Therapeutic working relationships with people with schizophrenia: literature review

Abstract

The aim of this paper is to review the evidence for the necessity and sufficiency of therapeutic relationships when working with people with enduring mental health problems, such as schizophrenia. The value of therapeutic relationships in mental health nursing has been the subject of some debate within the profession. This debate has centred on the spectrum of beliefs about therapeutic relationships, ranging from the position that the relationship is both necessary and sufficient to enable change, to more technical approaches, to therapeutic intervention which de-emphasises the influence of the relationship. Searches for published material in English between 1986 and 2003 were carried out using the following databases: Cumulative Index of Nursing and Allied Health Literature; MEDLINE; Applied Social Sciences Index and Abstracts; Sociological abstracts; and social service abstracts. The search terms were: therapeutic alliance; therapeutic relationship; working alliance; and nurse-patient relationships. Papers chosen for inclusion in the review were those with a research focus on the elements and potential benefits/costs of therapeutic relationships in nursing. People who experience a relationship as being therapeutic appear to have better outcomes. A consistent finding of a number of meta-analyses is that therapeutic relationships characterized by facilitative and positive interpersonal relationships with the helper have in-built benefits, and that this is an important element of advanced techniques. In order for cognitive behavioural therapy to be successful, people need to feel understood and involved in the therapeutic relationship. Therapeutic relationships are necessary but not sufficient to enable change when working with people with schizophrenia.