{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:49:57Z","timestamp":1775065797636,"version":"3.50.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"9-10","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,29]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients\u2019 adherence to treatment, satisfaction, and health outcomes. When service members with a history of mild traumatic brain injury (mTBI) present to rehabilitation clinics with nonspecific symptoms, a disparity between their experience of disability and clinical expectations of mTBI may disrupt the establishment of a positive therapeutic relationship between patients and providers. The objectives of this study are to (1) explore disparities between military service members and rehabilitation clinicians about the clinical diagnosis and illness experience of mTBI and (2) identify barriers to the establishment of a positive therapeutic relationship.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>This is a qualitative descriptive study of military service members with prior mTBI (n\u2009=\u200918) and clinicians (n\u2009=\u200916) who participated in interviews and focus groups. Data were analyzed thematically using Kleinman\u2019s framing of illness experience and clinical diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Three themes reflected the potential breakdowns in the therapeutic relationship. The first theme, clinical expectations for post-injury recovery versus patients\u2019 experience of ongoing disability, reflects the inconsistency between clinicians\u2019 expectations of symptom resolution within 90\u2009days following mTBI and service members\u2019 experiences of symptoms that worsened over several months or years. The second theme, symptom attribution to mental health conditions versus tissue injury, describes the difficulty in attributing symptoms to the physical impact of the mTBI or mental health diagnoses that may also stem from the injury event. The third theme, suspected malingering versus valid disability, describes clinicians\u2019 reports of frustration with cases in which they suspected malingering for secondary gains in contrast with service members\u2019 feelings that their problems were not taken seriously by clinicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study extended previous research on therapeutic relationships by examining the situation of mTBI rehabilitation services for military service members. The findings reinforce the best practice recommendations of acknowledging patients\u2019 experiences, addressing the presenting symptoms and problems, and encouraging progressive return to activity following mTBI. Acknowledgment of and attention to patients\u2019 illness experience by rehabilitation clinicians is necessary and important for supporting a positive therapeutic relationship and ultimately to optimize patients\u2019 health outcomes and reduce disability.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad143","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T18:20:14Z","timestamp":1684261214000},"page":"e3010-e3016","source":"Crossref","is-referenced-by-count":2,"title":["Therapeutic Relationship in mTBI Rehabilitation: The Disparity Between the Illness Experience and Clinical Definitions"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6800-1988","authenticated-orcid":false,"given":"Alison M","family":"Cogan","sequence":"first","affiliation":[{"name":"Mrs. T. H. 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