Patient satisfaction is defined as the extent to which patients perceive their general health care and medical needs are being met . Most health care providers are aware of the great importance of patient satisfaction in facilitating the provider-patient relationship. Recently there has been an increased effort to use patient satisfaction as a measure of overall quality of health care. Unfortunately, research on patient satisfaction with psychiatric care is scarce. Different instruments have been used to measure satisfaction [2, 3], yet, more studies are needed to ascertain the best technique for measuring quality of health care services and the determination of predictors of overall satisfaction. Recently there has been an increased effort to use patient satisfaction as one of several measure of overall quality of health care[1, 2] and with the approval of the Affordable Care Act (ACA) patient satisfaction is now tied to medicare reimbursement in some cases.
The PSQ-18 was designed using 18 questions to ensure rapid completion (2–3 minutes)  and has been used in different recent studies [5–12]. The questionnaire evaluates perceptions of technical quality, interpersonal manner, communication (doctor-patient), financial aspects, time spent for patient, convenience, accessibility and overall satisfaction.
The clinician’s ability to explain, listen and empathize is thought to not only improve patient satisfaction and experience of care but also effect functional health outcomes. [4, 5] However, there is growing evidence that other factors outside the doctor patient relationship influence patient satisfaction (disease, age, educational level, anxiety, pain and personality). [6,7]
Several studies have looked at patient's satisfaction in psychiatric settings[8–10]. Kelstrup et al sent 274 German patients a questionnaire concerning satisfaction with psychiatric treatment 1 month after their discharge from a psychiatric hospital. Patients who were diagnosed as suffering from affective disorders or from reactive psychoses, were more satisfied than patients with schizophrenia or paranoia or with transitory adjustment reactions. Patients who had no personality disorder diagnosis and patients with character neurosis, were more satisfied than patients with antisocial or borderline personality disorders. Patients on antidepressant medication were much more satisfied than other patients.  More recently, Gebhardt et al evaluated 113 German patients at time of discharge from a psychiatric hospital. They found that patient satisfaction was dependent on symptom severity, global functioning at discharge, pharmacologic disturbances during treatment, and on the diagnostic group.[11An Indian study of 60 individuals utilized a cross-sectional study design, to evaluate patient satisfaction in an outpatient setting utilizing the patient satisfaction questionnaire. They found that patient's satisfaction was correlated to illness severity. 
In a post hoc analysis of 6 randomized trials of patients with major depression under antidepressant medication (selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor), a correlation of satisfaction with the improvement in depressive symptoms was observed. 
Factors that influence patient satisfaction are likely disease specific, also older age, educational level and the absence of anxiety and pain influences satisfaction with care . To our knowledge, there have not been any studies that focused specifically on the physicians skills as a potential factor influencing patient satisfaction.
The ability to empathize is a key skill for psychiatrists because it helps the therapist conduct their sessions sensitively and flexibly. It is also an important skill in every doctor- patient interaction, including those devoted primarily to prescribing and monitoring medication. Effective “Mentalizing” sessions can foster effective communication, problem solving skills and empathy (15,16). Despite these positive attributes, to date there are no formal studies assessing how patient satisfaction is affected by clinicians utilizing a Mentalization approach.
Although patient satisfaction has been evaluated in a broad psychiatric setting. No study has yet to evaluate patient satisfaction on initial outpatient visit. Mood symptoms are a primary symptom or presentation to a psychiatrist, our study evaluated whether or not mood symptoms played a role in affecting patient satisfaction during an initial evaluation.
This study sought to examine PSQ-18 measures and the relationship to symptom severity (as assessed with the PHQ-9 and GAD-7) from psychiatric patients seen in a resident psychiatry. A secondary aim of the study was assess the impact of resident mentalization training on PSQ-18 outcomes. We hypothesized that empathy training based on teaching basic skills of mentalization would improve therapeutic alliance and that that therapeutic alliance would be reflected in improved patient satisfaction scores.
An exploratory aim examined the Interpersonal Reactivity Index (IRI) performed among patients.