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

Maxi Miciak; Maria Mayan; Cary Brown; Anthony S. Joyce; Douglas P. Gross

doi:10.1186/s40945-018-0044-1

Authors

Maxi Miciak Alberta Innovates, 1500, 10104 – 103 Avenue NW, Edmonton, AB T5J 0H8, Canada
Maria Mayan Faculty of Extension, University of Alberta, 10230 – Jasper Ave, Edmonton, AB T5J 4P6, Canada
Cary Brown Department of Occupational Therapy, University of Alberta, 8205 114 Street, 2-64 Corbett Hall, Edmonton, AB T6G 2G4, Canada
Anthony S. Joyce Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
Douglas P. Gross Department of Physical Therapy, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada

DOI:

https://doi.org/10.1186/s40945-018-0044-1

Keywords:

Therapeutic alliance, Working alliance, Psychotherapy, Patient-therapist interaction, Patient-therapist relationship, Patient-centred care

Abstract

Background: The 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. Methods: Interpretive 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. Results: Four 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. Conclusions: These 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.