Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, London, UK.
Psychother Psychosom. 2011;80(2):70-7. doi: 10.1159/000320976. Epub 2010 Dec 23.
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).
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).
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.
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.
许多研究表明，患者与临床医生之间的治疗关系 (TR) 的质量是不同形式心理治疗结果的重要预测因素。TR 是否也能预测精神病患者（即传统心理治疗之外）的精神科治疗方案的结果则不太清楚。
我们进行了系统综述，确定了 9 项前瞻性测试 TR 与 3 个结果（即住院、症状水平和功能）之间关联的主要研究。由于所使用方法的异质性，因此无法进行荟萃分析。使用投票计数法来确定假设方向上具有统计学意义的效应数量（即更积极的 TR 预示着更有利的结果）。
对于每个结果，卡方分析表明，如果假设的无关联的零假设为真，则假设方向上具有统计学意义的发现数量大于预期。然而，这些研究存在方法学上的缺陷，且阳性关联的效应大小相当小。
可以得出结论，有一些但不是压倒性的证据表明，TR 可以预测精神病患者复杂精神科治疗方案的结果，需要进行更严格的方法学研究。此类研究应在治疗的初始阶段测量 TR，并同时使用经过验证的 TR 和结果评估工具。
