What is Therapeutic Alliance?

Reference:Ferreira PH, et al The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. PhysTher. 2013Apr;93(4):470-8.

Therapeutic alliance commonly refers to the relationship between a psychiatrist/psychologist and a client. A strong alliance means the client feels comfortable with the therapist and feels a sense of safety and trust in the therapy process.

For mental health therapists to be effective, it is well researched that they must have a strong therapeutic alliance with their clients. But how important is this alliance in physical therapy?

This RCT involved 180 patients with chronic LBP who received manual therapy and/or stabilization exercises and concluded that irrespective of the actual treatment the therapeutic alliance between a PT and the patient was consistently a predictor of outcome for all the measures of treatment outcome.

Conclusion: “Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP.”(Ferreira et al 2013)

Both the PT and the patient complete the Working Alliance Inventory which a questionnaire consisting of 36 questions such as

I am confident in my PTs ability to help me.
Never sometimes very often always

My PT and I trust one another.
Never sometimes very often always

We agree on what is important for me to work on.
Never sometimes very often always

In a nutshell, do not underestimate the value of building a relationship with your patient; it often supersedes the value of anything physical you may do on them.

If the patient does not believe in you or trust you, they are very unlikely to comply with any of your advice and home exercises which we know directly effects outcomes.

Suggestion on How to Build Alliance

Say their name frequently during your conversations.
E.g. Can you show me Michael exactly where your pain is?

Find out what hobby or activity they enjoy and frequently ask them of it.
E.g. How was your golf game last week?

Ask them what other language they speak, then ask them how to say hello in their language and write it in your chart.
E.g. Saying Bon Journo to my Italian patients has gone a long way.

Posted on: August 23, 2014

Categories: Relevant Physical Therapy Articles

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