Patient-Physician Symmetry in Addiction Psychiatry: Clinical Methods for Aligning Relationships

Objectives: This clinical model for substance use disorder (SUD) treatment aims at (1) devising ways for the patient-physician dyad to align toward common goals and (2) utilizing individual clinical visits for addressing the current clinical problems as well as phase-specific tasks of ultimate recovery. Method: SUD care involving both mutual collaboration of the patient-physician dyad and alignment of current care with long-term recovery is defined as "symmetric." This manuscript reviews relevant patient-physician relationship studies, lists therapeutic challenges to that relationship imposed by SUD, provides treatment examples and techniques for meeting these challenges, and describes a model for achieving symmetric care. Results: Within this model, achieving symmetry in SUD care involves 3 steps. First, patient and physician select interpersonal approaches consistent with their respective expectations of the clinical transaction. Second, based on these individual decisions, the patient-physician dyad adapts an interactive style that can be symmetric (functional, mutually productive) or asymmetric (dysfunctional, unproductive). Third, if interacting symmetrically here-and-now, the physician and patient can then shape the current clinical event to benefit the patient's eventual recovery. Conclusions: The physician first identifies and, if needed, corrects misalignment in the patient-physician relationship. Once alignment is established, the physician can then work toward 2 salient tasks at each clinical encounter: first, resolution of the current clinical challenges; and second, utilizing the current clinical event to address a phase-related aspect of recovery. Although eventual recovery rests primarily with the patient, the physician's assistance with phase-specific recovery tasks maximizes the patient's chances for ultimate recovery.