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      Court-Mandated Patients’ Perspectives on the Psychotherapist’s Dual Loyalty Conflict – Between Ally and Enemy

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          Abstract

          Background

          Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma.

          Methods

          This qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis.

          Results

          We first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: (1) respecting the patient’s pace and perceived coercion; (2) patient health needs to be first priority; (3) clarity in roles and responsibilities; and (4) the art of communication – between transparency and unchecked information sharing.

          Discussion

          Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings.

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          Most cited references81

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          Using thematic analysis in psychology

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            Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

            Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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              Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report.

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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                06 January 2021
                2020
                : 11
                : 592638
                Affiliations
                [1] 1Insitute for Biomedical Ethics, University of Basel , Basel, Switzerland
                [2] 2Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern , Bern, Switzerland
                [3] 3Unité Thérapeutique, Centre de Psychiatrie Forensique, Réseau Fribourgeois de Santé Mentale , Fribourg, Switzerland
                Author notes

                Edited by: Conor Duggan, University of Nottingham, United Kingdom

                Reviewed by: Beata Pastwa-Wojciechowska, University of Gdańsk, Poland; Clare Sarah Allely, University of Salford, United Kingdom

                *Correspondence: Helene Merkt, Helene.merkt@ 123456unibas.ch

                This article was submitted to Forensic and Legal Psychology, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2020.592638
                7815763
                c4e40285-767e-4546-8db1-93c765bd7a7e
                Copyright © 2021 Merkt, Wangmo, Pageau, Liebrenz, Devaud Cornaz and Elger.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 07 August 2020
                : 01 December 2020
                Page count
                Figures: 5, Tables: 1, Equations: 0, References: 81, Pages: 15, Words: 0
                Funding
                Funded by: Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung 10.13039/501100001711
                Categories
                Psychology
                Original Research

                Clinical Psychology & Psychiatry
                dual role,dual loyalty,triangular relationship,prison,offender,therapeutic alliance,coercion,limited confidentiality

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