The Praxis Planner

(AKA – Rule #1: you have to like your psychiatric provider)

Research consistently shows that the quality of the therapeutic relationship is an even stronger predictor of treatment success than the specific modality used by a psychotherapist. When we talk about psychiatric medication, we often focus on the pharmacology—the mechanism of action, side effects, dosage, and clinical efficacy. These are, of course, vital elements of care. But what often gets overlooked is something less tangible, yet profoundly impactful: the therapeutic relationship between the patient and provider.

Medication Works, But Context Matters

Psychiatric medications have changed countless lives. Antidepressants, mood stabilizers, antipsychotics, and other medications can be essential tools in the treatment of mental health conditions. But mounting research shows that how these medications are delivered—and by whom—can significantly influence their effectiveness.

A 2011 study by Roter et al. found that patients who felt emotionally supported by their providers reported better adherence to medication and, notably, better outcomes. In fact, the perceived warmth and competence of the provider were strong predictors of treatment success. Similarly, a meta-analysis published in Psychotherapy (Norcross & Wampold, 2011) emphasized that the quality of the therapeutic alliance is as predictive of outcomes as the specific treatment modality—including pharmacotherapy.

The Power of Liking and Trust

Simply put: people are more likely to take medication from someone they like. When a patient feels that their provider genuinely listens, understands, and respects them, this fosters trust. That trust then becomes the foundation for better engagement, honest communication about side effects or hesitations, and a stronger commitment to the treatment plan.

Consider two providers prescribing the same medication. One takes the time to listen, validate the patient’s concerns, and offers psychoeducation in an empathetic, collaborative manner. The other delivers the same prescription quickly and with minimal dialogue. Despite the identical pharmacology, the outcomes may differ significantly. The difference lies not in the pill, but in the relationship around it.

Integrated Skills: Why Psychotherapy Skills Matter in Psychiatry

While not every psychiatric visit is a full psychotherapy session, providers who bring therapeutic skills into medication management visits often enhance outcomes. Empathic listening, reflective responses, motivational interviewing, and other psychotherapeutic techniques can transform a brief med check into a meaningful interaction. This not only strengthens rapport but also deepens insight and supports behavior change.

Psychiatric providers trained in psychotherapy are better equipped to hold space for complexity. They can recognize when symptoms are rooted in unresolved trauma, relational patterns, or existential distress—and they can integrate this understanding into a more holistic medication strategy.

The Power of Listening: Lessons from “Every Patient Tells a Story”

Dr. Lisa Sanders, in her book Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis, illustrates how listening to the patient’s story is often the single most important factor in arriving at the correct diagnosis. Sanders, who also served as a consultant for the TV show House, M.D., emphasizes that while diagnostic tests and technology are valuable, they are no substitute for the human narrative. She writes that a careful, detailed history is responsible for the majority of accurate diagnoses in clinical settings.

This aligns with my practice philosophy. I do not rush the intake and assessment process. My longer session times allow space for listening—not just to symptoms, but to the context in which those symptoms arise. I incorporate a thorough mental health assessment and, when applicable, a targeted physical examination, because they are foundational to building an accurate diagnostic picture.

Unfortunately, insurance models often fail to account for this. They prioritize speed and volume over accuracy and relationship. But this short-term mindset misses the long game: proper diagnosis leads to proper treatment, which leads to faster symptom remission, reduced suffering, and ultimately lower long-term healthcare costs. Listening saves lives—and money.

Conclusion: Medication and Relationship Go Hand-in-Hand

Medications are powerful. But they do not exist in a vacuum. The context in which they are prescribed—especially the therapeutic rapport between provider and patient—can dramatically shape their effectiveness. When patients feel seen, heard, and valued, they are more likely to engage meaningfully in their care.

As mental health professionals, we do not just prescribe medications. We offer ourselves as part of the healing process. And that makes all the difference.

References:

• Roter, D. L., et al. (2011). The impact of patient-centered communication on patients’ decision making and evaluations of physicians: A randomized study of medical consultations. Patient Education and Counseling, 84(3), 386-392.
• Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98-102.
• Kelley, J. M., et al. (2014). The influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE, 9(4), e94207.
• Sanders, L. (2009). Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis. Broadway Books.

Since I began practicing as a therapist over seven years ago, I have always believed that the insight gained in therapy must lead to action for lasting change. My appreciation for insight stems from my training in psychodynamic psychotherapy. In essence, this approach is about understanding why we feel and respond the way we do.

Much like a wind-up music box, where the beautiful melody comes from hidden gears and springs working together inside, our feelings and behaviors often come from hidden parts of our minds—those internal parts shaped by early relationships and experiences, both known and unknown to us. In psychodynamic therapy, we “open the lid” to explore those internal gears and notice how our “gears,” or past experiences, memories, and unconscious thoughts, work. By understanding how these hidden parts influence the “music” of our emotions and actions, we gain insight into ourselves.

However, just knowing how the music box functions isn’t enough to change the melody. We also need to adjust how we wind it up and care for it. This is where action and behavior change come in; they are like turning the key differently or playing a new melody. Just like our minds, music boxes need occasional tune-ups to keep playing their melodies. Some music boxes from over 100 years ago still work, although their music may sound a bit off-key due to dust, rust, wear, and tear. With a correct assessment and understanding of what needs care,  we can adjust and mend the internal parts – they can then continue to play us their tunes.

In psychiatry, we do this as well. We use therapy and insight to explore the “dust” of past experiences and the “wear and tear” of how old patterns or untreated dis-ease impact our life. Through action – whether behavior change, medication, lifestyle adjustments – all within the context of a relationship with a provider we trust we can keep the inner music playing. By using our insights to make real changes in how we respond and behave, we can create new, more harmonious “music” in our lives. The new name, Praxis, reflects our commitment to helping you gain insight and create lasting change through action.