DOES A "THERAPEUTIC RELATIONSHIP" MAKE A DIFFERENCE?

One of the reasons that I am not a provider for medical insurance [so my patients have to pay out of pocket for my services] is that reimbursement is very restricted and the medical insurance companies justify this by suggesting that a reasonable and customary amount of time with a patient to help them with their medications is 10-15 minutes. That is not enough time for me to help my patients determine if the medication is helping and if the dose is appropriate. I am convinced that I need to have established a relationship with my patients so that they feel comfortable telling me things and trust my judgement about their medications. This takes more than 10-15 minutes, initially taking 60 + minutes and after that a minimum of 30 minutes. When 30 minutes has been scheduled helping my patients can take longer and I will then add another 15 minutes and even another 30 minutes sometimes. I hesitate to do this if I am scheduled without an immediate break and yet my patients have been understanding if I am running late due to needs of one of my patients as they know that I would spend extra time with them if it were needed.

What if therapeutic relationships with patients is not important to how well they do with medications? There was an article in Psychiatr Serv. 2018 Jan 1;69(1):41-47 by Totura, CMW, et al. entitled "The Role of Therapeutic Relationship in Psychopharmacological Treatment Outcomes: A Meta-analytic Review". This study looked at the role of therapeutic relationships in the delivery of effective psychopharmacological treatment.

The authors reviewed many publication sites looking for articles addressing the above question. They found eight independent studies that were empirically based [involving 1065 patients] in which measures of the therapeutic relationship were administered and psychiatric treatment outcomes were assessed. They found that the overall average weighted effect size for the association between the therapeutic relationship and treatment outcomes was z = .30 indicating a statistically significant, moderate, positive effect of the alliance on outcomes of psychopharmacological treatments. 

So, the above review of 8 studies supports the benefit of a therapeutic alliance [relationship] on the outcome of psychopharmacoloical treatments [treating people who have psychiatric disorders with medication].

I see the benefit everyday in my work with people who come to me.