Understanding Over- and Under-Involvement in Therapeutic Relationships Between Nursing Staff and Patients in Forensic Mental Health Settings: A Qualitative Synthesis

Abstract

Introduction: Nursing staff often struggle with balancing care and security in forensic settings, which can lead to over- or under-involvement. These are a cause for concern as this can directly impact therapeutic relationships. Aim: To systematically review and synthesise qualitative evidence relating to nursing staff and patient perceptions of over- and under-involvement experienced. Method: Of 465 studies identified, twelve were included in the review. A thematic synthesis of included studies exploring therapeutic relationships, including therapeutic over- and under-involvement, was conducted. Results: Three analytical themes were developed from the data: (1) The importance of trust in therapeutic interactions; (2) Implications arising from power imbalances and staff's lack of confidence or experience; and (3) The importance of relational security. Discussion: Therapeutic relationships are influenced by factors such as gender, experience, trust, communication style and empathy. Over-involvement occurs when patients become overly reliant on certain staff members, whereas under-involvement can lead to feelings of loneliness, lack of autonomy and distrust. Implications for Practice: This systematic review highlights the need for individualised care, effective communication and well-defined boundaries to create a safe and effective therapeutic environment. Recommendations: Further research is required to explore the experiences of over- and under-involvement based on staff characteristics, participant gender and security levels within forensic care.