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ORIGINAL RESEARCH article

Front. Health Serv.
Sec. Patient Centered Health Systems
Volume 4 - 2024 | doi: 10.3389/frhs.2024.1388906

"I have some wishes, which are actually demands." A qualitative mixed methods study on the impact of consumerism in mental healthcare on the therapeutic relationship

Provisionally accepted
Linda Krikken Mulders Linda Krikken Mulders 1*Evelien Tonkens Evelien Tonkens 1M. Trappenburg M. Trappenburg 1,2
  • 1 University of Humanistic Studies, Utrecht, Netherlands
  • 2 Utrecht University, Utrecht, Netherlands, Netherlands

The final, formatted version of the article will be published soon.

    Introduction: Alongside the logic of care many Western welfare states have introduced market elements or a logic of choice in their healthcare systems, which has led to consumerist behavior in patients. For the medical field, it is well documented how consumerism creates complex ethical dilemmas and undermines ways of thinking and acting crucial to healthcare. Little is known about these dynamics in mental healthcare.Methods: This study used a qualitative mixed-methods design, combining 180 online patient narratives (blogs) with 25 interviews with therapists in a grounded theory approach.Results: Findings show that articulate behavior can be divided into two categories: assertive and adamant. While assertive behavior is understood as an integral, reciprocal part of therapy and is stimulated by therapists, adamant or consumerist behavior is experienced as damaging the relationship -the "commodity" the patient is seeking to obtain, as the single most important predictor of treatment success. Findings also show that articulate behavior in both varieties takes a different shape over time during the course of treatment.Discussion: Adamant behavior clashes with the internal logic of care, which is especially problematic in mental healthcare where the relationship with one's therapist is key to successful treatment. Therefore, patients should be taught and helped to display assertive behavior without resorting to adamancy. This could be taken up by individual therapists but also by their organizations.

    Keywords: consumerism1, mental health care2, therapeutic relationship3, patient narratives4, professionalism5, logic of care6

    Received: 20 Feb 2024; Accepted: 25 Oct 2024.

    Copyright: © 2024 Krikken Mulders, Tonkens and Trappenburg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Linda Krikken Mulders, University of Humanistic Studies, Utrecht, Netherlands

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.