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Therapeutic Communication in Schizophrenic Patients: A Systematic Literature Review

Authors:
  • Sekolah Tinggi Ilmu Kesehatan Papua Sorong

Abstract

Introduction: Schizophrenia is a complex mental disorder that affects an individual's thoughts, perceptions, and behaviors. Therapeutic communication in schizophrenic patients refers to the communication approach used by health professionals or therapists to interact with schizophrenic patients with the aim of assisting them in recovery and improving their quality of life. This study aimed to explore forms of therapeutic communication that could be used to improve improvements in schizophrenia patients. Methods: The literature search process was carried out on various databases (PubMed, Web of Sciences, EMBASE, Cochrane Libraries, and Google Scholar) regarding therapeutic communication and schizophrenia. The search was performed using the terms "therapeutic communication" OR "psychoeducation" OR "psychotherapy" AND "schizophrenia”. Results: Among all studies included in the review, there were three qualitative studies and one observational study. In addition, the study did not provide information on whether there were deviations from the intervention data, bias in measuring outcomes, and bias in the selection of reported outcomes. Conclusion: Therapeutic communication can be adapted to the individual needs of schizophrenic patients. To build a strong therapeutic alliance, open conversation, trust, and respect play a fundamental role, with the ultimate goal of building a partnership to optimize patient outcomes.
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Scientia Psychiatrica Volume 4 Issue 3 2023
1. Introduction
Schizophrenia is a serious mental disorder that
affects a person's thoughts, perceptions, and behavior.
Symptoms can range from positive symptoms, such as
hallucinations and delusions, to negative symptoms,
such as decreased ability to speak and interact
socially.1,2 People with schizophrenia also often
experience cognitive disorders, such as difficulties
with memory, attention, and problem-solving.
Although the exact causes are not fully understood,
the understanding of schizophrenia is growing
through research and clinical experience.3
According to data from the World Health
Organization (WHO), in 2019, there were 21 million
people affected by schizophrenia. An epidemiological
study in 2018 stated that the estimated prevalence of
schizophrenia in Indonesia is 0.3-1% and usually
occurs at the age of 18-45 years.4 Another study noted
that 57,000 people were diagnosed with mental
disorders, and as many as 18,800 people in Indonesia
were shackled and experienced neglect from their
families.4,5
Management of schizophrenia involves a
combination of pharmacological approaches and
psychosocial therapy. Antipsychotic drugs are used to
reduce psychotic symptoms such as hallucinations
and delusions. However, it is important to note that
the response to medication can vary between
individuals, and some side effects may occur. Apart
from medication, psychosocial therapy is also
important in managing schizophrenia. Cognitive
Therapeutic Communication in Schizophrenic Patients: A Systematic Literature
Review
Rifki Sakinah Nompo1*
1Nursing Study Program, STIKES Papua, Sorong, Indonesia
ARTICLE INFO
Keywords:
Caregiver
Psychotherapy
Psychotic
Schizophrenia
Therapeutic communication
*Corresponding author:
Rifki Sakinah Nompo
E-mail address:
rifkisakinahnompo@gmail.com
The author has reviewed and approved the
final version of the manuscript.
https://doi.org/10.37275/scipsy.v4i3.158
A B S T R A C T
Introduction: Schizophrenia is a complex mental disorder that affects an
individual's thoughts, perceptions, and behaviors. Therapeutic
communication in schizophrenic patients refers to the communication
approach used by health professionals or therapists to interact with
schizophrenic patients with the aim of assisting them in recovery and
improving their quality of life. This study aimed to explore forms of
therapeutic communication that could be used to improve improvements in
schizophrenia patients. Methods: The literature search process was carried
out on various databases (PubMed, Web of Sciences, EMBASE, Cochrane
Libraries, and Google Scholar) regarding therapeutic communication and
schizophrenia. The search was performed using the terms "therapeutic
communication" OR "psychoeducation" OR "psychotherapy" AND
"schizophrenia”. Results: Among all studies included in the review, there
were three qualitative studies and one observational study. In addition, the
study did not provide information on whether there were deviations from the
intervention data, bias in measuring outcomes, and bias in the selection of
reported outcomes. Conclusion: Therapeutic communication can be
adapted to the individual needs of schizophrenic patients. To build a strong
therapeutic alliance, open conversation, trust, and respect play a
fundamental role, with the ultimate goal of building a partnership to optimize
patient outcomes.
Scientia Psychiatrica
Journal Homepage: www.scientiapsychiatrica.com
eISSN (Online): 2715-9736
406
behavioral therapy assists patients in developing
problem-solving skills, understanding and changing
unhealthy thought patterns, and increasing social
interactions. Social support therapy also plays an
important role in providing emotional and practical
support for individuals with schizophrenia.7,8
Education and understanding of schizophrenia are
very important to overcome the stigma and
discrimination experienced by individuals with this
disorder. In addition, family and community support
also play an important role in ensuring individuals
with schizophrenia receive adequate care and get the
support they need. An inclusive environment and
removing stigma can help patients feel more accepted
and involved in society.9
Therapeutic communication is a form of
psychoeducation for schizophrenia. Therapeutic
communication in schizophrenic patients refers to the
communication approach used by health workers or
therapists to interact with schizophrenic patients with
the aim of assisting them in their recovery and
improving their quality of life.10 This study aimed to
explore forms of therapeutic communication that can
be used to enhance improvement in schizophrenic
patients.
2. Methods
The literature search process was carried out on
various databases (PubMed, Web of Sciences,
EMBASE, Cochrane Libraries, and Google Scholar)
regarding therapeutic communication and
schizophrenia. The search was performed using the
terms: (1) "therapeutic communication" OR
"psychoeducation" OR "psychotherapy" AND (2)
"schizophrenia. The literature is limited to clinical
studies and published in English. The literature
selection criteria are articles published in the form of
original articles, an observational study about
therapeutic communications on schizophrenia,
studies conducted in a timeframe from 2000-2023,
and the main outcome was improvements in clinical
symptoms of schizophrenia. Meanwhile, the exclusion
criteria were studies that were not related to
schizophrenia, the absence of a control group, and
duplication of publications. This study follows the
preferred reporting items for systematic reviews and
meta-analysis (PRISMA) recommendations (Figure 1).
Records identified from:
Databases (n = 52)
Records removed before screening:
Duplicate records removed (n =0)
Records marked as ineligible by
automation tools (n = 0)
Records removed for other reasons (n = 0)
Records screened
(n = 22)
Records excluded
(n = 30)
Reports sought for retrieval
(n = 20)
Reports not retrieved
(n = 2)
Reports assessed for eligibility
(n = 5)
Reports excluded:
Full text article exclude (n = 8)
Published not in English (n = 5)
Inappropriate methods (n = 4)
Studies included in review
(n = 4)
Identification of studies via databases and registers
Figure 1. Research PRISMA diagram.
407
3. Results
Among all studies included in the review, there
were three qualitative studies11-13 and one quantitative
study14 (Table 1). In addition, the study did not provide
information on whether there were deviations from the
intervention data, bias in measuring outcomes, and
bias in the selection of reported outcomes.
Table 1. Characteristics of included studies.
Authors
Assessment methods
Results
Siregar et al.11
The adapted treatment process
in 5 sessions.
Effective therapeutic
communication techniques were
building trust, troubleshooting
with constructive coping, and
giving appreciation.
Donner et al.12
Qualitative research was
synthetized with Fredriksson's
theory of caring conversations.
Compassion and willingness to
engage, and preparedness to
remain in the uncertainty of not
knowing were effective in
improving clinical symptoms.
Haman et al.13
Focus group discussion and
content analysis.
Open and honest therapist
emphasizing being active in
consultation.
Johansen et al.14
Positive and negative syndrome
scale (PANSS) and Working
alliance inventory-short form
(WAI-S).
The working alliance was
associated with specific
demographic and symptom
characteristics.
4. Discussion
Therapeutic communication in schizophrenic
patients refers to the communication approach used
by health workers or therapists to interact with
schizophrenic patients with the aim of assisting them
in their recovery and improving their quality of life.15
To build a strong therapeutic alliance, open
conversation, trust, and respect play a fundamental
role, with the ultimate goal of building a partnership
to optimize patient outcomes. The study by Johansen
et al. states that strong therapeutic alliances have
been shown to correlate with positive patient
outcomes, especially symptom severity,
hospitalization, drop-out rate from psychosocial
treatment, and treatment adherence.14
The study conducted by Siregar et al. states that
therapeutic communication will be effective if it is
based on the principle of trust, overcomes problems
with constructive coping, and gives appreciation to
schizophrenic patients.11 It is important to form a
trusting and empathetic relationship with a
schizophrenic patient. Research conducted by Donner
et al. stated that building empathy can be done by
listening attentively, showing concern, and respecting
their feelings and experiences.12
Poor insight is one of the symptoms of
schizophrenia and can make it difficult to establish
therapeutic communication between patient and
therapist.16 Disturbed insight hinders therapeutic
relationships because there is a negative effect on
social interaction and the patient's poor perception of
the actions of those around them. A study by Haman
et al. found psychoeducation and therapeutic
communication to be one of the most consistently
effective treatment modalities, with a 50% reduction in
relapse rates compared to no psychoeducation.13 Eye
contact can strengthen engagement and show interest
in the patient. This can help build a better relationship
and improve understanding of communication
between therapist and patient.17
Clear communication structures can help
schizophrenic patients understand and follow
408
conversations. The use of open questions, short and
simple sentences can help improve rapport between
therapist and patient. Open discussion of the need for
pharmacological treatment is fundamental and should
always be initiated as early as possible. Discussions
around drug choices can be influenced by the poor
insight of schizophrenics, especially during the acute
phase, so the therapeutic alliance with the patient's
family must be considered. Reflection techniques can
be used in a way that involves repeating and validating
the feelings or experiences expressed by the patient.
This helps strengthen relationships and helps patients
feel heard and understood.18,19
Every schizophrenic patient has different needs
and preferences, so it is important to adapt the
therapeutic communication approach according to the
patient's individual needs. Therapists or health
workers who are experienced in treating schizophrenic
patients can provide more detailed and specific
guidance in therapeutic communication. Previous
studies have shown that having a family member or
caregiver who provides informal support is associated
with better medication adherence.19,20
5. Conclusion
Therapeutic communication can be adapted to the
individual needs of schizophrenic patients. To build a
strong therapeutic alliance, open conversation, trust,
and respect play a fundamental role, with the ultimate
goal of building a partnership to optimize patient
outcomes.
6. References
1. Lestari R, Yusuf A, Hargono R, Setyawan FEB,
Hidayah R. Adapting to people with
schizophrenia: a phenomenological study on
rural society in Indonesia. Indian J Psychol
Med. 2021; 43(1): 31-7.
2. Bromley E, Gabrielian S, Brekke B.
Experiencing community: Perspectives of
individuals diagnosed as having serious mental
illness. Psychiatr Serv; 2013; 64(7): 6729.
3. Phelan JC, Link BG. Fear of people with mental
illnesses: The role of personal and impersonal
contact and exposure to threat or harm. J
Health Soc Behav; 2004; 45(1): 6880.
4. World Health Organization. Schizophrenia.
Geneva: WHO, 2019.
5. Ministry of Health Republic of Indonesia. Basic
health resources 2018. Jakarta: Badan
Penelitian dan Pengembangan Kesehatan,
2018.
6. Dharmayanti I, Tjandrarini DH, Hidayangsih
PS, Nainggolan O. The impact of environmental
health and socio-economic condition on mental
health in Indonesia. Indonesian J Health Ecol;
2018; 17: 6474.
7. Abbay AG, Mulatu AT, Azadi H. Community
knowledge, perceived beliefs and associated
factors of mental distress: A case study from
Northern Ethiopia. Int J Environ Res Public
Health; 2018; 15: 122.
8. Shankar J, Liu L, Nicholas D. Employers’
perspectives on hiring and accommodating
workers with mental illness. SAGE Open, 2014;
4:113.
9. Farooq S, Johal RK, Ziff C, Farooq N. Different
communication strategies for disclosing a
diagnosis of schizophrenia and related
disorders. Cochrane Database Syst Rev. 2017;
2017(10): CD11707.
10. Juntapim S. Therapeutic relationship in person
with schizophrenia: a skills for practice. Am J
Nursing Health Services. 2020; 1(1): 11-4.
11. Siregar I, Rahmadiyah F, Siregar AFQ.
Therapeutic communication strategies in
nursing process of angry, anxious, and fearful
schizophrenic patients. Br J Nursing Studies.
2021; 1(1).
12. Donner L, Gustin LW. Navigating between
compassion and uncertainty-psychiatric
nurses’ lived experiences of communication
with patients who rarely speak. Issues Mental
Health Nursing. 2021; 42(4).
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13. Haman J, Kohl S, McCabe R, Buhner M, Mendel
R. What can patients do to facilitate shared
decision making? A qualitative study of patients
with depression or schizophrenia and
psychiatrists. Soc Psychiatry Psychiatr
Epidemiol. 2016; 51(4): 617-25.
14. Johansen R, Iversen VC, Melle I, Hestad KA.
Therapeutic alliance in early schizophrenia
spectrum disorders: cross sectional study. Ann
Gen Psychiatry. 2013: 12: 14.
15. Balaji M, Chatterjee S, Brennan B,
Rangaswamy T, Thornicroft G, Patel V.
Outcomes that matter: A qualitative study with
persons with schizophrenia and their primary
caregivers in India. Asian J Psychiatr; 2012;
5(3): 25865.
16. Lysaker PH, Davis LW, Buck KD, Outcalt S,
Ringer JM. Negative symptoms and poor insight
as predictors of the similarity between client
and therapist ratings of therapeutic alliance in
cognitive behavior therapy for patients with
schizophrenia. J Nerv Ment Dis. 2011; 199:
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17. Wittorf A, Jakobi U, Bechdolf A, Muller B,
Sartory G. The influence of baseline symptoms
and insight on the therapeutic alliance early in
the treatment of schizophrenia. Eur Psychiat:
The Journal of the Association of European
Psychiatrists. 2009; 24: 25967.
18. Huddy V, Reeder C, Kontis D, Wykes T, Stahl D.
The effect of working alliance on adherence and
outcome in cognitive remediation therapy. J
Nerv Ment Dis. 2012; 200: 614619.
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What does the alliance predict in group
interventions for early psychosis? J Contemp
Psychother. 2012; 42: 5561.
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of therapeutic alliance in early psychosis. Early
Interv Psychiatry. 2009; 3: 3003.
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