpersonal interactions and relationships with hospitalised patients over task-oriented duties, highlighting the need for nurses to balance patient competing needs for both closeness and distance. publishedVersion

This is an Accepted Manuscript of an article published by Taylor & Francis in Counselling Psychology Quarterly on 4 Oct 2019, available online: https://www.tandfonline.com/doi/full/10.1080/09515070.2019.1671319 First-hand experience of being a client is regarded by many psychotherapists as making an essential contribution to professional development. Although research has not established any direct influence on client outcome, arising from therapist participation in personal therapy, qualitative studies have explored how therapists transfer learning from one context to the other. A group of six therapists-researchers engaged in a collective autoethnography in which we shared narrative accounts of our own experiences as clients. Together we covered a wide set of therapies, sought for varied purposes, and from different stages in the life-course. Different areas of learning were identified: negative experiences could strengthen own convictions for acting differently; positive experiences worked as inspiration and support; being in therapy early in life represented a significant formative experience; working through complex personal issues in therapy gave the courage to identify similar conflicts in phantasies and realities of clients. The link between having been a client and working as a therapist is a subjective, reflective process of reworking figure and ground in the search for professional sensitivity.

Background: Studies investigating the subjective experiences of long-term recovery from substance use disorder are scarce. Particularly, functional and social factors have received little attention. Objectives: To investigate what long-term recovered service users found to build recovery from substance use disorder. Material and Methods: The study was designed as a phenomenological investigation subjected to thematic analysis. We interviewed 30 long-term recovered adult service users. Results: Our thematic analysis resulted in five themes and several subthemes: 1) paranoia, ambivalence and drug cravings: extreme barriers to ending use; 2) submitting to treatment: a struggle to balance rigid treatment structures with a need for autonomy; 3) surrendering to trust and love: building a whole person; 4) a life more ordinary: surrendering to mainstream social responsibilities; and 5) taking on personal responsibility and gaining autonomy: it has to be me, it cannot be you. Conclusions: Our study sample described long-term recovery as a developmental process from dependency and reactivity to personal autonomy and self-agency. The flux of surrendering to and differentiating from authority appeared to be a driving force in recovery progression. Participants called for treatment to focus on early social readjustment. publishedVersion

Background Social media is an integral part of human social life. More than 90% of young people use social media daily. Current theories, models, and measures are primarily based on face-to-face conceptions, leaving research out of sync with current social trends. This may lead to imprecise diagnoses and predictions. Objective To develop a theoretically based empirical model of current social interfaces to inform relevant measures. Methods A three-stage, qualitative, data-collection approach included anonymous individual Post-it notes, three full-class discussions, and 10 focus groups to explore 82 adolescents’ relational practices. Data analysis followed a meaning-condensation procedure and a field-correspondence technique. Results We developed an empirical model that categorizes adolescents’ social interactions into five experiential positions. Four positions result from trajectories relating to social media and face-to-face social interaction. Positions are described by match or mismatch dynamics between preferred and actual social platforms used. In matched positions, individuals prefer and use both face-to-face and social media platforms (position 1), prefer and use face-to-face platforms (position 2), or prefer and use social media platforms (position 3). In mismatched positions, individuals prefer face-to-face interactions but use social media platforms (position 4) or prefer social media but use face-to-face platforms (position 5). We propose that matched positions indicate good social functioning while mismatched positions indicate serious social challenges. Conclusions We propose a model that will expand previous unidimensional social interaction constructs, and we hypothesize that the described match and mismatch analyses provide conceptual clarity for research and practical application. We discuss prediction value, implications, and model validation procedures.

To evaluate the factor structure and clinical validity of a Norwegian translation of the treatment outcome package (TOP). Exploratory factor analysis was used to confirm the factor structure of the TOP (n = 334). Samples collected from university students (n = 137) were used to evaluate 1-week test–retest reliability. Concurrent validity was examined using data collected from a hospital sample (n = 197), who completed several referent measures. Logistic regression (n = 293) was applied to determine the translated TOP's ability to differentiate between clinical and non-clinical samples. A 12-factor solution was the best-fit for the data, largely supporting the US TOP structure. One-week test–retest reliability ranged from ICC = 0.56 to ICC = 1.00. Internal validity ranged from α = 0.49 to α = 0.93. The TOP subscales correlated most highly with referent measures or appropriate subscales. Logistic regressions correctly identified 77% of subjects as clinical or non-clinical. Conclusions: While larger and more...

Purpose: Losing weight and keeping it off for the long term is difficult. Weight regain is common. Experiences of successful non-surgical weight loss after severe obesity are largely unexplored. We know little about long-term weight loss processes, and how health care services can be of help to those living them. Methods: Drawing on in-depth interviews of 8 women and 2 men, the aim of this phenomenological study is to describe the experiences of adults who have been severely obese, who have lost weight and maintained weight loss for the long term (>5 years). Results: Findings show that after severe obesity, sustained weight loss has no endpoint, yet is always easy to end. Keeping weight off means committing to oneself, continuing profound changes and cultivating sensitivity towards oneself and others. A phenomenological understanding of sustained weight loss can inform professionals who deal with health issues and challenges occurring in the life of people leaving severe obesity. publishedVersion

Background In line with the evidence-based paradigm, routine outcome monitoring and clinical feedback systems are now being recommended and implemented in youth mental health services. However, what constitutes a good outcome for young service users is not fully understood. In order to successfully monitor outcomes that are clinically and personally relevant for the service user that are to benefit from these systems, we need to gain more knowledge of what young service users value as meaningful outcomes of youth mental health services. Aim To contribute knowledge into what constitutes “good outcomes” from the experiences of adolescent service users in public mental health systems. Methods A qualitative in-depth study of the experiences and reflections from 22 adolescents aged 14–19 years, currently or recently being in public mental health services. The data material was analyzed using a systematic step-wise consensual qualitative research framework for team-based analysis. Results An overarching theme of outcome as having developed a stronger autonomy and safer identity emerged from the analysis, with the subsequent five constituent themes, named from the words of the adolescent clients: (1) I’ve discovered and given names to my emotions, (2) I’ve started to become the person that I truly am, (3) I’ve dared to open up and feel connected to others, (4) I’ve started saying yes where I used to say no, and, (5) I’ve learned how to cope with challenges in life. Conclusion “Good outcomes” in youth mental health services should be understood as recovery oriented, sensitive to developmental phases, and based on the personal goals and values of each adolescent client.

Objective: The aim of this study was to gain knowledge about how the integration of personal and professional experiences affects therapeutic work. Method: Therapists (N = 14) who had been recommended by their leaders at their individual workplaces were interviewed twice with semi-structured qualitative interviews, which were then subjected to thematic and Interpretative Phenomenological Analysis. Results: All the therapists in the sample described their personal qualities as an experienced tension between their personal strengths and vulnerabilities in the therapeutic setting. This tension came to expression through four subordinate themes: (a) The tension between perceiving oneself as a helper while dealing with one’s own needs for attention and care; (b) The tension between the ability for embodied listening to the patient while tuning into oneself; (c) The tension between staying present while handling aggression and rejection from clients; and (d) The tension in striving for a constructive balance between closeness and distance. Conclusion: The results point to ways in which the personal selves of the therapists may affect their professional role performance. Drawing upon previous research and literature on the topic, the paper discusses how therapists’ personal qualities are experienced as affecting their work and suggests several implications for psychotherapy training and practice.

Background The mental health field sees a surge of interest in Routine Outcome Monitoring, mandated by a wish to help better those not-on-track to recovery. What constitutes positive outcomes for these patients is not fully understood. Aims To contribute knowledge into what constitutes meaningful outcome concepts in the experiences of patients with long and complex mental health suffering and treatment, and the clinicians who work to help them. Methods A qualitative in-depth study of 50 participants’ experiences. Data are collected through focus groups and individual interviews, and analyzed using a team based structured thematic analytic approach. Results We found an overarching theme of outcome as an ongoing process of recovery, with the four constituent themes: (1) strengthening approach patterns for new coping; (2) embodying change reflected by others; (3) using new understandings developed in dialogue; and (4) integrating collaborative acceptance. Conclusions We discuss our findings in light of existing empirical studies and different recovery concepts, and suggest that if outcomes monitoring is to become an integral part of routine practice, it might be beneficial to integrate an understanding of outcomes as ongoing processes of recovery within mental health suffering into these systems.

The voices of service users are often silent in mental health research issues. A Norwegian mental health research organization, however, recognizes the importance of involving service users as coresearchers, and it has initiated a training program in research design and methodology intended to empower them as active participants in research projects. In this study, we use qualitative methods to explore how coresearchers with mental health service user background experience their participation as coresearchers and how they experienced attending an academic training program in research methodology. We invited 12 coresearchers with service user background to be participants in the study. We used focus groups as our data collection method, transcribed the group discussions verbatim, and analyzed the transcriptions using qualitative methodology. We then took the preliminary analyses back to the participants for discussion, auditing, and reanalysis. We identified three core themes that represent important cores...

“A precious, but challenging teamwork for improved healthcare”. Service users´ experiences from participatory researchIn spite of identifying the importance of service user (SU) involvement in healthcare research, few studies define specific activities. Although an effective infrastructure is acknowledged as key to enable SU’s equal contribution, we, in Norway, recognize a lack of their involvement in studies on Chronic Obstructive Pulmonary Disease (COPD). Consequently, a preliminary project was designed to implement a research-training programme for co-researchers and seek their collaboration in a participatory research study on COPD. This paper reports the co-researchers’ experiences using a focus group interview. Through content analysis, we describe coresearchers’ experiences, which recognize the importance and challenges of participatory research.These experiences demonstrate how acknowledgement, a fruitful climate for collaboration, new insight and practical arrangements promote involvement, whilst too extensive training and vague expectations may hinder involvement. Empowering equality of relationships and involvement, particularly for co-researchers with failing health and no former research training, demands thorough planning and organizing. Samarbeidspartnarar: brukarar Nina Maria Dolmen, Aud Jenny Jensen, Sissel Stavøstrand og Steinar Valvik, spesialsjukepleiar Grete Berg Grimelid, Helse Førde, ergoterapeut Evy Aarsheim, Flora kommune, og sosionom og PhD stipendiat Tone Larsen, Helse Førde

Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of providing naturalistic research data and enhancing mental health care. However, implementation in routine care is challenging, and we need more knowledge about clinicians' and patients' needs from such systems.We aimed to study perspectives of clinicians and patients to explore how ROM/CFS can be helpful and acceptable to them.We interviewed 55 participants in focus groups and individual interviews and analyzed the data through rigorous team-based qualitative analyses.We report 3 overarching domains: (a) Shared needs, (b) Specific patient needs, and (c) Specific therapist needs. Shared needs, in which perspectives of different stakeholders converge, was the dominant domain in the material. Under each domain, we report 3 specific themes: (a1) Degree of trust in therapy, (a2) Allowing for openness, (a3) Monitoring joint objectives; (b1) Life functioning, (b2) Canary in the coal mine, (b3) Holistic report; and (c1) Emotional presence and style, (c2) Monitoring risk and symptoms, and (c3) Agency and ownership of process.In what should increase our confidence toward core aspects of ROM, we suggest that an integration of relational feedback concepts and stringent clinical dimension tracking into the ROM/CFS can be beneficial.

What works for whom in mindfulness-based group interventions for social anxiety disorder (SAD)? The present article compared the experiences of 14 participants in a clinical study of mindfulness-based stress reduction (MBSR) for young adults with SAD.A two-staged mixed methods design was used to identify the participants who reported the highest (n = 7) and lowest (n = 7) levels of symptomatic change on outcome measures after treatment, and analyze qualitative in-depth interviews to explore what they experienced as helpful and unhelpful during the MBSR program. The qualitative interviews were analyzed using a thematic analysis methodology.We identified the global theme of (i) Discovering agency to change or not feeling empowered through the MBSR program, and four sub-themes: (ii) Forming an active commitment or feeling ambivalence toward learning mindfulness, (iii) Engaging with others or avoiding contact with the group, (iv) Using the mindfulness exercises to approach or resigning when facing unpleasant experiences, and (v) Using the course to break interpersonal patterns or remaining stuck in everyday life.MBSR may be helpful for young adults with SAD, although it may be important to match clients to their preferred form of treatment.

The present study investigated mindfulness-based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty-three young adults in a higher education setting underwent a standard eight-week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self-compassion, and self-esteem. Using intention-to-treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self-compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance-based interventions for SAD.

Qualitative research has the potential to explore patient and therapist experiences of psychotherapeutic processes, as well as the challenges and opportunities inherent in relational and technical aspects of therapy. This paper examines explorative and reflexive ways of doing qualitative research on psychotherapy, based on the ontological and epistemological premises of hermeneutic phenomenology. An explorative–reflective thematic analysis is presented as a team-based approach, with a firm and transparent structure to the process of finding and interpreting experiential commonalities and differences in empirical material from semi-structured interviews. We use two examples of the interplay between phenomenological exploration and reflexivity from the interviews of two adolescent psychotherapy patients in a research project examining experiences of useful ways to establish a productive therapeutic relationship. A systematic way of conducting explorative–reflexive thematic analysis in a research team and wi...

OBJECTIVE. We wanted to explore how psychotherapists from various theoretical affiliations handle difficult impasses in therapy, in a way that they experience helps the therapeutic process towards further constructive development. DESIGN. We purposefully sampled 12 highly skilled and experienced therapists from the leading theoretical affiliations in the field. We conducted semi-structured in-depth interviews to explore their recall of impasse experiences. Participants were interviewed individually about a specific impasse from their experience that later resolved successfully. METHODS. The transcribed interviews were analysed using a hermeneutically modified method of systematic text condensation. The results that come out of such analyses are 'meaning patterns' or 'themes'. Analyses were technically carried out with the assistance of Nvivo 8 software. RESULTS. Analysing the needs of the therapists when working through the impasses, we found two general themes across the sample: (1) the need for a move--from confusion and bodily tension to shared systems of meaning, and (2) the need for a witness--to find a home for the stalemate scenario in another relationship. We present how having these needs met evokes the experience of (3) the vital clearing--an experiential space between self and impasse. CONCLUSION. We discuss how our findings relate to contemporary psychotherapy theory concepts such as mentalization, mindfulness, and experiential capacity. We discuss our process of reflexivity in carrying out the study and suggest implications of our findings for further research.

Interviews were conducted to explore the recall of impasse experiences of 12 highly skilled and experienced therapists. Participants were interviewed in depth individually about a specific impasse from their experience that resolved successfully. The transcribed interviews were analysed using qualitative methodology. The authors found that participants understood their reported impasse experiences as important for their professional development. The category of “helpful subjective presence” describes the mode of being with patients that the participants found therapeutic. The categories of “losing hope” and “difficult feelings in the therapist in the here and now” are processes that threaten the helpful presence. The participants' inner work on the two latter categories is identified as a key to the successful resolution of impasses.

Psychotherapy researchers are increasingly using qualitative approaches to gain knowledge about the experiential, relational, and sociocultural aspects of psychological treatments. In this article, we explore and discuss five core functions of qualitative approaches within this field. They include: (a) a discovery function—to fill in knowledge gaps and challenge our pre-assumptions; (b) a reflexive function—to make ourselves more conscious about our prejudices and basic assumptions on personal, theoretical, and ideological levels; (c) a critical function—to address contextual issues of political and social injustice; (d) an emotional receptive function—to offer an emphatic listening perspective that facilitates the exploration of the emotional realities of psychotherapy; and (e) an evocative and aesthetic function—to communicate the experiential realities of psychological treatments that bring these realities to life while also providing a deeper understanding. publishedVersion

Objective: To investigate how psychotherapists' lives and relationships are influenced by their work. Method: Twelve senior psychotherapists took part in qualitative interviews. Results: Thematic analysis yielded four significant themes: (i) it has been a privilege to know and contribute, and to be allowed to grow personally; (ii) facing suffering and destructiveness has been a burden; (iii) being a therapist has had an impact on my personal relationships—for better and worse; and (iv) I have needed to construct a way of living that allowed me to continue to do the work. Conclusion: Working as a therapist seem to imply a potential for developing openness, tolerance, and creativity, while being vulnerable to becoming overwhelmed with responsibility and feelings of inadequacy, isolation, and despair.

Health experts advise and expect patients to eat healthily after bariatric surgery. For patients, difficulties with eating might have been a long-standing, problematic part of life—a part that is not necessarily healed by surgery. Empirical research on patients’ experiences of eating practices after bariatric surgery is lacking. Aiming to contribute to the development of clinical practice, we explored meanings attached to eating in the long term and sought descriptions of change and bodily sensations. We interviewed 14 patients at least 5 years after bariatric surgery. The surgical restriction forced changes in the way patients sensed their own body in eating, but the uncertainty related to maintaining weight loss in the long term remained. Meanings attached to eating transcended food as choices situated in a nourishment and health perspective, and were not necessarily changed. Eating was an existential and embodied practice, which remained an ambiguous and sensitive matter after surgery.

Traditionally, the voices of service users have been silent in research into mental health issues. A Norwegian research network, however, recognizes the importance of involving service users as coresearchers and initiated a training program in research methodology and design intended to empower them as active participants in research projects. In this article, we explore how these coresearchers with a mental health service user background experience their participation in projects as well as in attending the training: What is it like being a service user coresearcher in collaborative studies on issues in mental health? How do coresearchers negotiate their roles and mandate?We used focus groups as our data collection method, transcribed the group discussions verbatim, and analyzed the transcriptions using qualitative methodology. We then took the preliminary analyses back to the participants for discussion, auditing, and reanalysis.We identified themes that represent important social processes around which the participants developed a consensual understanding: self-definition, constructive differentiation and negotiations.Our findings generate hypotheses on how participatory research into mental health issues can be fruitfully organized, in a way that empowers service users to active and constructive participation.

The aim of this study was to explore how adolescents in ongoing psychotherapies prefer their therapists to interact with them when they are establishing a therapeutic bond. Semi-structured qualitative interviews were held with 14 patients. A hermeneutic-phenomenological approach was used to analyze interview transcripts. The participants’ descriptions of important experiential dimensions in their interaction with their therapists clustered around five themes: the adolescents (1) feeling vulnerable and ambivalent in relationship with a potential helper when therapy started; the therapists (2) showed them that they were comfortable with being a therapist (3), strengthened their autonomy by establishing therapeutic boundaries, (4) showed that they recognized patients' individuality by respecting their personal boundaries, (5) helped them make their experiences understandable and meaningful, and (6) allowed mutuality and emotional closeness.