I cannot over-emphasise how important it is to me as a persistent pain patient to have a strong, supportive therapeutic alliance, with all of the healthcare professionals 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 others. 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 healthcare professional 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 need to feel that I’m an equal partner in my care. I need my therapist or clinician 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 feel able to trust my therapist or clinician, so I feel that any exercise or other treatment proposals are worth trying. I need to have enough faith in their judgement to put the required hard work in outside of the clinic sessions.
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 healthcare professional 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 have treatment options explained in a balanced way. I need to think that when discussing, for example, surgery that I will be told both the pros and cons and that I won’t be ‘led’ when making a decision. I need to think I am being given the same advice that my healthcare professional would give a family member.
I need my healthcare professional to be sensitively honest with me. Living with persistent pain is difficult, and at times confusing. It is difficult to be able to step back from your situation and to see things objectively. I need my healthcare professional to help me do that. I need them to understand me well enough to be able to help me do that.
I think we as patients also have a responsibility in building a good therapeutic alliance, that provides the framework for our support. Our attitude to our health care and our healthcare professional must surely be an important factor too.
When the therapeutic alliance 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 healthcare professional, poor.
In my view a good therapeutic alliance is key to providing, and receiving, good healthcare. With the support of good healthcare, patients will be better able to Live Well with Pain.
The strong therapeutic alliance I developed with my physiotherapist, Matt Low, helped ensure an episode of care based on Cognitive Functional Therapy was life changing for me. That episode of care, which you can read about HERE, was the start of my journey to Living Well with Pain.