Positive Health Online

Intuitive practice

Intuition is an area which fascinates many in the health care world. To some – the academically orientated in particular – it is an area to be disparaged and discouraged, whereas to many in the bodywork field in particular – intuitive methods are seen to be an integral and vital component of their work.

What is intuition?

Well it is certainly not a fully plotted strategy, a carefully worked out and adhered to plan of action.

Professor Donald Schon at the Harvard Business School, 75th Anniversary Colloquium, 1987 stated the following

Often when a competent practitioner recognises in a maze of symptoms a particular pattern, and constructs the basis for a coherent design in dealing with it, or discerns an understandable pattern in a jumble of information, something is being done which cannot easily be described. Practitioners/therapists make judgments of quality for which they cannot state adequate criteria. They display skills for which they cannot describe procedures or rules.

When we define rigour only in terms of technical rationality we exclude much of what competent practitioners (of anything) actually do.

Schon speaks of

the varied topography of professional practice where there is a high ground which overlooks a swamp. On the high ground manageable problems lend themselves to solution through the use of research based theory and technique. In the swampy lowlands, the real world, problems are messy and confusing and often incapable of technical solution.

In truth it is in the swamp that problems of real human concern lie.

Many practitioners choose to work in the swamp immersing themselves in confusing but important situations. They describe their methods of inquiry by speaking of experience, trial and error, intuition, muddling through, and many are plagued by feelings of inferiority in relation to those who present themselves as models of intellectual rigour.

Is there then another way of looking at problem-setting and intuitive artistry?

Reflection - in - action

There is a special demonstration of knowledge which we see in many of our spontaneous actions. In practice this is demonstrated by skilled practitioners when they display the ability to recognise, judge, decide and perform skills in patterns of what can be called ‘knowing-in-action’.

If we can see competent practice as something other than, or additional to, the application of knowledge we are acknowledging that ‘know-how’ in action is operating.

A tightrope walker’s abilities on the high wire, or a bowler’s ability to ‘know’ and exploit a batter’s weaknesses cannot be seen to depend upon planned, structured decision making.

Yes we often (sometimes?) think before acting, but in truth much spontaneous action in skilful practice suggests a knowledge which is not directly linked to intellectual activity.

We can all relate to the fact that we can describe a something as deviating from the norm far more easily than we can describe what that difference is, or than we can describe what the norm is. This is particularly true of palpation information. Our hands recognise normality and deviations from it, but trying to put this difference into words or to analyse the difference is far from easy, and often impossible. When we explore the tactile sensations associated with the surface of a material (skin or anything else) we can describe what we feel in terms of rough, warm, smooth, cool, pliable, hard etc but we do not speak of the actual sensation of compression or abrasion on the finger tips, although these are the sensations which produce the awareness of what it is we say we feel. We perceive from the fingertips sensations which we interpret as certain qualities in the tissues.

Ultimately skilled people learn to perform complex operations without being able to give verbal descriptions which are even remotely capable of describing the action faithfully.

When what we do does not work as anticipated we may fall back on ‘reflection-in-action’ in which we may solve problems through trial and error as we invent procedures to overcome difficulties. Trial and error when applied by someone with basic skills is more than a hit and miss affair but flows from an inner logic in which unexpected consequences influence the design of what is done next.

A jazz musician displays an ability to listen to others and to their own performance simultaneously and to adjust constantly to what is happening – usually organised around an underlying musical structure or harmony. This is reflection in action. We do this every day in conversation with others in which the form and content of the conversation may take unpredictable directions and in which we collectively improvise.

A skilful therapist/practitioner continually engages in a process of appreciating, probing, modelling, experimenting, diagnosing, assessing, psyching out, evaluating what is being done, and which can only imperfectly be described. A skilful practitioner (of anything at all) may respond to a situation that is puzzling, unique by reflecting at one and the same time on the situation and on the reflection in action they spontaneously bring to it. In the midst of action they are able to turn thought back on itself, surfacing, criticising and restructuring the thinking by which they have tried to make the situation intelligible to themselves.

Many practitioners treat each person as a unique case constructing and testing assessment/diagnosis – inventing, evaluating lines of treatment through on the spot experiment – based on their acquired skills and knowledge as to what is safe, possible, worth trying.

But – for many people locked into a view of themselves as technical experts, there seems little to occasion reflection. Uncertainty seems a threat, an admission of weakness. They may have become proficient at techniques of ‘selective inattention’, the use of junk categories to dismiss anomalous data – aimed at preserving the constancy of their apparently stable knowledge of what to do and how to do it.

The intuitive practitioner is willing to embrace error, accept confusion, reflect critically on previously unexamined assumptions, even though they may feel profound unease because they cannot describe what they know how to do, and cannot easily help others to learn it.

The study of professional artistry is profoundly important – we should be turning the puzzle of professional knowledge on Its head, not seeking only to build a science applicable to practice but also to reflect on the reflection-in-action already embedded in competent practice.

We need to

• explore how on-the-spot experimentation occurs in professional settings
• analyse how skilled people build-up repertoires of examplars & strategies
• understand how skilled people learn to see novel one-of-a-kind phenomena
• be attentive to differences in the framing of problematic situations
• make sense of confusing predicaments.