Table 3 Guidelines for standard treatment sessions of the Positive Therapeutic Alliance Group [55,56,57,58,59]
Addressed aspect | Description | Key issues to approach |
|---|---|---|
Appointment outset | A warming and caring reception | “Hello! I was waiting for you!” “Apart from the pain, are you all right today?” |
Demographic questions | Show interest in getting to know the patient | “I think I know your family name…” “Tell me more about yourself” |
Medical diagnosis | Ask about patient’s condition in an interested manner | “This part of the assessment interests me very much, tell me about your condition, what did the physician say?” |
Primary complaint | Demonstrate interest in the current complaint | “In your daily routine, what bothers you the most? What is your primary complaint? Tell me so I can help you.” |
Clinical history | Address issues about the patient’s condition (beginning, development, current condition) Inquire about medical history, involving other issues, not only low back pain | “First, I have a few questions that will help me better understand your pain” |
Pain location | Investigate and demonstrate an effort to understand the patient’s pain complaint | “Use your hand to show me where your pain is” “From this point, does this pain go up/down or sideways? |
Pain behavior | Investigate and demonstrate an effort to understand the patient’s pain complaint | “I am also interested in your personal symptoms” “Does this pain change during the day?” “Describe the pain to me” “Which activity of your daily life makes the pain worse?” |
Primary limited daily activity | Question the patient demonstrating an interest in a way to encourage a return to activities | “How did this pain affect your lifestyle?” |
Session closure | Reinforce positive messages | “You did very well today! And certainly you will be fine” “I understand that these chronic situations sometimes get out of our control, but I am sure you will do well” “No matter what happens. Try to be patient with yourself and look for positive things that are happening to you ” |
Eye contact | Maintain eye contact while listening to the patient | - |
Facial expressions in response to patients’ questions | Demonstrate emotions through facial expression Facilitate nonverbal communication through facial clues | - |
Posture | Adopt a posture of attention, mutual respect and receptivity | - |
Tone of voice | Use different tones of voice to emphasize the importance or the focus on a particular subject during treatment | - |
Affection | Demonstrate the importance of patient participation in the therapeutic process Ask about emotional aspects | - |
Understand the biopsychosocial context | Address issues related to work, family and social life | - |
Shared decision making | Share decision-making regarding treatment Involve the patient in the healing context | “Shall we set some goals together in order to improve your condition?” |
Demonstration of empathy | Reflect the emotions that patients present Create an environment of comfort and responsiveness | “Your back pain must be very hard for you” “I can put myself in your shoes and feel how that pain hinders you” |
Concerning the treatment provided | Focus on information about the success of treatment, based on the best available scientific evidence | “The treatment being offered to you is scientifically proven to be the most suitable for your case” |
Personal experience | Demonstrate successful experiences with similar cases | “The clinical experience I have had with this new treatment is promising! Often patients already feel much better soon after the treatment” |