title: Does the therapeutic relationship predict outcomes of psychiatric treatment in patients with psychosis? A systematic review.
abstract: BACKGROUND
  Numerous studies have shown that the quality of the therapeutic relationship (TR) between the patient and the clinician is an important predictor of the outcome of different forms of psychotherapy. It is less clear whether the TR also predicts outcomes of psychiatric treatment programmes in patients with psychosis (i.e. outside conventional psychotherapy).
  
  
  METHODS
  We conducted a systematic review and identified 9 primary studies that prospectively tested the association of the TR with 3 outcomes, i.e. hospitalisation, symptom levels and functioning. Because of the heterogeneity of the methods used, a meta-analysis was not feasible. A vote counting method was used to determine the number of statistically significant effects in the hypothesised direction (i.e. that a more positive TR predicts more favourable outcomes).
  
  
  RESULTS
  For each outcome, a χ² analysis showed that the number of statistically significant findings in the hypothesised 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.
  
  
  CONCLUSIONS
  It may be concluded that there is some, but not overwhelming, evidence that the TR predicts outcomes of complex psychiatric treatment programmes in patients with psychosis, and that methodologically more rigorous research is required. Such research should measure the TR at initial stages of treatment and use validated assessment instruments for both TR and outcomes.
authors.affiliation: Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, London, UK. s.priebe@qmul.ac.uk
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
authors.forename: Michelle
authors.initials: M
authors.lastname: Richardson
authors.forename: Maire
authors.initials: M
authors.lastname: Cooney
authors.forename: Oluwatoyin
authors.initials: O
authors.lastname: Adedeji
authors.forename: Rosemarie
authors.initials: R
authors.lastname: McCabe
mesh_terms: D000553:Ambulatory Care; D003431:Cross-Cultural Comparison; D006801:Humans; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*