Different subjective research approaches to the study of the therapeutic relationship (see companion paper for objective approaches)1
| Approach | Discipline | General format of research question | Preferred study design | Quality defined in terms of (=> potential for ‘metrics’) |
| 1. Psycho-dynamic analysis (eg, the Balint method) | Psycho-analysis | What unconscious and irrational forces are at work in the consultation, and how can these be used therapeutically? | Reflexive discussion in which unconscious/irrational motives of doctor and patient are explored (eg, in a Balint group) | Attention to the hidden agenda: To what extent does the clinician connect emotionally with the patient, show unconditional positive regard and allow the ‘real’ reason for the consultation (perhaps a neurotic illness) to be revealed and dealt with7 8? |
| 2. Narrative analysis | Literary theory, moral philosophy | How does the teller–listener relationship influence the narration and enactment of the illness narrative and how might ‘active listening’ be supported? | Close reading of texts (eg, patients' stories) | Narrative competence: To what extent does the co-constructed illness story (a)] place the patient as narrator/subject and the practitioner as active listener/witness, (b) achieve coherence and moral order and (c) reflect mutual trust and obligation?9 10 |
| 3. Critical consultation analysis | Socio-linguistics | What external social forces shape, enable and constrain the therapeutic relationship? What is the nature of trust in this relationship? | In-depth qualitative designs, for example, ethnography, conversation analysis, narrative interview | Power dynamics: system/lifeworld: To what extent is interaction in the consultation communicative and based on voluntary trust? To what extent is the discourse of the patient's lifeworld given space?11 12 |
| 4. Socio-technical analysis | Philosophy (actor-network theory) | How is the therapeutic relationship situated within the wider care network of people and technologies, and what emerges from it? | Ethnography (detailed observation of talk and action in a naturalistic setting) | Underlying logic: To what extent is the therapeutic relationship underpinned by the logic of care (continuous, adaptive and affective) as opposed to the logic of choice (episodic, decision focused and objective)?13 |