Improving therapeutic relationships: Joint crisis planning for individuals with psychotic disorders

Simone Farrelly*, Helen Lester, Diana Rose, Max Birchwood, Max Marshall, Waquas Waheed, R. Claire Henderson, George Szmukler, Graham Thornicroft

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


Outcomes for individuals with psychosis remain far from acceptable. Recently, prominent psychiatrists have called for an improved understanding of the impact of social contexts, and how social contexts might influence the development and maintenance of mental health problems. A key social context for individuals with psychosis is the therapeutic relationship. As part of a trial of joint crisis planning in England, this qualitative study aimed to determine the mechanism through which joint crisis planning might affect the therapeutic relationship. Results suggest that routine processes in mental health care are affected by policy and organizational requirements for risk mitigation - aspects that undermine person-centered approaches. In contrast, strong therapeutic relationships are characterized by individualized care and reliable and respectful treatment. The Joint Crisis Plan intervention partially succeeded in reducing contextual influences on routine role enactments, facilitating the demonstration of respect and improving the therapeutic relationship.

Original languageEnglish
Pages (from-to)1637-1647
Number of pages11
JournalQualitative Health Research
Issue number12
Early online date12 Jan 2015
Publication statusPublished - 1 Dec 2015


  • communication, medical
  • crisis management
  • grounded theory
  • group interaction
  • mental health and illness
  • nursing, community
  • psychiatry
  • qualitative analysis
  • relationships, patient-provider
  • risk
  • schizophrenia
  • symbolic interactionism


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