Therapeutic Engagement in Medium-Secure Care: An Interpretative Phenomenological Analysis of Service Users’ Experiences

Abstract

Service users (SUs) detained in forensic hospitals are usually required to engage in psychological therapies aimed at reducing mental distress and/or for preventing further offending. Poor therapeutic engagement (TE) can lead to adverse clinical outcomes and reoffending, at a cost to the individual, staff, the service provider, and the public. To understand what factors influence TE from a SUs’ perspective, the experiences of 10 male residents of a medium-secure hospital were explored. Using a service-user informed design, interpretative phenomenological analysis of interview data was completed. Four superordinate themes emerged: different worlds; what the individual brings; what the therapy entails; and control. Consideration of how these factors may be of use to professionals working in secure care settings is discussed in relation to existing theory and research.