“I don't go in there with expectations… my driving force is compassion and connection”: A qualitative study of therapeutic relationships and person-centred care in community AOD and mental health services

Background and primary aim of this research The communication skills and care practices of frontline workers in community AOD and mental health services are key to maintaining consumer engagement and encouraging wellbeing improvements. However, the qualitative transformative effects that stem from strong therapeutic relationships can be overshadowed in importance by quantitatively measured treatment outcomes, such as reductions in substance use or distress acuity. This research examined the strategies that workers utilise to encourage consumer engagement, support self-efficacy, and optimise service effectiveness. Method and scope Interviews were conducted with workers from community AOD and mental health services in NSW and Queensland, from August 2024. Data referencing communication and care approaches were examined using thematic analysis techniques, with the aim of understanding what workers thought was most valuable and effective in promoting consumer wellbeing. Results Workers reported that service participants experienced a range of life difficulties, such as social isolation or legal problems, and saw these as contributing to negative self-concepts and inhibited trust. To overcome this, workers focused on demonstrating unconditional positive regard, reflecting the person’s expressed values and goals, and providing a sense of acceptance and safety. Workers implicitly and explicitly drew upon their own lived experiences within this, to help foster connection and understanding. Implications and key takeaways Developing strong therapeutic relationships is not only a necessary precondition for effective service provision but can also be the primary mechanism by which enabling self-concepts and health-affirming changes are fostered. To help reduce intrapersonal barriers to service engagement or continuance, such as feelings of shame or inadequacy, services and funding bodies could look to prioritise models and indicators of therapeutic trust and of improvements in participant self-efficacy over more proscriptive concepts such as abstinence or recovery.