Therapeutic relationships in psychiatry: The basis of therapy or therapy in itself?

Abstract

All healthcare is delivered in relationships between professionals and patients, and this relationship is particularly central to mental healthcare. Although fewer studies have been conducted in community psychiatry than in psychological treatments, there is increasing evidence that the therapeutic relationship predicts outcome across various psychiatric settings. The clinician-patient relationship and communication may indirectly improve outcome, e.g. mediated through better treatment adherence. Yet, evidence suggests that these interpersonal processes also have a direct therapeutic effect. Thus, depending on the conceptual model of therapeutic processes they may be seen as therapy in itself. Clinicians receive little specific instruction and supervision in communication skills, and research on the issue is scarce. Whilst there are conceptual and methodological challenges to such research, the aim should be to identify therapeutically effective elements of relationships and communication that can be tested in experimental studies. Although still rare, interventions to improve clinician-patient communication in routine mental healthcare show favourable results. A further step may be adapting established psychological treatment models, such as cognitive behaviour or solution focused therapy, to make routine clinical interactions more therapeutic and evidence based. This would be in the interest of clinicians, in optimizing their therapeutic potential, and patients alike.