I cannot over-emphasise how important it is to me as a persistent pain patient to have a strong, supportive therapeutic relationship, both with my physiotherapist and other clinicians involved in my care.
I need the confidence to be able to raise things that are important to me, but that I’m concerned might be seen as ‘silly’ by the therapist. If I can’t, these thoughts don’t go away. If I can, and they can be discussed in an open, non-judgemental way then I can be supported to better understand.
I need to feel that I am listened to. My ‘story’ as a persistent pain patient is hugely complex, and I need the confidence that my PT is interested, and can pick out the relevant points for expansion. I don’t want him/her to just sit there and listen to me, I want to have a genuine, mutually respectful conversation.
I want to feel that I’m an equal partner in my care. I need my PT to take the lead at times, and I need him/her to let me take the lead at times. I need to feel that I’m not just ‘being done to’, and that me as a person doesn’t matter. I need to feel that I am being treated as an individual, with a unique presentation of my condition and set of psycho-social factors.
I need his/her explanations of what might be happening with my body and I need to feel able to discuss how that fits in with my lived experience. I need to be able to understand the possible causes of my pain experience, and how to manage it. I need to feel able to say when I don’t think their hypothesis about my condition is right.
I need to be able to build up enough trust that I feel, particularly after having expressed any thoughts/concerns, that any exercise/treatment proposals are worth trying. I then need to have enough faith in their judgement to put the hard work in outside of the therapy sessions to give it a real good go.
I need encouragement, and I need to want to try hard at whatever I am asked to do. Chances are it may not be easy, but having faith in my PT means I will be able to persevere. I need to have my successes, however small, positively reinforced. I need to be able to openly discuss, without judgement, my ‘failures’.
I need to think that when discussing treatment options, eg surgery, that I will be told both the pros and cons in a balanced way. I need to think I am being given the same advice that they would give a family member. (My clinician work colleagues have given me a much more honest, balanced picture of, for example surgery, than some of my own clinicians.)
Living with persistent pain is difficult, and at times confusing. It is difficult to be able to step back from your situation and see things objectively. I need my physiotherapist to help me do that. I need them to understand me well enough to be able to help me do that. I need to believe they will be sensitively honest with me.
I am lucky, my physiotherapist does all of these things for me. If he didn’t then I know I wouldn’t have made the progress I have, or be able to make the progress I still need to.
I think we as patients also have a responsibility in building this therapeutic relationship that provides the framework for our support. Our attitude to therapy and our therapist must surely be an important factor too.
When the therapeutic relationship is strong and mutually trusting then magic can happen, and people’s lives can be changed. Without it then progress is likely to be less, and the satisfaction, from both the patient and clinician, much less.