The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis

PURPOSE: The aim of this study was to identify communication features that may affect the development of the therapeutic relationship during telephone support sessions for people undertaking self-directed therapy.

METHODS: Recorded telephone support sessions of 61 people with chronic dizziness were analysed for communication behaviour using the Roter Interaction Analysis System (RIAS). Working alliance was assessed and was correlated with the RIAS to determine whether communication behaviour affected the therapeutic relationship. Thematic qualitative analysis of support sessions was then carried out to explore the content of sessions with high or low levels of person-centredness.

RESULTS: The level of person-centredness was related to the therapeutic relationship. High person-centred sessions were more likely to address concerns and include therapist reassurances about the safety of the treatment and its side effects.

CONCLUSION: It is possible for rehabilitation therapists to build a strong therapeutic relationship very quickly and over the telephone. Person-centred communication is important for the development of the therapeutic relationship during telephone-delivered support. This research suggests how person-centred communicative behaviours, such as reassurance, encouragement and approval could be incorporated into practice.

IMPLICATIONS FOR REHABILITATION: Person-centred communication is important for the development of a strong therapeutic relationship during support for self-directed rehabilitation. It is possible for rehabilitation therapists to build a strong therapeutic relationship very quickly and over the telephone. Positive communication behaviours such as encouragement, approval, reassurance of safety, and responsiveness to participant cues aid the therapeutic relationship.