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Letters   |    
Coercion in Treatment: Researchers' Perspectives
Erik Roskes, M.D.
Psychiatric Services 2011; doi:
View Author and Article Information

Dr. Roskes is director of forensic services at Springfield Hospital Center, Sykesville, Maryland.

Copyright © 2011 by the American Psychiatric Association.

To the Editor: In her Taking Issue commentary in the May issue, Dr. LeBel (1) asserts that “the orientation of the researcher biases the study. Research findings are inherently flawed—and our understanding of coercion along with them—unless the study and the data analysis are conducted by consumers who have experienced coercion.” Does Dr.LeBel really believe thatresearch conducted by trained researchers who have not been patients coerced into treatment is flawed and therefore somehow of less value, or that research conducted by consumers is somehow unbiased?

A different perspective is offered in several related articles in the May issue. For example, the study by Link and colleagues (2) suggests that assisted outpatient treatment reduces arrest rates, and Sheehan and Burns (3) report an inverse relationship between perception of coercion and the quality of the therapeutic relationship. Perhaps Dr. LeBel's conclusions would have been more balanced had she also considered these findings. As I suggested in a letter in 2009 (4), and as Link and colleagues (2) discuss in some detail, coercion is not a categorical variable but a dimensional one. As such, it cannot be considered an all-or-nothing phenomenon. Similarly, research into this complex phenomenon, which is potentially present in all relationships, must be multifaceted and must value all relevant perspectives. Although there is certainly a need for research into coercion from a consumer perspective, we know far too little about this complex process to conclude that any research is “flawed” because the researchers are observers but not participants.

The opinions expressed are those of the author alone and do not necessarily reflect those of the Maryland Mental Hygiene Administration or Springfield Hospital.

LeBel  JL:  Coercion is not mental health care.  Psychiatric Services 62:453, 2011
 
Link  BG;  Epperson  MW;  Perron  BE  et al:  Arrest outcomes associated with outpatient commitment in New York State.  Psychiatric Services 62:504–508, 2011
 
Sheehan  KA;  Burns  T:  Perceived coercion and the therapeutic relationship: a neglected association? Psychiatric Services 62:471–476, 2011
 
Roskes  E:  The role of coercion in public mental health practice (letter).  Psychiatric Services 60:1273, 2009
 
References Container
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References

LeBel  JL:  Coercion is not mental health care.  Psychiatric Services 62:453, 2011
 
Link  BG;  Epperson  MW;  Perron  BE  et al:  Arrest outcomes associated with outpatient commitment in New York State.  Psychiatric Services 62:504–508, 2011
 
Sheehan  KA;  Burns  T:  Perceived coercion and the therapeutic relationship: a neglected association? Psychiatric Services 62:471–476, 2011
 
Roskes  E:  The role of coercion in public mental health practice (letter).  Psychiatric Services 60:1273, 2009
 
References Container
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