Coercion in Treatment: Researchers' Perspectives

To the Editor: In her Taking Issue commentary in the May issue, Dr. LeBel (1) asserts that “the orientation of the researcher biases the study. Research findings are inherently flawed—and our understanding of coercion along with them—unless the study and the data analysis are conducted by consumers who have experienced coercion.” Does Dr.LeBel really believe thatresearch conducted by trained researchers who have not been patients coerced into treatment is flawed and therefore somehow of less value, or that research conducted by consumers is somehow unbiased?

A different perspective is offered in several related articles in the May issue. For example, the study by Link and colleagues (2) suggests that assisted outpatient treatment reduces arrest rates, and Sheehan and Burns (3) report an inverse relationship between perception of coercion and the quality of the therapeutic relationship. Perhaps Dr. LeBel's conclusions would have been more balanced had she also considered these findings. As I suggested in a letter in 2009 (4), and as Link and colleagues (2) discuss in some detail, coercion is not a categorical variable but a dimensional one. As such, it cannot be considered an all-or-nothing phenomenon. Similarly, research into this complex phenomenon, which is potentially present in all relationships, must be multifaceted and must value all relevant perspectives. Although there is certainly a need for research into coercion from a consumer perspective, we know far too little about this complex process to conclude that any research is “flawed” because the researchers are observers but not participants.