Service user and staff experiences of the therapeutic relationship after physical restraint in a secure hospital

The therapeutic relationship is the relationship between service users and staff, based on collaboratively working towards the service users’ goals. Within a secure hospital environment, staff sometimes have to physically restrain service users, as a last resort to manage risk. The aim of this research was to explore both service user and staff perspectives of the therapeutic relationship after physical restraint in a secure hospital environment. This was investigated in an independent sector medium-low secure hospital in Wales. Ten semi structured interviews were conducted with five service users and five staff members; all of whom had been involved in at least one incident of physical restraint. These participants described their experiences of therapeutic relationships with those that they had been involved in a physical restraint with. Interpretative Phenomenological Analysis was used to separately analyse the service user and staff member data. Four master themes emerged from the service user experiences: changes to the therapeutic relationship; appraisal of the necessity of physical restraint; emotional impact; and dependency and power. A further three master themes emerged from the staff member experiences: personal impact; conflicting professional roles and responsibilities; and making sense of the physical restraint. These findings are discussed in relation to implications for secure hospital services and recommendations for future research are outlined.