Exploring therapeutic alliance in spinal cord injury rehabilitation: Control, identity, and liminality

Article

Lovric, Esha, Edwards, Niki and King, Julie. 2024. "Exploring therapeutic alliance in spinal cord injury rehabilitation: Control, identity, and liminality." Physiotherapy Theory and Practice: an international journal of physical therapy. https://doi.org/10.1080/09593985.2024.2443028
Article Title

Exploring therapeutic alliance in spinal cord injury rehabilitation: Control, identity, and liminality

ERA Journal ID16768
Article CategoryArticle
AuthorsLovric, Esha, Edwards, Niki and King, Julie
Journal TitlePhysiotherapy Theory and Practice: an international journal of physical therapy
Number of Pages17
Year2024
ISSN0959-3985
1532-5040
Digital Object Identifier (DOI)https://doi.org/10.1080/09593985.2024.2443028
Web Address (URL)https://www.tandfonline.com/doi/full/10.1080/09593985.2024.2443028
Abstract

Background
The therapeutic alliance (TA) has emerged as a key principle in enhancing the quality of health and rehabilitation services.

Purpose
This study aimed to explore patient perspectives on the influence of TAs with practitioners during inpatient rehabilitation following spinal cord injury (SCI).

Methods
Using a qualitative methodology, (n = 18) in-depth interviews were conducted with inpatient participants. Interviews were transcribed verbatim and analyzed using reflective thematic analysis. The study was grounded in a social constructionist epistemology, employing theories of liminality and psychotherapy as theoretical frameworks.

Results
Patient narratives suggest TAs are central to the rehabilitation experience. Additionally, analysis of patient stories revealed that patients entered a state of liminality upon admission. The primary theme, “Control as Enabling: Transition, the Marge,” highlighted during rehabilitation, patients navigated an identity separation and transition phase central to liminal spaces. Where practitioners accommodated patients’ identity journeys, meaningful TAs were established, enhancing rehabilitation. Conversely, when control was constrained, TAs weakened, increasing identity risks. TAs were found to be instrumental in protecting and preserving pre-SCI identity as well as facilitating movement through the liminal phase.

Conclusion
This research underscores the significance of TAs in SCI rehabilitation, demonstrating their role in enabling patient control, safeguarding identity, and facilitating the potential exit from liminality. To address the unique needs of SCI patients, it is recommended that SCI practitioners receive specialized TA training and professional development.

Keywordsspinal cord injury; rehabilitation; therapeutic alliance; patient-centred care; liminality
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020420199. Allied health and rehabilitation science not elsewhere classified
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Byline AffiliationsQueensland University of Technology
School of Psychology and Wellbeing
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