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The therapeutic relationship in community mental health services: a systematic review of the literature

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Abstract

Purpose

This systematic review aimed to investigate the therapeutic relationship (TR) between mental health professionals (MHPs) and their patients in community mental health services (CMHS).

Methods

PubMed (Medline), PsycINFO, CINAHL, CENTRAL, and Web of Science were searched for studies that assessed TR in CMHS using quantitative measures developed specifically for this setting (i.e., Helping Alliance Scale [HAS] and the Scale to Assess the Therapeutic Relationship [STAR]). Studies were included if they considered adult patients with a psychiatric disorder and/or any MHP working in CMHS. Meta-analysis and narrative synthesis assessed the association between patients’ and MHPs’ ratings and identified predictors of TR.

Results

Of 1934 studies, 15 were included in the review, including 3004 patients. A total of 1127 patients and 963 MHPs were considered in the meta-analysis. The heterogeneity of the studies was high, and there was no significant difference between the patients’ and MHPs’ TR ratings in the random-effects model (standardized mean difference [SMD]: − 0.39 [95% CI: − 1.03; 0.24]). In the multivariable meta-regression, only duration of illness was significantly associated with TR ratings (unstandardized regression coefficient [B]: 0.388 [95% CI: 0.217; 0.558]). A recovery-oriented service, shared decision-making, and the recognition of patient needs contributed to more positive TR ratings.

Conclusion

Patients and MHPs converged in their TR ratings, although patients gave lower ratings. Routine assessment of TR in CMHS can inform reflective practice and service development, as TR can be assessed easily and early in the treatment process. Future research should focus on developing and testing interventions to improve TR in CMHS.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

    Mattia Marchi & Gian Maria Galeazzi

  2. Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy

    Mattia Marchi, Giulia Venturi, Margherita Pinelli & Gian Maria Galeazzi

  3. Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy

    Chiara Visentini

  4. East London NHS Foundation, London, UK

    Stefan Priebe

Authors
  1. Mattia Marchi
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  2. Giulia Venturi
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  3. Chiara Visentini
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  4. Margherita Pinelli
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  5. Stefan Priebe
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Contributions

Conceptualization: Stefan Priebe; literature search: Chiara Visentini, Margherita Pinelli, Giulia Venturi; data analysis: Mattia Marchi; writing—original draft preparation: Mattia Marchi, Giulia Venturi; writing—review and editing: Gian Maria Galeazzi, Stefan Priebe, Mattia Marchi.

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Correspondence to Gian Maria Galeazzi.

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The authors declare that they have no conflicts of interest.

Ethical standards

This systematic review is exempt from ethics approval because we are collecting and synthesizing data from previous studies in which ethical approval has already been obtained by the trial investigators at their respective local sites.

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Marchi, M., Venturi, G., Visentini, C. et al. The therapeutic relationship in community mental health services: a systematic review of the literature. Soc Psychiatry Psychiatr Epidemiol 59, 731–743 (2024). https://doi.org/10.1007/s00127-023-02581-2

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