Exploring the meaning and establishment of the therapeutic relationship in physiotherapy through reflective practice: A qualitative study

ObjectiveTo explore, through reflective practice, physiotherapists' perspectives on the meaning and establishment of the therapeutic relationship with patients.DesignThe study formed part of a broader mixed-methods implementation study based on participatory action research and corresponded to the initial stages of recognition, analysis, action and observation, framed within a constructivist paradigm aimed at improving the therapeutic relationship. A qualitative study was conducted.SettingThe study was carried out at the Rehabilitation Service of El Bierzo Hospital (Ponferrada, Spain).ParticipantsAll physiotherapists were invited to participate. Of the 19 physiotherapists and one physiotherapist manager invited, 18 consented to take part in the study.Main measuresFocus groups and self-observation through reflective diaries were undertaken. Focus groups were audio-recorded, and data from both methods were transcribed, coded, and thematically analysed.ResultsSix key categories were identified that provide insight into how physiotherapists understand, construct, and experience the therapeutic relationship: (1) meaning of the therapeutic relationship, (2) importance of the therapeutic relationship, (3) purpose of the therapeutic relationship, (4) establishment of the therapeutic relationship, (5) bi-directionality in the therapeutic relationship, and (6) the environment of the therapeutic relationship.ConclusionThis study highlights physiotherapists' perceptions regarding the therapeutic relationship and how these are transferred to daily clinical practice. The therapeutic relationship is centred on accompaniment and trust. Participants emphasised the importance of initial patient contact, during which the therapeutic bond is established through a friendly and cordial approach. Subsequently, physiotherapists lack a structured process for the development of the therapeutic relationship.