The perfect recipe for a world class clinical consult and creating therapeutic alliance
Words by Sarah Yule
I recently purchased Jamie Oliver’s 15 minute meals because, being a marketers dream and hungry at time of said book purchase, I was drawn in by the pictures of the camembert parcels and golden chicken dish. My first attempt at one of meals left me with immense satisfaction at my creation but I couldn’t help but feel mild frustration at my inability to adequately prepare the dish within the 15 minute time frame that Jamie had so proudly attested to. The meal had in fact taken longer than 15 minutes to complete. How did Jamie and I get the same dish with such a time difference? Culinary skills and an obvious difference in professional repertoire aside, Jamie had the obvious capability of being able to prioritize what needed preparing, what needed cooking first, what required less attention and more attention and the expertise to be on autopilot for some of the easier tasks. Essentially, practice and prioritization meant that he was able to create the perfect dish from his recipe whilst no doubt still being charming for the cameras. So, same recipe, similar dish outcome (flattering myself there, I know) different chef skill sets and efficiency levels for the task.
Which leads me to my question: How do some clinicians fit everything into a review session and have time to excel with education, build rapport, treat...the list goes on? Is the difference between the patients, the clinician or something else? What do your consults have to look like to ensure your patients walk out having felt heard, treated and know what direction they’re heading? In essence what is the recipe for therapeutic alliance and what factors influence its strength?
We know that therapeutic alliance has a strong correlation with treatment outcomes (Babatunde, Macdermid & Macintyre 2017). Babatunde and colleagues (2017) reviewed 130 articles which have indicated that the core ingredients of the recipe may include:
Congruence: an alliance on goals and shared aim
Connectedness: metrics include empathy, warmth, honesty
Excellent communication: non verbal and verbal. Remember we are always communicating even when we are not talking.
Clear expectations: expectations of the patient/client, the therapist and the session and plan for future sessions
Factors that may vary the outcome of the recipe, not dissimilar to a cook and the oven they use:
Therapist experience and skills, emotional intelligence
Patient expectations, engagement, personal resources, health experience and social constructs
So how do we incorporate all of this into a consult? Remember once you have the ingredients for the recipe and are aware of factors that can alter the end product and you can make ongoing changes to perfect it. We can take a few lessons from Jamie for this one:
Scripting: knowing what conditions you regularly explain and what phrases you may regularly use lends themselves to scripting. Through scripting, you can practice what you want to say that has maximal impact and clarity whilst using time most efficiently. Scripting saves the occasional waffling that can happen when we are explaining something for the first time.
Prioritize your consult and explain to your patient the shared priorities: setting boundaries for the consult will help you both structure your subjective, objective, treatment and plan. If the patient is aware that it is your plan to spend some time talking, then assessing and treating before returning for goal setting, they are clear what the consult may look like.
Perfect the stuff that’s automatic to allow room for more magic: watching Jamie chop the garlic into a million pieces whilst explaining to the cameras his childhood inspiration for cooking is a direct contrast to my version of dicing the garlic, it certainly doesn’t look as effortless. Jamie is able to multi-task because the task is automatic for him. Patients are often able to feel the clinicians that are very confident and comfortable with their manual handling because it comes with an element of ease combined with efficiency. Perfecting your manual handling and assessment skills may clear up more mental space for further clinical reasoning and discussions.
Remember, recipes for the perfect dish can be tweaked to suit you once you’ve explored the ingredients and the end product. Keep reflecting and perfecting!
References:
Babatunde, F., Macdermid, J., & Macintyre, N. (2017). Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: A scoping review of the literature. BMC Health Services Research, 17(1), 375.