Therapeutic Relationships

Question 1

Define Therapeutic Relationship

Answer 1

Mutally beneficial bond that exists btw healthcare professional and their patient

Question 2

Define Personal Relationship

Answer 2

A relationship with a person that has elements of specialness, exclusivity, or intimacy

Question 3

Expectations of Therapeutic Relationship

Answer 3

Therapist places patient needs first
Therapist will not exploit the relationship
Therapist will manage relationship components
APTA Code of Ethics and Guide for Professional Conduct

Question 4

Power

Answer 4

Imbalance of power exists
Possible contributors (education, license, knowledge)
Impact on patient - vulnerability

Question 5

Trust

Answer 5

Patient trust in PT competence
PTs responsibility not to exploit the patient or do harm
Impact on patient - breach of trust

Question 6

Respect

Answer 6

PTs responsibility to treat patients with respect regardless of personal bias/differences
PT allowing patient to participate in his or her care
Impact on patient - feeling devalued

Question 7

Personal Closeness

Answer 7

Nature of PT and client relationship requires various levels of physical, emotional, and psychological closeness
Impact on patient - vulnerability

Question 8

Elements of effective therapeutic relationships

Answer 8

Trust - influenced by competence, honesty, reassurance 
Integrity
Courtesy 
Caring behaviors 
Focus

Question 9

Individualized Approach

Answer 9

Personal comfort
Personal interests
Expanding patients’ awareness
Empathy

Question 10

Challenges to Therapeutic Relationships

Answer 10

Anxiety/fear
Attitude/bias
Resistance
Communication barriers
Distractions
Casualness
Irreconcilable differences
Transference - shifting feelings from one person to another
Bias

Question 11

Ways to undermine therapeutic relationship

Answer 11

Encourage patient to establish personal relationship
Attracting attention to yourself
Socializing with patient outside of sessions
Doing favors for patient that you wouldnt do for all patients

Question 12

Time to Refer

Answer 12

Lack experience or knowledge needed
When there is serious personality conflict pr challenge to safety/respect
There is negative bias toward the person or group with which they belong
When there is too much dependency

Question 13

Professional Boundaries

Answer 13

Physical and emotional boundaries
Goal of patient well being
Maintaining caring respect

Question 14

Physical Boundaries

Answer 14

Informed Consent
Unconsented Touching 
- Battery
- Sexual Touching
- Sexual Harassment

Question 15

Sexual Harrassment

Answer 15

Title VII and Title IX

Over 90% of PTs experience some sort of innapropriate sexual behavior during work

Question 16

Emotional Boundaries

Answer 16

Dual Relationships
Sympathy vs. Pity
Overidentification
Caring too much

Question 17

What can we do - Pity

Answer 17

Use your communication skills to redirect conversations

Refer patient to appropriate member of health care team

Question 18

What can we do - Personal Identification

Answer 18

Refrain from sharing similar experiences
Stress uniqueness of patent’s situation
Listen First

Question 19

What can we do - Caring too much

Answer 19

Refrain from visiting patient outside treatment sessions

Limit depth of conversation

Question 20

5 Levels of Communication

Answer 20

1. Cliche Conversation
2. Reporting Facts
3. Personal Ideas/Judgements
4. Feelings and Emotions
5. Peak Communcation

Question 21

Patient Loss

Answer 21

Physical Function
Cognitive Function
Physical Appearance
Life Roles
Self-Image
Relationships
Finances
Control

Question 22

Intensity of Loss Determined by

Answer 22

Pathology
Change in environment
Change in roles and values of these roles
Coping mechanisms

Question 23

Addressing Patient Loss - PTs role

Answer 23

Acknowledge the loss and its impact on the patient
Create an effective plan of care to address primary contributors to the loss
Identify and engage other team members
Identify resources - psychological support, spiritual support, family support, community resources

Question 24

Terminating the Patient

Answer 24

Could be loss for both parties
Start discussing plans for discharge at initial visit 
Provide rationale for discharge
Collaborate with others 
Provide patient with follow up plan