Therapeutic alliance development in physical therapy for people with serious mental illness: a qualitative study

Physical therapy (PT) has been demonstrated to be beneficial for people with serious mental illness (SMI). Literature in this field is emerging and growing rapidly. However, little is known about how therapeutic relationships are formed in PT for people with SMI. Expanding our knowledge of how people with serious mental illness perceive and experience their relationships with physical therapists, and how these perceptions impact the development of therapeutic alliance (TA), may inform the development of strategies to enhance TA. The purpose of this study was to explore how people with SMI perceive the development of TA with their therapists during PT.

This study employed an interpretive descriptive qualitative approach, utilizing interviews with study participants. This qualitative study analyzed interview transcripts from 30 adults with SMI who had received skilled PT. Interview transcripts were analyzed using inductive and deductive applied thematic analysis, informed by Peplau's Interpersonal Relations Theory and core principles of psychiatric rehabilitation.

Six themes were generated: 1) orient to care, 2) develop a strong relationship, 3) provide person-centered care, 4) importance of life history, 5) it takes time, and 6) empower to get better.

The findings of this study provide preliminary evidence supporting factors that drive the development of a therapeutic alliance for individuals with SMI in PT. Our findings suggest that PTs treating people with SMI should consider: 1) offering a pre-examination orientation using Peplau's Interpersonal Relations Theory as a guide; 2) allow for extra time for relationship building; 3) engage clients as active partners throughout the rehabilitation process; and 4) demonstrate respect for a patient with SMI's personal boundaries during all stages of care. These recommendations are supported by the core psychiatric rehabilitation principles of empowerment, person-centered care, and collaborative partnership. Adding them to PT practice may enhance engagement in rehabilitation for people with SMI, making PT more inclusive and recovery-oriented.