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\"From [an] ... author, psychotherapist, and national advice columnist, a ... book that takes us behind the scenes of a therapist's world--where her patients are looking for answers (and so is she)\"-- Provided by publisher.

The impact of the relationship (therapeutic alliance) between patients and physical therapists on treatment outcome in the rehabilitation of patients with chronic low back pain (LBP) has not been previously investigated. The purpose of this study was to investigate whether the therapeutic alliance between physical therapists and patients with chronic LBP predicts clinical outcomes. This was a retrospective observational study nested within a randomized controlled trial. One hundred eighty-two patients with chronic LBP who volunteered for a randomized controlled trial that compared the efficacy of exercises and spinal manipulative therapy rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session. The primary outcomes of function, global perceived effect of treatment, pain, and disability were assessed before and after 8 weeks of treatment. Linear regression models were used to investigate whether the alliance was a predictor of outcome or moderated the effect of treatment. The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome. The therapeutic alliance moderated the effect of treatment on global perceived effect for 2 of 3 treatment contrasts (general exercise versus motor control exercise, spinal manipulative therapy versus motor control exercise). There was no treatment effect modification when outcome was measured with function, pain, and disability measures. Therapeutic alliance was measured at the second treatment session, which might have biased the interaction during initial stages of treatment. Data analysis was restricted to primary outcomes at 8 weeks. Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP. Future research should investigate the factors explaining this relationship and the impact of training interventions aimed at optimizing the alliance.

During the COVID-19 pandemic, people have been encouraged to maintain social distance. Technology helps people schedule meetings as remote videoconferencing sessions rather than face-to-face interactions. Psychologists are in high demand because of an increase in stress as a result of COVID-19, and videoconferencing provides an opportunity for mental health clinicians to treat current and new referrals. However, shifting treatment from face-to-face to videoconferencing is not simple: both psychologists and clients miss in-person information cues, including body language. This review proposes a new theoretical framework to guide the design of future studies examining the impact of a computer as a mediator of psychologist-client relationships and the influence of videoconferencing on the relationship process. We conducted a literature review including studies focused on communication and key concepts of the therapeutic relationship and therapeutic alliance. Studies have reported that clients are generally satisfied with videoconference therapy in terms of the relationship with their therapists and the establishment of the therapeutic alliance. Conversely, studies indicate that psychologists continue to highlight difficulties in establishing the same quality of therapeutic relationship and therapeutic alliance. The contrasting experiences might underlie the differences in the type of emotional and cognitive work required by both actors in any therapy session; furthermore, the computer seems to take part in their interaction not only as a vehicle to transmit messages but also as an active part of the communication. A new model of interaction and relationship is proposed, taking into account the presence of the computer, along with further hypotheses. It is important to consider the computer as having an active role in the client-psychologist relationship; thus, it is a third party to the communication that either assists or interferes with the interaction between psychologists and clients.

Background The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Despite its influence, we do not know what conditions enable a physiotherapist and patient to establish and maintain a therapeutic relationship. This knowledge has implications for how clinicians approach their interactions with patients and for the development of an assessment tool that accurately reflects the nature of the therapeutic relationship. Therefore, this study’s aim was to identify and provide in-depth descriptions of the necessary conditions of engagement of the therapeutic relationship between physiotherapists and patients. Methods Interpretive description was the qualitative methodological orientation used to identify and describe the conditions that reflect and are practically relevant to clinical practice. Eleven physiotherapists with a minimum 5 years of clinical experience and seven adult patients with musculoskeletal disorders were purposively sampled from private practice clinics in Edmonton, Canada. The in-person, semi-structured interviews were completed in a location of the participant’s choice and were audio recorded and transcribed. Qualitative content analysis was used to analyze the textual data and constant comparison techniques were integrated to refine the categories and sub-categories. Rigour strategies used throughout the study were peer debrief, interview notes, reflexive journaling, memoing, member reflections, audit trail, and external audit. Results Four conditions were identified as necessary for establishing a therapeutic relationship: present , receptive , genuine , and committed . These conditions represent the intentions and attitudes of physiotherapists and patients engaging in the clinical interaction. Although distinct, the conditions appear related as being present and receptive create a foundation for being genuine and committed. Conclusions These conditions of engagement are needed for physiotherapist and patient to “be” in a therapeutic relationship. Although communication skills are important for advancing therapists’ relational abilities, awareness and integration of intentions and attitudes are essential for shaping behaviors that develop the therapeutic relationship. These findings also suggest there are characteristics of the therapeutic relationship specific to physiotherapy. Therefore, theories from other contexts (e.g., psychotherapy) should be used judiciously to guide physiotherapy practice and research.

Background Effective communication between healthcare providers and patients is essential for high-quality care and patient satisfaction. Barriers to communication can lead to misunderstandings and poorer health outcomes. This study aims to identify communication obstacles between physical/occupational therapists (PTs/OTs) and patients in the Saudi Arabian context. Methods This cross-sectional study, which was conducted from September 2022 to January 2023, involved 228 patients and 46 therapists from the rehabilitation services department. Data were collected via two self-administered questionnaires and analyzed via Pearson’s chi-square test of independence and Fisher’s exact test for categorical nominal data to assess associations between variables. A p value of less than 0.05 was considered statistically significant. Results Most patients (25.4%) were young adults aged 18–30 years, predominantly Saudi nationals (96.5%), with undergraduate degrees (63%). High satisfaction with therapists was reported by 69.3% of patients. The key barriers identified included limited consultation time (15.8%) and the use of medical records (4.8%). Therapists, primarily young professionals aged 25–30 years (54.3%) with 3–5 years of experience (43.5%), also reported time limitations (30.4%), physical setup issues (37.0%), and poor patient history-taking (56.5%) as significant barriers. Additional findings from our study indicated that monolingual Arabic-speaking therapists faced greater challenges in understanding language (p = 0.02), and younger therapists (aged 25–30) reported greater difficulties in managing multiple problems during sessions (p = 0.03), highlighting age and linguistic background as significant factors influencing communication efficacy. Conclusions Addressing communication barriers through targeted interventions, such as enhanced training, improved clinical structures, and advanced electronic health records, can improve patient satisfaction and treatment outcomes. Future research should focus on longitudinal studies and specific communication training programs.

Studies of criteria-based assessment tools have demonstrated the feasibility of objectively evaluating eHealth interventions independent of empirical testing. However, current tools have not included some quality constructs associated with intervention outcome, such as persuasive design, behavior change, or therapeutic alliance. In addition, the generalizability of such tools has not been explicitly examined. The aim is to introduce the development and further analysis of the Enlight suite of measures, developed to incorporate the aforementioned concepts and address generalizability aspects. As a first step, a comprehensive systematic review was performed to identify relevant quality rating criteria in line with the PRISMA statement. These criteria were then categorized to create Enlight. The second step involved testing Enlight on 42 mobile apps and 42 Web-based programs (delivery mediums) targeting modifiable behaviors related to medical illness or mental health (clinical aims). A total of 476 criteria from 99 identified sources were used to build Enlight. The rating measures were divided into two sections: quality assessments and checklists. Quality assessments included usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. The checklists included credibility, privacy explanation, basic security, and evidence-based program ranking. The quality constructs exhibited excellent interrater reliability (intraclass correlations=.77-.98, median .91) and internal consistency (Cronbach alphas=.83-.90, median .88), with similar results when separated into delivery mediums or clinical aims. Conditional probability analysis revealed that 100% of the programs that received a score of fair or above (≥3.0) in therapeutic persuasiveness or therapeutic alliance received the same range of scores in user engagement and content-a pattern that did not appear in the opposite direction. Preliminary concurrent validity analysis pointed to positive correlations of combined quality scores with selected variables. The combined score that did not include therapeutic persuasiveness and therapeutic alliance descriptively underperformed the other combined scores. This paper provides empirical evidence supporting the importance of persuasive design and therapeutic alliance within the context of a program's evaluation. Reliability metrics and preliminary concurrent validity analysis indicate the potential of Enlight in examining eHealth programs regardless of delivery mediums and clinical aims.

[This corrects the article DOI: 10.1371/journal.pone.0144623.].

Purpose of Review Telemental health, which is treatment mediated by technology, is an increasingly common method of delivering mental health care. However, its impact on the therapeutic alliance is unclear. This review examines studies of telemental health and its impact on therapeutic alliance. Recent Findings Findings indicate that a therapeutic alliance can be maintained through a variety of communication technologies, with some caveats. Considerations on maintaining a successful therapeutic alliance include using technology as an adjunct to treatment and ensuring patients and providers have back-up plans for continuing communication in the event of technical difficulties. Summary Overall, the studies found that clinicians often have more concerns about alliance than patients do, suggesting that clinicians could make some changes to feel more comfortable. Recommendations are offered for implementing techniques into practice that will help clinicians increase their awareness of ways to support the therapeutic alliance when using telemental health.

As mental healthcare expands to smartphone apps and other technologies that may offer therapeutic interventions without a therapist involved, it is important to assess the impact of non-traditional therapeutic relationships.AimsTo determine if there were any meaningful data regarding the digital therapeutic alliance in smartphone interventions for serious mental illnesses. A literature search was conducted in four databases (PubMed, PsycINFO, Embase and Web of Science). There were five studies that discuss the therapeutic alliance when a mobile application intervention is involved in therapy. However, in none of the studies was the digital therapeutic alliance the primary outcome. The studies looked at different mental health conditions, had different duration of technology use and used different methods for assessing the therapeutic alliance. Assessing and optimising the digital therapeutic alliance holds the potential to make tools such as smartphone apps more effective and improve adherence to their use. However, the heterogeneous nature of the five studies we identified make it challenging to draw conclusions at this time. A measure is required to evaluate the digital therapeutic alliance.

Objective The therapeutic alliance is central to psychotherapy. However, research on the relationship between alliance and suicidality is scarce. We examined whether pretreatment suicidality is associated with an impaired alliance formation in brief cognitive behavioral therapy (CBT) and whether the therapeutic alliance is associated with change in suicidal ideation (difference between pretreatment and posttreatment assessment). Methods N  = 643 outpatients (64% female; age: M [ SD ] = 37.09[13.15], range: 18–73 years), received 12 sessions of manual-based short-term CBT for primary diagnosis treatment. Using self-report questionnaires, suicidal ideation and behavior were assessed before and after therapy, patient-rated therapeutic alliance was assessed after the fourth session and posttreatment. We performed correlation analyses and two hierarchical linear regressions, unadjusted and adjusted for possible confounding variables (age, gender, lifetime suicide attempts and depression). Results Pretreatment suicidal ideation was not predictive of the quality of the early alliance. In addition, the therapeutic alliance was not predictive of change in suicidal ideation. Conclusions In the outpatient setting, no association was found between therapeutic alliance and suicidality. Future studies should investigate therapeutic alliance as a predictor of prospective suicidal behavior in different clinical settings.