young man representing session with a psychiatrist for schizophrenia
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Summary: Yes, having a good psychiatrist can help people with schizophrenia. More specifically, having a strong relationship with a good psychiatrist can help people with schizophrenia. A strong provider-patient relationship increases the likelihood of open and honest communication that can improve overall treatment outcomes.

Key Points:

  • Treatment for schizophrenia often focuses on medication rather than psychotherapy
  • Medications target symptom reduction, which is important, but healing/recovery is more than the absence of symptoms
  • A strong relationship with a psychiatrist is called a positive therapeutic alliance
  • A positive therapeutic alliance relies on components that are often missing from typical treatment for schizophrenia, which can improve quality of life, in addition to the symptom reduction associated with medication

For Schizophrenia, Medication is Important, But A Good Psychiatrist Can Help People With Schizophrenia Make More Progress Than Medication Alone

An article published in 2020 called “Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making” identifies and addresses a deficit in standard care for schizophrenia: the importance of emphasizing and prioritizing a strong therapeutic alliance between a psychiatrist and a person with schizophrenia.

Here’s how the study authors describe the situation:

“Integrated pharmacological and psychosocial treatments, such as psychoeducation (PE) and shared decision-making (SDM), have been shown to significantly improve outcomes for people living with schizophrenia (PLWS). Underpinning the success of these interventions is a strong therapeutic relationship between PLWS, their carers [i.e. family or non-family who help manage daily living], and their healthcare team.”

In the study, mental health experts advocate reconciliation, or finding a balance, between a medical/disease model of schizophrenia and a biopsychosocial model of schizophrenia. In brief, a medical model of mental illness prioritizes addressing dysfunction in brain chemistry and brain function, whereas a biopsychosocial model of a mental illness like schizophrenia:

“…considers the cause and course of schizophrenia as equally related to biological vulnerability interacting with social and psychological factors, e.g., isolation and low self-esteem, with recommended psychological interventions based on individual requirement.”

Addressing and resolving these psychosocial factors improves when a good psychiatrist helps people with schizophrenia by establishing a robust and positive therapeutic alliance.

Importance of a Strong Relationship/Positive Therapeutic Alliance in Schizophrenia Treatment

Evidence indicates a positive therapeutic alliance between a person with schizophrenia and their psychiatrist can lead to the following benefits:

  • Improved overall outcomes
  • Decreased symptom severity
  • Decreased hospitalization
  • Improved adherence to psychosocial support
  • Improved adherence to medication

However, in schizophrenia treatment today, there are factors, or barriers, that prevent or reduce the likelihood of a strong relationship. Barriers to strong relationships between patients and psychiatrists include:

  • Lack of insight from patient:
    • Patients may or may not recognize the scope of their illness
    • Most recognize and acknowledge the presence of hallucinations
    • Fewer recognize/admit the presence of delusions
  • Stigma, from:
    • Patient to self
    • Family to patient
    • Caregivers/support staff to patient
    • Cultural norms to patient
    • Therapist to patient
  • Inadequate/incomplete sharing of information:
    • Provider to patient:
      • May be result of poor provider training in psychoeducation
    • Includes lack of information about treatment, goals, outcomes
  • Absence of/minimal value of patient-centered outcomes:
    • Provider outcome goals:
      • Symptom reduction
      • Relapse prevention
    • Patient goals:
      • Acceptance by family, peers, and society
      • Return to work, school, or social life
    • Old/Archaic/Outdated POV:
      • Clinicians may avoid talking about:
        • Sexual activity
        • Alcohol/drug use
      • Families may avoid mental health topics altogether
        • People with schizophrenia from families who avoid mental health issues may not seek mental health treatment
      • Cultural groups may avoid mental health topics altogether
        • People with schizophrenia from cultural backgrounds/traditions that avoid mental health issues may not seek mental health treatment

Those barriers can increase the sense of isolation, loneliness, and disconnect a patient may feel during treatment. Those feelings can impair treatment progress, and in some cases, cause a patient to discontinue treatment. In most cases, it’s not that they want to quit/give up, but more that they don’t feel seen, and therefore, don’t see the point in continuing.

However, there is good news: a good psychiatrist can help people with schizophrenia overcome those barriers by strengthening the therapeutic alliance.

How to Strengthen the Bond Between Patient and Psychiatrist

This is where having a good psychiatrist can help people with schizophrenia the most. A good psychiatrist can help people with schizophrenia by improving their relationship in two primary ways:

  • Improving the quantity, quality, manner, and type of psychoeducation (PE) they offer during treatment
  • Prioritizing shared decision-making (SDM) in the therapeutic process

We’ll discuss what PE and SDM involve now, starting with PE.

Psychoeducation in Schizophrenia Treatment

In general, psychoeducation (PE) includes, but is not limited to:

  • Providing accurate, relevant and up-to-date information to PLWS, carers and family
  • Improving patient insight – see above – and giving practical support on managing symptoms

For patients and families, PE includes:

  • How to recognize symptoms
  • Understanding the impact of symptoms on daily function
  • Recognizing importance of treatment and adherence to treatment

Patient-focused PE includes:

  • Problem-solving skills
  • Identifying and achieving life goals

Family/caregiver PE includes:

  • Symptom awareness/recognition
  • Acceptance of the illness itself, the person, and atypical behaviors that cause no harm

As we can see, psychoeducation is a logical area to improve: knowledge is not only power, but knowledge empowers patients and their families.

Next, we’ll cover what we mean by SDM.

Shared Decision-Making in Schizophrenia Treatment

Shared decision-making involves:

  • Collaboration between patients and clinicians
  • Sharing information openly and honestly:
    • Provider to patient, and vice versa
    • Provider to family, and vice versa
    • Patient to family, and vice versa
  • Encouraging patients to express themselves

Empowering patients to make informed decisions about treatment preferences

Commonly identified barriers to SDM include:

  • Poor insight, among patients, leading to inability to make informed decisions
  • Society and culture-wide misunderstanding and misconception about schizophrenia
  • Ideas about treatment based on misunderstanding/misconceptions, rather than evidence

Those are the components of PE and SDM identified by study authors that can improve overall treatment outcomes for people with schizophrenia. We’ll close this article by offering their insight into practical approaches to improving both PE and SDM.

Strengthening the Treatment Alliance by Enhancing Psychoeducation and Shared Decision-Making

A good psychiatrist can help people with schizophrenia by focusing on the following aspects of psychoeducation:

  • Prioritize problem solving skills for the patient
  • Prioritize helping patients identify life goals
  • Helping patients learn skills to achieve life goals
  • Improve symptom identification/understanding for family/caregivers
  • Help caregivers learn to understand and accept the illness itself
A good psychiatrist will also self-monitor to ensure their preconceptions and/or opinions don’t influence how they treat patients with schizophrenia.

Here are the ways a good psychiatrist can help people with schizophrenia feel motivated to participate in shared decision-making during the treatment process:

  • Prioritize openness and honesty:
    • From providers in interactions with patients and families
    • From patients and families about symptoms and adherence to treatment
  • Build real trust:
    • Facilitated by openness, honesty, and genuine listening
  • Show genuine respect:
    • Felt by patients when providers listen and act on patient input
  • Create an atmosphere of warmth:
    • Kindness and understanding should be present in every interaction between provider and patient
  • Show interest in patient ideas and goals:
    • Providers should listen actively, and respond positively to appropriate insights from patient
    • Providers should actively facilitate the process of achieving patient identified life goals
  • Empathy:
    • Like warmth, kindness, and understanding, empathy and compassion should be obvious – on the part of the provider – in every interaction between provider and patient

With those objectives in mind, the authors of the study also recognize that pharmacological approaches to treating schizophrenia are essential:

“In our view, following pharmacological treatment guidelines is the gold standard of treatment in schizophrenia in order to prevent hospitalization, relapse, and to promote community independent living which is imperative for patient recovery.”

However, that’s not news, and not the goal of their work, nor is it the reason we wrote this article. Here’s their stated goal:

“…to identify the barriers to developing productive therapeutic relationships and explain how PE and SDM…can improve adherence to treatment, strengthen therapeutic relationships, and ultimately equip patients to achieve better functional outcomes.”

We can safely say they were successful. The mindful application of the information and techniques above can help everyone involved – patients, providers, and family/caregivers – improve treatment outcomes, and ultimately, quality of life, for people with schizophrenia.

Finding Help: Resources

If you or someone you know needs professional treatment and support for schizophrenia, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.