Posted on Aug 18, 2020

Building Therapeutic Relationships Through Communication

By Kara Shannon, DC, and Robert Vining, DC

Effective communication is a known factor in creating a strong therapeutic relationship.1 Therapeutic relationships can facilitate patient adherence to therapy, satisfaction with care and improved outcomes; they have also been associated with reduced malpractice claims.2–7 This article addresses aspects of communication which are key to building therapeutic relationships in chiropractic practice.

A Dynamic Process

During clinical encounters doctors and patients alternately send information while simultaneously playing a secondary role as information receiver (Figure 1). The information exchange occurs both verbally and non-verbally. Using this model as a reference, one might ask: Can this help us understand and potentially improve doctor-patient communication? Research evidence suggests the answer is likely “yes.”  


The Consultation

Whether conducting an initial or follow-up visit, there is typically a set time for obtaining problem-focused history information. During the consultation stage of a clinical encounter, the doctor’s main purpose is to obtain (receive) information needed to direct follow-up activities. Important clinical information can be obtained verbally or through observation of facial expression, inflection, postures, etc. Table 1 describes key elements consistent with a biopsychosocial approach that may support an effective information exchange.


An Example Case Study

After asking standard history questions a doctor conducted an exam of the low back. Following the exam, the doctor explained the working diagnosis. At the opportunity for questions, the patient asked: “Do you think falling off a ladder could cause this?” This question made the doctor aware of the recent fall. Given this new information the doctor inquired further, which led to uncovering the cause of the fall, light-headedness, and a diagnosis of hypotension. A referral to reassess anti-hypertensive medication was generated.

Fortunately, in the case described above, key information about the patient’s fall was uncovered during the visit. But, why wasn’t it discovered earlier? It could be that the doctor did not provide the right opportunity for the patient to fully explain the problem. In this example, simply asking “what else” until the patient’s history and questions were exhausted, could have led to earlier disclosure of the fall and the hypotension diagnosis.


Secondary Messages

Secondary messages are sent or received alongside other forms of communication. Ideally, non-verbal and paraverbal communication (e.g., facial expressions, voice inflection) facilitate healthy therapeutic relationships.11 Table 2 displays other positive secondary messages patients can potentially receive when clinically evaluating different aspects of a problem.



As providers, we have a responsibility to facilitate an environment that fosters an effective information exchange with patients. Understanding our roles as both information sender and receiver may be enhanced through self-reflection. We conclude this topic by offering a critical self-reflection checklist (Table 3) with items drawn from literature reviewed during the development of this article. 1,9–17 The checklist is a tool designed to help self-reflect on key communication concepts that facilitate professional patient-centered communication using a biopsychosocial approach.



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