“Sharing Success with Someone”: Building therapeutic alliance in physiotherapist-delivered physical activity coaching for healthy aging

ABSTRACT

Introduction

Therapeutic alliance, a goal-orientated partnership between clients and practitioners, can enhance program engagement and adherence, and improve treatment outcomes and satisfaction.

Objectives

To develop an empirical model that describes how therapeutic alliances can be operationalized in clinical and research settings and use this in our evaluation of the Coaching for Healthy Ageing (CHAnGE) trial.

Methods

Secondary analysis of interviews with participants in the CHAnGE trial (n = 32) and a focus group with the physiotherapists who delivered health coaching in that trial (n = 3). Analysis was inductive (thematic) and deductive (using a therapeutic alliance model derived from a literature review and informed by earlier analyses).

Results

Data from participants and physiotherapists indicated that health coaching in CHAnGE built effective therapeutic alliances (i.e. it facilitated collaborative decision-making and trusting person-centered relationships) which were underpinned by professional skills and structural supports. Components of the intervention that strengthened therapeutic alliance were health coaching training, home visits, the coaching format, and provision of free activity monitors.

Conclusion

This study identifies key concepts and practical ‘building blocks’ of therapeutic alliance, showing how these were operationalized within an intervention. This may help those in clinical and research settings to recognize the importance and characteristics of therapeutic alliance and put it into practice.

KEYWORDS:

• Therapeutic alliance
• health coaching
• physical activity
• older adults
• qualitative methods

A Note about Qualifying Degrees of Therapeutic Alliance

Some studies refer to TA as constant while others qualify it. Our view is that TA is, at heart, a relationship and thus there are likely to be gradations of strength/effectiveness/positiveness on multiple dimensions, but that when used without qualification the term TA indicates a threshold in which a sufficient degree of strength/effectiveness/positiveness on key dimensions has been reached because, by definition, there is some form of client/practitioner alliance and it is deemed to be therapeutic.

Acknowledgments

Thanks to the CHAnGE trial participants who took part in this study, and to Courtney West for her administrative support.

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

This work was supported by the Australian National Health and Medical Research Council [APP1083495].