I started to reply to a post over at Mental Nurse but had to stop. It was becoming a rant and I rather feel it's bad form to go somewhat off topic and to rant on someone else's site. So instead I've shamelessly nicked the theme and can wax lyrical at length, as is my wont. At length, hmmmm. I do "at length" well enough, I do "brevity" appallingly badly. As my nursing colleagues tell me, flawed though I am that at least I'm self aware :-) After a manager wanted to highlight some good practice in our service I've been charged to talk at a conference in a couple weeks time for a total of 15 minutes. 15 minutes?! An impossible task, reinforcing views that managers are out of touch with clinicians and heartless ;-)
Back on topic . . . therapeutic relationships.
The point, well made, is that outcomes of therapeutic interventions is uncontestably associated with the quality of the therapeutic relationship. For some folk in some situations this isn't true. A mother with a newborn baby who has crashing postnatal depression needs to be well, and quickly, evidence is ECT is more effective than medication or talking therapies and has better outcomes than pills, talk or watchful waiting (and less side effects, and half the deaths that tablet treatment results in). As one cheeky colleague has told me sometimes bedside manner counts for nigh on naught and what you want is to be found within the National Grid.
But, for most folk, most of the time, the form of the clinical interaction adds benefits in addition (or even more so) than the content of the clinical event. Psychodynamic psychotherapists would be more extreme, saying their interaction is almost everything.
The content matters too, but as has been said, a clinician with a great relationship doing anything can be useful to most people. A clinician with appalling relationships with their patients doing the "best" intervention is useless to most of their patients. Patients have no trust in the diagnosis, no belief in the formulation, no confidance in the intervention, no conviction they will improve and see no credibility in the interaction.
How the relationship between a doctor and a patient is framed matters, Primary Care are good at looking at this, with Michael Balint's view of "the doctor is the drug" being oh so true.
In 2003 we were told about New Ways of Working for all by NIMHE. In 2005 the Department of Health told us all about New Ways of Working for psychiatrists. More recently CSIP have told us about New Ways of Working. I believe I do a lot of the New Ways of Working malarky already (as do managers, it seems, as they want me to talk for 15 minutes about it).
But really, there's not a whole heap of new stuff to do, is there? I think we used to have it right. So in my corner, at least, we can have medics and nurses and PAMs and clerical staff and managers all working towards patients getting excellent care (we do, the Healthcare Commission says so) with clinicians having the time and space to form meaningful, useful therapeutic relationships.