Ever have a patient you instantly connected with? Didn’t everything feel easy? Your explanation of their diagnosis and how it relates to PT landed right away, they left the initial evaluation feeling better, and they nailed their home exercise program on day one and actually stuck with it!
Of course, several factors in patient care make our lives easier: no significant past medical history, no psychosocial or financial barriers. Many of these factors are beyond our control, and we do our best to adapt to what’s on our schedule.
The Factor We Control
One factor we do control is the therapeutic alliance. As the name implies, the therapeutic alliance describes the collaboration between PT and patient during care. It includes agreeing on mutually set goals, agreeing on the interventions to reach those goals, and the personal connection that forms during treatment. Forming a strong therapeutic alliance is highly beneficial to our patients.
Evidence and Connection Go Together
Following an evidence-based practice model is a critical piece of patient care, but a strong therapeutic alliance shouldn’t be overlooked. I’ve often had patients who didn’t fit neatly into a clinical practice guideline (CPG) or a biomechanical model, and they usually needed extensive patient education.
Patient education built on the patient’s history, through frequent active listening, is key. Showing patients that their functional limitations and impairments have been heard, and that there is a plan to address them, is critical for the alliance to form. Tying all of this to the patient’s specific goals completes the process. You’ve shown that you’re empathetic, responsive to individual needs and goals, and have the patient’s best interest in mind.
Image spot (optional): therapist actively listening to a patient
The Challenges
This may sound like sunshine and rainbows, but there are challenges. Not every patient will be trusting at first. Our medical system has serious gaps in accessibility and cost that can make patients wary of healthcare professionals. Personal barriers come into play too: patients with chronic pain or lesser-known diagnoses can receive subpar care. These patients are still our patients, and the extra work needed to form the therapeutic alliance must still happen, to the best of our abilities.
Closing Thoughts
Like any human relationship, the therapeutic alliance will change. There can be rifts that must be addressed, and there will be wins and losses. Maintaining the alliance to the best of our abilities must remain a prominent part of our practice as PTs.
