Patient-therapist Relationship Research Articles

Case Report: Nonverbal approaches in the treatment of a patient with fibromyalgia with anger rooted in adverse childhood experiences

IntroductionIn psychotherapy, it is important to establish and deepen a therapeutic trusting relationship, but patients who have experienced extreme adversity in childhood tend to have difficulty in building such a relationship. This paper reports a case of fibromyalgia with adverse childhood experiences (ACEs) in which a nonverbal approach was successful in building a trusting relationship.Case and methodsThe patient is a woman in her late 40s. She had strong anger rooted in ACEs, including neglect by her father, a feeling of unfair parenting by her mother compared to her younger brother, overcontrol of her life by her mother, and sexual abuse by her uncle. She was filled with strong interpersonal distrust and anger, and the experience of an unsuccessful surgery compounded her distrust of medical care. The therapist initially had severe difficulty in verbal interaction with the patient. When conducting “drawing” therapy, she ignored the therapist's comments and completely blacked out the drawing paper. However, the patient-therapist relationship gradually changed, and verbal interaction became possible through the use of nonverbal approaches such as framing her drawing paper and “Towel Baby Holding.”ResultsThe therapist was able to understand the patient's emotions through these nonverbal approaches and to communicate with the patient that she understood her feelings. This approach was also successful in the patient’s understanding of her own pathology. The patient became able to honestly express her feelings in words, which eventually enabled her to be introduced to mindfulness therapy, leading to a favorable treatment course.ConclusionFor patients with ACEs, a nonverbal approach helps build a therapeutic relationship and plays an important role in understanding the patient.

Evaluating the 20-day Dynamic Interpersonal Therapy (DIT) training programme: a mixed methods investigation to identify characteristics associated with successful outcomes of DIT

Dynamic Interpersonal Therapy (DIT) is a brief psychodynamic therapy for depression, developed from the fundamental competences of evidence-based psychoanalytic/dynamic therapeutic methods. The 20-Day DIT training programme at the Anna Freud Centre in London is offered for clinicians who do not meet these psychoanalytic/dynamic competences. 28 therapists, each with three patients, underwent the 20-Day DIT training in 2019. The current study evaluated the 20-Day DIT training by investigating factors associated with the successful patient outcomes of this cohort. Reliable recovery and reliable improvement of patients was 69% and 90%, respectively. Quantitative analyses found that patients who have positive outcomes were likely to have lower baseline Patient Health Questionnaire-9 (PHQ-9) scores and lower patient complexity. A thematic analysis of the therapists’ perspectives suggested that the most important elements of DIT perceived to be associated with successful patient outcomes cluster around four superordinate themes: aspects of the DIT model/training, characteristics of the patient, aspects of the patient-therapist relationship, and characteristics of the therapist. The results suggest that the DIT protocol can be acquired by novice therapists in psychoanalytic/dynamic methods and offer insight into the factors that may be associated with successful outcomes.

Psychodynamic therapists treating patients with eating disorders during COVID-19: perceptions of the therapeutic relationship, patient experiences and symptomatology, and therapeutic processes

Psychodynamic therapy is commonly used to treat patients with eating disorders. Patients with a diagnosed eating disorder have varying and complex treatment needs. Psychodynamic therapists transitioning their practices to telehealth during COVID-19 experienced the novelty of developing and sustaining a therapeutic connection with their patients without inhabiting a shared physical space. The aim of this qualitative phenomenological study was to gain insight into how psychodynamic therapists treating patients with eating disorders via telehealth during COVID-19 perceived their patients’ experiences and personally experienced the therapeutic relationship and therapeutic processes. Twelve respondents met inclusion criteria, consented to participate, provided demographic data, and participated in a 30–45 minute semi-structured interview. Results from the data analysis included four emergent themes: (1) depth of content; (2) manifestations of patient distress; (3) therapist-patient relationship; and (4) implementation of techniques. Participants spoke about the challenges and resilience experienced by themselves and their patients. They highlighted having to rapidly transition their therapy practice to serve patients with exacerbated symptoms. They shared the complexities of navigating a global pandemic and considered the delivery of relational and dynamic therapy via telehealth. Practical implications and considerations for future research are offered with an emphasis on the treatment of patients with eating disorders.

Mechanisms of Haptotherapy, specific- and nonspecific therapy factors

In addition to the insightful conversations, the experiential skill exercises and the affective contact-oriented therapeutic touch, the therapist-patient relationship in HT can also be seen as a specific therapy factor. While this article does not yet provide a conclusive rationale for the efficacy of haptotherapy, it offers a good overview of the specific and nonspecific therapy factors in haptotherapy and the presumed mechanisms of haptotherapy. Looking forward, the authors recommend e.g. demonstrating the importance of the body-subject experience. The authors’ aim with this article is to contribute to clear communication regarding the presumed mechanisms of haptotherapy, as well as their hope of contributing to future scientific research.

Predictors of Early Treatment Termination in Patients Detained under §64 StGB - A Literature Review

The treatment of addicted offenders detained under § 64 of the German Criminal Code can be terminated prematurely. There is an extensive literature on predictors of such premature termination concerned with factors established before treatment. The aim of this paper is to present predictors of premature termination that become apparent during the course of therapy. We conducted a systematic literature search and included 16 publications. Patients and therapists rated impulsivity/aggressiveness, substance use relapses and a lack of patient-therapist relationship as negative predictors. Both groups assessed as beneficial the presence of motivation and a positive social network. To prevent early treatment termination a positive patient-therapist relationship, motivation and working through incidents during therapy is essential.

Exercise Adherence in Chronic Obstructive Pulmonary Disease: Review of Current Evidence from the Netherlands

Chronic obstructive pulmonary disease is one highly prevalent chronic disease that demands increasing care; it is already the third leading cause of death worldwide. There is accumulating evidence that in patients with chronic obstructive pulmonary disease pulmonary rehabilitation is effective in improving the prognostic risk factor profile and in delaying mortality. In order to benefit from pulmonary rehabilitation, exercise adherence plays a crucial role. The present review discusses the current evidence on exercise adherence in chronic obstructive pulmonary disease and provides practical tips for assessing and adopting strategies to improve adherence in the Dutch context. Studies from the Netherlands identify varying rates of exercise adherence depending on the complexity of the disease, such as comorbidities, and its treatment. Multiple factors determine exercise adherence in chronic obstructive pulmonary disease. In the Netherlands, factors such as perceived behavioral control, self-efficacy, exercise history, motivation, education, physical health, comorbidities, depressive symptoms and fatigue determine exercise adherence. The Dutch version of the Rehabilitation Adherence Measure for Athletic training and a prediction model, the Predicting Adherence in paTients with CHronic diseases tool, can be used to identify poor adherence. Improving exercise adherence requires a multifaceted approach with strategies targeting healthcare providers, patients and healthcare systems. In the Dutch context, raising awareness of the patient’s context, emphasizing the importance of the patient-therapist relationship, providing clearer information, and enhancing social support within the patient’s environment are essential for improving exercise adherence and chronic obstructive pulmonary disease control.

Physical activity for patients with chronic low back pain: What are physical therapists prescribing?

Despite the extensive evidence supporting physical activity (PA) for managing chronic low back pain (CLBP), little is known about PA prescription by physical therapists treating patients with CLBP. 1) Explore how PA prescriptions provided by outpatient physical therapists treating patients with CLBP align with PA guidelines. 2) Examine the barriers and facilitators of PA prescription among physical therapists working with patients with CLBP. We conducted a qualitative study with outpatient physical therapists who treat CLBP. Semi-structured interviews provided an understanding of physical therapist experience with PA prescription among patients with CLBP. The interviews were transcribed, coded, and analyzed thematically. The 18 participants had an average of 13.4 (6.4) years of clinical experience in outpatient physical therapy. Thematic analysis revealed: 1) Physical therapists' articulate knowledge of PA guidelines and importance of physical activity; 2) Patient factors take priority over the PA guidelines for people with CLBP; and 3) The importance of building and maintaining a strong patient-therapist relationship influences physical therapist prescription of PA for patients with CLBP. When providing PA recommendations for patients with CLBP, general movement recommendations are emphasized in place of explicit PA prescriptions. Our findings highlight factors for consideration when prescribing movement and PA for patients with CLBP.

The role of therapist-patient relationships in facilitating engagement and adherence in upper extremity rehabilitation.

Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation. To explore therapists' perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services. Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results. SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts. In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

PSYCHIATRY IN THE BIO-PSYCHO-SOCIAL RESEARCH PARADIGM AS OPTION FOR ENDURING AND SUSTAINABLE CHANGE IN A TIME OF CHRONIC CRISIS.

The prevalence of mental disorders and global burden of disease increases and need an integrated psychiatric treatment at the best point of service. Severe mental disorders have medical consequences and solid psychiatric interventions are necessary. Research is required to be conducted along the bio-psycho-social paradigm. Based on the dynamics of memory and mentalization theory this paper presents clinical and therapeutic considerations for change. Mentalization is influenced by patterns of parental rearing styles, attachment, and traumatic incidents. In psychoanalytic theory, unconscious memory contents are enacted in the patient-therapist relationship. This editorial gives a review and intends to bridge the gap between psychiatry, the neurosciences, psychoanalysis and other sciences concerned with the study and processing of memory and its associated psychological, cognitive, and affective functions. The role of memory and related abilities and factors affecting psychological functioning are outlined. Research findings on memory dynamics and vulnerability as well as insights that are relevant to bridge the gap to related sciences are highlighted. For treatment, a dynamic view of long-term memory with a plasticity of states of memories when they are reactivated is supported. For intervention technique, affect-related therapist-centered interpretations and a sound working through of such enacted states in the interpersonal environment of the treatment is essential.

How do non-specific back pain patients think about their adherence to physiotherapy, and what strategies do physiotherapists use to facilitate adherence? A focus group interview study

ABSTRACT Background Long-term effectiveness of physiotherapy (PT) for low back pain (LBP) depends on the adherence of patients. Objectives: (1) Identify aspects associated with the adherence of patients with LBP to physiotherapy, and (2) identify factors to facilitate adherence of patients with LBP to PT. Method Focus group interviews were conducted with 10 patients with LBP (n = 10, 5 women) and 11 physiotherapists (5 women) from Germany and Switzerland, treating patients with LBP. Data analysis was based on structured content analysis. Deductive and inductive categories were identified and coded. Results Patients with LBP requested more and effective home programs, long-term rehabilitation management, and individualized therapy to achieve a higher level of adherence. Physiotherapists requested more time for patient education. Communication, quality of the therapist-patient relationship, and individualized therapy were identified as essential factors by both representatives. Conclusion Patients and physiotherapists identified aspects contributing to adherence. These may guide the development of multidimensional measurement tools for adherence. In addition, this information can be used to develop PT approaches to facilitate the level of adherence.

Treatment of multiple traumatized adolescents by enhancing regulation skills and reducing trauma related symptoms: rationale, study design, and methods of randomized controlled trial (the Mars-study)

BackgroundThere is ongoing debate regarding the treatment of severe and multiple traumatized children and adolescents with post-traumatic stress disorder (PTSD). Many clinicians favor a phase-based treatment approach (i.e., a stabilization phase prior to trauma-focused therapy) over immediate trauma-focused psychological treatment, despite the lack of scientific evidence. Research on the effects of different treatment approaches is needed for children and adolescents with (symptoms of complex) PTSD resulting from repeated sexual and/or physical abuse during childhood.ObjectiveThis paper describes the rationale, study design, and methods of the MARS-study, a two-arm randomized controlled trial (RCT) that aims to compare the results of phase-based treatment with those of immediate trauma-focused treatment and determine whether immediate trauma-focused treatment is not worse than phase-based treatment in reducing PTSD symptoms.MethodsParticipants are individuals between 12 and 18 years who meet the diagnostic criteria for PTSD due to repeated sexual abuse, physical abuse, or domestic violence during childhood. Participants will be blindly allocated to either the phase-based or immediate trauma-focused treatment condition. In the phase-based treatment condition, participants receive 12 sessions of the Dutch version of Skill Training in Affective and Interpersonal Regulation (STAIR-A), followed by 12 sessions of EMDR therapy. In the immediate trauma-focused condition, the participants receive 12 sessions of EMDR therapy. The two groups are compared for several outcome variables before treatment, mid-treatment (only in the phase-based treatment condition), after 12 trauma-focused treatment sessions (post-treatment), and six months post-treatment (follow-up). The main parameter is the presence and severity of PTSD symptoms (Clinician-Administered PTSD Scale for Children and Adolescents, CAPS-CA). The secondary outcome variables are the severity of complex PTSD symptoms (Interpersonal Problems as measured by the Experiences in Close Relationship-Revised, ECR-RC; Emotion Regulation as measured by the Difficulties in Emotion Regulation Scale, DERS; Self Esteem as measured by the Rosenberg Self Esteem Scale, RSES), changes in anxiety and mood symptoms (Revised Anxiety and Depression Scale; RCADS), changes in posttraumatic cognitions (Child Posttraumatic Cognitions Inventory, CPTCI), changes in general psychopathology symptoms (Child Behavior Checklist, CBCL), and Quality of Life (Youth Outcome Questionnaire, Y-OQ-30). Furthermore, parental stress (Opvoedingsvragenlijst, OBVL) and patient-therapist relationship (Feedback Informed Treatment, FIT) will be measured, whereas PTSD symptoms will be monitored in each session during both treatment conditions (Children’s Revised Impact of Event Scale, CRIES-13).DiscussionTreating (symptoms of complex) PTSD in children and adolescents with a history of repeated sexual and/or physical abuse during childhood is of great importance. However, there is a lack of consensus among trauma experts regarding the optimal treatment approach. The results of the current study may have important implications for selecting effective treatment options for clinicians working with children and adolescents who experience the effects of exposure to multiple interpersonal traumatic events during childhood.Trial registrationsThe study was registered on the “National Trial Register (NTR)” with the number NTR7024. This registry was obtained from the International Clinical Trial Registry Platform (ICTRP) and can be accessed through the ICTRP Search Portal (https://trialsearch.who.int/).

The effect of digitalization on service orientation and service perception among Israeli healthcare professionals: A qualitative study.

Healthcare systems globally are adapting to rapid changes, including digitalization, to thrive. The main objective of this study is to investigate the impact of adapting to rapid changes, including embracing digitalization on the services provided by healthcare organizations, by mapping the healthcare professionals' perceptions and characterizing their experiences, as well as examining the difficulties and barriers they face in transforming their organization. This qualitative study, based on semi-structured in-depth interviews with 38 healthcare professionals, examines the impact of embracing digitalization in service and clinical care and their perception of service. Interviews were analyzed using a categorial deductive and inductive approach across three levels. Eight main themes arose from the analysis: The need for change, The importance of change, Communication, Training, Competitive leverage, Challenges and barriers and Implications for patient-therapist relationship. The themes and subthemes were examined through the three levels of organizational change-the system, the organization, and the personal level. The results of the study indicate limited embrace of change within the systemic and organizational levels and inconsistencies across the three levels. The study also highlights the barriers and difficulties that stand in the way of these processes of change and development. To ensure successful implementation, these processes require systemic planning, including budgeting for personnel training, organizational adjustments, and technological equipment. Additionally, addressing personal-level considerations such as relevant training and setting boundaries for caregivers is crucial to prevent burnout. Effective planning and management of these changes will facilitate optimal assimilation and enhance system efficiency.

Visual Assessment of Therapeutic Relationships in Psychiatric Patients: A Pilot Study Using the Pictorial Representation of Illness and Self Measure.

Although the therapeutic relationship (or 'alliance') is well known to be a key component of psychiatric treatment, there has been no simple way to objectively measure the patient-therapist relationship. Here, we measured the psychological distance between patients and their therapists by using the Pictorial Representation of Illness and Self Measure (PRISM). We analyzed the patient-therapist relationship of 112 patients from two hospitals in Japan (54 males, 57 females, 1 unknown; age 46.20 ± 15.03 years [mean ± SD]) who completed the PRISM and self report questionnaires (LSNS-6, K6, and BASIS-32) about their social network, psychological distress, and outcomes of mental health treatment. PRISM measurements were available for all patients who consented to participate. In the comparison by disease category, schizophrenia recorded the closest distance to the psychiatrist in charge, followed by bipolar disorder, depression, and neurotic disorder. Regarding the distance to the psychiatrist in charge, PRISM showed a weak negative correlation (r = -0.23, p < 0.05) with age, indicating that with increasing age, the therapeutic rela tionship was more important to the patients. Our findings indicate the possibility of implementing PRISM to assess the impact of the therapeutic relationship in patients with a wide range of psychiatric disorders, and they suggest that PRISM holds great potential for clinical application.

Insights into the clinical profile and comorbidities of Factitious Disorder in a multispecialty setting in southwest Nigeria: A cases series and review

Background: Factitious disorder (FD) is an under-recognized and under-diagnosed mental condition. Healthcare professionals often have challenges to diagnose and treating the disorder. As a result, needless and endless medical resources are recommended to assess and evaluate those affected. FD may present as a physical condition, a psychological disorder, or maybe both depending on the prominent symptoms. However, there is a strong correlation between having FD and psychiatric symptoms. Main Text: FD occurs in early adulthood, with a mean age of onset of 25 years in both genders, although with differing demographic features. The lifetime prevalence of FD imposed on oneself in clinical settings is 1.0%, 0.1% in the overall population (ranging between 0.007% and 8.0%) and occurs more in female health care professionals. FD may make up 0.6%–3.0% of psychiatric referrals, and it accounts for 3-5% of doctor-patient contacts. In actuality, 1-2% of hospital admissions and an average of 6-8% of all psychiatric admissions have been underreported. The study aimed to highlight the signs and symptoms of FD identified in a psychiatry department of a multispecialty center and to increase the awareness of health practitioners. A critical review of the literature was done with an emphasis on psychological symptoms. PubMed, Mendeley, and Google Scholar were thoroughly searched and full-text publications of journals from 2010-2021 were included. Conclusion: FD is a diagnostic puzzle that necessitates adequate, prompt medical attention as well as social support because of the potentially fatal consequence. A stronger patient-therapist relationship can strengthen the patient's conscious self-control to minimize the symptoms; therefore the healthcare provider has to be open-minded. For the diagnostic enigma to be removed and for ease of treatment, additional research, increasing awareness among medical professionals and the general public, accurate evaluation, diagnosis, and psychotherapy should be encouraged. These case studies will contribute to the knowledge base of FD and improve the quality of care.

‘Thinking about pain in a different way’: Patient perspectives of a neuroscience-informed physiotherapy programme for rotator cuff-related shoulder pain

BackgroundRotator cuff-related shoulder pain (RCRSP) is a common musculoskeletal problem. The multi-factorial contributors to persistent pain are often overlooked during treatment. Pain neuroscience education (PNE) contributes to a holistic approach for patients with persistent pain but has not yet been researched for patients with RCRSP. ObjectiveTo explore the perspectives and experiences of participants with RCRSP who had completed a programme of PNE-informed pragmatic physiotherapy. DesignA qualitative study using semi-structured interviews. MethodsWe included a sub-group of five males and five females, aged 46–75 years, with persistent RCRSP of at least three months. They had undertaken a three-month pragmatic physiotherapy integrated with PNE. Individual semi-structured interviews were recorded, transcribed verbatim, and analysed using the General Inductive Approach. ResultsFour themes emanated from the interviews. The first two themes were named ‘Patient Beliefs’ and overall ‘Rapport and Relationship’. Another theme, ‘Perspective and Understanding of the Resources’, indicated diverse uptake of the resource information. The participants reported developing self-management skills, active coping strategies and a reduction in fear of pain described by the theme: ‘Empowerment: My Shoulder into the Future’. ConclusionsParticipants experienced a change in their beliefs, which were enhanced by an individualised delivery and a strong therapeutic relationship through the course of the physiotherapy care. The participants appeared to value when the physiotherapist listened to and understood their beliefs. This required a shift in the patient-therapist relationship from the physiotherapist being the ‘expert’ to facilitating the patient's ability to take control of their shoulder health.

Die Vertrauenskrise in der Gesellschaft

Ausgehend von in empirischen Studien erhobenen Daten über ein weitverbreitetes Misstrauen der Bevölkerung gegenüber der derzeit in Deutschland praktizierten Demokratie und deren politischen Repräsentanten und Repräsentantinnen soll mithilfe eines psychoanalytisch-bindungstheoretischen Ansatzes die als überzogen und unangemessen-irrational erscheinende Einstellung reflektiert werden. In den Erklärungen gesellschaftskritischer, in der Tradition der Kritischen Theorie stehender Autoren werden letztlich die Erfordernisse der ökonomischen Verhältnisse für demokratiefeindliche Einstellungen verantwortlich gemacht. Im Gegensatz dazu soll im vorliegenden Beitrag an das Freud’sche Verständnis grundlegender menschlicher Bedingungen in ihrer Wechselwirkung mit den Anforderungen der Außenwelt angeknüpft werden. Neuere Erkenntnisse wie das aus der Entwicklungspsychologie hervorgegangene Konzept des „epistemischen Vertrauens“ von Peter Fonagy werden einbezogen. Es wird eine Analogie zwischen dem Therapeut*in-Patient*in-Verhältnis und dem Verhältnis zwischen Politiker*innen und ihren potenziellen Wähler*innen hergestellt. An einem „Fallbeispiel“ aus der öffentlichen politischen Kommunikation sollen mithilfe dieser Analogie das erweiterte Verständnis veranschaulicht und ein Vorschlag zur „Behandlungstechnik“ gemacht werden.

Object Relations: How Early Relationships Create Map for Later Ones

Object Relations: How Early Relationships Create Map for Later Ones

Personality Disorders as a Possible Moderator of the Effects of Relational Interventions in Short-Term Psychoanalytic Psychotherapy with Depressed Adolescents.

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. Background: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. Methods: Depressed adolescents (N = 69), aged 16–18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including “time”, “treatment group” and “number of PD criteria”. Results: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient–therapist relationship in the here and now. Conclusion: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology.

Jak tělu rozumět tělem. Příspěvek fenomenologie k překonání limitů mechanistického paradigmatu ve fyzioterapii

This article aims to explain how Merleau-Ponty’s phenomenological account of embodiment contributes to the theory and practice of physiotherapy. The mechanistic conception of the body, to which physiotherapy usually refers, assumes a universal model of its functioning and interprets its relationship to the environment causally. In fact, however, it does not allow a satisfactory explanation of the efficiency of the therapeutic methods used in practice. In contrast, Merleau-Ponty’s concept of motor intentionality points to the fact that the body “understands” the practical meaning of a situation. Bodily understanding is then manifested in particular by the ability to adequately differentiate, adapt or vary motor and postural responses to environmental challenges. This change in the conception of embodiment also has important implications for understanding the therapist-patient relationship and the intervention itself. Physiotherapists should draw more on the fact that they are themselves a body and, on this basis, guide the patient’s bodily intentionality towards a more developed understanding of the practical meaning of situations.

Towards developing a comprehensive treatment schedule for patients with cerebral palsy: factors influencing patient's adherence to physiotherapy treatment.

This study is aimed to identify factors influencing patient's adherence to treatment in a bid to characterize the extent to which these factors are considered while developing a treatment schedule for patients with cerebral palsy in Nigeria. Descriptive cross-sectional study of physiotherapists involved in the care of patients with cerebral palsy. Factors influencing treatment adherence were assessed using a pre-tested, self-administered questionnaire. Participants were sampled from physiotherapists working at University of Nigeria Teaching Hospital, Enugu State, Nigeria. The data were analyzed using descriptive statistics of percentage and frequencies. A total of fifty three (31 males and 22 females) physiotherapists completed and returned the questionnaire. Participants (84.9%) agreed that patients occasionally forget to meet up with their appointment days; with majority of them agreeing that distance to the clinic and economic factor (cost of treatment and transportation) influence patient's adherence to treatment. Presence/absence of a caregiver and relationship between patients and their physiotherapist are also important factors influencing patient's treatment schedules. Distance to the clinic when compared to other (economic, patient-therapist relationship) factors is the major barrier to patient's adherence to treatment and therefore should be considered while developing treatment schedules for patients with cerebral palsy.