Creating Working Relationships through Therapeutic Alliances

A therapeutic alliance (TA) is described as the working relationship or positive social connection between the physiotherapist and the patient. It is a central component of the therapeutic process and a big determinant of treatment outcome, even more so than conventional treatments, which at best, provide only moderate effects. When we look at the four foundational conditions fostering engagement within the physiotherapist-patient relationship, you’ll see that they can be easily extrapolated and applied to a philosophy encompassing any salesperson-customer relationship, and ultimately lead to customer satisfaction. Let’s take a look.

Being “Present”

Physiotherapists make conscious choices about the amount of time they spend in direct proximity with patients, oftentimes in a potentially chaotic setting laden with competing responsibilities. In instances like these, studies show that patients can easily distinguish between a “busy” therapist and a “rushed” therapist, where a busy therapist could be present despite the hectic environment.

Being Receptive

Being receptive requires the physiotherapist to have an open attitude and set aside personal agendas. This involves being willing to listen to the patient’s story and understand what the patient needs from you. In doing so, you will foster a safe and receptive atmosphere. Furthermore, being attentive to both verbal and non-verbal cues helps the physiotherapist gain insight into the patient’s physical and psychological states; for example, the patient becoming guarded or tightening up is a sign that they are becoming upset. Finally, make note of certain aspects of the interaction that allow you to gauge what the patient’s interests are. This receptivity fosters deeper engagement during the immediate interaction and provides the opportunity for the same in the future.

Being Genuine

Being genuine in the grand scheme of the TA involves being yourself, being honest, and investing in the personal. Being yourself and not putting on a facade creates an environment where patients can also express themselves – their personalities, stories, and social and cultural realities. Honesty is necessary for any healthy relationship, and in the context of the TA involves being transparent (i.e. providing the necessary information to help the patient move forward in a meaningful way) and being direct in the tone and manner of the communication, while not being interpreted as stern, especially in challenging situations. Finally, investing in the personal can be done by taking an interest in something the patient says or does beyond the referral for your service, as well as being willing to disclose something personal about yourself.

Being Committed

Being committed is characterized by two aspects: committed to understanding and committed to action. A commitment to understanding involves delving deeper than the general overview that a patient may give. While a commitment to action involves making “all efforts” to honour the best interests of the patient.

The conditions of engagement speak to the essence of what is required to have a meaningful therapeutic alliance. Much literature has focused on how important communication can be in developing this relationship: however, they are more than a compilation of skills and behaviours that can be dutifully checked off when completed. Relationships are dynamic, requiring the intent to ensure that behaviours and skills are consistent with the situation. If physiotherapists are aware of and able to critique their thoughts, emotions, attitudes, and assumptions and adjust them as needed, these conditions can be developed, maintained, or deepened. Reflective practice targeting the therapeutic alliance is critical for encouraging physiotherapists’ abilities to cultivate the conditions of engagement. Without it, physiotherapists risk self-limiting their ability to influence what is considered a key contextual factor impacting successful clinical outcomes . . . or for you, a successful sale

Pat Stanziano

Registered Sport Physiotherapist (Dip SPC, IFSPT), Certified in Mechanical Diagnosis & Therapy, Certified Strength & Conditioning Specialist