Bolsinger Julia, Jaeger Matthias, Hoff Paul, Theodoridou Anastasia
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland.
Department of Adult Psychiatry, Psychiatrie Baselland, Liestal, Switzerland.
Front Psychiatry. 2020 Jan 15;10:965. doi: 10.3389/fpsyt.2019.00965. eCollection 2019.
The therapeutic relationship and its importance for psychotherapy outcome have been the subject of extensive research over the last decades. An acute psychiatric inpatient setting is a unique environment where severely ill patients receive intensive treatment over a limited, relatively short, period of time. This renders establishing a good therapeutic relationship difficult for various reasons. It seems likely, however, that the therapeutic relationship in such a setting plays a vital role on factors such as clinical outcome, patient satisfaction, and rehospitalization rates. Little information is available on special attributes and caveats of building and maintaining a good therapeutic relationship in an acute psychiatric setting, neither on its influence on therapy success. An extensive systematic literature search was performed using PubMed, science direct, psyc info, and google scholar databases. Keywords used were therapeutic alliance, therapeutic relationship, psychiatry, emergency, acute, coercion, autonomy, involuntary, closed ward. RCTs, observational studies, reviews, meta-analyses, and economic evaluations were included, case reports and opinion papers were excluded. Factors specific to an acute psychiatric setting were identified, and the available information was categorized and analyzed accordingly. The PRISMA statement guidelines were followed closely upon research and preparation of the present review. A total of 48 studies were selected based on their relevance as well as design. They demonstrated that several factors related to setting, patient attributes, staff attributes, admission circumstances, and general situation, render building and maintaining a good therapeutic relationship difficult in an acute psychiatric setting compared to scheduled, long-term therapeutic sessions. The available literature on how to overcome this dilemma is scarce. Interventions involving staff and/or patients have been shown to be effective in terms of relevant outcome parameters. Increasing research efforts, as well as raising awareness and providing specific competencies amongst clinicians and patients in terms of nurturing a good therapeutic relationship in acute settings, are necessary to improve clinical outcome, economic factors, quality of patient care and patient as well as staff satisfaction.
在过去几十年里，治疗关系及其对心理治疗效果的重要性一直是广泛研究的主题。急性精神科住院环境是一个独特的环境，重症患者在有限的、相对较短的时间内接受强化治疗。由于各种原因，在这种环境中建立良好的治疗关系很困难。然而，在这样的环境中，治疗关系似乎在临床结果、患者满意度和再住院率等因素方面起着至关重要的作用。关于在急性精神科环境中建立和维持良好治疗关系的特殊属性和注意事项，以及其对治疗成功的影响，目前几乎没有相关信息。我们使用PubMed、科学Direct、PsycINFO和谷歌学术数据库进行了广泛的系统文献检索。使用的关键词包括治疗联盟、治疗关系、精神病学、急诊、急性、强制、自主性、非自愿、封闭病房。纳入了随机对照试验、观察性研究、综述、荟萃分析和经济评估，排除了病例报告和观点论文。确定了急性精神科环境特有的因素，并对现有信息进行了相应的分类和分析。在本综述的研究和准备过程中，严格遵循了PRISMA声明指南。根据相关性和设计，共选择了48项研究。这些研究表明，与定期的长期治疗相比，一些与环境、患者属性、工作人员属性、入院情况和一般状况相关的因素，使得在急性精神科环境中建立和维持良好的治疗关系变得困难。关于如何克服这一困境的现有文献很少。涉及工作人员和/或患者的干预措施在相关结果参数方面已被证明是有效的。为了改善临床结果、经济因素、患者护理质量以及患者和工作人员的满意度，有必要加大研究力度，提高临床医生和患者在急性环境中培养良好治疗关系方面的意识并提供特定能力。
