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Chiropractic Journal of Australia : CJA March 2013
Chiropractic Journal of Australia Volume 43 Number 1 March 2013 25 INTRODUCTION The therapeutic alliance is traditionally thought of as a signifcant factor infuencing outcomes from psychological interventions. In a recent conference, the power of non- specifc effects, expectations, and therapeutic alliance were identified as emerging trends promising new directions research on low back pain in primary care,1 refecting a growing awareness that the therapeutic alliance may also be a signifcant factor in physical and manual therapies. In a recent Australian study exploring the therapeutic alliance between physiotherapists and patients, Ferreria et al suggested that it is a signifcant predictor of response to treatment in chronic low back pain.2 182 patients with chronic low back pain were allocated to general exercises, motor control exercises, and spinal manipulative therapy groups. Therapeutic alliance was found to be a signifcant predictor of global perceived effect of the type of intervention and functional outcomes. Differences were as large as 4 points on an 11 point scale and could represent an improvement from a status of "no change" to a status of "completely recovered" in the patient outcome scores. In a 2007 US study of the physician--patient relationship, Feurtes et al suggested that working alliance could be measured in medical care.3 Further, it appeared to be strongly associated with patients' adherence to, and satisfaction with, treatment. Feurtes et al recommended that patients' self- effcacy ought to be assessed and promoted because it is also associated with treatment adherence and outcomes may A Commentary - The Role of Therapeutic Alliance in Physical and Manual Therapies STANLEY INNES and MELAINIE CAMERON Stanley Innes B App Sc (Chiro), M Psych Private Practice Lilydale Victoria 3140 We certify that there is no confict of interest with any fnancial organisation regarding the material discussed in the manuscript. Melainie Cameron B App Sc (Ost), MHSc, PhD 1: School of Health and Sport Sciences, Cluster for Applied Health Innovation and Translation (CAHIT), University of the Sunshine Coast. 2. Centre for Physical Activity Across the Lifespan (CoPAAL), Australian Catholic University. Received 18 November 2012, accepted 10 February 2013 Abstract: The role and importance of the therapeutic alliance (TA) has been extensively studied in the delivery of psychological services. More recent research has highlighted its signifcance in non psychological disciplines, in particular physical and manual therapies. The authors review the literature relevant to this transition and describe the nature of TA and how it may be utilised for improved treatment outcomes. INDEX TERMS: PSYCHOTHERAPEUTIC PROCESSES;MANUAL THERAPY; OUTCOME ASSESSMENT; HEALTHCARE. Chiropr J Aust 2013;43:25-7. be predicted on the basis of to the strength of the working alliance. We contend, along with Johansson et al that these results, together with other research across healthcare disciplines, indicate that the expectancy-alliance-outcome mediational chain is a general phenomenon, not limited to subgroups of patients or modes of treatment.4 WHAT IS THE THERAPEUTIC ALLIANCE? In its simplest form it is described as the relationship between a psychologist or psychotherapist and a patient, and it is regarded as important for the outcome of psychological therapy.5 The therapeutic alliance construct refers to the collaborative aspect of the relationship between therapist and client(s) in the context of psychotherapy. The conceptualization of the alliance that has been most prominent in individual psychotherapy, proposed by E.S. Bordin in 1979,6 includes three components: (1) an agreement between therapist and client about the goals of treatment, (2) an agreement about the therapy tasks needed to accomplish those goals, and (3) the emotional bond developed between therapist and client that allows the client to make therapeutic progress. An important finding that has emerged from a large number of studies is that the alliance assessed early in treatment predicts ultimate therapeutic success across a variety of clinical issues and treatment modalities.7 A positive relationship between client and counsellor may be one of the most important and most frequently overlooked variables for predicting client response to an intervention. It accounts for more variance in psychological treatment outcomes than any single client characteristic.8 Therapeutic Alliance Across Differing Therapeutic Domains. Therapeutic alliance (TA) is a strong predictor of outcomes in individual psychotherapy across diverse treatment orientations and modalities.7,8
CJA December 2012
CJA June 2013