Patient-rated therapeutic relationship and outcome in general practitioner treatment of psychological problems.

OBJECTIVE: To explore the association between therapeutic relationship and clinical outcome in general medical practitioner (GP) treatment of emotional problems.
DESIGN: Correlational analyses of patient and observer measures of GP consultations with 3-month clinical outcomes.
METHOD: Patients of nine GPs, presenting with emotional problems as assessed by the 30-item General Health Questionnaire (GHQ-30), were interviewed and completed a questionnaire about their experience of their consultation with the GP. The audiotaped consultations were coded by external observers for patient involvement, doctor empathy and amount of the consultation that involved listening interactions (patient talking and doctor listening). After 3 months the patients completed a postal follow-up questionnaire including the GHQ-30 and a single item measure of patient perceived change.
RESULTS: Fifty-seven patients provided follow-up data. Interview and questionnaire measures of patient perceptions of their relationship with the GP in the consultation predicted both GHQ-30 outcome at 3 months (partial correlations controlling for initial GHQ-30, r = .30 and r = .36) and patient perceived change on the single item measure. Observer ratings of patient involvement and doctor empathy predicted patient rated change on the single item measure, but not follow-up GHQ-30. Observer coded listening interactions were unrelated to both outcome measures.
CONCLUSION: The results indicate an association between patient perceptions of how GP and patient related in the consultation and reduction in symptom severity 3 months later.