I want to take a brief detour from the longer series of posts I’m writing on concept of the virtual to ask about an odd paradox in health professional education that’s puzzled me for some time.
This makes complete sense to me, as someone highly experienced in getting injured! I've had plenty of physio over the years as a result of footballing injuries, and the results vary. However, what became very clear to me in ageing, is that I never really understood what I was being asked to do, and why. The instructions were usually about the technicalities of the injury (ruptured tendon, ligament, meniscus etc), and the exercises that would help, and the program of exercise. However, there was nothing about the feeling of the injury, and nothing about the feeling of normality (once healed). I walked with a limp, through habit, for a long time (despite still playing football!), because it was never pointed out to me that I was compensating for a previously broken leg now healed. It wasn't until I did some Alexander method "lessons" that I really got what I was doing wrong, and learned to fully pay attention to my body and catch myself in poor form.
That said, I'm not suggesting that physios had to have experienced a broken bone or torn ligament. It does strike me that the ones I so, though, had no particular connection to their body, no lived awareness. Neither was it their passion, which I think is probably more key. Like me in my dreary office work, when a subject becomes professionalised, process driven, systematised and simplified, I expect many just walk through it, and follow the steps and motions and instructions required of the job - they see it as a job. There's no philosophy, no deep thought, no revision and study, simply that abstract notion that jobs give us - it pays the bills. Perhaps that's why psychotherapists are required to "mental health" themselves. To ensure that they have that depth of thought, and continued curiosity. I suspect that psychotherapy tends toward the philosophical and depth of thought, compared to the technical and scientific of physiotherapy. Or, at least, you can likely spend an entire career in physiotherapy concentrating solely on the technical and scientific side of things (ignoring things like the placebo effect, the effect that stress can play in injuries and healing and other such things).
Anyway, I'm rambling, hope you get me. I'm just a guy who has been injured a lot, and who enjoys reading your blogs (not quite sure who they sneaked up on me if I'm honest!).
I've spent a long time pondering why it is that the physio profession put so much focus on instrumental thinking at the expense of their own subjective thought and experience that it ended up being the book The End of Physiotherapy. Briefly, I think it was about creating a particular identity for the profession. A lot of the founders were nurses, who didn't want to be associated with the kinds of sisterly caring that professional nursing had claimed. They enjoyed being hands-on, and working in short sessions with people, fixing things. They learned tons of anatomy and pathology as a way to remove all the risky sensuality from their touch (in the way doctors did). Remember too that PT and psychotherapy emerged as professions at about the same time, so while PTs were content to focus only on the body, psychotherapy professionalised the mind. Now, if you're going to focus only on the body, you don't need practitioners to be particularly reflective; they need to be technical. So, the conditions for this way of thinking and practicing were set down more than a century ago but haven't really changed. Which is interesting in itself. But I think its because if you focus only on the body, it's very hard later to shift to attention on a bigger world. It's what I called the physiotherapy paradox; what was key to setting the profession up is now causing us all sorts of problems.
Well, I would have read your reply yesterday, but in a wild twist of fate, and for the first time in over a decade, I tore ligaments in my ankle playing football! Whilst the initial pain was quite shocking, I managed to sit with it and be aware of it, meditate on it I guess. To the extent that on day two, the pain is reduced to a ~3/10, despite bruising and swelling. I'm managing to pinpoint exactly where the range of motion is lacking and where and what I'm doing in compensation. I'll likely still take Ibuprofen for swelling, I don't require it for pain control. I'm not going to immediately embark on strength training or exercises, but I do think I'll be ready in far greater time than any of the (many!) previous ankle injuries. I'll likely contact a physio in the coming couple of days, but now you've got me wondering if I should go through an interview process with them to see if they've had an injury themselves!!
"To that end, I’ve written a lot in the past about how the inclusion of just transference and counter-transference might transform physiotherapy training"
Thanks both. If you download a free copy of Physioheresy - a compilation of my blogging from the first 10 years of the Critical Physiotherapy Network - and search for 'transference' you'll find some references to that there.
I've just checked the link again Karli and it's odd. The hyperlink address is right but doesn't take you to the page. This link works but, oddly, it's the same address. I'll ask the Library people about it.
Would psychotherapists exclude candidates from training if they considered a person had ‘good’ mental health? Or would they consider everyone to be in need of some form of psychotherapy?
The psychotherapists I know argue that everyone should engage in their own personal therapy. They argued that the purpose of therapy wasn't in fact rehabilitation or recovery - even in cases of severe mental illness - but insight. So they were less interested in pathology, but did assess everyone to make sure they were well enough to cope with the rigours of study. So people could have good mental health as long as they were engaging in personal therapy.
This makes complete sense to me, as someone highly experienced in getting injured! I've had plenty of physio over the years as a result of footballing injuries, and the results vary. However, what became very clear to me in ageing, is that I never really understood what I was being asked to do, and why. The instructions were usually about the technicalities of the injury (ruptured tendon, ligament, meniscus etc), and the exercises that would help, and the program of exercise. However, there was nothing about the feeling of the injury, and nothing about the feeling of normality (once healed). I walked with a limp, through habit, for a long time (despite still playing football!), because it was never pointed out to me that I was compensating for a previously broken leg now healed. It wasn't until I did some Alexander method "lessons" that I really got what I was doing wrong, and learned to fully pay attention to my body and catch myself in poor form.
That said, I'm not suggesting that physios had to have experienced a broken bone or torn ligament. It does strike me that the ones I so, though, had no particular connection to their body, no lived awareness. Neither was it their passion, which I think is probably more key. Like me in my dreary office work, when a subject becomes professionalised, process driven, systematised and simplified, I expect many just walk through it, and follow the steps and motions and instructions required of the job - they see it as a job. There's no philosophy, no deep thought, no revision and study, simply that abstract notion that jobs give us - it pays the bills. Perhaps that's why psychotherapists are required to "mental health" themselves. To ensure that they have that depth of thought, and continued curiosity. I suspect that psychotherapy tends toward the philosophical and depth of thought, compared to the technical and scientific of physiotherapy. Or, at least, you can likely spend an entire career in physiotherapy concentrating solely on the technical and scientific side of things (ignoring things like the placebo effect, the effect that stress can play in injuries and healing and other such things).
Anyway, I'm rambling, hope you get me. I'm just a guy who has been injured a lot, and who enjoys reading your blogs (not quite sure who they sneaked up on me if I'm honest!).
Thanks so much, Rico.
I've spent a long time pondering why it is that the physio profession put so much focus on instrumental thinking at the expense of their own subjective thought and experience that it ended up being the book The End of Physiotherapy. Briefly, I think it was about creating a particular identity for the profession. A lot of the founders were nurses, who didn't want to be associated with the kinds of sisterly caring that professional nursing had claimed. They enjoyed being hands-on, and working in short sessions with people, fixing things. They learned tons of anatomy and pathology as a way to remove all the risky sensuality from their touch (in the way doctors did). Remember too that PT and psychotherapy emerged as professions at about the same time, so while PTs were content to focus only on the body, psychotherapy professionalised the mind. Now, if you're going to focus only on the body, you don't need practitioners to be particularly reflective; they need to be technical. So, the conditions for this way of thinking and practicing were set down more than a century ago but haven't really changed. Which is interesting in itself. But I think its because if you focus only on the body, it's very hard later to shift to attention on a bigger world. It's what I called the physiotherapy paradox; what was key to setting the profession up is now causing us all sorts of problems.
Well, I would have read your reply yesterday, but in a wild twist of fate, and for the first time in over a decade, I tore ligaments in my ankle playing football! Whilst the initial pain was quite shocking, I managed to sit with it and be aware of it, meditate on it I guess. To the extent that on day two, the pain is reduced to a ~3/10, despite bruising and swelling. I'm managing to pinpoint exactly where the range of motion is lacking and where and what I'm doing in compensation. I'll likely still take Ibuprofen for swelling, I don't require it for pain control. I'm not going to immediately embark on strength training or exercises, but I do think I'll be ready in far greater time than any of the (many!) previous ankle injuries. I'll likely contact a physio in the coming couple of days, but now you've got me wondering if I should go through an interview process with them to see if they've had an injury themselves!!
Great post. More please.Can you direct me to the transference bits please?
Thanks Karli.
What transference 'bits' do you mean?
I'm guessing that they meant links to writings:
"To that end, I’ve written a lot in the past about how the inclusion of just transference and counter-transference might transform physiotherapy training"
mentioned in the article.
Yes indeed
Thanks both. If you download a free copy of Physioheresy - a compilation of my blogging from the first 10 years of the Critical Physiotherapy Network - and search for 'transference' you'll find some references to that there.
Link: https://ojs.aut.ac.nz/tuwhera-open-monographs/catalog/book/11
Did this link change?
I've just checked the link again Karli and it's odd. The hyperlink address is right but doesn't take you to the page. This link works but, oddly, it's the same address. I'll ask the Library people about it.
https://ojs.aut.ac.nz/tuwhera-open-monographs/1/catalog/book/11
Would psychotherapists exclude candidates from training if they considered a person had ‘good’ mental health? Or would they consider everyone to be in need of some form of psychotherapy?
The psychotherapists I know argue that everyone should engage in their own personal therapy. They argued that the purpose of therapy wasn't in fact rehabilitation or recovery - even in cases of severe mental illness - but insight. So they were less interested in pathology, but did assess everyone to make sure they were well enough to cope with the rigours of study. So people could have good mental health as long as they were engaging in personal therapy.
So physiotherapists could be physically well but should be engaged in some kind of regular exercise programme?
Interesting question. Keep on such questening