On the Healing Pathway – Zooming in on Patient-Provider Roles and Interactions in Psychotherapy

The therapeutic relationship is a paramount constituent of psychotherapy. Thus, the patient and provider persona who form this bond, as well as their interactions, are central within the therapeutic process. Accordingly, research underpins that patient and therapist characteristics as well as features of their interaction affect therapy outcomes considerably. Yet, several questions remain open comprising ethical, process, and interaction-related aspects and hence deserve further scrutiny. Clinical practice would, for instance, benefit from an expanded understanding of patients’ decision making, effects of transparent practitioner communication, and prospects of individualized therapy implementation. Given the challenge of disparities and inappropriate provision of psychotherapy across countries, a thorough understanding of patient-provider effects and underlying mechanisms might also support the provision of optimized, ethically eligible, and feasible psychotherapies.
To this aim, the present thesis zoomed in on three examples of patient-provider interactions in order to determine the importance of patient and provider roles and interactions for apt and ethically sound psychotherapies. Due to the complex and dynamic nature of psychotherapy, it seemed appropriate to adopt different methodological approaches. Consequently, this thesis builds upon distinct methodologies. Hence, i.) in order to determine health care providers’ influence on patients’ therapy uptake, a longitudinal study with oncological patients was conducted (Frey Nascimento et al., 2019; Study 1). Then, ii.) in order to assess the importance of a comprehensive treatment rationale, a randomized-controlled trial with a placebo intervention without deception was carried out with healthy participants by means of a heat pain experiment (Locher et al., 2017; Study 2). Further, iii.) a theoretical and ethical analysis on active patient involvement within the psychotherapeutic process was undertaken (Gerger et al., 2020; Study 3).
The study of oncological patients’ therapy uptake (Study 1) showed that patients who reported to have received a recommendation by their oncologist were more likely to use the offer than those who did not report having received a recommendation independent of distress level (odds ratio = 6.27, 95% confidence interval = 3.14-12.85, p < 0.001). The heat
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pain open-label placebo study (Study 2) revealed that healthy participants who obtained a plausible treatment rationale reported significantly less subjective heat pain intensity (t(146) = -2.15, p = 0.033, d = 0.43) and unpleasantness (t(146) = - 2.43, p = 0.016, d = 0.49) in comparison to a control group. The theoretical and ethical analysis (Study 3) indicated that active patient involvement should be strengthened and highlighted the need for transparent and patient-oriented communication within the therapeutic process.
Concluding, the three presented studies corroborate the need for health care providers to be conscious about how their behavior and communication shapes patients’ decisions and affects therapy outcomes. What is more, in order to comply with ethical principles and to provide psychotherapy aptly, therapies should be patient-centered and, whenever possible, communication should be transparent.