The relationship, or alliance, between a patient and medical provider has been considered a critical factor in the success of any treatment plan. The therapeutic alliance refers to the sense of collaboration, warmth, trust, and support between a patient and their medical provider (physician, physical therapist, etc). There are three proposed components which contribute to the therapist-patient relationship. These components are therapist-patient agreement on goals, therapist-patient agreement on the treatment plan, and the affective bond between the patient & therapist.
The Therapeutic Alliance in Mental Health & General Medicine
A positive therapeutic alliance has been associated with positive mental health outcomes for depression, anxiety, mood, interpersonal problems, and overall psychological well being. Trust is an important factor in the patient-physician relationship. Research shows that a patient’s trust in his or her general practitioner is positively correlated with improved pain, general health, and quality of life. Trust forms the basis for self-efficacy which in turn leads to improved patient adherence and health outcomes. A positive therapeutic alliance has been associated with improved treatment outcome in psychotherapy and general medicine but what about physical therapy? Physical therapy involves a high level of patient-therapist interaction where patients often attend multiple clinic visits per week each lasting 30 to 60 minutes. Therefore, it is plausible that maximizing the therapeutic alliance can positively influence outcomes for patients attending outpatient physical therapy.
The Therapist-Patient Relationship in Physical Therapy
In 2010, Hall and colleagues reviewed the research investigating the influence of the therapeutic alliance on physical therapy outcomes. Not surprisingly, the researchers found the alliance between the physical therapist and patient has a positive effect on multiple domains of treatment outcome in physical therapy. In particular the alliance between the patient and therapist positively correlates with an improved ability to perform activities of daily living, reduced pain levels, improved physical functioning, decreased depression, improved overall health, and improved patient satisfaction.
In order to maximize the positive impact of the therapist-patient relationship a practitioner must measure and continually seek to improve their abilities in this domain. The Working Alliance Inventory is the most frequently cited method to measure this relationship or alliance. At our Barnegat and Manahawkin outpatient physical therapy clinics we have chosen to utilize the Consultation and Relational Empathy (CARE) Measure to track the strength of the relationships we develop with our patients. Our physical therapists collectively discuss and seek to improve skills in fostering the therapist-patient relationship. From the available research in this area, this only improves the overall outcome patients achieve at our clinics.
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