Relationsship between staff that provide professional support and clients with complex psychiatric needs

A good and trusting relationship with the person who provides professional support can be a factor that affects how a client with complex psychiatric problems recovers and engages in treatment and support. When the support provided is in the form of therapy, this relationship is often called the therapeutic alliance.

Reading time approx. 6 minutes Published: February 16, 2024 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

What systematic reviews have been published regarding the relationsship between those that provide professional support for complex psychiatric needs and their clients?

Method

A systematic literature search was performed using the following databases: MedLine (Ovid), Scopus and PsycInfo.

Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

One relevant systematic reviews with moderate risk of bias were identified [1]. The results and conclusions are presented in Table 1. In fourteen relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [2-15].

Table 1 Systematic reviews with low/moderate risk of bias.
Included studies	Population, Intervention, Control	Outcome and Results
Authors' conclusion:“The observed TA-therapy engagement and TA-outcome associations were broadly consistent with those identified across non-psychotic diagnostic groups. Well-powered studies are needed to investigate the relationship between TA and process as well as outcome in psychological therapy for psychosis specifically.”
Bourke et al, 2021 [1] Systematic review and meta-analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis
24 articles 13 articles included in meta-analyses Setting: United Kingdom: 10 studies USA: 6 studies Canada: 3 studies Australia: 2 studies Ireland, Netherlands, Sweden: 1 study each	Population: Patients with affective or non-affective psychosis, or dual diagnosis of psychosis and substance use disorder (n=1656). Exposure: Alliance in psychological therapies (CBT (different combinations and focus), skills training, cognitive remediation therapy, individual psychotherapy, behavioural family management or acceptance and commitment therapy). Alliance measure: Working Alliance Inventory (WAI), WAI short form, WAI group, Psychotherapy Status Report, California Psychotherapy Alliance Scale, Vanderbilt Therapeutic Alliance Scale, Agnew Relationship Measure, Working Alliance Inventory, System for Observing Family Therapy Alliances.	Global psychiatric symptoms and Client-rated alliance (5 studies) r=0.29 (95% CI, 0.13 to 0.45) Global psychiatric symptoms and Therapist-rated alliance (6 studies) r=0.24 (95% CI, 0.09 to 0.39) Psychotic symptoms and Client-rated alliance (5 studies) r=0.17 (95% CI, 0.04 to 0.30) Psychotic symptoms and Therapist-rated alliance (3 studies) r=0.30 (95% CI, 0.14 to 0.46) Engagement in therapy and Client-rated alliance (5 studies) r=0.36 (95% CI, 0.13 to 0.60) Engagement in therapy and Therapist-rated alliance (4 studies) r=0.40 (95% CI, 0.12 to 0.68)

Search strategy

Medline via OvidSP 24 Jan 2024
Search terms		Items found
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract;.kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population
1.	Stress Disorders, Post-Traumatic/	42 340
2.	(ptsd or post traumatic or posttraumatic).ab,bt,kw,ti.	89 252
3.	1 or 2	98 420
Intervention
4.	written exposure therapy.ab,bt,kw,ti	48
5.	exp Psychotherapy/
6.	(psychotherapy or ((exposure or psychological) adj3 (therapy or treatment))).ab,bt,kf,ti.	65 554
7.	5 or 6	249 794
Study types: systematic reviews and meta-analysis
8.	((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys" or metaanalys).ti,bt,ab.) not (editorial/ or letter/ or case reports/))
Combined sets
9.	3 and 7 and 8	751
10.	4 or 9	798
Final result
11.		798

Scopus via scopus.com 24 Jan 2024
Search terms		Items found
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); />ALL = All fields W/n = Within. Proximity operator retrieving terms within n words from each other. PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words. LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range. DOCTYPE = Publication type “re” = review “le” = letter “ed” = editorial “ch” = book chapter “cp” = conference proceedings * = Truncation “ “ = Citation Marks; searches for an exact phrase
Population
1.	TITLE-ABS-KEY ( ptsd OR posttraumatic OR "post traumatic" )	144 937
Intervention
2.	TITLE-ABS-KEY(“written exposure therapy”)	50
3.	TITLE-ABS-KEY ( psychotherapy OR ( ( exposure OR psychological ) W/3 ( treatment OR therapy ) ) )	214 380
Study types: systematic reviews and meta-analysis
4.	TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy" OR metaanaly ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))
Combined sets
5.	1 AND 3 AND 4	1150
6.	2 OR 5	1196
Final result
7.		1196

CINAHL, PsycInfo, SocINDEX, Psychology and behavioral science collection via EBSCO 24 Jan 2023
Search terms		Items found
TI = Title AB = Abstract SU = Keyword, exact or part (including all other fields for indexed and author keywords) MH = Exact subject heading, indexed keywords TX = All text PT = Publication type Nn = Near. Proximity operator retrieving terms within n words from each other. * = Truncation “ “ = Citation Marks; searches for an exact phrase ^a. Glanville J, Dooley G, Wisniewski S, Foxlee R, Noel-Storr A. Development of a search filter to identify reports of controlled clinical trials within CINAHL Plus. Health Info Libr J. 2019;36(1):73-90. Available from: https://doi.org/10.1111/hir.12251.
Population
1.	TI ( ptsd OR posttraumatic OR "post traumatic" ) OR AB ( ptsd OR posttraumatic OR "post traumatic" ) OR SU ( ptsd OR posttraumatic OR "post traumatic" )	141 192
Intervention
2.	TI (“written exposure therapy”) OR AB(“written exposure therapy”) OR SU (“written exposure therapy”)	64
3.	TI ( ( psychotherapy OR ( ( exposure OR psychological ) N3 ( treatment OR therapy ) ) ) ) OR AB ( ( psychotherapy OR ( ( exposure OR psychological ) N3 ( treatment OR therapy ) ) ) ) OR SU ( ( psychotherapy OR ( ( exposure OR psychological ) N3 ( treatment OR therapy ) ) ) )	314 850
Study types: systematic reviews and meta-analysis / randomized controlled trials^a.
4.	((TI((systematic N3 review) OR "meta analys" OR metaanalys) OR AB((systematic N3 review) OR "meta analys" OR metaanalys) OR SU((systematic N3 review) OR "meta analys" OR metaanalys)) OR (PT "Systematic Review" OR PT "meta analysis")) NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter")
Combined sets:
5.	1 AND 3 AND 4	1073
6.	2 OR 5	1162
Final result
7.		1162

Page published February 16, 2024