The Therapeutic Alliance!!

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The ‘Therapeutic Alliance (TA) is a term that basically describes an enhanced patient-PT interaction with patient centered care as the driver.  Empathy, compassion and a safe positive atmosphere all fall into this realm as well.  (The term is more associated with psychotherapy as far as I can tell).

So there have been a few articles on the benefits of TA in outcomes from physical therapy.  (Bias warning: I am quite apt to believe this without even reading the articles… but I did anyway.)

So for those of you that have not looked into the “non-specific” factors in treating, here are some good reads:

1.) The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain 

Conclusion: Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP. Future research should investigate the factors explaining this relationship and the impact of training interventions aimed at optimizing the alliance.

2.) Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study

Conclusion: The context in which physical therapy interventions are offered has the potential to dramatically improve therapeutic effects. Enhanced TA combined with active IFC appears to lead to clinically meaningful improvements in outcomes when treating patients with CLBP.

Seems to make sense.  These factors are not treatment and do not account for all gains, however these techniques do work best in populations with high psychosocial components to their symptoms.  Chronic conditions, for example.

I know that one can work on and develop interaction behaviors, but I also had the preconceived notion that there was some natural ability as well.  Interestingly enough the personality of the therapist was not shown to be a large determinant in outcomes.  PTs were given a script, and regardless of  true natural empathy skills they were able to create the alliance.  Hmm, So just follow a template?

(The guys at PT Podcast also addressed this article.  Listen to their discussion/critique here.)

Take home message: engage the patient and treat them with care, it just might help them improve and maximize outcomes.

Matt D

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8 thoughts on “The Therapeutic Alliance!!

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