The Therapeutic Relationship
Physiotherapists must always act in the best interest of the patient. They also have a professional obligation to establish and maintain an appropriate physiotherapeutic relationship with each of their patients. Therapeutic relationships are not the same as social relationships between friends or colleagues.Often, patients do not appreciate that there is a difference between these two types of relationships and they may engage in behaviors that are unacceptable within a therapeutic relationship.
Just as patients have the right to expect certain behaviours from a physiotherapist when receiving physiotherapy treatment, physiotherapists have the right to expect certain behaviours from a patient. However, physiotherapists are responsible for managing the relationship at all times. At the initial assessment, physiotherapists should establish the boundaries of the relationship and explain their expectations related to the patient’s behavior within these boundaries; for example, that a physiotherapist expects the patient to be on time for appointments, to comply with the policies of the organization regarding parking, payment of fees for physiotherapy services provided and any additional administrative costs or fees for missed appointments. The consequences of non-compliance should also be disclosed. If a patient knowingly ignores organizational policies about which they have been informed and that a consequence of non-compliance is discharge from treatment, the physiotherapist may discharge the patient.
Not every behaviour or incident can be managed by the creation of a policy. If a patient arrives for their appointment intoxicated, or if a patient begins to ask questions of a personal nature, the physiotherapist must deal with those situations on an individual basis by:
- identifying the behaviour or comment that is problematic;
- describing how the behaviour must change to be acceptable within a therapeutic relationship; and
- describing the consequences of non-compliance should the behaviour occur again.
