How Do Collaborative Approaches Shape Power Dynamics in Therapeutic Relationships? Evidence From Recovery-Oriented Mental Health Services

Introduction: Recovery-oriented mental health services emphasise collaboration, empowerment and service-user involvement. However, less is known about how power is enacted within relationships described as collaborative. This study explores how power dynamics are interactionally produced, negotiated and made visible within recovery-oriented therapeutic relationships. Methods: The study involved 15 service users from an Italian recovery-oriented mental health service and 15 facilitators identified by them as significant to their recovery. Data comprised 30 individual interviews and 15 dyadic interviews. Dyadic interviews served both to gather participants' accounts and to observe how the relationship was narratively enacted in interaction. Transcripts were analysed through a narrative-interactional framework informed by Gubrium and Holstein's approach, with attention to narrative activation, composition, performance, collaboration and control. Coding focused on both what participants said about the relationship and how they co-constructed, confirmed, redirected or constrained each other's narratives. Results: Four interpretive patterns were identified: parity-oriented dynamics, declared parity with observed dominance, non-categorizable dynamics, and acknowledged dominance. These patterns are better understood as heuristic configurations rather than definitive typologies. Parity-oriented dyads were characterised by reciprocal narrative completion, mutual recognition and flexible turn-taking. In other dyads, participants described the relationship as collaborative, while interaction showed more asymmetrical narrative control. One dyad displayed acknowledged directiveness, experienced by the service user as supportive rather than coercive. Across cases, professional role alone did not explain how power was enacted. Conclusion: Collaboration in recovery-oriented relationships cannot be inferred from participants' declarations or professional role categories alone. Rather, it needs to be examined through the situated interactional practices by which participants make space for, limit, complete or authorise one another's accounts. The study contributes a qualitative framework for analysing power as a relational and negotiated process within therapeutic relationships. Patient or public contribution: Individuals with lived experience were actively involved in interpreting the research findings through discussion and feedback sessions. A final dissemination meeting with participants enabled the validation of these interpretations and contributed to concluding reflections on the practical implications for mental health services.