It’s good to talk: training psychiatrists to improve communication with patients


Understanding what it is like living with psychosis is very difficult. Staff and service users often struggle to talk openly and freely about symptoms. Therefore being able to develop a therapeutic relationship is key in mental health; however, it remains poorly taught and misunderstood across all health care professionals.

This study by McCabe et al (2016) aimed to see if psychiatrists’ communication skills and therapeutic relationship could be improved by focusing on developing a shared understanding.


The study was a cluster randomised controlled trial, with psychiatrists being randomised into two groups:

  1. The intervention was a manualised training course of four 3-hour sessions and one feedback session. The TEMPO manual (PDF) itself covers 150 pages
  2. The control group delivered care as usual.

Video data of consultations were collected at baseline and follow up (five months later).

The main outcomes focused on psychiatrists attempts to establish shared understanding (self-repair) and therapeutic relationship.


  • 25 out of 35 psychiatrists were randomised, however a further 4 were excluded
  • There were 10 psychiatrists in the intervention group and 11 in the control
  • 97 out of 407 eligible patients were recruited, 64 of which were followed up
  • Psychiatrists in the intervention group used 44% more self-repair (95% CI 1.46 to 11.33, P<0.011)
  • The therapeutic relationship was perceived more positively by psychiatrists (95% CI 0.03 to 0.37, P<0.022) and patients (95% CI 0.01 to 0.41, P<0.043) in the intervention arm
  • Psychiatrist self-confidence in communicating with those who were psychotic increased after the training (t=5.19, 95% CI 1 to 2.04, P<0.01).
This trial found that a manualised training programme helped psychiatrists build more self-confidence in their communication.

This trial found that a manualised training programme helped psychiatrists build more self-confidence in their communication.


The authors concluded:

This is the first study to test an intervention for psychiatrists to enhance communication with patients with psychosis. It suggests that shared understanding, which can be challenging in the treatment of psychosis, can be targeted in training and is important for improving the quality of the communication and the therapeutic relationship.


This is a relatively small trial which focuses on improving the communication style and therapeutic relationships of psychiatrists through measuring self-repair. Whilst improving the therapeutic relationship is important, whether this brings about meaningful improvements and helps aid recovery is undoubtedly more important.

My first impression after reading this paper was surprise that improving the communication skills of psychiatrists had not been tried in this way before, indeed this was reported as the first trial of its kind for psychiatrists. For more than 30 years, there has been substantial training of health care practitioners to help them communicate therapeutically with people living with psychosis. Surely such fundamentals of good care should be a core part of training for all psychiatrists?

Readers wanting to find out more may like to explore the lessons learned from Thorn training and subsequent Cognitive Behavioural Therapy/Psychosocial Interventions for psychosis courses, which have been in existence for more than 20 years. Given the multidisciplinary nature of mental health work, more cross-discipline research in this area may yield benefits and avoid duplication of effort.

There are lots of useful resources out there to guide clinicians towards improve communication skills with someone who may be psychotic. I would recommend starting with this 2009 report called Talking with acutely psychotic people (PDF), by Len Bowers and colleagues.

Communication skills: surely a prerequisite for all professionals working with people with severe mental illness?

Communication skills: surely a prerequisite for all professionals working with people with severe mental illness?


Primary paper

McCabe R, John P, Dooley J, Healey P, Cushing A, Kingdon D, Bremner S, Priebe S. (2016) Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial. The British Journal of Psychiatry Jul 2016, bjp.bp.115.179499; DOI: 10.1192/bjp.bp.115.179499

Other references

Bowers L, Brennan G, Winship G, Theodoridou C. (2009) Talking with acutely psychotic people. Communication skills for nurses and others spending time with people who are very mentally ill (PDF). City University, London.

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John Baker

John Baker was appointed to Chair of Mental Health Nursing in 2015. John's research focuses on developing complex clinical and psychological interventions in mental health settings. He is particularly interested in i) acute/inpatient mental health services and clinical interventions; ii) medicines management in mental health care; iii) the attitudes and clinical skills of mental health workers, iv) the mental health workforce. The good practice manuals which he developed have been evaluated, cited as examples of good practice, and influenced clinical practice in the UK and abroad. The training package for patients, service users and carers to promote research awareness and understanding has been cited by the MHRN and NICE as an exemplar of good practice.

John is a member of the NIHR post-doctoral panel, sits on the Editorial boards for Journal of Psychiatric and Mental Health Nursing & International Journal of Mental Health Nursing. He is a Registered Nurse Teacher with the Nursing, Midwifery Council (NMC) and is active within Mental Health Nursing Academics (UK).

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