Background: Therapeutic relationships in psychiatry services have been shown to have a significant impact on outcomes for people in severe mental distress. Service user experience-based studies consistently show relationships are an important factor in either helping or hindering recovery. Few studies have conducted a detailed exploration into the interpersonal mechanisms within these relationships by asking service users directly about what emotional impact these relationships have had on them. This is important knowledge for improving the quality of mental healthcare for people in severe mental distress. Aims: The purpose was to co-create a piece of research with a service user organisation that explored services users' experiences and perceptions of helpful and hindering relationships with mental health practitioners. The aim was to gain a greater understanding of the components in the relationship that brought about psychological change. Little research about relationships in psychiatry settings has been conducted in collaboration with service users outside of government-led mental health services. Participants: Eight participants were recruited from the service user organisation. The participants self-reported as having a mental health problem. Seven of the eight participants had long-term experience of using psychiatry services. Method: This research was service user-informed. The data was collected using single in-depth interviews focused on service users' views of their relationships with mental health practitioners. Interpretative Phenomenological Analysis (IPA) methodology was used to analyse the data and explore the participants' lived experiences of relationships in mental health services. Findings: The main themes identified were 'Trying to survive: am I a person or just an object in the system', 'Traumatic experiences and relationships' and 'Transformative relationships'. The findings showed the transformative components of these relationships were power, security and identity. The findings highlighted how the participants experienced a relationship to the system of psychiatry through their relationships with staff. Conclusions: How the components of power, security and identity were managed by practitioners determined whether relationships helped or hindered recovery. The responsibility for relationships in psychiatry needs to be broadened beyond the interpersonal relationship provided by practitioners. The systemic institution of psychiatry based on statutory control, risk aversion, the biomedical model and under resourcing were a cause of many of the problems in relationships in psychiatry settings.