Schizophrenia and schizoaffective disorder and the therapeutic relationship: Client perspectives

At the heart of counselling psychology (CoP) practice is the use of the therapeutic relationship (TR). However, there is little research about the TR and schizophrenia/schizoaffective from a CoP or client perspective.The aim of this study was to explore how adults diagnosed with schizophrenia or schizoaffective disorder experience the TR and discover what factors influence the relationship.Four participants were interviewed and the data was analysed using thematic analysis.The analysis revealed six main themes: TR is special; trust; TR is a mirror; the management of symptoms; therapist factors; and client factors.The results indicate that clients with schizophrenia/schizoaffective generally experience a positive TR. Practitioners might encourage a healthy TR by giving the client power and control, creating trustworthiness, being open to symptoms, showing understanding, having a flexible approach and offering self-disclosure. The strengths of the study included the original design and aims of the study, the TR as a primary focus, the characteristics of the participants, respondent validation and the emphasis on client perspectives. Key limitations of the study were the small number of participants, lack of data saturation, over-representation of female participants and the use of one coder.The study suggests that clients with schizophrenia/schizoaffective disorder generally develop a positive therapeutic relationship. The study offers client-based insight about the therapeutic relationship and provides recommendations on how clinicians can use these insights to aid their practice.