144 Chapter 7 DISCUSSION In the current study, we explored perspectives of persons with severe mental illness, of which most had a psychotic disorder, their family and professionals on collaboration during the recovery process. The study was set in the context of longterm mental healthcare and used a participative, bottom up approach, starting from subjective experiences. We used a reflexive thematic analysis of interviews supplemented by focus groups, to develop themes that represent processes of collaboration for recovery. The persons with severe mental illness we have studied have a high level of illness chronicity and lasting psychosocial needs (16), which together with the high prevalence of psychotic illness means recurring or lasting perspective differences are common. The care context of our research, although recovery oriented, still has an illness-based focus. It also involves frequent changes in living environment and professionals involved (27, 38). In the following, we will discuss our results in this light. The two central themes we developed concern role attribution and interacting with the others in the triad. One part of role attribution referred to establishing unconditional and meaningful contact, put otherwise, working on a meaningful relationship, which was viewed as a recovery goal in itself, a familiar finding in recovery literature on persons with severe mental illness as well as their family (1, 12, 13). It also was viewed as an entry to taking the second, problem oriented, part of attributing roles, and vice versa. We note that the above understanding of roles within the triad aligns to the widely held interactional view that communication has got a relational and a content aspect (39). Although recovery by nature is a transdiagnostic concept that transcends the illness domain (2, 40), our findings point out that it matters in collaboration for recovery if there is a shared perspective on the problem. All parties of the triad in our study frequently commented on the impact of differences over problem definition, a core feature of psychotic disorders, a common trait in the context of study. Our analysis shows the importance of the relational aspect of a role. Respondents from all perspectives found establishing unconditional and meaningful contact important, because it would help navigating diverging perspectives. They noted this contact took time to establish. The reverse also held: experienced differences over problem definition and problem oriented role seemed to connect with a negative interaction process: negative expectations including stigma, not informing others or not being informed, not experiencing agency to change and experiencing disagreement and struggle, which could in turn negatively impact meaningful contact.
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