Aim Meaningful client‐dietitian relationships are central to effective dietetic practice. The chronic disease management setting provides an opportunity to examine what is meaningful and how these relationships are constructed, because the dietitian and client generally have multiple interactions over an extended period of time. This study aimed to explore dietitians' perspectives of how they develop meaningful relationships with clients managing lifestyle‐related chronic diseases. Methods Study design and analysis were guided by Charmaz's constructivist grounded theory. Dietitians working in Australia with clients managing chronic diseases were recruited through initial, snowball and theoretical sampling. Online videoconference and telephone semi‐structured interviews were conducted. Recorded interview transcripts were analysed using repeated reviews comprising initial, focused and theoretical coding and memoing. Results Twenty‐two dietitians were recruited. A conceptual model developed from the data showed the dietitian's role in developing the client‐dietitian relationship is complex. Key elements were identified and described as ‘Sensing a Professional Chemistry’, and the dietitian's skills in ‘Balancing Professional and Social Relationships’ and ‘Managing Tension with Competing Influences’. Influences were categorised as relating to the client and dietitian as individuals (eg, their values), their support network and external contextual factors (eg, working with interpreters). Conclusion Developing relationships with clients in the chronic disease context appears complex due to the dietitian's role of managing multiple interrelated elements and influential factors simultaneously. To deepen understanding, research should explore clients' perspectives of relationship development and how knowledge of practitioner‐client relationships in other disciplines may be utilised to enhance dietetic service delivery.

Spending more time in a session appears related to increased bonding, a key component of therapeutic alliance. Preparatory work may help build therapeutic alliance and agreement on goals appears to influence follow-up completion. These exploratory findings provide directions for research addressing the professional relationship in dietetic consultations for weight loss.

Scientific evidence underpins dietetics practice; however, evidence of how the therapeutic relationship influences outcomes is limited. This integrative review aims to provide a comprehensive overview of the topic of the therapeutic relationship between clients and dietitians in the individual counselling context by summarising empirical literature into qualitative themes. Methods: An electronic literature search of the Cumulative Index of Nursing and Allied Health Literature, PsychInfo, Scopus and Web of Science databases was conducted in October 2018 and repeated in February 2021. Studies were included if they explicitly referred to the therapeutic relationship (or associated terms), were based on study data and available in full text.Extracted data were checked by a second researcher and the methodological quality was evaluated independently by two researchers using the Mixed Methods Appraisal Tool. An iterative process of qualitatively coding, categorising and comparing data to examine recurring themes was applied. Results: Seventy-six studies met the inclusion criteria. Five themes were identified which showed the extent and nature of research in this area. Studies revealed the therapeutic relationship: (i) is valued within clinical dietetic practice, (ii) involves complex and multifactorial interactions, (iii) is perceived as having a positive influence, (iv) requires skills training and (v) is embedded in practice models and tools. Conclusion:Studies show the therapeutic relationship is a valued and multifactorial component of clinical dietetic practice and is perceived to positively influence the client and dietitian. Observational data are needed to assess the extent to which the strength of the therapeutic relationship might contribute to clients' health outcomes.

Aim How dietitians are trained to develop relationships with clients is not clearly articulated despite its importance being well‐documented. This study aimed to describe how this relationship is expressed and addressed in curriculum documents of Australian dietetics education programs, and to explore program coordinators' perspectives of this description and how relationship development is actually taught. Methods Data extracted from subject outlines included subject descriptions, learning outcomes, assessments, readings and the mode of delivery (eg, lectures). Guided by a pre‐existing coding framework, deductive thematic analysis was utilised to explore qualitative themes from subject outline data. Semi‐structured telephone interviews were conducted with 10 program coordinators and analysed using inductive thematic analysis. Results Subject outlines for 122 subjects across all 21 accredited Australian programs were analysed. The over‐arching theme was the wide “variability” in the ways that the client‐dietitian relationship was expressed across subject outlines. Program coordinators perceived that findings from the analysis of subject outlines made sense, however, acknowledged limitations of analysing data from curriculum documents. The relationship appeared ambiguously defined amongst programs and was described as occurring mostly in communication, counselling and medical nutrition therapy subjects and through theoretical and practical learning. Conclusion The client‐dietitian relationship appears inconsistently embedded in the curriculum of Australian dietetics education programs despite widespread acceptance of its importance to practice. Further research is needed to investigate if training programs should embed more consistent language around therapeutic relationships, and how this might be achieved to reflect current competency standards.

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