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A better therapeutic relationship predicts better outcomes. However,
there is no trial-based evidence on how to improve therapeutic
relationships in psychosis.
To test the effectiveness of communication training for psychiatrists on
improving shared understanding and the therapeutic relationship (trial
In a cluster randomised controlled trial in the UK, 21 psychiatrists were
randomised. Ninety-seven (51% of those approached) out-patients with
schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the
sample recruited at baseline) were followed up after 5 months. The
intervention group received four group and one individualised session.
The primary outcome, rated blind, was psychiatrist effort in establishing
shared understanding (self-repair). Secondary outcome was the therapeutic
Psychiatrists receiving the intervention used 44% more self-repair than
the control group (adjusted difference in means 6.4, 95% CI 1.46–11.33,
P<0.011, a large effect) adjusting for baseline
self-repair. Psychiatrists rated the therapeutic relationship more
positively (adjusted difference in means 0.20, 95% CI 0.03–0.37,
P = 0.022, a medium effect), as did patients
(adjusted difference in means 0.21, 95% CI 0.01–0.41, P
= 0.043, a medium effect).
Shared understanding can be successfully targeted in training and
improves relationships in treating psychosis.
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