How can two patients with the same diagnosis and treatment plan have different outcomes in physical therapy?
One of the most underappreciated variables in rehabilitation is the professional relationship between the patient and the provider. This relationship is called a therapeutic alliance, and it is one of the keys to success in physical therapy.
In a world of hurried appointments and back-to-back patient loads, I built Mitchell Physical Therapy around a different idea — that you can’t truly help someone heal if you don’t truly know them.
What Is The Therapeutic Alliance?
The therapeutic alliance is a collaborative partnership between you and your physical therapist. You work with your therapist to set goals and decide on a treatment plan, instead of the therapist dictating what they think is the best course of treatment.
There are three core components to the therapeutic alliance:
- The emotional bond between the client and therapist founded on mutual respect, trust, empathy and genuine connection.
- An agreement on goals for therapy to share a clear, mutual understanding of what you want to achieve at physical therapy.
- An agreement on tasks needed to reach set goals.
What Does the Research Actually Say?
Several studies have indicated that a strong therapeutic alliance is correlated with better functional outcomes, especially in cases of chronic pain. 1,2 This means your client-therapist bond could be one of the determining factors for success in your physical therapy journey!
Also, this client-therapist bond can carry over even after your session has finished. A 2020 study showed that a strong therapeutic alliance can improve adherence to exercises and general physical activity outside of the clinic.3 Basically, when you and your therapist work together as a team to create solutions, typically you feel more motivated to stick to the plan!
There’s still plenty of research to be done, but the results so far have been promising!
Why Does This Gets Lost in Traditional Healthcare Settings?
Unfortunately, in today’s medical system, there are many barriers to forming a true therapeutic alliance. High patient volume, short appointment times, insurance-driven care models can all make you feel like a cog in the machine. It can be extremely difficult for overworked providers to put the full strength of their empathy and caring into each patient interaction.
At Mitchell Physical Therapy, we take the time to get to know you and your challenges. You are the expert of your own life, so we strive to work with you as a co-captain to navigate your hurdles. The more involved you are with your therapy, the better your outcomes!
What Does a Strong Therapeutic Alliance Actually Looks Like in Practice?
Ok, so we know that a strong therapeutic alliance is a good thing. It can improve functional outcomes and pave the way towards success in your physical therapy journey. But what does it look like in real life?
In each session, you will see a few indicators of a developing therapeutic alliance. Your physical therapist will:
- Practice collaborative goal setting
- Adjust the plan based on your feedback
- Create psychological safety (active listening, no judgement, clarity, consistency) so you feel comfortable being honest
- Take time to understand your full story, not just your chief complaint
With this PACT in place, you can be sure your physical therapist is working towards building that alliance. Lean in and work with them to get back to doing the things you love!
What Does This Mean for Your Recovery?
The research has shown that the client-therapist bond is important for reaching your goals. It’s important to find a provider who prioritizes this alliance. If you feel unheard in your sessions, or uncomfortable to voice your opinions about your treatment plan, it might be time for a change.
Recognize the difference between feeling like a cog and feeling like a person! You deserve to be treated as the expert of your own life. We’re here to help you reach your goals, but you’re always in the driver’s seat.
At Mitchell Physical Therapy, we believe healing starts with being truly heard. If you’re ready for a different kind of care, we’d love to connect.
References:
- Kinney, M., Seider, J., Beaty, A. F., Coughlin, K., Dyal, M., & Clewley, D. (2020). The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 36(8), 886–898. https://doi.org/10.1080/09593985.2018.1516015
- Paulo H. Ferreira, Manuela L. Ferreira, Christopher G. Maher, Kathryn M. Refshauge, Jane Latimer, Roger D. Adams, The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain, Physical Therapy, Volume 93, Issue 4, 1 April 2013, Pages 470–478, https://doi.org/10.2522/ptj.20120137
- Andrew J Moore, Melanie A Holden, Nadine E Foster, Clare Jinks, Therapeutic alliance facilitates adherence to physiotherapy-led exercise and physical activity for older adults with knee pain: a longitudinal qualitative study, Journal of Physiotherapy, Volume 66, Issue 1, 2020, Pages 45-53, https://doi.org/10.1016/j.jphys.2019.11.004