The Therapeutic Alliance in Rehabilitation

A strong collaborative relationship between a person in treatment with her/his healthcare professional(s), also known as therapeutic alliance, has the potential to contribute to a more favourable and sustainable rehabilitation. However, the findings of the studies in this thesis shows the lack of awareness and experience in reflecting about the therapeutic alliance by healthcare professionals on the one hand, and lack of negotiation between the persons in treatment and their healthcare professionals on the other hand. In addition, persons in treatment reported that they regularly avoid open communication with their healthcare professionals about relational issues. These study findings, suggest that for improving the therapeutic alliance in rehabilitation, it would help if healthcare professionals became more sensitive to the existence and influence of (subtle indications of) strains and ruptures in the therapeutic relationship. Repairing these strains and ruptures may contribute to the empowerment and relational equality of the person in treatment which may result in a stronger therapeutic alliance and more person-centred care in rehabilitation.
For further research regarding the effect of therapeutic alliance in rehabilitation a valid measurement of therapeutic alliance is needed. The findings of the studies in this thesis showed that the adapted questionnaire, based on a valid questionnaire for use in psychotherapy, can be used to measure therapeutic alliance in a one-to-one relationship in rehabilitation, but outcomes should be interpreted carefully since content validity of both questionaries remains unclear. Additionally, the discriminative validity of both questionnaires seems too limited.