10 tips to developing a strong Therapeutic Alliance as Physiotherapist by Jesse Awenus

10 tips to developing a strong Therapeutic Alliance as Physiotherapist by Jesse Awenus

Jesse Awenus

We hear it all the time as therapist, the need to build a better therapeutic alliance with our patients. While the importance of doing this cannot be understated, seldom are we actually told HOW we should go about doing  this in the clinic. Below are some pretty great tips to help you build fans for life


10 tips to developing a strong Therapeutic Alliance as Physiotherapist 


1) Introduce yourself (shake hands if appropriate) and with a big smile say "hello, my is is ______ and i'll be your physiotherapist, please feel free to call me _____."

You only get once shot at a first introduction so it's important you look your patient in the eye and make them feel as welcome as possible...more on that below


2) Say their full name. "And you are ____, but is there another name you'd prefer to be addressed by?"

(Pro tip: Try and repeat their name at least 3 x during the initial consultation, once when you introduce yourself, second at the end of the subjective exam as you reflect back to them what you've heard, and a third time when saying goodbye at the end of the assessment. By saying the patients names a few times, you are subconsciously making the experience feel more individualized to the patient...Why do you think Starbucks and Lululemon ask for your name? Last I checked they were pretty successful companies 💡


3) Thank them for waiting and say sorry if you are running late (acknowledge and respect). "Thank you so much for waiting, I really appreciate it"

(I used to dislike doing this, thinking I am in healthcare and things cannot always be scheduled to the minute. But by sucking up my ego and saying sorry for keeping people waiting I have found my patients to be much less hostile and more forgiving when I do run a few minutes behind). 


4) Treat them like a house guest by introducing them to the front desk staff and showing them around the clinic, "The bathroom is down the hall and to your left, you can grab a class of water right here and this will be the room I treat you in."

(Just imagine if your dentist or family doctor did this. I bet you would feel pretty good about seeing that person as well as very well respected and taken care of)


5) Sit one arm length away from your patient, using the same level chair and diagonal to each other

(there is actually a study that shows patient satisfaction was higher when the MD sat at the same level as the patient instead of towering over them on a higher chair or stool.)


6) Get verbal consent/permisson to ask questions and to physically assess them. Don't just assume that because they are there they know what's about to happen.  "I am going to ask you some questions and then do a physical exam to see how I can help you, is that okay with you?"
(This goes back to the respect thing. My asking permission you are showing respect to the person in front of you)


7) Be 100% present, nod, lean forward when listening and be engaged without interrupting. This is what we call Active Listening.

(No looking at your cell phone or typing furiously with every word they say. Just stop taking notes and listen to them for a few minutes. You can always go back and write stuff down later) 


8) After a few minutes into the subjective exam, say "Let me make sure that I've got this right." Paraphrase what they just said and at the end ask "Was that accurate? Did I miss anything you feel is important"

(By doing a good summary of their issues you are showing proof that you have listened to their concerns and understand their unique problem. On a side note, I also do a mini-review of the initial assessment findings at their first follow up. I just find it helps the patient focus in in why they are there and also serves to remind me exactly what's going on) 


9) For people with persistent pain who have been unresponsive ti past treatments, be blunt and ask, "What do YOU think is the reason for your pain?"...many say they don't know, but some say "It's cause of mu disc, I'm out of alignment, etc"...this provides a clear entry way to start re-framing their beliefs as to why they hurt. This needs to be done slowly and tactfully... it definitely takes practice as people hold their structuralist pain beliefs very close to heart. You will alienate a patient if you immediately discredit their beliefs about their pain. Just a sprinkle of pain science people, not a whole cup :) 


10) At the end of your summary ask them "is there any other important piece of information about you that I should know?" 

(This gives the patient the chance to explain more about themselves... they may say that they are stressed out at home with 3 kids or having a terrible time at work. These are huge pieces of info that will affect treatment outcomes (unfortunately) 


***Bonus Tip***

11) We obviously need to chart, so when appropriate get permission and ask "May I take a moment to write this down?"... every time you ask for consent you are empowering the patient, it is a sign of respect and in return they will respect you more!)

I want to thank Dr. Bahram Jam and many others for helping all therapists understand the importance of building a strong Therapeutic Alliance.


Jesse's Bio: 

Jesse is the rehabilitation director and co-owner of Synergy Sports Medicine located on the east end of Torotno, Canada. Jesse specializes in managing acute and chronic pain stemming from sports injuries as well as the aches brought on by long hours of sedentary desk work. He believes in providing his patients with the independence, confidence, and ownership in their recovery. Jesse’s background in strength and conditioning allows him to tailor his treatments to the unique needs of each individual patient. He uses a movement-based examination to figure out what might be contributing to the pain and from there may elect to incorporate hands-on manual therapy, dry needling, and/or a specific exercise routine to get his patient moving and feeling better as quickly as possible. A cornerstone of Jesse's practice is education: he believes that each patient should leave their assessment with a clear understanding of what's wrong and how they might fix it.


To read more please visit www.synergysportsmedicine.com


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