From theory to practice: A critical review and meta-framework for operationalising person-centredness, therapeutic alliance and empathy in pharmacist-led mental health consultations

Despite their expanding patient-facing roles and increased involvement in mental health services, pharmacists' interactions with clients remain largely medicines-focused. This limitation is compounded by a reported lack of pharmacists' confidence and inadequate training in both mental health conditions and communication skills. The interrelated concepts of person-centredness, therapeutic alliance, and empathy play a pivotal role in effective mental health consultations, positive client outcomes, and high-quality care delivery. Grounded in the interpretivist and pragmaticist paradigms, this critical review of the literature enabled the development of a meta-framework that unifies this triad. The resulting model conceptualises person-centredness across three interconnected levels: the Consultation (analogous to the therapeutic alliance), the Systems (focusing on multidisciplinary collaboration and leadership), and the Intrapersonal (encompassing the practitioner's intellectual, practical, and phenomenological attributes). Functioning as an integral, unifying component across the entire model, empathy is detailed as a three-stage process at the Consultation level between pharmacist and client, involving exploration, shared understanding, and optional therapeutic action. Presented both as a conceptual model and comprehensive series of targeted recommendations, this work provides timely guidance, enabling pharmacists to deliver high-quality, holistic, and meaningful mental health care, with the aim of improving client outcomes and fostering effective interprofessional working relationships.