Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial.

BACKGROUND: A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis. AIMS: To test the effectiveness of communication training for psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: ISRCTN94846422). METHOD: In a cluster randomised controlled trial in the UK, 21 psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship. RESULTS: Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46-11.33, P<0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03-0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01-0.41, P = 0.043, a medium effect). CONCLUSIONS: Shared understanding can be successfully targeted in training and improves relationships in treating psychosis.

How to value patients with psychosis: An inductive study of psychiatrists' behaviour in routine consultations.

Valuing patients underlies good communication in psychiatry and mediates positive outcomes. The aim of this study was to (1) identify and reliably assess valuing and devaluing communicative behaviour of psychiatrists in routine consultations, and (2) explore whether valuing behaviour is associated with patient satisfaction. In an inductive study, psychiatrists' valuing and devaluing behaviours were operationalized and identified in 100 video-recorded consultations with patients with psychosis. Inter-rater reliability of identifying these behaviours was assessed. Associations with patients' satisfaction were explored using a mixed linear regression model. We identified 18 different valuing behaviours ­ e.g. seeking patient's views and supportive statements ­ and four devaluing behaviours ­ e.g. talking over the patient and poor responding to concerns ­ that could be assessed with good reliability. The inter-rater reliability was high (ICC=.89). More valuing behaviour was linked to higher patient satisfaction with the communication (ß=.45, CI .14 to.77, p p<.01). It was found that psychiatrists value and devalue patients through a wide range of different behaviours, on which there is agreement among different observers. The inductively developed list of valuing behaviours may be validated through the association with higher patient satisfaction. The behaviours may be used in training and supervision to enhance the valuing of patients in consultations.