Participants’ unspoken thoughts and feelings negatively influence the therapeutic alliance; a qualitative study in a multidisciplinary pain rehabilitation setting

Abstract

Purpose: This study aimed to explore factors that influence participants' perceptions of the therapeutic alliance with healthcare professionals; their participation in the alliance; and their commitment to treatment in a multidisciplinary pain rehabilitation setting. Materials and methods: A qualitative research-design was used and 26 participants in a multidisciplinary pain rehabilitation program were interviewed in-depth. Results: Initially, participants reported to be satisfied with their healthcare professionals. After deeper reflection on the therapeutic alliance, several unspoken thoughts and feelings and relational ruptures emerged. Almost all participants mentioned a history of disappointing and fragmented healthcare, and they reported on how this affected their cognitions, perceptions, and beliefs about the current program. Participants felt insufficiently empowered to voice their concerns and regularly chose to avoid confrontation by not discussing their feelings. They felt a lack of ownership of their problems and did not experience the program as person-centered. Conclusions: Several factors were found that negatively influence the quality of therapeutic alliance (agreement on bond) and efficacy of the treatment plan (agreement on goals and tasks). To improve outcomes of pain rehabilitation, healthcare professionals should systematically take into account the perceptions and needs of participants, and focus more on personalized collaboration throughout the program offered. ä IMPLICATIONS FOR REHABILITATIONDifferences in perceptions and experiences of pain, together with differences in beliefs about the causes of pain, negatively influence the therapeutic alliance. When participants and healthcare professionals operate from different paradigms, it is important that they negotiate these differences. From the perspective of participants, a clear-cut organization of healthcare that encourages collaboration is required. It is important to focus on personalized collaboration from the start and during treatment, and to recognize and discuss disagreement on diagnosis and treatment plans. During this collaboration, healthcare professionals should systematically take into account the perceptions and needs of the participants.

Consultations Preliminary to Interdisciplinary Chronic Pain Rehabilitation

“…However, it is possible to reach an understanding that is truly shared only if patients open up about any concerns or different perspectives with regard to the factors involved in their health situation. Therefore, it is important that practitioners make an interactional effort to actually encourage patients to make their concerns or even objections explicit, so that these become open for discussion (see also Monzoni et al, 2011;Paap et al, 2022).…”

“…Achieving a completely shared understanding of a patient's pain and disability may not always be possible or even entirely necessary. However, an interview study by Paap et al (2022) indicates that patients' latent disagreement with their team's problem analysis negatively influences their commitment to rehabilitation treatment. Thus, it is important to identify discordances, as this may support patients and practitioners to communicate in ways that result in more effective medical practice (Coran et al, 2013).…”

The Working Alliance Inventory's Measurement Properties: A Systematic Review

“…In general, previous qualitative studies shows that patients report their subjective experiences of their working alliance (e.g., satisfaction, overall experiences and so forth) when they fill out an alliance measure concerning their treatment with a therapist (Bedi, 2006;MacFarlane et al, 2015;Paap et al, 2021). The outcome of the current review concerning content validity may be concerns not only the WAI, but may concern difficulties in content validity of alliance measures in general.…”

“…This approach can clarify whether the way clients/patients (or therapists) see themselves and their positions in psychotherapy or other healthcare contexts corresponds with Bordin's (1979) theory: do clients/patients see themselves as engaged in a mutual working relationship with their therapist with whom they share the same identified goals and tasks? Results of earlier qualitative research showed that clients/patients do not think this way about a working relationship (Bedi, 2006;MacFarlane et al, 2015;Paap et al, 2021). Furthermore, the WAI is applied in several other contexts besides psychotherapy, and the measurement studies in this systematic review all used the theory of Bordin concerning the working alliance.…”

Therapeutic alliance with psychotherapist versus dietician: a pilot study of eating disorder treatment in a multidisciplinary team during the COVID-19 pandemic

“…Eating disorder treatment requires health professionals from various disciplines to work together as a team ( 9 , 10 ). However, forming TAs within a multidisciplinary team can be challenging due to the patient’s need to establish and maintain multiple TAs with different members of the multidisciplinary team ( 11 ). Each member of the team brings unique expertise and perspectives, and patients can feel that they are more comfortable with one team member than with the other ( 12 ).…”