Pilates Teachers' Manual

Building A Therapeutic Alliance

July 21, 2022 Olivia Bioni Season 6 Episode 8
Pilates Teachers' Manual
Building A Therapeutic Alliance
Show Notes Transcript

In my teaching experience, having a relationship with clients that's built on trust, mutual respect, and shared goals is key in better helping our clients. The research also supports this idea, including an awesome systematic review by Lin et al. that includes building a therapeutic alliance with clients as part of best practices for working with clients with any musculoskeletal pain or injury. Tune in!

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Show Notes:

Check out my Masterclass series: Foam Roller Fun On The Mat and join in live or check out the replays! Starts July 6th, 2022.

Two articles are referenced in podcast are:  What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review by Lin et al. 

My favorite research article, which is about back pain not knee pain: Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study by Fuentes et al.  

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Episode Music:

Tracks: Tobu - Good Times, Tobu & Itro - Sunburst 
Tobu Official YouTube: https://www.youtube.com/tobuofficial
Itro Official YouTube: https://www.youtube.com/user/officialitro
Released by NCS 

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[00:00:00] Welcome to Pilates Teachers' Manual, your guide to becoming a great Pilates teacher. I'm Olivia, and I'll be your host. Join the conversation and the Pilates community on Instagram at @pilatesteachersmanual and visit buymeacoffee.com/OliviaPodcasts to support the show. Today's chapter starts now. 

[00:00:56] Hello, hello everybody. Welcome to the podcast. [00:01:00] Today, we're gonna be talking about how to build trust with your clients. And that's another way of saying, you know, how to have a positive relationship with your clients and the words that I had been looking for, because I've talked about this idea of sort of working with clients and like working with people in general and the words that I've learned, or sort of discovered through the Diploma of Clinical Pilates that I'm currently enrolled in is that this is really all about building a therapeutic alliance with your clients. 

[00:01:36] So today we're gonna be diving into what that means, what that looks like, why that's awesome, and something we should all really be focusing on doing, I think, with our clients and also strategies for developing that relationship with your clients that really positive working relationship with your clients is just so amazing and so like, one of the highlights [00:02:00] of working with people is when you have this type of relationship, so we're really gonna dive into what that is, what that means. 

[00:02:07] There's benefits to this idea of having a therapeutic alliance with your clients that exist in both like anecdotally how much easier it is to work with people who trust your judgment and are on board for trying things and working together towards solutions, but also in the literature and in scientific research that having a therapeutic alliance with your clients also improves their outcomes when they are recovering from injury and just in terms of building overall positive outcomes for them in their life. Having a therapeutic Alliance is one of those things that is a positive indicator of a good prognosis of good outcomes.

[00:02:56] One research paper that really touches [00:03:00] on this topic is a paper by Lin et al. The name of the paper is What Does Best Practice Care For Musculoskeletal Pain Look Like? 11 Consistent Recommendations From High Quality Clinical Practice Guidelines, Systematic Review. And that's a big mouthful, but what happened or what a systematic review is, is that this group of researchers looked at all of the systematic reviews and research papers, covering the topic of musculoskeletal pain in the knee, in the ankle, in the wrist, in the shoulder, in the elbow, in the spine and pretty much anywhere that you can have musculoskeletal pain. And that research has been done on that area and that pain and that, you know, condition or whatever. And they, these researchers, Lin and a cohort of brilliant scientists looked at all of these papers [00:04:00] and then synthesized, you know, what are 11 things all of those recommendations have in common, whether someone has knee pain or shoulder pain, what is, what are the things we're gonna do with this person, regardless. 

[00:04:12] Of those 11 consistent recommendations that they found across all spectrum of musculoskeletal pain, several of these points, address this idea of forming a therapeutic alliance with your clients. Some of their recommendations include giving patient centered care, assessing psychosocial factors, giving a physical examination, agreeing on outcome measures, explaining the condition that your client has and managing the condition, addressing their physical activity, you know, offering non-surgical care first. There are more points, but a lot of those points really speak to this idea of having a therapeutic alliance.

[00:04:56] This is really a massive perk of being a Pilates [00:05:00] teacher, because we have so much more time with our clients than a surgeon has with a patient or than even a physical therapist might have with a patient. When we are working one on one with a client, especially, they have our undivided attention for the entire session. They aren't, you know, in a waiting room, you know, while we're seeing other people there, it's not. It doesn't have the same limitations on time that if you go to your doctor for a checkup and you see them for 15 minutes, that you know, that sort of situation has, they get our time for the entire time. 

[00:05:36] A study that comes to mind that I will try to find and link in the show notes, but it is hands down my favorite study and really illustrates the importance of a therapeutic alliance of having this trusting relationship between yourself and your client. And I've definitely talked about it on the podcast before. So if you've heard it before, I hope [00:06:00] that you still smile when you hear about it now. Um, but there was a study done with four groups of people who were doing physical therapy, I believe for a knee something. And the treatment for this knee, something is to use a tens unit, which is those little electrodes that they put on you and then they send you little electric bursts and your muscle contracts, and you can't control it, but it's like doing a bajillion of an exercise, but it's just the electricity asking your muscles to contract. 

[00:06:32] And so the tens unit is a proven way to strengthen the muscle in the area. That's like a proven treatment. And then they had a placebo group that were not going to get the tens unit. They would do something else. Within those two groups of receiving the tens unit treatment and then receiving the placebo treatment. We had a group of people who were receiving care from a healthcare professional they had a therapeutic [00:07:00] alliance with. This person was gonna check in with them and, you know, be really compassionate and develop a relationship with. And then there were also people who were receiving the tens unit that were just gonna have a minimal interaction with the person they were working with. They weren't having a therapeutic alliance, same thing in the placebo group. You had therapeutic alliance within the placebo group, and then the very perfunctory relationship that does not have a therapeutic Alliance associated with it as well.

[00:07:26] So these are the four groups. What they found when they ran this trial is the people who had the best outcome were the people who had the proven care of using the tens unit and a therapeutic alliance with the person they were working with. And the group that had the second most effective outcome or best outcome was the group that was had a placebo treatment and a therapeutic alliance. Then the next effective was the tens unit, the proven treatment [00:08:00] plan with no therapeutic alliance and then no therapeutic alliance, placebo treatment was the least effective. 

[00:08:06] What that study says to me is that the relationship we have with our clients is very important to the outcomes that our clients have and just to their overall success and something that we can do as Pilates teachers, because we have so much time with them is we can really develop this working relationship with them. That makes our lives easier because it's easier to work with people who trust you, who aren't going to fight you tooth and nail to try things or work on things, or you know, that we're working together towards our goals. It's the type of clients that you look forward to seeing, you don't dread seeing them. You actually are really excited to see them and work with them and try things and, you know, celebrate their success. And it's when we know also that it's really good for our clients to have that kind of relationship with us as well, [00:09:00] that is all well and good. 

[00:09:01] But how do we go about building a therapeutic Alliance maybe with existing clients or maybe with new clients? That's a great question. We're gonna talk about it all after the break. So stay tuned.

[00:09:18] Hi there. I hope you're enjoying today's chapter so far. There's great stuff coming up after the break too. Be sure to subscribe wherever you're listening and visit buymeacoffee.com/OliviaPodcasts to support the show there you can make a one time donation or become a member for as little as $5 a month.

[00:09:37] Membership comes with some awesome perks, including a shout out in the next episode, a monthly newsletter, a monthly zoom call with me and more. You can also visit links.OliviaBioni.com/affiliates to check out some sweet deals on products I use and love. Now, back to the show.[00:10:00] 

[00:10:14] A big part of building a therapeutic alliance with your clients is listening to them. And that seems pretty obvious, but it is really a skill that we can work on with our clients in order to build this therapeutic alliance with them, to build this working relationship with them. We learn a lot by listening to our clients and listening to how they relate to what's going on in their body and also what's going on in their life, beyond their body.

[00:10:49] One of the ways that I've seen myself change as a teacher over time is that I've really shifted from searching for a root cause or a [00:11:00] biomechanical issue that, you know, if only we strengthened your bicep, then this wouldn't be an issue. I used to look at the body very much like a mechanic looks at a car and I understand that the parts are related to each other, but I wasn't understanding how like, the car's hopes and dreams really like play into it.

[00:11:22] And I say that a little bit facetiously, but also quite seriously, that we don't know a lot about pain and what causes pain, because we do know that pain and injury are not the same thing. And we know that people can have pain without an injury or with an injury that is healed. The tissue is no longer damaged, but the pain is still there. And that pain is still real. We don't know why that happens exactly. But we do know that more things play a part than just tissue damage and just the biomechanical injury of it, that that [00:12:00] injury can a hundred percent be a contributing factor. But it is not the determining factor of whether or not someone is experiencing musculoskeletal pain.

[00:12:09] Building a therapeutic alliance means getting to know your clients beyond just what's going on in their body and really beginning to understand their beliefs, what's important to them, the stories that they tell themselves about themselves, about their body, about what's going on, about their prognosis, all of these things.

[00:12:30] And when you understand how your client is thinking about a problem that they have, or a goal that they have, you can better meet their needs and frame the solution in a way that has value to them. 

[00:12:47] It's always easier. I would say to work with someone brand new, because you can set the groundwork, you can lay the foundation and you can find all of these things while working [00:13:00] with this client, like you can set the baseline as this is how we're gonna interact. Like I'm interested in how you're feeling, and I'm also interested in how much sleep you're getting and how much stress you're under and if your newborn is sleeping through the night and all of this stuff, because all of these psychosocial factors, your beliefs about your pain, whether you believe you're gonna get better, whether you believe you have any control over getting better, says a lot about whether you get better.

[00:13:27] Yeah, we're Pilates teachers. We're definitely gonna use Pilates as the mechanism to help you meet your goals. But we also wanna recognize that there's a whole person there and we can meet that whole person's needs by having this social relationship with this person. Not that you have to be best friends with your clients, but that understand that some of the support we give in Pilates is just being another person in a room. Especially over COVID, when everyone is [00:14:00] feeling very isolated, like there are people who feel very isolated all the time. Like I work with a lot of older clients who, you know, coming to Pilates is like a big deal and they get to get out and see people and interact with me. And that's like a huge thing for them. Like this is a time that's for themselves. And that social component is as valuable as the strengthening component of, you know, doing the exercises or the flexibility component of exploring end range movement, things like that. 

[00:14:30] The best thing you can do in terms of listening to your clients is ask them questions that have open-ended responses. So instead of saying like, does that feel good? Or like, did you have a good weekend? You know, where they can just say yes and then it kind of shuts down more conversation. You can ask, you know, how was your weekend? You know, how, how was your new puppy treating you? Things like that. Because we know as [00:15:00] professionals that this is also playing a part in their experience and like their experience of aches and pains, as well as their recovery from injury. Like we've all had mysterious pains that pop up and, you know, using this model can also really help you there. 

[00:15:16] So really asking open ended questions is going to get you more rich answers that will begin to show you, the beliefs they have about, you know, what is causing their pain? Like do they think that their posture is causing their pain? And this isn't to say that their posture is, or isn't causing their pain. But if they believe that posture is causing their pain, then we want to frame the way we work with them as, Hey, this is addressing your posture, which I know is something you believe to be causing your pain. So we're working on things that work on that. 

[00:15:52] If you know, that person has a goal, they wanna pick up their grandkid [00:16:00] or something like that, we do exercises, we practice movements that are similar to them, picking up their grandkid and relate it back to the thing that is valuable to them. Wow. That's so great. You just picked up, you know, 15 pounds. That's nearly your grandkid's size. I don't know how much kids weigh, but you know, things like that. You give them value. And then they see, wow, this person cares about me. They care about what matters to me. And they're really making sure that what we do together is trying to meet my goals.

[00:16:32] Even the fact that we come to our goals, cooperatively. That we discuss together, like, what do you wanna get out of this? And some people have functional goals. I wanna pick up my grandkid and some people don't have functional goals and they just know they need to exercise, or they'll say their goal is I wanna have better balance or I wanna have better posture. I wanna have a stronger core, but when we ask these open-ended questions, oh, you wanna have a stronger core? Well, why do you wanna have a stronger core, like [00:17:00] getting to a deeper layer of things. And then, you know, why do you think your core isn't strong? Let's do some strength tests to see where your core strength is.

[00:17:12] So we know where we can work from, it's easier to do with a brand new client, because again, you're setting the foundation, they're, they've never done anything different. This is how you're setting it up for clients you've worked with for a while, who you're like. Yeah. I actually would like to know more about this person.

[00:17:27] And I think that, you know, the more I know about this person, the more I'm gonna be able to help them. You can just start with checking in with them. You can say, Hey, you know, I know I haven't done this before, but I'd love to ask you a couple questions about how you're sleeping and how you know work is and how are things. We can start to sprinkle that in. We can make that the new normal with our clients.

[00:17:51] And this doesn't mean that you have to be a shoulder for them to cry on, or that you have to offer them any sort of therapeutic, like in terms of [00:18:00] therapy, you're not doing cognitive behavioral therapy with this person. We're definitely still here to do Pilates, but knowing what's going on with them is gonna help them trust us. 

[00:18:11] And when you come to things like people who think that their posture is causing their pain or that their weak core is causing their pain, um, things like this, by continuing to work compassionately with this person and to develop a program that meets their goals in a way that is Pilates friendly, because we're Pilates teachers, you can then begin to change the narrative just a bit, and you can begin to challenge some of the beliefs that we know to be not true things that, you know, your posture is not related to pain that, you know, your weak core is not necessarily a reason that you're in pain and we can sort of sprinkle in challenges to those beliefs. [00:19:00] That's like, oh, well, you know, your core is really strong. It's gotten really strong over these months of us working together. So, you know, I don't think your weak core is contributing to this because you're so strong and there's diplomatic ways to phrase it, of course, but we can't begin to challenge our clients' beliefs and kind of expand their view of themselves and what they believe themselves to be capable of really boosting their self-efficacy and independence and autonomy and all of this beautiful stuff as well um, without first building this relationship. 

[00:19:33] Because it takes time. Like the stories that we believe about ourselves and what we believe about what we're able to do, didn't happen overnight. They have been told to us by doctors and parents and friends and other professionals that we've worked with, you know, like there's a lot of building that story that's gone into it. So to change the belief that we have also takes a bit of time. And when you have a therapeutic alliance [00:20:00] with your client, You can begin to have that conversation. 

[00:20:05] That was literally one strategy that was, you should listen to your clients, but I guess there's a few more strategies that we talked about in there that we are framing our programs for those clients in a way that addresses our clients' specific concerns. We are checking in with them throughout the session, maybe checking in, in between sessions, sending them an email. Hey, I was thinking about you. And I think that this exercise might be great to add into your program. Can't wait to give it a try with you on Friday. Things like that. 

[00:20:36] It's rewarding. I think on a professional level, because I'm really passionate about who I work with and my clients, and I feel like I'm able to give them the best care and the best program because of this relationship. And then also just feeling so good about, you know, the [00:21:00] positive impact that I know I'm having in their life. And then, you know, they're very grateful and wanna continue working with you and wanna take their mat with them on vacation so that you can still do mat Pilates while they're in Bermuda. Like all of this stuff. It's really rewarding and makes programming in my opinion, a bit easier because your client has told you the answers and then you can just, uh, reflect them back to them, which is, seems like a psychology trick. But if it has such a great outcome, I think it's also worth it. 

[00:21:32] Really big thank you to all of my supporters and new members on Buy Me A Coffee. And a really big shout out to some of the newest members and supporters of the podcast project. Jamie Lady Bridgette SJ, Karna, Kathryn, Natalie, and Chuck. Thank you so much for supporting the project. I hope you'll be able to take advantage of the free to members, uh, webinar that I'm going to be doing this weekend on [00:22:00] working with pregnant clients, Working Confidently with Pregnant Clients, which is what I know we all want to do. And I think a big piece of the confidence is just knowing the best practice because the best practices are the proven best things that we can do for our clients. And so getting really comfortable and confident with what those best practices are means that we can really fearlessly support our pregnant clients when they come to our class. Hope to see you all there. It's gonna be an absolute blast. I hope you have a great couple weeks and I'll talk to you again soon.

[00:22:43] Thanks for listening to this week's chapter of Pilates Teachers' Manual, your guide to becoming a great Pilates teacher. Check out the podcast Instagram at @pilatesteachersmanual, and be sure to subscribe wherever you listen. [00:23:00] For more Pilates goodness, check out my other podcast, Pilates Students' Manual, available everywhere you listen to podcasts.

[00:23:07] The adventure continues. Until next time.