Therapeutic relationships and trust take time and effort to create. A positive therapeutic relationship should be a cooperative relationship between the physiotherapist and the patient that is caring, clear, positive, and professional. There is a significant amount of research that shows having a positive therapeutic relationship with your health care provider results in both a better patient experience and better outcomes. You and your physiotherapist work together to build that positive therapeutic relationship. Relationships and people are complex, so sometimes it doesn’t go as planned. This article will walk you through what creates that positive therapeutic relationship and how you and your physiotherapist can keep the relationship positive and professional.
What are the foundations of a positive therapeutic relationship?
- You are both engaged in the process of physiotherapy. You let the physiotherapist know what your goals are as well as potential barriers to improvements. The physiotherapist works with you to develop a treatment plan to help you reach those goals.
- You are both open to working together to achieve your goals. You discuss your progress and if a treatment is effective for you. The physiotherapist works with you to adjust the treatment plan to better match your needs and the physiotherapist’s skills.
- You are honest with each other when it comes to the physiotherapy care you are receiving. You are upfront with the physiotherapist about any issues or barriers. You let them know when things are going well and when they are not. The physiotherapist is also honest with you about your progress towards your goals and anything else that may be affecting your care.
- You are both committed to the process. You put in the work required to achieve your goals, you stay focused on the process, and your time spent in physiotherapy is focused on physiotherapy. Your physiotherapist is focused on you during your sessions. They pay attention to your progress and adjust your treatment plan to keep you on track to reach your goals.
What are some potential issues that can create problems in the therapeutic relationship?
As we mentioned above, relationships between patients and health care providers can break down or become strained at times. Often this occurs when expectations are not set out, or those expectations are not met. The relationship you have with your physiotherapist should always be professional and focused on your goals. Let’s talk about some situations where the therapeutic relationship can become strained.
Is your physiotherapist your friend or just friendly?
Your physiotherapist should be friendly, and make you feel comfortable. They want to provide a safe space for you to open up about your illness or injury and get a better understanding of what motivates you and what can be a barrier to achieving your goals. They should ask you questions, take the time to let you answer, pay attention to what you are saying, and be invested in you and your care. Over the course of your treatment, you may have discovered that you get along well but while you are in their care the physiotherapist must maintain a professional boundary that ensures the time spent together is focused on your physiotherapy care. They are friendly, but this is not a personal relationship.
Keeping Conversations Focused on You and Your Goals
Conversations between you and your physiotherapist should always remain professional even as you get into discussing the score in the hockey game, your kids, or shared life experiences. It’s not that you can’t be friendly with your physiotherapist or vice versa, it’s just that the focus should be on you and your injury and the steps that your physiotherapist is taking to help you get better.
Conversations should not stray into areas of a more personal nature like relationships, dating, or politics as these areas of conversation aren’t related to your illness or injury, nor are they likely to contribute to your physiotherapy plan of care. If you need to let the physiotherapist know about certain religious beliefs or cultural practices that affect your care or how they treat you, then absolutely your physiotherapist needs to know that in order to provide safe and culturally appropriate care. Just take a moment to think about why you are sharing something and whether it has to do with the reason you are in physiotherapy in the first place and understand if your physiotherapist generally steers conversations away from some topics.
Keeping Personal Lives and Professional Lives Separate
Keeping personal and professional lives separate not only occurs in the location where services are provided but outside those locations as well. Patients and physiotherapists are both entitled to their privacy outside of the clinic so interacting with your physiotherapist outside of the clinic can and should look different than how you interact with each other inside the clinic.
Interacting with your physiotherapist outside of the clinic in the community is more frequent in smaller communities than in larger urban settings but it will happen from time to time. You shouldn’t be too surprised if your physiotherapist doesn’t approach you to say hi as they are respecting your privacy and theirs. However, if you do interact outside of the clinic you should know that physiotherapists are told that discussions around physiotherapy should be left for the clinic.
There are several reasons why your physiotherapist may not answer questions or chat with you regarding your injury or condition. Privacy plays a role as there isn’t much privacy in the grocery store or at your kids’ little league game, making it hard to keep personal details of your injury or issue away from prying eyes or ears. The physiotherapist also has no way to document your conversation, and if they give you advice regarding your injury the College expects that those pieces of advice and education are documented in your chart. There is also limited ability for the physiotherapist to take the time or have the appropriate environment to properly hear your issues, assess the area of concern, and then answer your questions about it.
The same goes for online socializing or interacting. The College has advised physiotherapists to keep their online personal and professional lives as separate as possible. Interacting with your physiotherapist regarding your injury or condition on social media channels is discouraged as physiotherapists are directed to avoid sharing private information on these platforms. If you do wish to reach out to your physiotherapist it should be done through their professional website or social media channels, [JC10] their organization’s email, or by contacting them at their organization directly. So don’t be surprised if your friend request is ignored or denied if you reach out to them on their personal channels.
Why your physiotherapist declined to accept your gift
You should feel no pressure or expectation to give your physiotherapist a gift for services you have received. However, at times patients may wish to convey their thanks to the staff or organization as a whole for the quality of care they received. If you wish to give your physiotherapist a gift there are a few things you should consider.
Are you still under your physiotherapist’s care? If the physiotherapist accepts your gift while they are still treating you it could constitute a conflict of interest for the physiotherapist. Especially if an insurance company or other party is paying for your care.
Gifting, especially personal gifts intended to be used and enjoyed by one person, is typically part of a personal relationship, not a therapeutic relationship. If a gift is expensive or personal, the intent of the gift-giving can be misunderstood or create a conflict of interest. Giving a personal or more expensive gift could make your physiotherapist uncomfortable as they may wonder about the intent or meaning behind it. It's not that your physiotherapist doesn’t like appreciation, but a sincere thank you is enough.
Physiotherapists and patients should work together to keep the therapeutic relationship a positive and professional one by staying focused on the reasons you are accessing physiotherapy services. Hopefully, your journey through your treatment plan is a positive one and you enjoy working with the physiotherapist along the way.
If you have questions or concerns about your therapeutic relationship with your physiotherapist, we encourage you to discuss that with the physiotherapist or their manager. If you are still unsure you can always contact professionalpractice@cpta.ab.ca for more information.Sean FitzGerald, PT
