Communication as negotiation processes in long-term physiotherapy: a qualitative study

Purpose: The purpose of this study was to describe communicative patterns about change in demanding physiotherapy treatment situations. Methods: A multiple case study of eleven treatment courses was carried out, based on in-depth individual interviews, focus group interview, personal notes and repeated video-recordings. To compare communication within and over sessions, a two-step procedure was applied: identification of communication patterns and detailed analysis of selected dialogues from video-recorded sequences. Findings: One main communicative pattern was identified: Seeking for common ground demanding negotiating process. This pattern was interrupted by short episodes of two types of challenges; the pattern of ambivalence and uncertainty, and the pattern of impatience and disagreement. Communication between the participants appeared as a demanding and complex process of negotiations during the treatment processes. The physiotherapists' sensitivity of and ability to negotiate the tasks, the emotions related to tasks and the nature of the relationships, seemed to facilitate change. The patients' and the physiotherapists' capacity to bear and come through demanding situations created new ways of interaction. Conclusion: The demanding situations may generate a potential for the development and the improvement of treatment outcomes. Understanding such episodes as open and dynamic, in contrast to defining the patient as demanding, suggests a useful perspective for treatment.