Participants

37 former patients were selected based on their computerized medical records. One person called to express a refusal to participate; 36 other persons were called, out of whom 10 were not able to be reached on the phone, 8 refused to participate, 4 asked to reschedule a call and then did not answer the calls. 2 persons scheduled an interview but did not come and did not respond later to our calls.

12 former patients (7 men, 5 women) were interviewed. The age range was from 21 to 50 years old (mean: 38.3 years old). 3 patients were diagnosed with a depressive disorder, 7 with an adjustment disorder, one with PTSD (post-traumatic stress disorder), and one with an anxiety disorder, a depressive disorder as well as a personality disorder.

Analysis

Our analysis yielded 3 superordinated thematic fields. The first one is the participants’ understanding and evaluation of the treatment setting (see Tables 1, 2). As “treatment setting”, the participants sometimes referred to the overall setting with two mental health clinicians, sometimes to the joint sessions (with both clinicians), and sometimes to the separate sessions (with one clinician at a time). The second thematic field is the characteristics attributed to the resident, to the nurse, or to the pair of clinicians (see Fig. 1). The third thematic field (nurse’s role defined in comparison with the doctor’s) (see Table 3) is related to our finding that the participants often define the nurse’s role with regard to the doctor’s.

Table 1 Participants’ views on the reasons there are two clinicians and what they think of itTable 2 Patients’ views on the reasons for joint versus separate sessionsFig. 1

Nurse’s role defined in comparison with the doctor’s

Table 3  Nurse’s role defined in comparison with the doctor’sParticipants’ understanding and evaluation of the treatment settingParticipants’ views on the reasons there are two clinicians and what they think of it

As shown in Table 1 (see below), participants mainly attribute clinical and relationship reasons to the setting, and more advantages than disadvantages. First, they value having two points of view on their difficulties, enabling a more comprehensive understanding.

“It was in order to have a more comprehensive view of the person, that is (silence) of me” (P11)

Second, several participants mention the continuity of care.

“..in times of crisis, one really needs to be cared for all the time[…] Not to hear someone say “well no, next week you cannot come because no one’s there”

(P2)

Third, participants also highlight the value of seeing two clinicians with different characters who can help them in different ways, influence each other to enhance treatment, or so that there is at least one with whom the patient can form a good connection.

“They have different characters and different ways of speaking and of saying things, and sometimes it is nice, one is a little quieter and the other pushes you a bit more, it is nice” (P2)

Fourth, one person appreciates the supportive effect provided by two clinicians who can “listen better than one”, and to whom it is less stressful to talk to than to only one professional.

Concerning the disadvantages, first, two participants mention the fact of talking to several professionals at a time.

“..but there are three people, it’s like, I don’t know, as if I was facing judges and I had to expose myself in front of several people”

(P7)

Second, one person mentions having to repeat one’s story, and third, another one expresses the fact of changing interlocutors.

“..but it’s true that to not always talk to the same person is a bit unsettling, because one.. I didn’t know if there were many things I had to say again” (P9)

Patients’ views on the reasons for joint versus separate sessions

As shown in Table 2 (see below), participants mainly attribute the choice of joint sessions to clinical reasons, such as specific sessions’ goals (for example first or final evaluation) or to the severity of the patient’s symptoms.

“I think that at the beginning it was more often the two of them, because it was more important and serious” (P2)

On the other hand, they mainly relate the choice of separate sessions to logistical reasons such as time and financial requirements.

" I think there were alternate sessions because, it’s a bit complicated to, to have them both there at the same time, regarding their schedules, weekly time arrangements, just that” (P12)

Two participants relate a better understanding of the patient’s case to joint sessions allowing a dual perspective during the session, while another one relates it to combining different points of view from separate sessions.

One participant considers the clinicians’ needs (to be together, because they cannot afford to make mistakes, or because they need to check on the patient regularly) as an underlying reason to choose joint or separate sessions.

“..and I had the impression that they kind of needed to be together..” (P6)

However, this finding may be considered with caution since the participant mentioned that the necessity to avoid mistakes was an explanation provided by the resident.

Characteristics attributed to the resident, to the nurse or to the pair of clinicians

Our data show that some characteristics are attributed to the pair of clinicians and the resident, some to the pair of clinicians and the nurse, some to the resident and the nurse, and some to the resident, the nurse and the pair of clinicians (intersections in Fig. 1).

However, some characteristics, notably those that enhance an exploration of the patient’s inner world, are mainly attributed to the resident. Whereas the ones imputed to the nurse refer more to the “here and now” of the session and what is concretely happening in the patient’s life.

“..and so on one hand there was more, well one was more objective (nurse) and the other, I don’t know if I can really say subjective but..” (P12)

Concerning their respective roles, our data suggest a clear leadership role attributed to the resident, and a more supportive and proximity role to the nurse.

“Then, indeed, concerning the decision-making and what is related, hum, it was always the doctor who had the upper hand” (P3)

“.. he (nurse) knows me better, he was seeing me the whole time” (P8)

Nurse’s role defined in comparison with the doctor’s

Our data show 4 additional themes concerning the nurse’s role regarding the doctor’s: “the doctor’s agent”; “ambiguous role”, “complementarity with the doctor”, “subsidiarity with the doctor”.

One participant views the nurse’s role mainly as an agent for the doctor, while some others view it as ambiguous (Table 3).

“Thinking of it now, I said to myself why do I have to tell all this to someone who is not necessarily qualified?” (P7)

On the other hand, a few participants define the nurse’s relationship to the doctor as less hierarchical, either complementary or subsidiary.

“And who (nurse) saw things a bit differently, who interpreted things a bit differently, and that was also very positive” (P2)