The Role of the Therapeutic Relationship in Psychopharmacological Treatment Outcomes: A Meta-analytic Review

Psychiatr Serv. 2018 Jan 1;69(1):41-47. doi: 10.1176/ Epub 2017 Sep 15.


Objective: Patient nonadherence to psychopharmacological treatment is a significant barrier to effective treatment. The therapeutic relationship is known to be a critical component of effective psychological treatment, but it has received limited study. A meta-analysis was conducted to examine the role of the therapeutic relationship in the delivery of effective psychopharmacological treatment.

Methods: PubMed, PsycINFO, CINAHL, Google Scholar, Ingenta, and the Web of Science-Science Citation Index were searched, including reference lists of found articles. Meta-analytic methods were used to examine the association between the physician-patient therapeutic relationship and outcomes in psychopharmacological treatment.

Results: Eight independent studies of psychopharmacological treatment reported in nine articles met the inclusion criterion (1,065 participants) of being an empirically based study in which measures of the therapeutic relationship were administered and psychiatric treatment outcomes were assessed. The overall average weighted effect size for the association between the therapeutic relationship and treatment outcomes was z=.30 (95% confidence interval=.20-.39), demonstrating a statistically significant, moderate effect.

Conclusions: Findings indicate that a positive therapeutic relationship or alliance between the physician and the psychiatric patient is associated with patient improvement over the course of psychopharmacological treatment. Results suggest that more attention should be paid to psychiatrist communication skills that may enhance the therapeutic alliance in psychopharmacological treatment.

Keywords: Adherence; Meta-Analysis; Physician-Patient Relationship; Psychopharmacological Treatment; Therapeutic Alliance.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Combined Modality Therapy / statistics & numerical data
  • Humans
  • Mental Disorders / drug therapy
  • Mental Disorders / therapy*
  • Middle Aged
  • Outcome and Process Assessment, Health Care / statistics & numerical data*
  • Physician-Patient Relations*
  • Psychotherapy / statistics & numerical data*
  • Psychotropic Drugs / therapeutic use*
  • Therapeutic Alliance*
  • Young Adult


  • Psychotropic Drugs