The therapeutic alliance refers to the collaboration between a patient and medical provider, their affective bond, and agreement on treatment goals. The therapeutic alliance was described in more detail in a previous article.¬†As a matter of review, trust and empathy have also been closely linked with the therapeutic alliance.¬†Research has shown that maximizing the therapeutic alliance can positively impact treatment results, health, and patient satisfaction.¬†A strong therapeutic alliance results in improved patient adherence and overall engagement in their treatment.¬†Thus, maximizing the therapeutic alliance is an important component of patient-centered health care.
Communication and Therapeutic Alliance
Effective communication between the patient and medical provider is arguably the most important factor associated with the therapeutic alliance and maximizing its impact on treatment outcomes.¬†Three key communication factors are involved in the patient-therapist encounter.¬†These are verbal factors, non-verbal factors, and interaction styles.¬†Verbal factors pertain to such aspects as greetings and specific questioning during the medical interview.¬†Non-verbal factors include facial expressions, gestures, and body orientation.¬†Interaction styles refer to information giving, providing emotional support, and sharing responsibility in decision making with the patient.
Researchers from Australia investigated which communication factors was most closely associated with a strong therapeutic alliance.¬†Compared to verbal and non-verbal factors, patient-centered interaction styles showed the strongest association with the therapeutic alliance.¬†Specifically, interactions that promoted patient involvement, support, and engagement were strongest.¬†Allowing patients to tell their story and attentively listening to patient concerns are important considerations during the patient-therapist interaction. Answering all patient questions in a comforting and caring manner facilitates and supports the therapist-patient relationship. Finally, the therapeutic alliance is strengthened when therapists ask questions with a focus on the patient‚Äôs emotional issues and when therapists show sensitivity towards these emotional concerns.¬†Brushing over patient’s emotional cues during a medical interview is never a good idea.
Patient-Centered Communication Enhances Treatment Effects
Medical providers who adopt communication styles which are comforting, caring, empathetic, and involve the patient will foster a positive therapeutic alliance.¬†This promotes patient adherence and engagement allowing for the best possible treatment outcome for the patient.¬†For patients receiving care in outpatient physical therapy clinics it is important to keep in mind that these non-specific factors will only enhance the effects of any specific treatments used, such as exercise or manual therapy.¬†I believe that both specific and non-specific aspects of treatment need to be considered for patients to obtain the best possible outcome and reach their goals.
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- Pinto RZ, Ferreira ML, Oliveira VC, et al. Patient-centered communication is associated with positive therapeutic alliance: a systematic review. J Physiother. 2012;58(2):77-87