Added February 7, 2019

One of the common mistakes within primary and psychiatric care is the lack of a solid therapeutic relationship between the healthcare provider and the patient.

A therapeutic relationship is also known as a therapeutic alliance, defined in part, as a bond which captures the human aspect of a relationship between the provider and patient based upon trust, respect and care, all the while maintaining professional boundaries. (1)

While striving to administer to the needs of patients with comorbid diseases, psychiatric illnesses, and substance abuse or dementia; healthcare providers may become unintentionally mechanical in their care. Patients may begin to form distrust in the healthcare provider and their ability to relate personally to them and accurately diagnose the underlying condition and provide adequate treatment.

This lack of confidence in the diagnosis contributes to 50% of patients having non-adherence to prescribed medications which cause other significant clinical problems for both patient and practitioner. Non-adherence is linked to continual relapse, rehospitalization, poor quality of life, death and high medical costs. (2)

“A good [mental health professional] possesses a unique set of qualities, including wisdom, insight, empathy and social intelligence, paired with the analytical ability and up-to-date grasp of psychopharmacology required to piece together medication strategies for complex and difficult-to-characterize symptoms… a good [mental health professional] has both a deep understanding of humanity and an extraordinary ability to relate to all types of people.” (3)

Abilash Gopal, M.D.

Drs. George Engel and John Romano of Rochester, New York strive to bring these qualities to their practice and to recognize a psychiatric patient’s needs allowing the patient to be understood and validated. Seeing the lack within existing traditional therapies, Engel and Romano developed a holistic alternative to the diagnosis and treatment protocols of their day.

The “Biopsychosocial model” pioneered by Dr. Engle and Romano systematically consider the person’s physical biology, psychological and social factors and their complex interrelationship. All the while providing humane compassionate care rather than strictly mechanical biomedical aspects of chronic and psychiatric disease management. (4)(5)

Today, implementing a biopsychosocial model could offer primary care doctors and clinicians, an in-depth perspective towards further understanding the interactions between biological and psychosocial elements of illnesses which would further benefit the dyadic relationship between physicians and clinicians and their patients.

The model is often considered impractical or too complicated to fully implement as a bridge between the healthcare provider and patient due to: workload, time constraints, and a lack of adequate psychiatric training and knowledge.

A strong therapeutic alliance could also be beneficial when applied to the multidisciplinary approach in transition-patient care. This would result in improved clinical outcomes because patients are now taking an active role towards their own health. Patients would then have a professional care management team who are experienced and can relate. (6)

“I think the biopsychosocial model helps encapsulate that we are human and that we have emotions. I think we forget that when we are in primary care, in that cog wheel of seeing patients left and right, every day, all day… When dealing with psychiatric disorders people are more disposed to being emotionally dysregulated and sensitive and I think we got to remember that we are dealing with humans and sometimes we need to give that empathy so that they can open up… And that is why I think it is important to address psychosocial factors because it may be the reason why they are depressed or anxious, they don’t like to go in the crowds, they are introverted and that is what causes their anxiety, so it is kind of a cause and effect or effect and cause.” – Rodney Ho, Psychiatric Physician Assistant. (7)

CareAdopt’s technology-enabled remote care management services provided real-time therapeutic alliance strategies between the psychiatric patient, primary care provider, clinician and care management team.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735851/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338634/
3. Abilash Gopal, M.D.
4. https://www.huffpost.com/entry/a-good-psychiatrist-is-hard-to-find_b_775645
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466742
6. https://www.merriam-webster.com/medical/biopsychosocial
7. https://www.urmc.rochester.edu/medialibraries/urmcmedia/education/md/documents/biopsychosocial-model-approach.pdf
8. CareAdopt Webinar #3: 12.18.2018