Therapeutic Alliance: Start With Why • Posts by EIM | Evidence In Motion Skip To Content

Therapeutic Alliance: Start With Why

October 19, 2018 • Practice Leadership • Private: Brian Freund

Do you strive on a daily basis to improve your therapeutic alliance with your patients?

Do you try to form stronger relationships with your patients, physician referral sources, and co-workers?

A hot topic in healthcare has been this idea of therapeutic alliance.Research has mentioned this as being a key in our delivery of positive patient outcomes.In 2010 Hall, et. al. made the following statement in conclusion of a systematic review looking at the association between therapeutic alliance and patient outcomes:

“From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings.”

In addition, Ferreira, et. al. in 2013 indicated a strong therapeutic alliance predicted outcomes in patients with chronic low back pain.At the end of the day the key is being able to understand your patient and develop a trusting connected relationship with them to allow the delivery of treatment interventions in a safe and healing environment.This has been shown to create an improved buy in from the patient leading to improved overall patient outcomes.Now don’t misunderstand me the interventions that you provide for the patient absolutely do make a difference, but the amount of difference can and will be affected by your overall relationship with your patient.I doubt there are many of you reading this who have a significant issue with what I said above.

So, why is this such an important topic and why do we have a strong therapeutic alliance with some patients and not with others?

Have you ever sat back and really thought about this question?Many of us probably have thought about this question.However, how many of you have asked yourselves the following: “What can I do better to have an improved alliance with my patients?”In other words, how can I make my communication more effective?My guess, without making any broad assumptions, is that fewer of us have really sat back and said: How can my communication be more effective?More often we place the onus on the patient as being unwilling to listen, unmotivated, or unable to understand.The reality is communication and dialogue by definition includes two or more people.It really is incumbent upon us to make sure we are asking ourselves how we can be better communicators.As therapists we spend a lot of time working on our therapy interventions.We go to continuing education courses to improve our skill set that includes manual therapy, exercise, myofascial release, pain neuroscience education, and the list goes on and on.When is the last time you attended a course to improve your communication skills?Have you ever considered the following question:

“Would my therapy interventions be more effective if I communicated better with my patients?”

I can’t sit here today and state I have all the answers, but I can say that I have some thoughts around this topic.When communicating with patients, way too often the communication involves a knowledge fest.We communicate to the patient in terms that show how smart we are or how much more knowledge we have than the patient.And in many cases we tell the patient what we are going to do for them and how we are going to do it.This is really the key to my thoughts today.I have read several books by the author Simon Sinek.Simon Sinek is a British-American author, motivational speaker and organizational consultant.His initial publication was a book titled: Start with Why.The premise of this book and all of the books Sinek has authored is around this idea that people buy why you are doing something rather than what or how you are doing it.

After I read several of Sinek’s books I really began to think about how this applies to me.I then began to think about therapeutic alliance, trust, and connectedness with my patients.More importantly I began to think about my communication with my patients and others.I found way too often I was telling patients what I was going to do for them and how I was going to do it.I also found I was not necessarily telling people on a consistent basis why I was doing it.I may tell patients I am going to do manual therapy, provide exercises, provide education, provide modalities, etc., and somewhere in that discussion I would probably provide some detail of the why.However, my communication could have been better as it was not always clear.Now comes the real question: Why should a patient come to you(physical therapist) rather than seek treatment with another provider(chiropractor, massage therapist, personal trainer, etc.)?The issue is not with any other providers as I would have this same discussion with all professional healthcare providers.

The question is: Why you?Why now?Why physical therapy?

As physical therapists we have to do a better job of explaining our why.We have become experts at telling people what we do and how we are going to do it, but we have not done such a great job explaining our why.True therapeutic alliance comes when patients believe what we believe.Think about it.If you pulled anyone off the street and asked them what a physical therapist does, many people would not be able to answer.For those that are able to answer, they would provide the what of physical therapy.They may state: “I did some exercises.They pushed around on my back.They used that blue stuff on me.”What if your neighbor walked up to you and said he/she has received a prescription for physical therapy, and you asked the patient the following: “Why are you going to therapy rather than just resting and putting heat on your back?”The neighbor most likely would tell you they are going as their doctor told them they need to go.The great news is when the patient comes into your office, we will have the opportunity to tell them why they are in the right spot.So the next time that patient comes into your clinic, make sure to take time to tell the patient why rather than just how and what.Remember patients “buy” your why rather than the how and the what.

 

Private: Brian Freund

Brian Freund graduated from Rockhurst University in 1999 with a Master’s degree in Physical Therapy and then had the dubious honor of working alongside with Adriaan in an outpatient private practice, where Adriaan and Brian “indulged” in manual therapy. Brian is one of the original founding members of Midwest Spine Therapists, which has since become...

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Keith Roper

Commented • October 20, 2018

Interesting post, Brian, and some good thoughts. I would argue that the biggest component by far in building TA is effective communication, and that the most important aspect of communication is our ability to listen effectively and with receptivity. Telling the patient why we are doing something implies our agenda vs. theirs. I know this is not what you are suggesting, but believe that many of us practice this way. If we can truly listen and allow the person to tell their story and share their problems we can begin to understand how we might help them reach THEIR goals. Using principles of cognitive reassurance we can then ask permission to educate them in what they can do and how PT might act as a catalyst to help them reach their goals. So nice to see blogs with this type of content. Lets keep the discussion going!


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