Related Experiment Video
Updated: Mar 22, 2026
Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats
Published on: January 16, 2019
Therapeutic alliance in spinal cord injury rehabilitation: power, institutions, and disabling control
Esha Lovrić1, Niki Edwards1, Julie King1
1School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia.
Background:
The therapeutic alliance (TA) is fundamental to improving the quality of health and rehabilitation services.
Purpose:
This study critically explored patient perspectives on the influence of TAs with practitioners while participating in inpatient rehabilitation after spinal cord injury (SCI).
Methods:
A qualitative design involving (n = 18) in-depth interviews with inpatients was employed. The verbatim transcripts were subjected to an iterative, reflective thematic analysis (RTA), guided by a social constructionist epistemology and deductively informed by theories of power and psychotherapy.
Results:
Patient accounts reinforce that TAs lie at the core of patient-centered rehabilitation. Significantly, narratives revealed that patients often struggled to find environmental conditions conducive to developing real and authentic working relationships. Narratives suggested that the institutional context and its associated responsibilities continuously introduced procedural complexities that shaped, ruptured, or obstructed the formation of effective working alliances, hindering therapeutic relationships. A primary theme that emerged, Control as disabling: Biopower and surveillance, highlighted that TAs could not develop with practitioners who constrained patient autonomy and control, thereby intensifying the experience of disability. Patients described an environment and behaviors characteristic of institutionalization, particularly when autonomy and agency were undermined.
Conclusion:
Institutionalized practices reduce the likelihood of developing effective TAs. The findings highlight that TAs in SCI rehabilitation can potentially mitigate the effects of institutionalization, safeguard person-first identity, reduce identity risk, and support genuinely individualized person-centered care. To address the unique and complex needs of people with SCI, specialized TA training for rehabilitation practitioners, reinforced through ongoing professional development, is strongly recommended.
