The Therapeutic Alliance
Estimated Reading Time: 2 minutes
Before attending physical therapy school, I was an athletic trainer. In the realm of athletics, the goal for every individual was the same: to get back into competition as soon as they can—or so I thought.
Goals were never something I brought up because I assumed that everyone's goals were the same. However, one experience in particular forever changed the way I now communicate with patients.
An athlete I was working with seemed to have hit a wall with his recovery and was becoming more frustrated and withdrawn from me and rest of the training staff. He was always physically present at his rehabilitation appointments, but was no longer mentally there.
His stagnation made no sense, and I realized that I needed to initiate a conversation to assess how he was feeling and investigate what could be causing this setback.
"I feel like everyone is pushing me toward something I won't be able to do." This response threw me back, but it led me to ask: "What do you want?" A very simple question that should be asked of every patient, and yet I never did.
In that moment, he revealed that he didn't even want to return to sport. He felt like he was being forced by his teammates, coaches, family, and even me.
This experience was my first insight to the therapeutic alliance and how pivotal it is to establish a strong relationship with patients. After this conversation, I began goal setting with him and giving him a voice in his therapy. His frustration settled, his rehabilitation progressed once again, and ultimately he decided he'd like to return to his sport. However, his top priority became the career he was chasing, and he now viewed the sport he played as a fun hobby and no longer his identity.
It is extremely important to make an ongoing effort to establish and maintain a therapeutic alliance with every patient.
PTs and PTAs working with the same patient need to establish this together. It must be one alliance between the patient, PT, and PTA.
If the PT and PTA are working toward separate goals for the patient, or have a different understanding of what the patient wants and needs, progress will be delayed and the quality of care will be diminished.
During my last clinical, the working relationship between the PTs and PTAs on staff was excellent, and there was an outstanding continuity of care between them. There was virtually no difference between treatment received from the PTs and PTAs, and they could pick up each other's patients if needed without missing a beat. I contribute this to the flawless communication, comradery inside and outside of the clinic among the staff, as well as the conscious effort of the PTs and PTAs to consistently communicate with the patient together and give that added sense of teamwork to the patient.
A well-established therapeutic alliance could be the pivotal difference in a patient's journey toward achieving their goals or not.
This is the final blog in a series called #StrongatHome. The aim of the #StrongatHome blog series is to strengthen the understanding of the PT–PTA relationship in the workplace, and help to create a vision as to what an ideal working relationship should look like. The therapeutic alliance is ultimately the patient experience, grounded in the PT and PTA having a functioning relationship, and thoroughly understanding each other's roles. Each previous blog addresses an area of education or practice where the relationship between the PT and the PTA makes a difference. Here you can access previous blog posts.
Ferreira PH, Ferreira ML, Maher CG, et al. The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Phys Ther. 2013;93:470–478. Free Article.
Horner S. Characteristics of therapeutic alliance. Foto Rehab Outcomes Blog. Focus on Therapeutic Outcomes Inc. Free Article.
Michael Jones, SPT