Effective nurse–patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance
Open accessAbstract
BACKGROUND: Therapeutic alliance is a core part of the nursing role and key to the attainment of positive outcomes for people utilising mental health care services. However, these relationships are sometimes difficult to develop and sustain, and nursing staff would arguably benefit from evidence-based support to foster more positive relationships. OBJECTIVES: We aimed to collate and critique papers reporting on interventions targeted at improving the nurse-patient therapeutic alliance in mental health care settings. DESIGN: Systematic literature review. DATA SOURCES: The online databases of Excerpta Medica database (Embase), PsycINFO, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched, eligible full text paper references lists reviewed for additional works and a forward citation search conducted. REVIEW METHODS: Original journal articles in English language were included where they reported on interventions targeting the nurse-patient therapeutic relationship and included a measure of alliance. Data were extracted using a pre-determined extraction form and inter-rater reliability evaluations were conducted. Information pertaining to design, participants, interventions and findings was collated. The papers were subject to quality assessment. RESULTS: Relatively few eligible papers (n = 8) were identified, highlighting the limitations of the evidence base in this area. A range of interventions were tested, drawing on diverse theoretical and procedural underpinnings. Only half of the studies reported statistically significant results and were largely weak in methodological quality. CONCLUSIONS: The evidence base for methods to support nursing staff to develop and maintain good therapeutic relationships is poor, despite this being a key aspect of the nursing role and a major contributor to positive outcomes for service users. We reflect on why this might be and make specific recommendations for the development of a stronger evidence base, with the hope that this paper serves as a catalyst for a renewed research agenda into interventions that support good therapeutic relationships that serve both staff and patients.
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The review reinforces that the quality of the therapeutic relationship is central to how psychiatric care is experienced.
“In line with previous literature, our review reinforces that the quality of the therapeutic relationship is central to how psychiatric care is experienced [164,165].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [164]
These complex processes can be hindered by the nature of organizational structures and positions that limit the care HCPs can offer.
“These complex processes can be hindered by the nature of organizational structures and positions that limit the care HCPs can offer [90].”
From Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis (2023) · cites this paper as [90]
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“…that nurses have with patients can benefit those experiencing negative mental health outcomes, and nurses participate in mental health screenings, support patients in adhering to treatment protocols, and act as emotional support when patients express their concerns (Hartley et al., 2020).”
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- Authors
- Hartley, S., Raphael, J., Lovell, K., & Berry, K.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- University of Manchester (GB)
- Corresponding author
- Hartley, Samantha
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 102
- Pages
- 103490
- ISSN
- 0020-7489 (ISSN-L)
- PMC
- PMC7026691
- OpenAlex
- W2991412702
- Cited by
- 245
- References
- 82
- Citations by year
- 2026: 43 · 2025: 35 · 2024: 52 · 2023: 39 · 2022: 45 · 2021: 23 · 2020: 7
- FWCI
- 2.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Nursing Studies (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Funders
- National Institute for Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- therapeutic relationship, psychiatric nursing, nursing interventions, nurse-patient relationship, mental health services, evidence base, methodological quality
- MeSH terms
- Therapeutic Alliance, Humans, Mental Health Services, Nurse-Patient Relations
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