The necessary conditions of engagement for the therapeutic relationship in physiotherapy: an interpretive description study

Abstract

BackgroundThe therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Despite its influence, we do not know what conditions enable a physiotherapist and patient to establish and maintain a therapeutic relationship. This knowledge has implications for how clinicians approach their interactions with patients and for the development of an assessment tool that accurately reflects the nature of the therapeutic relationship. Therefore, this study’s aim was to identify and provide in-depth descriptions of the necessary conditions of engagement of the therapeutic relationship between physiotherapists and patients.MethodsInterpretive description was the qualitative methodological orientation used to identify and describe the conditions that reflect and are practically relevant to clinical practice. Eleven physiotherapists with a minimum 5 years of clinical experience and seven adult patients with musculoskeletal disorders were purposively sampled from private practice clinics in Edmonton, Canada. The in-person, semi-structured interviews were completed in a location of the participant’s choice and were audio recorded and transcribed. Qualitative content analysis was used to analyze the textual data and constant comparison techniques were integrated to refine the categories and sub-categories. Rigour strategies used throughout the study were peer debrief, interview notes, reflexive journaling, memoing, member reflections, audit trail, and external audit.ResultsFour conditions were identified as necessary for establishing a therapeutic relationship: present, receptive, genuine, and committed. These conditions represent the intentions and attitudes of physiotherapists and patients engaging in the clinical interaction. Although distinct, the conditions appear related as being present and receptive create a foundation for being genuine and committed.ConclusionsThese conditions of engagement are needed for physiotherapist and patient to “be” in a therapeutic relationship. Although communication skills are important for advancing therapists’ relational abilities, awareness and integration of intentions and attitudes are essential for shaping behaviors that develop the therapeutic relationship. These findings also suggest there are characteristics of the therapeutic relationship specific to physiotherapy. Therefore, theories from other contexts (e.g., psychotherapy) should be used judiciously to guide physiotherapy practice and research.

The working alliance in stuttering treatment: a neglected variable?

“…We would also include the clinician's interpersonal style and the continued relevance of the flexibility, honesty, respect, trustworthiness, confidence, warmth, interest and openness highlighted by authors such as Ackerman and Hilsenroth (2003) or Van Riper (1973) for SLTs working with individuals who stutter. Those aspects mirror, for example, the work of Miciak et al (2018), who identified four main conditions necessary for establishing a therapeutic relationship: being present, receptive, genuine and committed. According to the authors, these conditions in conjunction with applying communication skills, represent the intentions and attitudes of both the clinician and client.…”

“…In the present study, although only one significant relation between bond and outcome was found, the scores on the bond subscale remained stable throughout the treatment period. It is possible that this stable, underlying bond, perhaps associated with clinician and client's characteristics such as being present, receptive, genuine and committed, in which, according to Miciak et al (2018), represent the intentions and attitudes in the clinical interaction and are needed for the physiotherapist and client to 'be' in a therapeutic relationship. To some extent, the bond may provide the foundation for mutual agreement of tasks and goals, which is in accordance with Wampold's (2015) Contextual Model.…”

“…As with the field of physiotherapy (Kayes and McPherson , Miciak et al . ), SLT has borrowed theory from psychotherapy to inform the research and practice. Within stuttering treatment research, the relationship between the working alliance and treatment outcomes have received little attention, with the exception of the work of Manning () and Plexico et al .…”

“…Those aspects mirror, for example, the work of Miciak et al . (), who identified four main conditions necessary for establishing a therapeutic relationship: being present, receptive, genuine and committed. According to the authors, these conditions in conjunction with applying communication skills, represent the intentions and attitudes of both the clinician and client.…”

The Hopkins Rehabilitation Engagement Rating Scale – Reablement Version (HRERS‐RV): Development and psychometric properties

“…Attending to the issue of engagement in the reablement context adds an interesting dimension to current understandings of this construct. In particular, it offers a new perspective to the relational dimension of engagement—the so‐called therapeutic alliance (Higgins et al, )—which stresses the continuity of relationship between patient and practitioner (Ferreira et al, ; Greenhalgh & Heath, ; Miciak, Mayan, Brown, Joyce, & Gross, ). However, reablement, at least in the United Kingdom, is typically delivered by multiple staff (Beresford et al, in press).…”