THE DOCTOR-PATIENT RELATIONSHIP IN A PSYCHOPHARMACOLOGICAL TREATMENT SETTING

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Abstract
The doctor-patient relationship in the initial interview was studied for 30 schizophrenic outpatients receiving combined drug and brief psychotherapy. The doctor and patient aspects of the relationship were objectively assessed and the paired ratings used for a designation of consistent or inconsistent treatment relationships. An inconsistent doctor-patient relationship was found to militate against a favorable response to placebo (10 out of 12 cases), as well as against continuation in treatment (nine out of 12 dropped out). When the relationship was consistent, the placebo responses were divided between favorable and unfavorable responses, there being 9 of each. In terms of clinic outcome, all 9 unfavorable placebo responders in the consistent group were found to be treatment "failures," either dropping out or being hospitalized. Amomg the favorable placebo responders, 6 out of the 9 continued in active treatment. We have thus demonstrated a sequence of events and their re-latedness in psychopharmacological treatment: initial doctor-patient relationship, placebo response, and ultimate clinical outcome. We view the schizophrenic outpatient in psychopharmacological treatment as being extremely sensitive to the initial interview relationship and placebo factors. When presented with a consistent relationship, if he is unable to respond positively to an oral placebo, active treatment involvement is precluded.

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