Cognitive behavioral therapy, routine care and supportive counseling are all equally helpful — or harmful — to patients experiencing schizophrenia or psychosis, depending on the quality of the relationship that the patient feels he or she has with the treatment provider, according to a study in Psychological Medicine.
The University of Manchester researchers reviewed data from a previous trial involving 308 patients with psychotic symptoms who were put into one of three treatment arms. They found that, across the board, patients felt they improved or worsened in relation to the quality of the “therapeutic alliance” with their treatment provider.
“The implications are that trying to keep patients in therapy when the relationship is poor is not appropriate,” the lead author said in a press release. “More effort should be made to build strong, trusting and respectful relationships, but if this isn’t working, then the therapy can be detrimental to the patient and should be discontinued.”
“This is the first ever demonstration that TA [therapeutic alliance] has a causal effect on symptomatic outcome of a psychological treatment, and that poor TA is actively detrimental,” concluded the researchers. “These effects may extend to other therapeutic modalities and disorders.”
Goldsmith, L. P., S. W. Lewis, G. Dunn, and R. P. Bentall. “Psychological Treatments for Early Psychosis Can Be Beneficial or Harmful, Depending on the Therapeutic Alliance: An Instrumental Variable Analysis.” Psychological Medicine FirstView (March 2015): 1–9. doi:10.1017/S003329171500032X. (Abstract and full text)
Dodo bird verdict given new life by psychosis therapy study (Manchester University press release, April 10, 2015)