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Objectives  The quality of therapeutic relationships in psychiatric services has a significant impact upon the therapeutic outcomes for people diagnosed with a severe mental illness. As previous work has not explicitly explored service users’ in‐depth views about the emotional impact of these relationships, the objective of this work was to bring this perspective to the fore and to gain a greater understanding about which relational components can lead to psychological change.    Design  The project was conducted alongside a service user organization. An interview design was used to qualitatively explore service users’ experiences and perceptions of their relationships with mental health practitioners.    Methods  Eight individuals who had experience of the mental health system in the United Kingdom were interviewed. Interpretative phenomenological analysis was used to analyse the data.    Findings  Three superordinate themes emerged from the analysis. These were (1)  Trying to survive: am I a person or just an object in the system? ; (2)  Traumatic experiences within relationships ; and (3)  Helpful and transformative relationships . Further, the key transformative components of these relationships were  power ,  safety , and  identity .    Conclusions  Mental health services should be more focused upon  care , rather than  control . The Power Safety Identity ( PSI ) model, a reflexive model based upon key relational components highlighted by participants, is proposed for services and professionals to consider their work. The components of this model are managed by mental health practitioners and can determine whether these relationships maintain, increase, or alleviate psychological distress.    Practitioner points    Awareness of the relational components of  power ,  safety , and  identity  has the potential to help practitioners reflect upon the tensions they experience in their relationships with service users.  Mental health services and professionals that are sensitive to issues related to  power ,  safety , and  identity  when responding to the needs of the service users can improve how individuals perceive the quality of care provided by them.  Relationships between service users and mental health practitioners can encourage recovery if they are consistent, safe, trusting, provide protective power, and mirror a positive sense of self.

psychology and psychotherapy: theory, research and practice

‘Like a human being, I was an equal, I wasn't just a patient’: Service users’ perspectives on their experiences of relationships with staff in mental health services