Manchester: A study by researchers at The University of Manchester and the University of Liverpool has examined the psychological treatment of more than 300 people suffering from psychosis, showing that, whatever the therapy, it is the relationship between the patient and therapist which either improves or damages wellbeing.
The research relates to one of the more controversial ideas in
psychotherapy research – the Dodo bird conjecture. Named after a bird
in Alice’s Adventures in Wonderland which sent several characters on a
race and then declared them all winners, this conjecture states that all
types of psychotherapy, even though often appearing to be very
different from each other, are equally beneficial to patients.
this case, the research showed that it is the quality of the
relationship between the therapist and patient which causes improvement
and not the different techniques employed in the two therapies that were
Many studies have looked at types of talking treatment
which can help people recover from psychotic episodes. These include
cognitive behavioural therapy (CBT) and family therapy. High quality
research uses a comparison group which also receives some kind of less
structured treatment, for example supportive counselling or befriending.
Surprisingly, patients in these comparison groups often benefit
from the comparison treatment as much as those receiving the specific,
targeted therapies (CBT or family therapy). Both groups who receive a
psychosocial treatment fare much better than those offered only
medication and usual care.
The researchers explored in depth the
causative effect of the ‘therapeutic alliance’ or relationship of trust
between patient and psychologist when schizophrenia patients were
treated during a trial of this kind.
Lucy Goldsmith, a PhD candidate from The University of Manchester’s Institute of Brain, Behaviour and Mental Health, carried out the research in collaboration with the researchers who had carried out the original trial: Manchester professors Shôn Lewis and Graham Dunn,
and Liverpool professor Richard Bentall. She said: “The quality of the
therapeutic relationship has been linked to outcomes before, but we
wanted to see whether the it really causes the changes in wellbeing
occurring during therapy.
“Does successful treatment make
patients feel well disposed towards their therapist or is the
relationship actually at the heart of whether therapy succeeds?”
using already established rating systems of these relationships and
taking data from the earlier study of 308 patients, the researchers
found that a good level of therapeutic alliance had a beneficial impact
on wellbeing, but where the relationship was poor, the treatment could
actually be damaging.
“The implications are that trying to keep
patients in therapy when the relationship is poor is not appropriate,”
Lucy said. “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.
study clearly shows that the two types of therapy are equally
beneficial to the patient – as long as the trust, shared goals and
mutual respect between client and psychologist are in place.”
The paper, ‘Psychological
treatments for early psychosis can be beneficial or harmful, depending
on the therapeutic alliance: an instrumental variable analysis,’ was published in the journal, Psychological Medicine.