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INTRODUCTION

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Diversity: the art of thinking independently together

—Malcolm Forbes

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*Mr. Ketterman's Case

Mr. Ketterman has indicated to me that he no longer wants to be treated by the therapist who covers for me when I am away. She is a 25-year-old woman who speaks with an accent and who has recently decided to share with everyone that she is gay. She also enjoys a rather casual approach to her wardrobe and her interaction with patients. I noticed she has been calling Mr. Ketterman Sam. I want to figure out why Mr. Ketterman has made this request and what if anything I might need to do about the therapist's behavior. (See Appendix for Mr. Ketterman's health history.)

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*Case Example—Sarah

Sarah is excited by her new job in a women's health clinic, particularly since this opportunity allows her to apply her manual therapy skills specifically to women's health issues. She is particularly pleased that the owner of the women's health clinic, Marsha, has a well-articulated philosophy about the importance of health education for everyone who receives services through her clinic. In fact, Marsha is a strong advocate for improving the health of lesbians, bisexual women, transgender people, and their families. Yet, Sarah is anxious. She has always lived in small, rural communities of people just like her and her family—white, middle-class, blue-collar, or professional people who are independent thinkers and either Jewish or Christian. She wonders how she will be able to connect with the patients and clients she will see weekly at an outreach clinic in a community health center in the most run-down neighborhood of her new town. How effective will she be in instructing people who have poor education and few resources? Earlier today, Marsha told her that the community health clinic also serves the Somali immigrant population that has swelled in numbers over the past 10 years. Despite being reassured that the Somali community has emphasized learning English, she worries about how she will be able to establish a therapeutic relationship with women who are so unlike herself.

Sarah knows that she has excellent reasons for being concerned. She, like virtually every other physical therapist, knows that a positive patient-practitioner relationship is pivotal to effective therapeutic outcomes. The physical therapy profession posits that positive therapeutic outcomes emerge from the interaction between the practitioner's technical therapeutic skills and the therapeutic relationship with the patient or client. While the degree to which the therapeutic relationship contributes is legitimately questioned,1,2 its importance to patient and client improvement is strongly promoted in physical therapy literature3,4,5 and education.6 The question Sarah asks herself is not should she develop therapeutic relationships with her patients and clients; instead, she asks how to develop the therapeutic relationship across the cultural differences of gender, age, class, race, ethnicity, religion, sexual orientation, and ablement (ability/disability). More important, she wonders how to advocate for the health care ...

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