Closed off and opening up
Creators: name: Sapiro, Beth Frances
Publisher: name: No Publisher Supplied
Year: 2018

description: The transition to adulthood is a critical developmental period. For marginalized youth, it is a stage of life when inequalities may either be magnified or reduced. Positive interpersonal relationships are an essential component of health and well-being; yet young people living with mental health difficulties may experience multiple barriers to the formation and maintenance of healthy interpersonal relationships, including shame, stigma, symptom management, and structural oppression. This qualitative study explored the relational experiences of transition-age youth living with mental health difficulties.   Within the larger context of the Cornerstone study, an intervention providing peer support and boundary-spanning case management to youth living with mental illness, this study explored how these young people experience three distinct aspects of relationships with others: trust, mutuality, and disconnection. Brief qualitative interviews focusing on relationships were conducted with 47 transition-age youth, ages 16-20, who were receiving services for a mood disorder, anxiety disorder, or thought disorder. In-depth interviews were conducted with 13 young women, ages 17-20, living with a mood disorder or an anxiety disorder, as well as the five service providers (social workers and peer mentors) employed in Cornerstone. This study was grounded in the theoretical framework of relational-cultural theory, emphasizing the role of relationships in young adult growth and development. It utilized multiple methods of data collection (brief interviews, limited group observations, and in-depth interviews with both youth and providers) as well as data analysis (thematic analysis and the Listening Guide).  Data analysis of the interviews with transition-age youth revealed that family continued to play a prominent role in the lives of young people living with mental health difficulties. For some, family was a source of support; for others, family relationships were characterized by lack of understanding or ongoing conflict. Thematic analysis indicated that these young people expressed both a desire for a trusted connection with a helping professional, as well as guardedness and wariness in these relationships. Experiences of mutuality in helping relationships were particularly valued by these youth. Relationships with peers were similarly valued by participants, and offered camaraderie, emotional support, practical assistance, and company for creative pursuits. Participants varied in the extent to which they felt comfortable being authentic and vulnerable with peers. Thematic analysis also found evidence of both growth-promoting relationships as well as the use of strategies of disconnection in peer relationships. The Listening Guide analysis of a single case revealed the use of multiple strategies employed to navigate a landscape of unsatisfying relationships, including minimizing feelings, asserting feelings, seeking connection, and lashing out.  Findings from this study make a number of contributions to the literature on the relational experiences of transition-age youth living with mental illness. They provide evidence of the central relational paradox in young people’s relationships with helping professionals, and reveal discrepancies in how some youth and some providers perceive the meaning of similarities and differences in a helping relationship.   Findings show that shared lived experience is meaningful in peer relationships as well as in helping relationships, and that supportive peer relationships make a significant contribution to recovery for transition-age youth. In this study, young women who described their peer relationships as mutually supportive were also likely to describe them as growth-promoting. Findings also reveal evidence of relational resilience among some participants with histories of maltreatment. The variations identified in approaches to peer relationships both support and build on existing research. Echoing the literature on stigma, some youth chose to limit their self-disclosure and relate to others using strategies of disconnection. However, others chose instead to embrace their vulnerability and represent themselves authentically with trusted peers.  Findings from this study suggest that social workers who work with transition-age youth would do well to emphasize relationships in treatment, be attuned to the impact of cultural messages and stereotypes, and address both similarities and differences between young people and themselves. Findings also suggest the importance of affirming youth agency in helping relationships and empowering young people to recognize the impact of structural oppression on the transition to adulthood.