Positive Health Online

‘The real voyage of discovery consists, not in seeking new lands, but in seeing with new eye.’ – Marcel Proust

So Who Does Treat the Therapist?

Maybe we need to establish, does the therapist actually need treatment in the first place?

What is it that motivates us to seek advice about our health? In fact, do we ever seek out advice about our health? Or is it our ill-health? If we look at health as a continuum, at one end of the scale is illness and chronic disease and at the other vibrant health.

Where would you place yourself on this continuum, remembering that health does not simply mean the absence of ill health! (See scale below).

Are we proactive or reactive in terms of trying to maintain or improve our health? Is being healthy purely a physical phenomena, or is a picture of good health an integral mix of ‘mind, body and soul’?

At the end of a typical day’s work mark where you feel you would be at? Physically Drained? Highly Energized? Mentally Tired? Mentally Alert? Emotionally Depleted? Emotionally Balanced?

If you score way out to the right hand side on all counts then pass this article on to someone who wouldn’t, and if you didn’t then maybe you need treatment?!

Some may simply turn round and say; ‘that’s just life isn’t it?’ My own personal experience of being drained on all three of the above counts would, in the past have had me agreeing with them.

But it doesn’t have to be like that, as I now feel totally energized and balanced at the end of a day’s work. This article is about how that shift took place, and how that shift could take place for you!

Therapist Insecurities and Uncertainties

‘The more I know, the more I know I don’t know!’
I have journeyed through a medical model where science is believed to hold all the answers. I have searched for the Holy Grail in the fields of alternative therapy, only to find the same degree of conviction and certainty in their beliefs that exists in western medicine. It has been my experience that neither holds the magic bullet, each with its certainties has promised much, and at times delivered nothing.

If you ever find yourself asking any of the questions, or making any of the observations below, when working as a therapist, then you may find the contents of this article helpful.

•    ‘I’m never going to get this client/ patient better’
•    ‘Oh no, not Mrs Snodgrass next, ahhh!’
•    ‘These symptoms just don’t seem to fit any pattern.’
•    ‘I know before the person walks in the room that they are going to be worse.’
•    ‘Why does this technique work so well for some and not for others?’
•    ‘What the hell am I going to try next with this person?’
•    ‘I just wish they’d stop going on and on about their pain.’
•    ‘I’m in a worse state than half my clients.’
•    ‘Am I imagining this or not?’
•    ‘I know what I need to do …ah right so its not that so what can it be?’

As a therapist of 16 years standing, I am less certain now of how to treat a patient than when I first qualified, not because I know less, but because I know more!

A Therapeutic Journey

How do you perceive yourself as a therapist? Do you see yourself as the ‘Fixer’ or the ‘Facilitator’? How might this role impact on your health as a therapist? What are your clients’ expectations of you as a therapist?

I have been both a ‘Fixer’ and a ‘Facilitator’. Neither way can be said to be right or wrong, I would suggest that there is a place for both in the world of therapy, but personally for my own health I now choose to be a Facilitator.

When living in a busy city, a car would often pull up beside me, a window wind down, a voice say, ‘could you tell me how to get to such and such a street please?’ I would reply something along the lines of ‘take the first left then right at the traffic lights and it’s the third road on the left’. If that person had asked me as a therapist I would have asked him to get in the passenger seat and I would have driven him there myself!

That is the difference between a ‘Fixer’ and a ‘Facilitator’.

Most drivers would not accept the offer for me to drive them to their destination, yet when it comes to people’s health they are more than happy to hand over the responsibility to someone else.

We Need Certainty in Our Lives,
or Do We?

As the driver of the above car we need to be certain that we are going to arrive at our destination.
Take a look at the drawing below.

What do you see?

Can you be certain what you actually see is the reality you think it is?

Well, some of you may have seen the old lady and others the beautiful young lady. It matters not, no one is right and yet no one is wrong. As therapists we all view the same thing in terms of the human being, but our interpretation of what we see and feel may be entirely different, but equally as valid. For example, a physiotherapist doing a mobilization technique over the soft tissue of a facet joint may say they are working on the joint, but an acupuncturist may say they are addressing the bladder meridian. It would depend on your belief systems as to which you chose to run with. Both may work or one or the other or neither! So what I used to say with certainty I now say with humility.

I can offer a possible answer but I cannot be sure. Today’s modern technology provides us with solutions to things we did not even know we needed solutions for. So ‘not knowing’ would appear somewhat incongruent with our modern lifestyles.

Search for Therapeutic Certainty

As therapists, are we ever going to know with certainty what we are doing is what we say we are doing, and what we are treating is really what we say we are treating, and does it matter? And can ‘not knowing’ effect my health, as a therapist?

Like many patients, some therapists look for a label to give a particular condition. People want to know what is wrong with them. Having worked as the specialist physiotherapist in a chronic pain department, I have seen patients who have tried literally everything. They had been told 30 different things by 30 different therapists, and no matter what label the condition was given, or what explanation, as to how the resultant treatment would work, they still had their pain.

In the past, I have had patients come in for treatment who have told me what their problem is and what treatment they have needed. In my younger days, I have persuaded them that ‘no that isn’t what you have got, and this is the treatment you need.’ Needless to say ‘my’ treatment made no difference whatsoever; it wasn’t until I plugged them into an electrotherapy machine that they dramatically got better. This on many occasions with the timer switched on, but the power to the actual machine switched off!! So even when we think what we are doing is why we are getting results, it may be down to a simple placebo effect.

In a sense, that needing to know that we have all the answers, reflects the conundrum faced by those chronic pain patients. They have had all the answers but it hasn’t made a blind bit of difference, apart from making them more anxious, frustrated and, in certain cases, angry. Ring any bells? Acceptance of not needing to know can be very therapeutic.

Eureka?!

I can’t actually say there was a moment when I leapt out of the bath and ran naked down Twickenham High Street yelling Eureka!! But over a period of months, maybe years, things changed in me as a therapist that negated the desire and need to unanswered questions. I am now happy with not knowing what it is that prevents those patients from not getting better. I finish a day’s work now energized, refreshed, revitalized, excited, enthused, and that is a great place to be in given the place I had journeyed from!

The Eureka transformation I underwent, although slow, was not due to the gaining of new knowledge or techniques, but rather the dropping away of long-held and cherished beliefs constructed by the ego (and the collective ego of the profession of which I was a member). The dissolving of my beliefs enabled greater clarity, insight and understanding into the relationship I had with the people I worked with.

‘I’ became the difference that made the difference, not what I did.

Belief Systems

The place where I’m at now has come about through challenging my own belief systems, as to the role of the therapist. Your beliefs as a therapist will influence the way in which you work. Your beliefs about your client/patient will influence the way in which you think and feel about how you work, and in turn have a bearing on your effectiveness and efficiency as a therapist. At least this has been my experience when I professed to know what I was doing!

In essence, we all have a different map of the world. Created through and by our individual belief systems, it is neither right nor wrong. But when we have absolute certainty in our convictions our flexibility diminishes, and when challenged we adopt a position of being ‘right’, and our challengers being ‘wrong’. Having to always be right can, at times, be a very draining business.

American poet John Godfrey Saxe (1816-1887) based the following poem on a fable which was told in India many years ago, which hopefully puts the notion of ‘knowing for sure’ into perspective. Hopefully, its implications for the therapeutic world is clear.

Mark on the continuum (pg 17) where you feel we are in terms of knowing everything there is to know about the human being.

Unless you are right out on the far right side of the continuum then there is room for doubt in everything we do. It is this uncertainty that, if we accept, will take us to a place where anything is possible. That includes being totally energized and invigorated at the end of a day’s work.

There are four steps I would identify with being a healthier happier therapist:

1.    Be your own Guru

‘Be that change you want to see in the world.’     – Gandhi

When teaching one-day courses, I show a particular technique for treating the diaphragm. I will then explain that this technique can be used anywhere in the body, look at the anatomy, what is it you are trying to achieve and go for it – i.e. ‘just make up the technique’. The shock that this brings never fails to shock me! I explain someone has to make up these techniques why not you? Having spent a large percentage of my adult life studying for three degrees has institutionalized my way of thinking. I was looking for the next guru to teach me what to do as opposed to being the guru myself! This is a novel concept, but maybe a concept worth exploring. I see my role as a therapist and teacher simply to point out the various sign posts on the road to… wherever anyone is journeying!

2.    Awareness

‘What you are aware of you are in control of; what you are not aware of is in control of you.’
    - DeMello

Are there days when everything goes well for you as a therapist and then others when things don’t go quite so well? Some days you feel really connected and tuned in, yet on others totally disengaged from what you are palpating, or who you are treating. What is it you feel like when you are connected, and what is the difference when you are not?

Through developing kinaesthetic awareness of what that difference feels like when you are connected and when you are not, you will be able to recognize your ‘Therapeutic Zone’. This is perhaps the place where we get our best results, even at times regardless of the technique or the therapy we are using. In the ideal world this is a place where we are free from our insecurities and uncertainties as a therapist, free from the burden of client and self-imposed expectations.

The therapeutic zone equates very well to the sporting zone. As an example take {rugby player} Jonny Wilkinson. He kicks the ball through the posts with tremendous regularity, but he does not have a one hundred percent success rate. There is no certainty he will kick the ball through the posts, but he gives himself, each time he kicks, the best chance.

In his mental preparation whilst addressing the ball, he is not thinking, “Shit, what are all my fellow players, fans, and media critics going to say if I miss this? The last time I attempted from this range I missed.” The place from where he performs his skill so successfully and effectively is his sporting zone. When you develop your therapeutic zone you will be amazed at the difference in your effectiveness.

Our mental and emotional state influences our physiology. Just take a minute to imagine your nightmare patient walking into the treatment room. Notice how your physiology, your mental tension, and your emotional state changes. This will all have a bearing on your effectiveness as a therapist and your energy levels. Why is it you react in such a way to those ‘draining’, ‘nightmare’ patients?

Wouldn’t it be great if you didn’t react in such a way? If you cultivate an awareness of your therapeutic zone, those patients will no longer be able to knock you off course.

3.    Control the Controllables

A professor describes teaching a concept to a class ‘I told them once, they didn’t understand, I told them twice, they didn’t understand. I told them a third time… and then I understood!’ As a therapist working with clients, I often feel we believe that our sphere of influence is greater than it really is. In truth what is it we have control over in our relationship with our client/patient. We cannot do the exercises for the patient, we cannot make lifestyle changes for them, we cannot think positively for them, we cannot hold them in a good posture, we cannot help them through difficult relationships, etc. What we can do is skillfully impress upon them the importance of their role in the self-healing process, then it is up to them. Even that in itself can be fairly meaningless if it doesn’t coincide with the client’s/patient’s beliefs.

So, if the client/patient is not getting better whose fault is it? Very often this situation is reflected back on our insecurities. So this proves it. I am crap! However, if you are prepared to accept that health is an individual’s responsibility, then it reflects back to that individual.

Even Albert Einstein questioned his sphere of influence. ‘There is a grotesque contradiction between what people consider to be my achievements and abilities and the reality of who I am and what I’m capable of.’

So just what exactly is it therapists are in control of? In a nutshell, ourselves; or are we? If you have meditated before then you will know what I am talking about.

You may have discovered that thinking just happens, in the same way as your heart just beats. You don’t have a say, your voice in your head has a life and an agenda of its own! So, if you are not in control of your mind who is? An article in itself! However, with practice you can learn to quieten the mind, heighten awareness and act from a place of stillness where insight and intuition abounds.

4.    A Way of Being – ‘not Knowing’

‘Que sais-je?’ (What do I know?)
    – Montaigne

In my experience, by searching for certainty and proof that ‘my’ philosophy and ‘my’ method of working is right, can increase the burden of expectation both for you and your client. Inevitably, you will not succeed with a percentage of patients, accepting this was part of my therapy. To be flexible in my beliefs has helped, but this flexibility has only arisen from not worrying about being ‘right’.

By being in a place of ‘not knowing for sure’ you release yourself from that burden of expectation; this gives you the freedom to explore. When I realized that it wasn’t so much what I did that was important but how I did it that I began to feel a connectivity and simplicity in the work that I did.

Modern day living is on a need-to-know basis. Most clients/patients will search for someone who is certain and confident in what they are doing. Most of us are conditioned to react to success and failure in a certain way. We feel good when we succeed and bad when we fail. In therapy some patients/clients get better and some patients don’t.

How do you feel if your patient/client doesn’t get better? Do you see yourself as a failure? If you set yourself up for success then you have got to expect failure as well. This is fine if you react to success and failure in the same way, i.e. it neither bothers you if you succeed or fail, then you will have a peaceful and invigorating existence as a therapist. That may sound flippant, but attaching your self-esteem with certainty to the uncertainty of whether a particular technique will be successful, or whether the person will get better, can be a very draining thing to do.

A Journey’s End or the Dawning of a New Day?

‘When the archer shoots for no particular prize, he has all his skills; when he shoots to win a brass buckle, he is already nervous: when he shoots for a gold prize, he goes blind, sees two targets, and is out of his mind. His skill has not changed, but the prize divides him. He cares! He thinks more of winning than of shooting, and the need to win drains him of power.’
    – Tranxu, Great Chinese Sage

Many therapists find their work exhausting. In reflecting on my own experiences as a tired, frustrated, ‘fed up’ therapist, I hope you can see more clearly that this doesn’t have to be the case, identifying this predicament may be a first step. We seek out the latest techniques, the latest theories as to what we should be doing to improve ourselves as therapists, but no one tells us how we should be. Exploration of a way of being is perhaps worthy of consideration. We are after all human beings and not human doings.