Cross Country 50 - Choices

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

At every course I spend a few minutes after lunch showing the class where there might go on the Internet to discover more. Of course, I show them around Soma Simple.

In St. Cloud Minnesota last Thursday a woman raised her hand after this and said quite seriously, “I have trouble choosing among all the salad dressings offered in a restaurant. I can’t begin to…” Her voice trailed off as she shook her head and it seemed clear that she wasn’t about to change the choice she’d made years ago. All I could tell her was that, for me, this subject can never grow too large.

But, in fact, as their options for treatment and theories of dysfunction increase many therapists grow paralyzed, unable to decide which of these they might use or study further. But I’ve heard it said that those among us who spend a lot of time looking for the “ideal” situation to place ourselves in never make any real progress. So choices must be made, and, if you think about it, looking back upon the consequences of any choice typically reveals that it was both the right and wrong one to make.

The anxiety I sense when students look at the many ways our patients might be understood probably has its roots in their work environment. Many are driven by productivity standards and a personal need to get along with others on the staff and, of course, these things tend to reduce the choices we consider. This is a problem when the student realizes that there are clinics where the care is not based on a theory that can be defended given what we know about human function lately. Talking about this isn’t the most popular thing I do.

But choices reduce anxiety, at least according to Feldenkrais. In The Elusive Obvious he says, “Anxiety appears when deep in ourselves we know that we have no other choice – no other alternative way of acting.” He goes on to suggest that we imagine how different we feel when walking along a 6-inch board on the floor and that same board suspended ten feet in the air. Works for me.

This site offers options and choices for care that won’t be found in most clinics, I know. I also know that something other than rational thinking isn’t tolerated well, if at all. Often in order to gain the former we have to relinquish the latter, and I know this isn’t an easy task.

I have to come up with a way of offering choices that doesn’t overwhelm so many who want to actually change.

[nari]

We live in a society which seems to think we have to be bombarded with choices; and I figure that the wealth of choices promotes anxiety - which car, which house, which TV, which food item....and for PTs, adding 'tools' to the 'toolbox' leaves them with an overflowing sense of 'which tool?'
Especially with the pressure to conform which seems to be there to a high degree in some clinics.

I think those who go into great detail and think of horses and donkeys and zebras and armadillos every time they see a patient, probably don't progress.
It is too difficult for them to actually decide.

On TV there was a classic segment of a science show where a youngish fellow wanted, and needed, a new mattress. The current one was sagging and fairly useless. After 9 months he could not decide which was best and which complied with the criteria of a good mattress; in a state of extreme anxiety, he gave up and kept the sagging mattress. He was quite happy.

Nari

[Barrett Dorko]

The large choice of "tools" is a problem we've discussd in other threads here and I agree it doesn't help. But a full toolbox implies a near absence of solid theory and a useful intolerance for ideas that aren't biologically plausible or physically possible.

Without that intolerance choices multiply - with it, they diminish rapidly. For me, they dwindled to, well, nothing.

[christophb]

I'm confused, do choices reduce or increase anxiety. I have to admit, I seem much more anxious after taking your course. You seem to have a way of presenting information that leaves you with few choices on how to treat (if you actually pay attention to how much sense the course makes). This is tough to do in the clinic where I work, or perhaps I just worry too much about what other people think about it. I dunno.

Chris

[nari]

Chris

I think that if one goes to two courses a year for x years and each course teaches a different approach to similar conditions - one can either pick out what gels with individual clinical practice or agonise over what to use according to EBP/M or ask a forum what to do. (You agree this does happen often?)
I think Barrett is saying for him, and for his students, hopefully, the choice is narrowed right down to almost nothing. If that extremely limited choice produces excellent results and is in keeping with modern neurophysiology -why not?
But in a clinic which operates on traditional methods ("the tried and true" catchcry) then you are in a tricky situation.
Personally, I would not care about what others think, but I come from a land of autonomous practice; that is easy for me to say.

What does your sensibility, your intuition tell you?

Nari

[christophb]

Well, I do what makes sense :D ... It's not always a comfortable thing though. :cry:

[Barrett Dorko]

Chris,

That thing about feeling anxious ever since you took my course? Try not to pass that around too much, okay?

Of course, the Sahrmann people at the course we did together in January solved this problem by simply ignoring everything they learned the day I was there. This takes some effort but it may be worth it.

I always ask those who come to me extolling the virtues of some previous teacher's method: "What's the theory of dysfunction or function behind this? What's the deep model? What do they think is wrong and can they defend that?" I have yet to hear an answer I agree with. Most of the time I get no answer at all. Most of the time the student walks away disappointed with the conversation. I've learned to live with this. I think the "Postural Restoration" thread may follow a similar path in the days to come.

If we respect physical law and the latest in neurobiologic knowledge our choices of treatable dysfunction leading to pain are extremely limited. It follows that our care should address these problems reasonably and, again, they will be limited to that which is reasonable. I say this to my classes and they nod, all the while knowing that they can't actually practice like that and expect their colleagues to tolerate it.

I would say that more choices (at least those you're willing to accept) leads to intellectual discomfort but interpersonal harmony.

Take your pick.

[christophb]

Sorry, about not being clear when I wrote the previous posts... right before bedtime and all. I should clarify that it was my response to doing something outside the norm that was probably the cause for anxious feelings. As your quote from Thomas Moore clearly states "the need to be normal is the greatest anxiety disorder in modern life" or something like that. Personally, I have never felt more comfortable or confident in my practice of PT. I haven't made many new friends however (in the PT work environment at least).

Chris

[Jon Newman]

A worthwhile read, and not too long. Here seems like a good spot for it.

The Burden of Skepticism (http://www.is.wayne.edu/mnissani/2030/burden.htm)

[nari]

Excellent stuff, jon!

Nari

[bernard]

Hi All,

I made a more readable version of the page. :lightbulb