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Establishing and maintaining a therapeutic relationship in psychiatric practice

Andrew Skodol, MD
Donna Bender, PhD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


The relationship between a clinician and a patient in psychotherapy plays a central role in alleviating symptoms and fostering character change [1]. 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 "Overview of personality disorders" and "Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis" and "Borderline personality disorder: Epidemiology, clinical features, course, assessment, and 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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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2016.
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