Fostering therapeutic relationships in brief interventions: an exploratory qualitative study of the Ensemble program for informal caregivers of adults with psychiatric disorders

TL;DR

This study explores how therapeutic relationships between caregivers and practitioners in the Ensemble program help improve caregivers' well-being.

Contribution

The study identifies four key relational dimensions that rapidly develop in a brief intervention for informal caregivers.

Findings

Four relational dimensions were identified in caregiver-practitioner relationships: therapeutic alliance, empathy, authenticity, and flexibility.

A strong therapeutic relationship formed quickly within the five-session Ensemble program.

Relational reciprocity and non-judgmental attitudes were crucial for caregiver engagement and hope.

Abstract

Informal caregivers play a crucial and multifaceted role in the recovery of individuals with psychiatric disorders, but this role can negatively impact their own quality of life. Therefore, targeted interventions that address caregivers’ specific needs are essential. The Ensemble program is a brief, targeted intervention designed to enhance caregivers’ psychological well-being through a helping relationship centered on their lived experience. This qualitative study explored how dynamic, co-constructed therapeutic relationships develop between practitioners and informal caregivers, and how both parties experience these relationships.

A qualitative design was employed, integrating semi-structured individual interviews with Ensemble practitioners and a focus group with informal caregivers. All data were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. Additional material was collected from post-program responses to the open-ended question, “What did you like most about this follow-up?”

Four relational dimensions characterized the informal caregiver–practitioner relationship: (1) therapeutic alliance; (2) an empathic, respectful, partnership-oriented, and accepting stance; (3) relational authenticity; and (4) flexibility, adaptation, and co-construction. A strong therapeutic relationship was shown to develop rapidly within the five-session Ensemble intervention. Facilitating factors included practitioners’ deep understanding of caregivers’ experiences, their relatives’ clinical and social backgrounds, and the challenges inherent to the caregiving role. Attentive, accurate, and non-judgmental listening promoted caregiver engagement and active participation.

Relational reciprocity emerged as a key mechanism, supporting partnership-based dynamics and emphasizing the importance of flexible frameworks along with empathic, welcoming, and non-judgmental attitudes in fostering hope and sustained engagement.

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