120 Chapter 4 were developed between patients and coaches during the intervention, (3) contact between patients and coaches was characterized by the provision of social support including positive social interactions and participation in accessible mutual activities, (4) these experiences regarding the social bond and social support were considered meaningful to both patients and coaches, however, meaningful and sustainable changes in patients’socialsituationsdidnotclearlyemerge,and(5)apersonalized,relationship-oriented approach that focuses on development and maintenance of a social bond between patient-coach dyads, rather than a structured and goal-oriented approach, was considered more feasible and preferable. To elaborate on our results, this study demonstrated barriers to engagement during the intervention in a forensic population, which have previously been demonstrated in comparable populations and other befriending intervention studies (Olver, Stockdale, & Wormith, 2011; Priebe et al., 2020; Siette et al., 2017). One study found overall dropout rates of 27.1% during standard treatment programs of offenders (Olver et al., 2011). The dropout rate we encountered in our sample was higher (i.e., 31.8% did not start with the intervention, 27.3% failed to meet with their coach more than 10 times), but falls within the ranges that were reported in befriending studies included in the meta-analysis of Siette et al. (2017). Moreover, our higher dropout rates can be explained by the fact that the experimental intervention was offered to patients in addition to, often mandatory, treatment programs in forensic psychiatric care. Engagement of forensic outpatients in non-binding additive interventions is expected to be more challenging. Although we found that the majority of the patients were willing to meet with a coach, many patients seemed unable or unwilling to actively improve their social network during the intervention. In particular, distrust, avoidant attitudes, and unfortunate timing due to various problems and responsibilities negatively influenced patient engagement to the intervention. These results may be explained by the fact that we examined experiences of a forensic outpatient population that consisted of vulnerable patients with multiple problems, including comorbid and persistent mental problems and permanent stress due to socio-economic problems (e.g., housing and financial problems). In line with Maslow’s need hierarchy theory (1943), patients with complex or unmet basic needs (i.e., lower-level needs), such as safe and stable housing and a good health, might have difficulty to feel and express the needs for social connectedness (i.e., higher-level needs) and to cooperate in social network-related goals. Next, in line with a recent mixed methods study investigating a group befriending program in patients with severe mental illnesses (Botero-Rodríguez et al., 2021), predominantly
RkJQdWJsaXNoZXIy MjY0ODMw