The Patient-Therapist Interaction: A Case Study

As the patient-therapist interaction is a collaborative effort of both participants, in the above conversation the therapist used an interrogative mode to know about the severity of pain while giving the treatment (Thornborrow, 2002). The intention may be to modulate the treatment according to the response from the patient side and the answer expected would have to be yes or no on the basis of the given form of the question. But, the patient utterance was not a direct answer. Instead of that, the patient indirectly expressed his unbothered attitude towards pain by comparing his previous experience of the pain that he experienced on the day of the accident. Even though it was an indirect response from the patient side it provides sufficient
information to the therapist that the therapist can compute a direct answer of ‘yes’ to her question.
Also, the patient considered recovery as his self-need and expressed it as a distinctive form of motivation.
This is apparent in the line that starts from ‘pain is not at all a problem’. This motivation considered a positive act to compliance with the treatment program. This form of patient attitude is entirely opposite to the attitude that we saw in the first example (old patient’s resistance attitude). There the conflicting ideology from the patient side made a clash with the philosophy of physiotherapy. However, here in this example (Extract 6) the high motivation of the patient to take the active role in his current situation or the awareness about his own responsibilities, that creates a compatibility with the philosophy of physiotherapy.
When considering P3’s identity, P3 was a driver and the main bread earner of his family. Below quoted the PTB19 views about the relationship between pain tolerance and socioeconomic status
‘Also I felt the patients coming from low social level seems to tolerate the pain at their maximum for improvement. I think this is for getting faster improvement… then only they can go back to work’
(PTB19)
According to PTB19 patients from low SES had better pain tolerance level. Very few studies had investigated the relation between pain tolerance and SES (Krantz & Ostergren, 2000; Milijkovic et al., 2014). In this none of the studies found patient from low SES had better pain tolerance level (Krantz & Ostergren, 2000; Milijkovic et al., 2014). Interestingly there were studies that identified the effect of patients’ pain tolerance on their compliance with the physiotherapy treatment. Previous studies related to patient’s pain tolerance find out that injured sports people with a high pain tolerance were significantly more likely to be compliance with the programme requirements than those with a poor tolerance (Fisher, Domm & Wuest, 1988; Fields et al., 1995). Potter, Gorden and Hammer (2003) explored from therapist’s perspective patient’s level of pain tolerance as an important factor that influenced therapeutic relationship. During the time of interview PTR17 shared the experiences on how patients level of tolerance influence her in the clinical practice. ‘’Certain patients have less pain tolerance level. This types of patients are very hard to handle. Can’t give proper treatment to such kind of patients… I can say this affects the patient-therapist relationship’’. (PTR7)
On the basis of above explained evidence the level of pain tolerance could be considered as a factor that influenced treatment compliance as well as the therapeutic relationship. Self-motivation is an important matter that can be identified in extract 6 in relation to compliance. During the time of interview P26 describes his motive behind exercise compliance and is given below
‘I am not going to the job now, I want to go back to my job. So I do follow the exercise and everything that what sir, saying’ (P26). Here, the P26’s motivation was an example of more autonomous or self-determined form of extrinsic motivation trough identification of his future goal as to go back to work (Chan et al., 2009).
Similarly, P3’s motivation might be considered as an extrinsic motivation aroused as a result of his external identification behavioural regulation. Identified behavioural regulation is a form of extrinsic motivation refers to a person performing an action because he or she values the benefits that will be derived (Ryan & Deci, 2000). Here, both patients were the bread earner of the family, from low SES and their identified social responsibilities made them more compliant with the treatment. PTM9 also expressed the similar opinion,
‘When considering the case of low socioeconomic family or a borderline middle-class family… usually, the men in the family were the main bread earner …and the rest of the family usually depend on that man. So such kind of patients usually seems to be highly self –motivated’. (PTM9)
According to PTM9 the life situations of the patients from low SES or borderline middle-class family might be acted as an external factor for their self- motivation. This possibly encouraged patient compliance with the treatment regimen and thereby create a positive relationship with the
therapist.
The therapist in this extract provided empathy to the patient in the form of alignment and reassurance. After the patient explained about his pain experience the therapist smiled at patient this is consider as an act of alignment with the patient. A reassurance talk can be seen in the line ‘’ will be alright’. The reassurance could be based on the assumption that the patient will cooperate with treatment.
A form of patient education can see in the line starting from ‘Hand will slowly become….’.That also can be considered as an effort from the therapist side to make the patient understood about the real fact about his prognosis rather than being over optimistic. The evidence of power imbalance between patient and therapist could not be identifiable in this conversation. A mutual give and take therapeutic relationship can see in this conversation. That is, expression of feelings from patient side and an empathetic as well as an educational approach from therapist side. This was identified as a positive aspect of this interaction.