By Joseph Kelly
Whilst some treatments are better than others, research is always trying to optimise or perfect treatment outcomes for patients by maximising the yield of treatment. One central modulator to achieve this is something called therapeutic alliance. Therapeutic alliance (TA) has been described as “the working relationship or positive social connection between the patient and the therapist” and is established between the patient and therapist through “collaboration, communication, therapist empathy, and mutual respect” (Babatunde et al. 2017). TA is a central component of the therapeutic process and has been a key determinant of treatment outcome for patients (Babatunde et al. 2017).
Therapeutic alliance has been heavily studied and observed to provide better results for patients in the field of psychology, in particular, showing positive results in the control of depression and anxiety. (Taccolini et al. 2018). Because of this, research interest shifted to other fields, namely physiotherapy. Individual studies have identified that better TA is generally beneficial in improving the outcomes of treatment. It has also been suggested that by borrowing common TA building techniques from psychologists, physiotherapists can also emulate the same benefits in their patients.
As mentioned above, building TA is dependent on a few things. Arguably the most important, is communication, which is a very general topic. This can be how the physiotherapist explains things, but also how the patient explains things. Alternatively, this could be how the physiotherapist interprets things, but also how the patient interprets things. The point I am trying to make here is that trust goes both ways, and therapeutic alliance is more than just having the patient trust the therapist; the therapist must equally trust the patient. When this relationship is met, patient outcomes and outlook improve.
From evidence in the literature, we see that when a physiotherapist and a patient have strong TA, patients have better health outcomes in regards to quality of life and perceived improvement (Taccolini et al. 2018). This looks like a few things; the patient is likely to have a greater sense of control over their own problem, more agency and higher self-efficacy.
As therapists, we know that TA is important. However, it is important to note that in the research, there is a lack of information directly connecting strong therapeutic alliance and pain relief in rehabilitative musculoskeletal physiotherapy (Taccolini et al. 2018). A key message from the literature is that further studies are needed directly examining how therapeutic alliance can alter pain, rather than just treatment outcomes.
References
Babatunde, F., MacDermid, J. and MacIntyre, N. (2017) Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature, BMC health services research. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450083/ (Accessed: 1 June 2024).
Taccolini Manzoni, A. C., Bastos de Oliveira, N. T., Nunes Cabral, C. M. and Aquaroni Ricci, N. (2018) Physiotherapy Theory and Practice, 34(12), pp. 901–915. doi: 10.1080/09593985.2018.1431343.
