The Therapeutic Relationship Between Patients Who Use Synthetic Cannabinoids and Staff in Secure Hospitals

Saim Kirhan

Research output: ThesisDoctoral Thesis

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Abstract

Levels of synthetic cannabinoid (SC) use and associated harms in forensic mental health hospitals present novel challenges to policy makers and practitioners. Research efforts to date have primarily focussed on the effects of SC use in prisons while similar investigations in forensic mental health hospitals remain scarce. Qualitative explorations from the perspectives of patients who use SC remains particularly absent in the literature. Therefore, the current study investigated how patients perceive forensic mental health staff’s responses to their SC use and the implications of this for long-term staff-patient relationships and patients’ relationship with themselves.

Semi-structured interviews were conducted with eight inpatients who have a history of SC use and who currently receive treatment in a medium secure mental health hospital. Staff responses that fostered or hindered the development of therapeutic relationships were explored. Interviews were analysed using reflexive thematic analysis (RTA), resulting in the development of three themes and nine subthemes. Themes included ‘the struggle for helpful responses’, ‘stigma impairs psychological safety’, and ‘the layered self’.

Themes revealed how initial staff responses to SC use were perceived as unhelpful and incompatible with the principles of trauma-informed and person-centred care. This had implications for the long-term trajectory of staff-patient relationships, leading to a perceived deterioration in the quality of the therapeutic relationship and reinforcing coping mechanisms among patients that were rooted in self-reliance, possibly due to the activation of insecure attachments. The overall outcomes related to the importance of a treatment approach that is centred in relational practice, based on an understanding of SC use as a marker of vulnerability and, potentially, trauma.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
Supervisors/Advisors
  • Harvey, Joel, Supervisor
  • Charles, Matthew, Supervisor, External person
Publication statusUnpublished - 9 Aug 2024

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