Horton Ayana, Hebson Gail, Holman David
Brunel University, Uxbridge, UB8 3PH, England.
Work and Equalities Institute, University of Manchester, Manchester, England.
BMC Health Serv Res. 2021 Jan 28;21(1):97. doi: 10.1186/s12913-021-06095-y.
The importance of the therapeutic relationship is widely recognised across healthcare professions. Despite the importance of therapeutic relationships, there are significant gaps in the knowledge base on how these relationships develop. To address these gaps, this study explores relationship dynamics by identifying relational turning points and trajectories in therapeutic relationships between occupational therapists and physical therapists and their patients. The implications for how a focus on these relational aspects can enhance clinical practice will be discussed.
Data collection was based on the Retrospective Interview Technique and consisted of two phases. In the first phase patients and therapists were asked to tell the story of their therapeutic relationship development and as part of this, identify the turning points that occurred. In the second phase, therapists-patient dyads were observed from their first interaction to their last to identify potential turning points and at the end of the relationship a participant verification interview was conducted with both dyadic partners individually. Template analysis was used to analyse the data.
Therapists identified 6 distinct categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Patients, Interpersonal Problems with Patients, Positive Feedback, and Negative Feedback. Patients identified 5 categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Therapists, Agreement with Therapist and Change in Treatment. These turning points varied regarding their impact on the trajectory of the therapeutic relationship. The trajectory patterns identified were stable, upward, downward, and multidirectional.
This study makes an important contribution to our understanding of therapeutic relationship dynamics in the occupational and physical therapy context. The results expose the challenges that therapists and patients face in building high-quality therapeutic relationships, the diversity of therapeutic relationships, and how these relationships develop over time. This is the first study to use a turning point analysis in research on therapeutic relationships.
治疗关系的重要性在各个医疗行业中都得到了广泛认可。尽管治疗关系很重要，但关于这些关系如何发展的知识库仍存在重大差距。为了填补这些差距，本研究通过识别职业治疗师、物理治疗师与患者之间治疗关系中的关系转折点和轨迹，来探索关系动态。将讨论关注这些关系方面如何能够增强临床实践。
数据收集基于回顾性访谈技术，包括两个阶段。在第一阶段，要求患者和治疗师讲述他们治疗关系发展的故事，并在此过程中识别出现的转折点。在第二阶段，从治疗师与患者的首次互动到最后一次互动进行观察，以识别潜在的转折点，并且在关系结束时，分别与二元组中的双方进行参与验证访谈。使用模板分析来分析数据。
治疗师识别出6种不同类别的转折点；朝着目标前进、朝着目标前进过程中的挫折、与患者的人际情感联结、与患者的人际问题、正面反馈和负面反馈。患者识别出5种转折点类别；朝着目标前进、朝着目标前进过程中的挫折、与治疗师的人际情感联结、与治疗师的共识以及治疗变化。这些转折点对治疗关系轨迹的影响各不相同。识别出的轨迹模式有稳定、上升、下降和多方向。
本研究对我们理解职业治疗和物理治疗背景下的治疗关系动态做出了重要贡献。研究结果揭示了治疗师和患者在建立高质量治疗关系中面临的挑战、治疗关系的多样性以及这些关系如何随时间发展。这是第一项在治疗关系研究中使用转折点分析的研究。
