Priebe Stefan, Mccabe Rosemarie
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Int Rev Psychiatry. 2008 Dec;20(6):521-6. doi: 10.1080/09540260802565257.
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.
所有医疗保健都是在专业人员与患者的关系中提供的，而这种关系在精神卫生保健中尤为核心。尽管社区精神病学领域的研究比心理治疗领域的研究少，但越来越多的证据表明，治疗关系能预测各种精神病学环境下的治疗结果。临床医生与患者的关系及沟通可能会间接改善治疗结果，例如通过更好的治疗依从性来介导。然而，有证据表明这些人际过程也具有直接的治疗效果。因此，根据治疗过程的概念模型，它们本身可能被视为治疗方法。临床医生在沟通技巧方面几乎没有得到具体的指导和监督，而且关于这个问题的研究也很少。虽然此类研究存在概念和方法上的挑战，但目标应该是确定关系和沟通中具有治疗效果的要素，并在实验研究中进行检验。尽管在常规精神卫生保健中改善临床医生与患者沟通的干预措施仍然很少见，但已显示出良好的效果。进一步的步骤可能是调整现有的心理治疗模式，如认知行为疗法或聚焦解决疗法，以使常规临床互动更具治疗性且基于证据。这将符合临床医生优化其治疗潜力的利益，也符合患者的利益。
