The quality of the professional-patient relationship in the treatment of mental illness predicts patient outcome. Hence, we conducted a review of recorded professional-patient communication to identify existing research, methods, and findings. Sixteen studies focused on (i) how psychiatric symptoms are manifested in patient communication; (ii) the role of therapist communication in patient improvement; (iii) the influence of sociodemographic characteristics on doctorpatient communication; and (iv) how patients and professionals jointly construct therapeutic interactions. The findings were disparate and included (a) patient nonverbal communication is impaired in depression and schizophrenia; (b) the use of specific therapeutic skills led to improvement in depression; high expressed emotion (criticism and emotional over-involvement) in treating schizophrenia was a state rather than trait characteristic of therapists; (c) patient gender, income, and education influenced communication about depression, anxiety, and medication; and (d) psychiatrists' varying institutional agendas, which sometimes competed with patients' agendas, strongly shaped their consultations. Few studies investigated two-way professional-patient communication, with most focusing on either patient or therapist communication in isolation from the other. Finally, methodological advances in linking communication processes with treatment outcomes in large-scale observational studies and trials are a challenge for research on medical communication.

Aims and MethodA positive therapeutic relationship is essential to psychiatry and should take into account patients' preferences. Preferences of 133 community care patients were surveyed regarding dress and forms of address of six professions. Participants' sex, age, ethnicity and diagnosis were recorded.ResultsNinety-eight per cent of participants expressed a preference. While most preferred to be called ‘patients' by general practitioners (75%) and psychiatrists (67%), there was no statistically significant difference in preference for the term ‘patient’ or ‘client’ when used by community psychiatric nurses, occupational therapists, psychologists or social workers. Participants over the age of 40 preferred the term ‘client’. Asymmetrical relationships were preferred with general practitioners and psychiatrists, evidenced by a preference to be addressed by first name (71% and 68%, respectively), to address the professional by title (81% and 80%, respectively), and the professional to be ‘smartly’ dressed (67% and 66%, respectively).Clinical ImplicationsA more differentiated approach may be suggested by taking professional background and some demographic characteristics into consideration.

Fox Z, Lloyd-Evans B, et al. A mixed-methods study exploring therapeutic relationships and their association with service user satisfaction in acute psychiatric wards and crisis residential alternatives. Health Serv Deliv Res 2014;2(22).

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Aims and Method A positive therapeutic relationship is essential to psychiatry and should take into account patients' preferences. Preferences of 133 community care patients were surveyed regarding dress and forms of address of six professions. Participants' sex, age, ethnicity and diagnosis were recorded. Results Ninety-eight per cent of participants expressed a preference. While most preferred to be called ‘patients' by general practitioners (75%) and psychiatrists (67%), there was no statistically significant difference in preference for the term ‘patient’ or ‘client’ when used by community psychiatric nurses, occupational therapists, psychologists or social workers. Participants over the age of 40 preferred the term ‘client’. Asymmetrical relationships were preferred with general practitioners and psychiatrists, evidenced by a preference to be addressed by first name (71% and 68%, respectively), to address the professional by title (81% and 80%, respectively), and the professional to be ‘smartly’ dressed (67% and 66%, respectively). Clinical Implications A more differentiated approach may be suggested by taking professional background and some demographic characteristics into consideration.