Reflections June 2021, Part One
To see parts 2 and 3 here are the links:
BigMan and I (yes, we both paid) settled down at 0800 on the Saturday morning to listen to Peter O’Sullivan on the cognitive functional therapy course.
He was zooming us from Perth, Australia in the first of four five-hour periods in which we learned more about helping people change, about really listening and understanding what’s going on. I put it on the 55-inch TV and it worked really well.
BigMan is bored of me trotting out one of my sayings – “You can’t convince anybody of anything. You can only help them convince themselves.” Since we’re both physiotherapists, we are automatically oriented towards telling rather than listening. This means it’s hard to change, to convince ourselves to change and really listen.
So here’s a list of the things I took from this course, some are brief and some I will discuss in more depth. Thoughts in square brackets [blah blah] are my personal reflections.
- Typically the therapeutic process takes 12 weeks [i.e. don’t expect it to take less time cos it probably won’t].
- [The process is finished when it’s finished, not when the 5 sessions are done and the person needs to be discharged, either due to NHS restrictions or insurance company instructions.]
- Many negative patient beliefs are based on encounters with health care personnel. [For example, us.]
- Pain behaviours arise early in life and may relate to parental styles of coping with pain. Asking about the family can be really illuminating.
- If a person is not conditioned to an activity, repeated attempts to achieve that activity may worsen pain. [What does conditioned for an activity really, really mean in terms of tendons, bursae, muscles, nerves..?]
- Flip the story away from damage towards movement, sleep, happiness and activity.
- Time, communication, access to the therapist and support are the primary elements. [It’s no use leaving your patient with the impression they can’t contact you at any time]
- [Never discharge your patients. This doesn’t mean you don’t stop seeing them. Discharge is something routine to us but can feel like abandonment to the patients. And abandonment is a very powerful force on the negative side]
- [Explicitly recognise the reality of a patient’s pain. It’s not enough to “express” it implicitly. You have to say it out loud.]
- Take care to check out discrepancies in the patient’s story. Problems may lurk there.
- “I’m interested in the things you’re concerned about” is a great way to express your intent. It tells them that their agenda is in the driving seat and you’re not just filling in a form.
- “How do you FEEL about that?” is a great question and not often asked by physiotherapists. But it is the key point. What have they interpreted from what’s been going on and how do they feel about what they have deduced is their problem.
- If a patient improves very quickly, be careful. They may worsen very quickly too.
The online version of the cognitive functional therapy course was working well. We’d already learned a lot about how to refine our approaches. Parts Two and Three related more to the patient management that Peter moved on to.