Training to Enhance Psychiatrist Communication with patients with Psychosis (TEMPO): A Cluster Randomized Controlled Trial

Abstract

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. Methods: In a cluster randomized controlled trial in the U.K., 21 psychiatrists were randomized. 97 (51% of those approached) outpatients with schizophrenia/schizoaffective disorder were recruited. 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualized 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 (6.4, 95% CI 1.46 to 11.33, p<.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (0.20, 95%CI 0.03 to 0.37, p=.022, a large effect), as did patients (0.21, 95% CI 0.01 to 0.41, p=.043, a medium effect). Conclusions: Shared understanding can be successfully targeted in training and improves relationships in treating psychosis. Trial Registration: Current Controlled Trials ISRCTN94846422