Bishop Megan, Kayes Nicola, McPherson Kathryn
Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.
School of Physiotherapy, University of Otago, Wellington, New Zealand.
Disabil Rehabil. 2021 Apr;43(8):1074-1083. doi: 10.1080/09638288.2019.1651909. Epub 2019 Aug 21.
The quality of the therapeutic alliance between a client and their clinician is thought to play an important role in healthcare but there is limited research about this concept in stroke rehabilitation. This study explored the core components of a therapeutic alliance and the factors perceived to impact on its development in a stroke rehabilitation unit.
Interpretive description methodology was used to gather and synthesise participants' experiences of their therapeutic relationships. Ten individual client interviews and one clinician focus group were conducted. Data was were analysed using conventional content analysis.
A therapeutic alliance appeared to consist of three overlapping core components: a personal connection, a professional collaboration, and family collaboration. Clients valued these components to different degrees and priorities could change over time. Alliance breakdowns were perceived to stem from a clinician's incorrect assumptions about their client's relationship preferences or lack of responsiveness to their needs. Recovery of the alliance seemed to depend on the strength of the pre-existing relationship and steps taken to repair it.
Establishing and maintaining a therapeutic alliance appears to be an individualised and complex process. A clinician's ability to use their personal attributes therapeutically, and professional skills flexibly, appeared integral to relationship quality.IMPLICATIONS FOR REHABILITATIONDeveloping therapeutic relationships requires a person-centred and sometimes family/whānau-centred approach.The judicious use of self-disclosure may achieve emotional proximity and yet maintain professional boundaries.Maintaining relationship health requires a proactive approach to detect and manage relationship disruptions.
客户与其临床医生之间治疗联盟的质量被认为在医疗保健中起着重要作用，但在中风康复领域，关于这一概念的研究有限。本研究探讨了治疗联盟的核心组成部分以及在中风康复单元中被认为会影响其发展的因素。
采用解释性描述方法来收集和综合参与者对其治疗关系的体验。进行了10次个体客户访谈和1次临床医生焦点小组访谈。使用常规内容分析法对数据进行分析。
治疗联盟似乎由三个相互重叠的核心组成部分构成：个人联系、专业协作和家庭协作。客户对这些组成部分的重视程度不同，且优先级可能会随时间变化。联盟破裂被认为源于临床医生对客户关系偏好的错误假设或对其需求缺乏响应。联盟的修复似乎取决于既有关系的牢固程度以及为修复关系所采取的措施。
建立和维持治疗联盟似乎是一个个性化且复杂的过程。临床医生将其个人特质用于治疗以及灵活运用专业技能的能力，似乎是关系质量的关键。
对康复的启示
发展治疗关系需要以个人为中心，有时也需要以家庭/毛利大家庭为中心的方法。
明智地运用自我表露可能会实现情感上的亲近，同时又能保持专业界限。
维持关系健康需要采取积极主动的方法来发现和处理关系破裂问题。
