Year of Award


Document Type


Degree Type

Doctor of Education (EdD)

Degree Name

Counselor Education and Supervision

Department or School/College

College of Education and Human Sciences

Committee Chair

Kirsten W. Murray

Commitee Members

Cathy Jenni, John Sommers-Flanagan, Charlie Palmer, Valerie Moody


University of Montana


As healthcare evolves to consider the psychosocial effects of injury and disease on patient well-being, attention has turned to patient-provider relationships. Heightened attention to the significance of this relationship necessitates healthcare providers shift to a patientcentered model. One foundational model, the working alliance, emphasizes emotional bond, collaboration on goals, and agreement on tasks between patient and provider. Despite emphasis on a working alliance in healthcare research, conceptual understanding of the components of athletic trainer-patient relationships in collegiate athletic training remains unexplored. In this grounded theory study, six participants completed two rounds of semi-structured interviews guided by the research question: What is the collegiate athletic trainer’s experience and process of developing a working alliance in athletic training? The results from this grounded theory study emphasizes how athletic trainers create and enter patient and coach relationships and move through the care process, and their experiences with patient investment and ever present environmental, place, and person factors that broadly influence athletic trainers efforts to develop patient relationships and provides a guide to integrate a working alliance into athletic training practice. Bolstering care contracts with informed consent and adapting patient education supports patient understanding, involvement, and facilitates collaboration. Rapport, connection, and trust are essential to developing patient relationships and an emotional bond. Navigating care as partners and educators enhances athletic trainers ability to collaboratively establish goals and agreement on tasks, provide patient-centered care, and improve working alliances. Effectively managing patient resistance helps athletic trainers encourage adherence and buy-in. Drawing attention to establishing and navigating skills most beneficial to training clinical preceptors enables them to model and introduce these skills’ value and importance to athletic training students sooner during education. These results also offer a framework to guide education and skills training in Athletic Training Programs, connecting athletic training students with skills that enhance clinical learning and patient-centered care experiences before professional practice. Knowing when, how, and where working alliance skills surface in athletic training patient care enables counselor educators to enhance current proficiency and introduce focused skills training in the athletic training discipline, which may also enhance bond formation, gaining agreement on goals, and collaborating on tasks, thus supporting development of a working alliance.



© Copyright 2017 Jessica Lealand Moore