{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T04:40:39Z","timestamp":1777092039691,"version":"3.51.4"},"reference-count":52,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100018812","name":"Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla","doi-asserted-by":"publisher","award":["ENFVAL1\/2022"],"award-info":[{"award-number":["ENFVAL1\/2022"]}],"id":[{"id":"10.13039\/501100018812","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Mental Health Nurs"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>This study examined how community mental health case managers, most of whom were mental health nurses, modified their day\u2010to\u2010day practice to strengthen the therapeutic relationship within community services. Using a participatory action research design across 10 centres in Catalonia, Spain, 24 case managers and 105 patients engaged in two action\u2010reflection cycles. Data from reflective diaries and focus groups were analyzed using inductive thematic analysis. Through cyclical observation and collaborative reflection, participants identified key facilitators and barriers to developing the therapeutic relationship and co\u2010designed two practice innovations: (1) jointly\u2010created informational materials clarifying case\u2010management scope and expectations, and (2) regular mixed patient\u2010professional reflective groups focused on the therapeutic process. Despite structural pressures, heavy workloads, service fragmentation, and limited opportunities for professional reflection, the participatory approach supported sustainable, relationally focused practice change grounded in patient\u2010provider dialogue. Embedding structured reflective spaces within routine care emerged as a practical mechanism to consolidate therapeutic alliance and advance recovery\u2010oriented practice. While findings apply across disciplines, they are particularly relevant to nursing\u2010led and nurse\u2010participating case\u2010management teams, in which continuous therapeutic contact, coordination functions and relational expertise intersect. The study offers a replicable framework for enhancing person\u2010centred care in community mental health settings, and it underscores the value of nurse\u2010involved co\u2010creation and structured reflection to maintain therapeutic presence, align expectations and integrate lived experience into ongoing quality improvement.<\/jats:p>","DOI":"10.1111\/inm.70256","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T02:20:53Z","timestamp":1775701253000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enhancing the Therapeutic Relationship Between Mental Health Case Managers and Individuals With Serious Mental Health Conditions: A Participatory Action Research Study in Community\u2010Based Services"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8853-0468","authenticated-orcid":false,"given":"Mart\u00ed","family":"Sub\u00edas\u2010Miquel","sequence":"first","affiliation":[{"name":"Community Mental Health Center (CMHC) Ciutat Vella\u2010Barcelona Parc Sanitari Sant Joan de D\u00e9u  Sant Boi de Llobregat Spain"},{"name":"Nursing and Health Doctoral Programme, Nursing School Universitat de Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3186-5368","authenticated-orcid":false,"given":"Ana Ventosa","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Department of Public Health, Mental Health and Maternal\u2010Child Nursing, Faculty of Nursing University of Barcelona  Barcelona Spain"},{"name":"Grup de Recerca en Cures Infermeres de Salut Mental, Psicosocials i de Complexitat, NURSEARCH \u2013 2021 SGR 1083  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1890-7554","authenticated-orcid":false,"given":"Sara","family":"S\u00e1nchez\u2010Balcells","sequence":"additional","affiliation":[{"name":"Department of Public Health, Mental Health and Maternal\u2010Child Nursing, Faculty of Nursing University of Barcelona  Barcelona Spain"},{"name":"Grup de Recerca en Cures Infermeres de Salut Mental, Psicosocials i de Complexitat, NURSEARCH \u2013 2021 SGR 1083  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1797-9409","authenticated-orcid":false,"given":"Hilari Andr\u00e9s","family":"Mora","sequence":"additional","affiliation":[{"name":"Head of Community Mental Health Management Parc Sanitari Sant Joan de D\u00e9u (PSSJD)  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9482-9474","authenticated-orcid":false,"given":"Maria Romeu","family":"Labayen","sequence":"additional","affiliation":[{"name":"South Barcelona Epidemiological Surveillance and Public Health Emergency Response Service, Public Health Agency of Catalonia. Department of Health Generalitat de Catalunya  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3893-4488","authenticated-orcid":false,"given":"Montserrat Puig","family":"Llobet","sequence":"additional","affiliation":[{"name":"Department of Public Health, Mental Health and Maternal\u2010Child Nursing, Faculty of Nursing University of Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5700-4315","authenticated-orcid":false,"given":"Antonio","family":"Moreno\u2010Poyato","sequence":"additional","affiliation":[{"name":"Department of Public Health, Mental Health and Maternal\u2010Child Nursing, Faculty of Nursing University of Barcelona  Barcelona Spain"},{"name":"Grup de Recerca en Cures Infermeres de Salut Mental, Psicosocials i de Complexitat, NURSEARCH \u2013 2021 SGR 1083  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0095655"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/07067437211052542"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2004.028662"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1476750319829633"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-69909-7_3470-2"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12610"},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u20106939\u201015\u201050"},{"key":"e_1_2_16_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12845"},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12700"},{"key":"e_1_2_16_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12523"},{"key":"e_1_2_16_12_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBISRIR\u20102016\u201000320"},{"key":"e_1_2_16_13_1","doi-asserted-by":"publisher","DOI":"10.1037\/prj0000568"},{"key":"e_1_2_16_14_1","volume-title":"Research Design: Qualitative, Quantitative and Mixed Methods Approaches","author":"Creswell J. 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