Establishing and maintaining a therapeutic relationship in psychiatric practice
- Andrew Skodol, MD
Andrew Skodol, MD
- Section Editor — Personality Disorders
- Research Professor of Psychiatry
- University of Arizona College of Medicine
- Donna Bender, PhD
Donna Bender, PhD
- Clinical Professor of Psychiatry and Behavioral Sciences
- Tulane University
The relationship between a clinician and a patient in psychotherapy plays a central role in alleviating symptoms and fostering character change . The treatment relationship can be a potentially powerful vehicle for patient improvement, as it can provide a supportive environment for exploration, and because issues that come up in this context can be processed in a very immediate and instructive way.
This topic describes common treatment issues, problems, and opportunities in the clinician-patient therapeutic relationship. Approaches to the therapeutic relationship in patients with personality disorders are described separately. The epidemiology, clinical manifestations, diagnosis, and treatment of specific personality disorders are also discussed separately. (See "Approaches to the therapeutic relationship in patients with personality disorders" and "Personality disorders" and "Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis" and "Borderline personality disorder: Epidemiology, clinical features, course, assessment, diagnosis, and differential diagnosis" and "Treatment of antisocial personality disorder" and "Treatment of borderline personality disorder".)
Whenever an individual decides to undertake mental health treatment of any sort, a relationship is begun with the treating clinician. Several components of the relationship can influence the outcome of treatment:
●How the relationship is established and evolves
●How the patient experiences, reacts to and uses the relationship
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- THERAPEUTIC RELATIONSHIP
- Therapeutic alliance
- PROBLEMS IN THE THERAPEUTIC RELATIONSHIP
- COMMON TREATMENT ISSUES
- Fee setting
- Personal disclosures
- Boundary crossings and violations
- RELEVANCE ACROSS TREATMENT PARADIGMS
- Psychodynamic/psychoanalytic psychotherapy
- Cognitive-behavioral therapies
- Psychiatric hospital settings
- SUMMARY AND RECOMMENDATIONS