“Navigating an undefined relationship”: the role of culture in clients’ experiences of boundary navigation with care coordinators in early intervention for psychosis services

Background: Understanding how culture shapes therapeutic boundaries is key to effective care, especially in settings like Early Intervention for Psychosis Services (EIPS), where developing trusting working relationships can be challenging. In these settings, the Care Coordinator (CC) plays a vital role in building trust and fostering engagement. This study explored the experiences of EIPS clients in navigating boundaries with their CC, with a specific focus on the cultural aspects of these boundaries. Methods: Ten EIPS clients were interviewed, and the data was transcribed and analysed using Interpretive Phenomenological Analysis (IPA). Results: Three Group Experiential Themes (GETs) were developed each with subthemes: Role Complexity, Blurred Lines and Self-Disclosure. Respect emerged as an overarching theme, with all participants identifying it as key to navigating boundaries with the CC. Several noted its importance within their cultural values. Clients also highlighted the lack of boundary discussions and the absence of space to decline certain support, contributing to power imbalances. Discussion: Findings suggest professionals should create more space for open discussions about boundaries with clients, while services should provide opportunities for staff to discuss boundary dilemmas and receive support. A deeper understanding of cultural differences related to boundaries would also support more equitable care.