When Behavioral Health Meets Physical Therapy: The Missing Link in Injury Recovery
/We often operate as though mental health and physical health live in separate neighborhoods—one “in the head,” the other “in the body.” But if you’ve ever felt your shoulders tighten with stress or cried because you couldn’t do something you once loved, you know: they’re next-door neighbors. Probably sharing a duplex, arguing over the thermostat, and borrowing each other’s coping mechanisms.
As a psychotherapist with a background in fitness, anatomy, and injury rehabilitation, I’ve spent years walking the line between both worlds. And I’m here to say: when physical therapy ignores the emotional toll of injury, it misses a critical piece of the healing process.
The Moment I Knew Something Was Missing
In 2018, after 20 years in the mental health field and teaching in fitness and providing personal training (plus tutoring anatomy and physiology), I considered going to PT school. I took refresher courses from undergrad, and spent a year volunteering in outpatient clinics to gather required observation hours.
During every single shift—without fail—a patient would come up to me, assume I was a PT (likely because of my age), and confide in me about their depression, frustration, or anxiety related to their injury.
And they weren’t looking for therapy. They were looking for someone who would just listen.
As someone with my own chronic injuries and connective tissue issues, I got it. Not just intellectually, but in my cells. I also noticed that most PTs—kind, skilled, and well-meaning as they were—didn’t usually engage when patients shared these emotional moments.
They’d redirect, continue tasks, or shift gears—not out of malice, but likely without realizing it was a key moment to build rapport and strengthen the patient-provider connection. Research shows that when patients feel heard and seen, they’re more likely to follow treatment plans and achieve better outcomes [1, 5].
I realized—and later confirmed—that interpersonal and relational skills are rarely emphasized in most training programs, despite their proven impact on patient adherence, satisfaction, and healing outcomes [2, 5].
So I Developed a Training
I created a two-part training for Physical and Occupational Therapy clinics.
Part 1:
The interpersonal side of patient care
Why empathy matters in brief but pivotal moments
Evidence-based communication tools to build trust, validate distress, and strengthen the therapeutic alliance
Part 2:
Recognizing signs of common mental health concerns that may affect PT participation—like depression, anxiety, trauma, or grief after a major injury
How It Was Received
· Occupational therapists showed the most interest. They’re often trained to consider emotional and psychological barriers to treatment and immediately saw the relevance.
· Some PTs were enthusiastic, already incorporating empathy into their practice, and shared examples of how this had benefitted their patients.
· Many PTs and clinics, however, expressed limited interest. Some misunderstood the focus, assuming it was a chronic pain training, while others felt too pressed for time to participate.
In some cases, some assumed I was suggesting they provide psychotherapy during PT sessions—which was never the point.
The training was designed to highlight that they already have the ability, and to stress the importance of not missing those brief but pivotal moments, when a patient expresses psychological distress related to their injury. Often, a simple heartfelt acknowledgment is all that’s needed to make a difference.
It was a telling response—and a reminder of how easily interpersonal skills can be overlooked and undervalued in busy clinical settings.
But Here’s the Research
This isn’t just a “nice-to-have.” It’s not fluff. It’s clinical. It’s measurable. It’s effective.
Studies show that:
Physicians with higher empathy deliver better clinical outcomes for patients with chronic illnesses such as diabetes—for example, improved glycemic control and fewer complications [1, 4].
Higher empathy in healthcare providers is linked to improved pain tolerance, stronger therapeutic alliance, greater treatment adherence, and better functional outcomes in rehab settings [5, 6].
A systematic review found that greater empathy is highly associated with better clinical outcomes and enhanced patient care experiences [2, 3].
In physical rehabilitation, alliance and rapport predict treatment adherence and improved functional outcomes [5].
Yet most PT training programs spend little time teaching interpersonal communication or how to respond when a patient suddenly says, “I’m scared I’ll never dance again.”
This Isn’t Therapy. This Is Just Being Human.
I’m not at all suggesting that PTs diagnose patients, treat trauma, or extend sessions by 30 minutes.
I’m highlighting something much simpler: recognize the moment when a patient needs to feel seen—and meet it.
Even a brief and well-intentioned response like:
“That sounds really hard. I hear you,” can change how that person feels about their body, their injury, and their care.
Those are the moments people remember.
They’re also the moments that shape your rapport, your outcomes, and your referrals—whether you’re a solo practitioner or part of a large clinic.
Mini Self-Check for Providers
✅ Do I pause and acknowledge when a patient expresses emotional distress?
✅ Do I feel confident responding with brief but validating language?
✅ Am I comfortable staying present, even if I can’t “fix” the emotional concern?
✅ Have I ever asked a patient how their injury has impacted their mental or emotional well-being?
✅ Do I feel curious—or defensive—when reading this?
If you answered “no” to most of these, that’s okay. This isn’t about judgment.
It’s about growth. And growth starts with awareness.
Final Thoughts: It’s Time to Bridge the Gap
If you’re a PT, you don’t need to become a therapist.
But connection and attunement are just as important in the clinic as they are everywhere—especially in those crucial “make or break” moments when a patient’s motivation, emotional state, or self-worth is hanging in the balance.
Patients who feel heard stick with their program. They come back. They get better.
If you’re a clinic owner, a school administrator, or a continuing education coordinator:
It’s time to include this training in your curriculum. Not because it’s trendy, but because it changes lives—and the research backs it up.
💬 Let’s bring this to your clinic or program.
Visit www.cecilylongotherapy.com to inquire. Trainings are customizable for student groups, staff in-services, or continuing ed workshops.
Disclaimer: I’m not a medical doctor or prescriber. This content is for general information only and isn’t a substitute for professional medical advice. Always consult a qualified healthcare provider about your health.
References
Del Canale, S., et al. (2012). The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients. Academic Medicine, 87(9), 1243–1249.
Derksen, F., Bensing, J., & Lagro-Janssen, A. (2013). Effectiveness of empathy in general practice: A systematic review. British Journal of General Practice, 63(606), e76–e84.
Mercer, S. W., & Reynolds, W. J. (2002). Empathy and quality of care. British Journal of General Practice, 52(Suppl), S9–S12.
Hojat, M., et al. (2011). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine, 86(3), 359–364.
Hall, A. M., et al. (2010). The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: A systematic review. Physical Therapy, 90(8), 1099–1110.
Fuentes, J., et al. (2014). Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: An experimental controlled study. Physical Therapy, 94(4), 477–489.