Therapeutic Alliance: Dynamics in the Exam Room

Part of the therapeutic alliance is understanding the dynamics in the room. My beliefs, my biases, the culture I come from, I bring all that into the room with me. The patient I’m working with, they have their cultural background, their beliefs, their expectations, and their past experiences.

Practitioners must

• Learn to recognize what they are effectively communicating to the patient and any other involved practitioners
• Collaborate on a plan to effectively move forward
• Understand patient cultural factors, which can be a huge component and must taken into account in order to work with others

Goals: what are the patient’s goals? Some intake questionnaires ask about function: “Can you do the dishes? Can you do laundry?” Some patients answer, “No. I’m unable to do that.” From a therapeutic alliance standpoint:

• We want to make sure we’re working towards the goals of the patient, not improving their score on a particular outcome measure
• We want to make sure they’re doing things that matter to them
• Culture will definitely play a role in what functionally matters to a patient, what their actual purpose is, and what brings them joy
• You can’t build a therapeutic alliance until you understand the individuality of a patient