An Interpretative Phenomenological Analysis of the Experience of the Therapeutic Relationship between Service Users and Staff after Physical Restraint in a Secure Mental Health Service

Abstract

Restrictive interventions, such as physical restraint, should be a last resort for managing imminent risk. There has been growing recognition of the harmful effects of them, for both staff and service users. Limited research has considered the impact of physical restraint on the therapeutic relationship between staff and service users. The aim of this research was to address this gap in the literature and explore both service user and staff perspectives of the therapeutic relationship after physical restraint, in a UK-based service that provides low and medium secure care for adults. Ten semi-structured interviews were conducted with five service users and five staff members. All participants had been involved in at least one incident of physical restraint. Interpretative Phenomenological Analysis was used to analyze the data. Three master themes emerged from the service user experiences: emotional impact; changes to the therapeutic relationship; and appraisal of the necessity of physical restraint. A further three master themes were produced from the staff member experiences: emotional response; balancing professional roles and responsibilities within the relationship; and moving forward with the therapeutic relationship after physical restraint. Findings support the need to continue to reduce restrictive interventions including physical restraint in secure mental health services and consider the impact upon those involved, both emotionally and relationally. Contemporary approaches to reducing power imbalances between staff and services users, as well as those that would reduce the likelihood of (re)traumatising service users, are also recommended.