In the current issue of Psychotherapy and Psychosomatics data are presented by S. Priebe and collaborators (London, UK) that point to the importance of the therapeutic relationship in psychotic disorders. Numerous studies have shown that the quality of the therapeutic relationship between the patient and the clinician is an important predictor of the outcome of different forms of psychotherapy.
It is less clear whether the therapeutic relationship also predicts outcomes of psychiatric treatment programs in patients with psychosis (i.e., outside conventional psychotherapy).
The investigators conducted a systematic review and identified 9 primary studies that prospectively tested the association of the therapeutic relationship with 3 outcomes that included hospitalization, symptom levels, and functioning.
A meta-analysis was not feasible because of the heterogeneity of the methods used. Instead, a vote counting method was used to determine the number of statistically significant effects in the hypothesized direction (i.e., that a more positive therapeutic relationship predicts more favorable outcomes). For each outcome, a χ2 analysis showed that the number of statistically significant findings in the hypothesized direction was greater than expected if the null hypothesis of no association were true.
However, studies had methodological shortcomings, and the effect sizes of positive associations were rather small. It may be concluded that there is some, but not overwhelming, evidence that the therapeutic relationship predicts outcomes of complex psychiatric treatment programs in patients with psychosis, and that methodologically more rigorous research is required. Such research should measure the therapeutic relationship at initial stages of treatment and use validated assessment instruments for both TR and outcomes.
Material adapted from Journal of Psychotherapy and Psychosomatics