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There has been significant research around the importance of deep and meaningful relationships – particularly during times of crisis. People with supportive and rewarding relationships have been shown to consistently have better mental health, higher levels of subjective well-being and lower rates of morbidity and mortality.


According to researchers Brooke Feeney of Carnegie Mellon University and Nancy Collins of University of California at Santa Barbara, deep and meaningful relationships help people in two important ways: in their ability to cope with stress or adversity, and in their efforts to learn, grow, explore, achieve goals, cultivate new talents, and find purpose and meaning in life (Feeney & Collins, 2016).


Thriving, Feeney and Collins contend, involves 5 components of well-being; hedonic well-being (happiness, life satisfaction), eudaimonic well-being (having purpose and meaning in life, progressing toward meaningful life goals), psychological well-being (positive self-regard, absence of mental health symptoms/disorders), social well-being (deep and meaningful human connections, faith in others and humanity, positive interpersonal expectancies), and physical well-being (healthy weight and activity levels, health status above expected baselines) (Feeney & Collins, 2016).


In describing the support functions that lead to thriving, Feeney and Collins emphasize the promotion of thriving through adversity, not only by buffering individuals from negative effects of stress, but also by enabling them to flourish either because of or in spite of their circumstances. This type of support they call source of support (SOS). Also essential is to support thriving in the absence of adversity by promoting full participation in life opportunities for exploration, growth, and personal achievement, and embracing and pursuing opportunities that enhance positive well-being, broaden and build resources, and foster a sense of purpose and meaning in life. This type of support they call relational catalyst (RC) support (Feeney & Collins, 2016).


“Relationships serve an important function of not simply helping people return to baseline, but helping them to thrive by exceeding prior baseline levels of functioning” (Feeney, 2016).


Both types of support must be responsive to the patient and require the knowledge of how to take their perspective, the resources (i.e., cognitive, emotional, and/or tangible) needed to provide effective support, and the motivation to accept the responsibility to support another.


On the other hand, say Feeney and Collins, clinicians may inadvertently do more harm than good if they make the person feel weak, needy, or inadequate; induce guilt or indebtedness; make the recipient feel like a burden; minimize or discount the recipient’s problem, goal, or accomplishment; blame the recipient for his or her misfortunes or setbacks; or restrict autonomy or self-determination. Support-providers might also be neglectful or disengaged, over-involved, controlling, or otherwise out of sync with the recipient’s needs (Feeney & Collins, 2016).


“It is not just whether someone provides support, but it is how he or she does it that determines the outcome of that support” (Feeney, 2016).


Another study found that with psychosis in particular, it was precisely the type of support given, and the therapeutic alliance that resulted, that predicted patient outcomes.


While numerous research designs have explored different types of talking treatment which can help people recover from psychotic episodes, such as cognitive behavioral therapy (CBT) and family therapy, surprisingly, patients in comparison groups – that receive no specific type of treatment – often benefit as much as those receiving the specific, targeted therapies (CBT or family therapy) (Goldsmith et al., 2015).


Research has further demonstrated that it is the quality of the relationship between the therapist and patient which causes improvement and not the different techniques employed in the two therapies that were compared (Goldsmith et al., 2015). However, the question Lucy Goldsmith, a PhD candidate from The University of Manchester’s Institute of Brain, Behavior and Mental Health, had was: “Does successful treatment make patients feel well disposed towards their therapist or is the relationship actually at the heart of whether therapy succeeds?”


Working in collaboration with Manchester professors Shôn Lewis and Graham Dunn, and Liverpool professor Richard Bentall, and taking data from an earlier study of 308 patients that had used already established rating systems of these relationships, the researchers explored in depth the causative effect of the ‘therapeutic alliance’ or relationship of trust between patient and psychologist when schizophrenia patients were treated during a trial of this kind.


What they found was that the therapeutic alliance was indeed the predictive factor in patient outcomes. That is, when there was that a good level of therapeutic alliance there was a beneficial impact on wellbeing, but where the relationship was poor, the treatment could actually be damaging (Goldsmith et al., 2015).


Goldsmith explains, “The implications are that trying to keep patients in therapy when the relationship is poor is not appropriate. More effort should be made to build strong, trusting and respectful relationships, but if this isn’t working, then the therapy can be detrimental to the patient and should be discontinued” (Goldsmith, 2015).

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