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Enhancing the Therapeutic Alliance

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In seeking physical therapy for an issue such as chronic pain, there are many factors that can influence the outcomes. Of course, it is important that your physical therapist is knowledgeable, is able to communicate clearly, and is able to provide interventions that fit your unique needs. However, successful therapy outcomes also rely on one more very important factor... the relationship between the patient and the clinician, known as the therapeutic alliance.

By definition, therapeutic alliance is

"the sense of collaboration, warmth, and support between client and therapist."1

Features of a strong therapeutic alliance include mutual agreement on goals and interventions, empathy, compassion, and mutual respect. A positive therapeutic alliance involves bi-directional open communication and kindness between the two. It is the therapist's job to create a safe space for healing, and to actively listen and respond to the needs of the client without judgment. It is the client's job to strive to believe in and implement the recommendations of the therapist, while being open and honest about their needs, as well as response to therapy.

Think back to the teachers you had while in school. Does any teacher stand out that you remember liking a whole lot? You likely have fond memories of this person, and can even recall many of the things you learned from them. They were probably kind and empathetic, and valued creating a safe space for learning. In return, it is likely that you put in effort to respect their wishes, listen to and incorporate their recommendations and lessons, which resulted in a positive learning experience.

Think back to a teacher you might not have liked so much... the results were probably much different! Being in therapy is very similar. A good therapist is like a teacher- we teach anatomy, movements, education about pain and dysfunction, as well as lessons to help you get to know your body better from the inside out. The better your relationship with your teacher, the more you will get out of the experience.

At the Wellness Station, your therapist will always strive to create a supportive healing environment by enhancing the therapeutic alliance. Here are some tangible methods that can enhance this alliance:
• "We" statements
• Open body language
• Eye contact
• Statements of reflection/summary
• Non-threatening touch

What are some behaviors to look out for that can detract from the therapeutic alliance?
• Talking down
• Interrupting
• Speaking for someone
• Lecturing
• Shaming
• Looking away, avoiding eye contact

Here is a quote from one of our clients who understood the importance of a strong
therapeutic alliance:

"I have been working with Jacob for several months on my hip bursitis, and shoulder arthritis. He has a wealth of knowledge, both about traditional physical therapy and Feldenkrais. He was careful to work within the home program that I felt I could manage, and went with the flow when I just wanted to come in and mellow out! Jacob carefully stayed in communication with me, when we had a misunderstanding, which actually improved our communication. I now have a workable home program which helps me relax around the discomfort I have had."

The relationship between the client and therapist can prove to be even more important than the therapy itself. Consider the importance of your therapeutic alliance as you continue on your healing journey in order to get the very most out of this experience.