A positive relationship between you and your patient is known as the therapeutic alliance.  This relationship is critical for patient satisfaction and your patient’s recovery (Pinto et al., 2012). As a physiotherapist, a desired goal is to help your patient recover and prevent a future recurrence. In other words, the goal is to reduce their pain, make them feel better, and get them back to the activities they know and love.

However, your patient’s recovery goals and their ability to understand and adhere to your professional advice play a huge role in their perceived effect of treatment. Do they intend to return to a certain sport? Do they fully understand the exercises you have prescribed? Do they believe and trust in your treatment plan and advice? Are they aware of any progress that has been made?

The answers to these questions depend on your ability as a physiotherapist to properly communicate with your patient.

Many healthcare professionals struggle with communication. Training for a career in healthcare has often been limited to one’s ability to understand and perform the tasks and activities required in their chosen specialty. While this is a necessary part of any career in healthcare, an emphasis has begun to shift toward the patient-therapist dynamic.

In this article, we will explore this relationship, factors that influence it, and how you can improve the therapeutic alliance with your patients.

The Therapeutic Alliance

The therapeutic alliance is also known as the therapeutic relationship or working alliance.  By definition the alliance represents the interactions between the patient and healthcare professional, including collaboration and an agreed upon goal for treatment (Pinto et al., 2012).

Pinto and colleagues (2012) reviewed 12 different scientific studies and concluded “a good therapeutic alliance can positively influence treatment outcomes such as improvement in symptoms, health status, and satisfaction with care.” The patient’s perceived effect of treatment was higher in those with a stronger and more positive therapeutic alliance.

What Promotes a Therapeutic Alliance?

From various studies, a patient-centered approach to treatment primarily promotes a positive therapeutic alliance (Pinto et al., 2012). A patient-centered approach means taking into consideration your patient’s concerns and goals in the treatment strategy.

It is about empowering your patient and delivering a thorough understanding of each stage of treatment. If you are asking your patient to do an exercise, explain why they need to complete it every day. Take the time to explain why they are feeling certain symptoms, such as pain, and that with their diagnosis or condition, these symptoms are normal. Treat the relationship as a partnership as opposed to a service.

care to listen

Clear communication, your ability to relate and educate is highly valued by patients

Through research and patient interviews, M.O. Kidd and colleagues (2011) gathered patients’ views on what characteristics make a good physiotherapist and contributed to a patient-centered approach. These 5 characteristics include:

  • Clear communication, involving good listening, instructional and demonstrative skills, as well as reassurance regarding the patient’s pain symptoms
  • Confidence
  • The nature of the professional relationship, which included the patient’s ability to give input regarding their treatment plan and goals
  • An understanding of people and an ability to relate, including expressing empathy, encouragement, and friendliness.
  • An emphasis on progress and the outcome, which was broken down into sub-categories such as the use of measurement tools and transparency.

The study emphasized the inclusion of these characteristics in building a lasting relationship between the patient and therapist. These characteristics gain the patient’s trust.  Drawing from own experience trust is a key aspect of any relationship, working or personal.

This style of partnership, in turn, engages the patient in their treatment process and leads to a more self-directed approach, promoting recovery (M.O. Kidd et al., 2011).

Patient-centered Interaction Styles for Success

Pinto and colleagues (2012) explained the correlation between a positive therapeutic alliance and certain interaction styles. Interaction styles studied include facilitation, involvement, education, and support.  Additionally verbal and non-verbal factors are important too.

Measured by communicative success, agreement, trust, and rapport from the patient’s perspective three styles impact the therapeutic alliance (Pinto et al., 2012). These interaction styles can be described as supporting/involving, facilitating, and educating. As an example an action viewed as supporting is taking the time to discuss patients concerns and being gentle during examination.  Greeting patients warmly would be facilitating and explaining symptoms educating.

7 Strategies to Improve Your Therapeutic Alliance

Incorporating specific interaction strategies can improve the therapeutic alliance. Here are 7 strategies you can easily incorporate:

  1. Taking the time to listen to your patient’s background and complaints. Allow them to express their concerns and goals.
  2. Being sensitive to emotional aspects. Show empathy. Treat them like any other person, and reassure them. Often, people are coming to you in pain. Be understanding of this.
  3. Asking questions of the patient’s situation and symptoms. Ensure your interest in knowing their pains and discomfort is perceived by them
  4. Discussing options with the patient. Take a collaborative approach. For example, if you believe a supervised exercise program would be beneficial discuss options with them.
  5. Explaining necessary information to the patient. If they understand why you are doing something or why they should do something, they will be more likely to trust and follow-through with your advice. For example, explaining to your patient why they may be more sensitive to pain.  What can provoke their pain can offer insight into how they can limit these symptoms.
  6. Making eye contact and uncross your arms and legs. As per most social situations, an open body language is more inviting and positive. Crossed arms and lack of eye contact promotes distrust.
  7. Using measurement or assessment tools, such as visual analogue scale (pain score) or our Navigate Pain software, to help understand and communicate your patient’s symptoms. Technology has vastly helped improve our communication abilities and extend our knowledge. As a physiotherapist, use it to your advantage. Our mapping and pain tracking software can visually display a patients symptoms and in return helping you explain them.  This can lead to a more appropriate and collaborative treatment plan.

Future studies may provide additional strategies on how to improve the patient-therapist dynamic and lead the way for further supplementary communication and patient care training. The latest research shows that taking a patient-centered approach can improve treatment effectiveness and promote a quicker recovery. Deliver the best quality care by communicating professionally and get your patients back to leading their best life, free of pain.


Pinto et al., (2012) Patient-centred communication is associated with positive therapeutic alliance: a systematic review. Journal of Physiotherapy 58: 77–87.

M.O. Kidd et al., (2011) Patients’ perspective of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative study. Physiotherapy 97 154-162.

Written and Edited by: 

Krista Bugden, BPhty and Shellie A. Boudreau, PhD