Therapeutic relationship refers to the relationship that exists between a physical therapist and a client during the course of physical therapy treatment. From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however. The Influence of the Therapist-Patient Relationship on Treatment Outcome in Physical Rehabilitation: A Systematic Review. Article · Literature.
The closeness of how the physical therapy aids the patient during the physical therapy exercise and the face-to-face communication common to physical therapist and the patients.
Other considerations worth noting are the place where the physical assessment takes place as well as verbal and non-verbal language and cues when interviewing the patient and the physical distance during the interview.
Since communication is very vital to the therapeutic relationship of the patient and the physical therapist, it is important that every physical therapist knows the five levels of intimacy by conversation. The levels are in a descending order and here they are: This is where the usual small talk begins. This is the most shallow of the five and usually there are no intimate or personal responses being garnered in this level.
This is the level where there is progress beyond the usual run-of-the-mill responses usually gathered in level five. Although there is nothing personal being talked about, there is that little sharing of general information between the patient and the physical therapist. This is the beginning of sharing about oneself. Most of the topics being talked about and answered would pertain to the illness and condition of the patient. The conversation goes back to Level Four once the patient becomes bored with the topic.
This level is about developing trust, emotions and feelings.
On Physical Therapy Boundaries | Physical Therapist Alliance
A much deeper personal information can be shared when there is already trust established on both parties. In order that the relationship flourishes to this stage, feelings of security, comfort and understanding must be cultivated. Each person involved wants to appear genuine and accepted.
This is the pinnacle of the communication. In this level, both parties are able to share thoughts and experiences in openness, respect and honesty. There is mutual understanding, which may lead to physical intimacy in some cases.
How do you manage the crossing of boundaries? In some cases, the boundaries may be crossed with respect to be able to make the patient better. Am I doing this so that the predetermined goals be achieved within the time span of the treatment? Are there means other than this that I can utilize to send my intent to the patient? Can I tell another therapist about what I am about to do? If I do this, will I be sending a gesture that might be perceived as confusing by the patient with regards to the patient-therapist professional relationship?
If I do this, will this give the patient more freedom? If other therapists are in my shoes, would they be doing the same gesture like mine or not?
Is it me or the patient or someone else who is going to benefit from this? Would the payer of the of the physical therapy services agree to what I am about to do?
It is the responsibility of the physical therapist to check from time to time whether he or she has deviated from the goals set. If the goals need to be re-determined and the roles re-set, do with the patient in mind. Being able to consider the opinions of other therapists is important to settle the considerations that you need to formulate. The alliance was most commonly measured with the Working Alliance Inventory, which was rated by both patient and therapist during the third or fourth treatment session.
On Physical Therapy Boundaries
The results indicate that the alliance is positively associated with: Limitations Among homogenous studies, there were insufficient reported data to allow pooling of results. Conclusions From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however, more research is needed to determine the strength of this association. The relationship between patient and therapist traditionally has been viewed as an important determinant of treatment outcome and is considered central to the therapeutic process.
The construct of the alliance in therapeutic situations is derived from theories of transference first outlined by Freud in and refers to the sense of collaboration, warmth, and support between the client and therapist.
Using this definition, researchers began to measure the alliance in clinical practice and formally assess its impact on treatment outcomes. The majority of this evaluation has been conducted in psychology, counseling, or general medicine settings, where the intervention is typically centered on a one-to-one interaction between the patient and the treating physician or therapist.
Standards of Practice Recognize Ongoing PT-Patient Relationship
Elvins and Green 13 recently conducted an extensive review to investigate the conceptualization and measurement of the alliance. They identified a broad consensus as to the key concepts of the alliance among the various measures, but no single unifying alliance model or a single measure that comprehensively addressed all of the key concepts. It would appear from the previous research that the alliance is positively associated with treatment outcome and could potentially be used as a predictor of treatment outcome in psychotherapy and general medicine settings.
However, the degree to which the alliance relates to outcome in other treatment settings is not clear. Physical rehabilitation, like psychotherapy and general medicine, includes a high level of patient-clinician interaction; however, the characteristics of the patient population, as well as the intervention, are arguably different.
It is plausible, therefore, that the relationship between the alliance and the outcome seen in psychotherapy or general medicine settings is not transferable to physical rehabilitation settings.
It is thus of great importance to determine whether the alliance of rehabilitation therapists is similar to that of psychotherapists and general practitioners and whether this alliance influences outcome in the physical rehabilitation setting.
To our knowledge, there has been no systematic review of the primary research in this area. The aims of this study were: We hypothesized that the patient-therapist alliance would have a positive correlation with treatment outcome. Citation tracking was performed by manually screening reference lists of eligible trials.
Theses and conference proceedings also were included. Additionally, personal communication with content experts in the therapeutic alliance field was conducted. Study inclusion was not restricted by language. The search strategy and exclusion process are illustrated in the Figure. Figure Search strategy and exclusion process. Study Selection From the titles identified by the search strategy, original studies were included if they: Physical rehabilitation is defined as an intervention that aims to enhance and restore functional ability and quality of life in those with physical impairments or disabilities.