What matters most to the therapeutic relationship in neurorehabilitation?

Abstract

Background: There is growing recognition of the role that therapeutic relationships have on outcome in neurorehabilitation. However, conceptual understanding of the therapeutic relationship within this context is limited. This results in a reliance on theories generated in psychotherapy which may lack fit in this setting. The aim of this research was to explore what matters most in the therapeutic relationship from the perspective of patients accessing neurorehabilitation services. Methods: Qualitative Descriptive methodology using semi-structured interviews. Participants were n=15 people currently receiving rehabilitation following a neurological event. Purposeful sampling was used to capture a diversity of perspectives. Data were analysed using conventional content analysis. Findings: The overriding concept relevant to the therapeutic relationship in neurorehabilitation was Do the right thing for me. This was underpinned by four interrelated themes: 1) Show me you know how; 2) Be my professional; 3) Connect with me as a person; 4) Value me and my contribution. Together, they created space for the patient to achieve more than they thought possible, referred to as the “X-factorâ€. Discussion: This research has advanced our understanding of what matters most to the therapeutic relationship in a neurorehabilitation setting. The themes provide a conceptual basis which could underpin the development of a measure, as well as inform strategies for practice. Health psychologists working in rehabilitation settings may have a role in supporting practitioners to develop a relational approach to practice, enabling them to tap into the true potential of the therapeutic relationship as a covariate of outcome.