How do people with first episode psychosis experience therapeutic relationships with mental health practitioners? A narrative review

Figures & data

Table 1. Search terms.

	Search Terms	No. of Results
First Episode Psychosis (S1)	TI ((first* OR initial* OR origin*) N5 (psychosis OR schizophren* OR psychotic*)) OR AB ((first* OR initial* OR origin*) N5 (psychosis OR schizophren* OR psychotic*))	31,555
Therapeutic Relationships (S2)	DE “Therapeutic Alliance” OR TI ((therap*) N5 (alliance OR relationship* Or partnership* OR connection*)) OR AB ((therap*) N5 (alliance OR relationship* Or partnership* OR connection*))	54,625
How do people with first episode psychosis experience therapeutic relationships with mental health practitioners?	S1 AND S2	172
Written in English language, available to access, explicitly stated aspects of the therapeutic relationship with mental health practitioners, aspects come from the experiences of individuals who have experienced FEP	Manually Identified	16

Table 2. Data extraction summary.

Author	Date	Location	Journal	Key Theme(s)/Findings	N (Age range; Gender Distribution)	Method
Chua et al.	2022	Singapore	Asian Journal of Psychiatry, Volume 72	Lack of attunement, effectiveness, mutual trust and respect	192 (16-40-years; gender not stated)	Quantitative
Bergstrom et al.	2021	Western Finnish Lapland	Community Mental Health Journal	Showing an interest, being able to talk about difficult things freely, non-judgemental	20 (Mean age 25 years; 12 Male, 18 Female)	Quantitative
Cox & Miller	2021	England	The Cognitive Behaviour Therapist, Volume 14	Friendly, genuine, flexible, collaboration, non-judgemental, consistency, validation	119 across 9 studies, (14-35-years; N/A Male, 40 Female)	Qualitative
Cowan et al.	2020	Canada	International Journal of Nursing Studies, Volume 108	Authority	24 (17-34-years; 16 Male, 6 Female, 2 Transgender)	Qualitative
Griffiths et al.	2019	England	International Journal of Mental Health Nursing, Volume 28, Issue 3, p 721-734	Common goals for therapy, ability to express difficulties, non-judgemental	12 (19-62-years; 7 Male, 5 Female)	Qualitative
Allard et al.	2018	England	Early Intervention in Psychiatry, Volume 12, Issue 3, p 410-416	Youth-sensitive, supportive, allowed to speak about and understand experiences, normalising	34 (18-81-years; 11 Male, 5 Female, 18 not stated)	Qualitative
Belanger et al.	2018	United States of America	Journal of Psychotherapy Integration, Volume 28, Issue 2, p 171-187	Negative aspects: empathy, mirroring, self-disclosure	1 (Early 20s; Male)	Qualitative
Jansen et al.	2018	Denmark	Early Intervention in Psychiatry, Volume 12, Issue 2, p 169-176	Friendly, non-stigmatising, safety/trust, accurate questioning	10 (18-27-years; 5 Male, 5 Female)	Qualitative
Mankiewicz et al.	2018	England	Counselling Psychology Review, Volume 33, Issue 2, p 4-16	Helpful to talk, being listened to, relief/unburdening, normalising, trust, impartiality	9 (17-33-years; 5 Male, 4 Female)	Qualitative
Tindall et al.	2018	Australia	Psychosis, Volume 10, Issue 3, p175-186	Trust, being heard, being understood, non-judgemental	9 (15-24-years; 6 Male, 3 Female)	Qualitative
Tindall et al.	2018	Australia	Early Intervention in Psychiatry, Volume 12, Issue 5, p 784-795	Dedicating time to talk, being heard, being understood, shared goals	210 across 9 studies (14-81-years; 116 Male, 92 Female, 2 not stated)	Qualitative
Tong et al.	2018	Australia	Early Intervention in Psychiatry, Volume 13, Issue 5, p 1236–1244	Trust, emotional closeness, confidentiality, non-judgemental, knowledgeable, relatable, not being pushed to talk about trauma	11 (18-27-years; 2 Male 9 Female)	Qualitative
Barr et al.	2015	England	Psychology and Psychotherapy, Volume 88, Issue 4	Non-judgemental, caring, valued, listened to, consistent	20 (18-35-years; 15 Male, 5 Female)	Mixed methods
Ferrari et al.	2015	Canada	BMJ Open, Volume 5, Issue 1	Non-judgemental, non-stigmatising	34 (Ages not provided; 13 Male, 12 Female, 9 not stated)	Qualitative
Tindall et al.	2015	Australia	International Journal of Mental Health Nursing, Volume 24, Issue 4, p 295-303	Opportunity to talk and make sense of experience, knowledgeable, being understood, confidential, warm, sensitive, easy going, feeling cared about, flexible	7 (18-22-years; 2 Male, 5 Female)	Qualitative
Lester et al.	2011	England	Psychiatric Services, Volume 62, Issue 8, p 882-887	Youth-friendly, consistent, long-term contact, not over engaging, genuine, supportive	36 (14-35-years; 24 Male, 10 Female, 2 not stated)	Qualitative

Figure 1. Themes and features of helpful therapeutic relationships for people with FEP.

Chua, Y. C., Tang, C., Abdin, E., Vaingankar, J. A., Shahwan, S., Cetty, L., Yong, Y. H., Hon, C., Ang, S., Verma, S., & Subramaniam, M. (2022). Therapeutic alliance with case managers in first-episode psychosis. Asian Journal of Psychiatry, 72, 103122. https://doi.org/10.1016/j.ajp.2022.103122

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Allard, J., Lancaster, S., Clayton, S., Amos, T., & Birchwood, M. (2018). Carers’ and service users’ experiences of early intervention in psychosis services: Implications for care partnerships. Early Intervention in Psychiatry, 12(3), 410–416. https://doi.org/10.1111/eip.12309

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Belanger, E. A., Leonhardt, B. L., George, S. E., Firmin, R. L., & Lysaker, P. H. (2018). Negative symptoms and therapeutic connection: A qualitative analysis in a single case study with a patient with first episode psychosis. Journal of Psychotherapy Integration, 28(2), 171–187. https://doi.org/10.1037/int0000107

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Jansen, J. E., Pedersen, M. B., Hastrup, L. H., Haahr, U. H., & Simonsen, E. (2018). Important first encounter: Service user experience of pathways to care and early detection in first-episode psychosis. Early Intervention in Psychiatry, 12(2), 169–176. https://doi.org/10.1111/eip.12294

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Mankiewicz, P. D., O’Leary, J., & Collier, O. (2018). ‘That hour served me better than any hour I have ever had before’: Service users’ experiences of CBTp in first episode psychosis. Counselling Psychology Review, 33(2), 4–16.

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Lester, H., Marshall, M., Jones, P., Fowler, D., Amos, T., Khan, N., & Birchwood, M. (2011). Views of young people in early intervention services for first-episode psychosis in England. Psychiatric Services, 62(8), 882–887. https://doi.org/10.1176/ps.62.8.pss6208_0882

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