The Therapeutic Relationship

As I write this I’m in Sunny Queensland, having just finished a professional development course ‘intro to assessment and treatment of the pelvic floor.’ It’s one of those ‘dip your toe into women’s, men’s and pelvic health’ courses and it was astoundingly helpful to learn some new things and consolidate some things I already teach in the clinic.

Spending time with lots of other physiotherapists this weekend got me thinking about how important it is to build trustwith colleagues and clients. These relationships take time to develop, and we invest so much into the work that we do. We care about others, and we can show that as clinicians by listening, reflecting back, being careful with our words and learning how to take the client on a journey as they recover and heal. It’s such a privilege. It reminded me of a chapter from my new book, and I wanted to share part of it with you.

This is an excerpt from the chapter titled ‘The Therapeutic Relationship.’

 

Words Can Harm, Words Can Heal
Remembering that words can both harm and heal is an integral part of being a good physiotherapist and building rapport with people. Clients come to see their physiotherapist for a service, but they also come for reassurance, kindness and support. The power of positive encouragement and a ‘can-do’ attitude must not be underestimated. The classic example of the impact that language can have is the physiotherapist telling the client of their ‘degenerative spine’ or ‘bulging disc’ – this does not help the patient to improve and may in fact worsen their pain.[i]

Finding the right way to communicate takes practice. Avoid the use of jargon, and tailor the approach to suit the client. It is important to also check in with the client to ensure they have understood what has been explained to them. This is an obligation under informed consent, discussed further in Chapter 13.

Occasionally, a client may speak negatively about another practitioner. Comments about the other practitioner’s skill or knowledge (e.g. ‘she was hopeless’, or ‘I felt much worse after that treatment’) may be indicators that the client must be handled with particular care. Explaining things thoroughly, ensuring the client leaves feeling satisfied, and a follow-up phone call to check on treatment effectiveness may be required until rapport has been built and trust established. It’s essential to not participate in any negative talk about another practitioner, and to certainly never instigate it. Use a diplomatic approach, change the subject respectfully, and consider helpful comments to suggest that things will be different, but without disparaging the other practitioner; for example: ‘I’m sorry to hear you’ve had that bad experience. Let’s see if we can try a different approach and turn things around for you.’

All practitioners will at some point make a mistake. Though it may be embarrassing, it’s very powerful to own the mistake. When it becomes apparent that a mistake has been made, the best thing to do is not to make excuses, but to identify the mistake and apologise for it where necessary. A small mistake such as forgetting to send a promised doctor’s letter or exercise program can usually be redeemed with a sincere apology and by making it right as soon as possible. However, a disclaimer here: keep in mind that if a mistake in clinical judgement, diagnosis or other serious clinical or legal issue has been made, it is wise to notify a senior physiotherapist or employer as soon as possible, before the incident is discussed in too much detail with the client. It may be necessary to seek advice before admitting full liability in some cases.

Being mindful of the words that heal and the words that can harm is vital for good communication and effective physiotherapy. Avoiding language that catastrophises and using affirmative language instead can help the client to think of their diagnosis in a more positive light, with significantly less worry.”

The physiotherapist must also try to speak in positive ways about themselves as well. The practitioner may say something like, ‘I like to be punctual’, or ‘I like to be thorough’. They may refer to things that are important to them, such as professionalism or keeping up-to-date with research. Clients will remember the words used and may reflect them back to the practitioner at a later stage.

 

Learning to Listen

While there are some challenges along the therapeutic journey, the rewards can be great if the physiotherapist can be quiet enough to listen and truly hear their client. A positive therapeutic relationship can change a person’s life for the better. This is a big part of why physiotherapists do what they do.

Listening and empathising will be easier on some days than it is on others. Being able to sit and listen to someone, without talking over them or finishing their sentences, is extremely valuable and takes practice and skill. Too often the subjective is hurried because of time restraints and the practitioner may not always listen enough. Developing good listening skills helps to reduce the chance of making assumptions about what people need without actually finding out what their needs are. While it is tempting to fill the space by talking, asking questions and really listening to the answers creates the space the client needs to feel safe.

Often, the most important skill to learn is how to validate another person’s situation. Phrases such as ‘I’m hearing that this is very hard for you’ show that the physiotherapist is listening and reflecting back what they’ve heard. This skill of reflective listening can be useful in difficult times or conversations, perhaps when a client tells their ‘story’, cries in the consult, or discusses a very traumatic experience. A simple phrase, such as ‘tell me where I’m wrong, but…’ can help to paint a picture of what the physiotherapist thinks is going on, but also provides the opportunity for the client to correct them if necessary. It is important to never underestimate the power of good listening skills, as they can help build rapport and ultimately make or break the therapeutic relationship.

 

Going the Extra Mile and Patient Advocacy

At the crux of good therapy is the patient-centred approach, in which the patient’s wellbeing is primary. Learning to build trust and positive relationships is essential, regardless of the area of physiotherapy. This means following up in a timely fashion, sending that last piece of helpful information, and going that little bit further to make the patient feel respected and cared for. It is the physiotherapist’s role to always seek the best outcome for their patients, and may involve advocating for the patient’s needs and defending against anything that is going to infringe on their rehabilitation journey (such as workplace issues in a compensable claim).

Building relationships can be hard work at times, and may be more challenging for some physiotherapists than others. Ultimately, it’s about human connection. It’s about hearing someone’s deepest truths, understanding their physical and emotional condition, and knowing how to validate that experience. It’s about helping them to rise up again, feel better, move better, and reach their goals. This is what can be achieved when meaningful therapeutic relationships are cultivated.

 

Questions for Self-enquiry

1. What do you enjoy about working closely with others?
2. What do you dislike or find challenging about working closely with others?
3. How would you rate yourself as a listener? Poor, fair, good, or very good? How can you take steps towards becoming a better listener?
4. Can you think of any examples of times that you have ‘gone the extra mile’ for a client?
5. Can you think about what appropriate sharing means to you? What parts of your personal life feel appropriate to share? What boundaries do you need in place? Boundaries will be further explored in Chapter 12.

 

Elizabeth is a Physiotherapist, Naturopath and Author who lives in the Adelaide Hills with her husband and little boy. When she is not working and writing you will find her adventuring in the hills with family and friends.

This blog post contains excerpts from Elizabeth’s first book ‘The New Graduates Guide to Physiotherapy’– Available late September!

 

 

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