Table 1

Different subjective research approaches to the study of the therapeutic relationship (see companion paper for objective approaches)1

ApproachDisciplineGeneral format of research questionPreferred study designQuality defined in terms of (=> potential for ‘metrics’)
1. Psycho-dynamic analysis (eg, the Balint method)Psycho-analysisWhat 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 analysisLiterary theory, moral philosophyHow 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 analysisSocio-linguisticsWhat 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 interviewPower 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 analysisPhilosophy (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