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dc.contributor.authorMcCabe, Rose
dc.contributor.authorThompson, L
dc.contributor.authorHowes, Christine
dc.date.accessioned2015-07-01T13:10:46Z
dc.date.issued2015
dc.description.abstractBackground Psychiatrist questions are the mechanism for achieving clinical objectives and managing the formation of a therapeutic alliance - consistently associated with patient adherence. No research has examined the nature of this relationship and the different practices used in psychiatry. Questions are typically defined in binary terms e.g. ‘open’ vs ‘closed’ that may have limited application in practice. Aims To undertake a detailed examination of the types of questions psychiatrists ask patients and explore their association with the therapeutic alliance and patient adherence. Method A coding protocol was developed to classify questions from 134 outpatient consultations, predominantly by syntactic form. Bivariate correlations with measures of patient adherence and the therapeutic alliance (psychiatrist-rated) were examined and assessed using Generalised Estimating Equations, adjusting for patient symptoms, psychiatrist ID and amount of speech. Results Psychiatrists used a small subset (4/10) of question types regularly 1) yes/no auxiliary questions 2) wh questions 3) declarative questions and 4) tag questions. Only declarative questions predicted better adherence and perceptions of the therapeutic relationship. Conversely, wh questions - associated with positive symptoms – predicted poorer perceptions of the therapeutic relationship. Declarative questions were frequently used to propose an understanding of patients’ experiences, in particular their emotional salience for the patient. Conclusions A more granular definition of questioning practices is necessary to improve communication in psychiatry. The use of declarative questions may enhance the alliance and adherence - or index their manifestation in talk e.g. better mutual understanding. The function of ‘soprefaced’ declaratives, also found in psychotherapy, are more nuanced than negatively connotated ‘leading’ questions. Hearable as displays of empathy, they attend closely to patient experience, while balancing the tasks of assessment and treatment.en_GB
dc.description.sponsorshipMedical Research Councilen_GB
dc.identifier.citationDOI: 10.1192/bjp.bp.114.151910en_GB
dc.identifier.doi10.1192/bjp.bp.114.151910
dc.identifier.grantnumberG0401323en_GB
dc.identifier.urihttp://hdl.handle.net/10871/17723
dc.language.isoenen_GB
dc.publisherRoyal College of Psychiatristsen_GB
dc.rights.embargoreasonPublisher Policyen_GB
dc.titleThe effect of questions used by psychiatrists on therapeutic alliance and adherenceen_GB
dc.typeArticleen_GB
dc.identifier.issn1472-1465
dc.descriptionAccepteden_GB
dc.descriptionThis is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.orgen_GB
dc.description© The Royal College of Psychiatrists 2015en_GB
dc.descriptionPublished online November 19, 2015, ahead of print.
dc.identifier.journalBritish Journal of Psychiatryen_GB
dc.identifier.pmid26585093


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