Where have I been?

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

Too quiet. My extended family having been here for the holidays are now off into their lives, I’ve no plans to travel anytime soon and my job prospects are in limbo. I’ve had a couple conversations with recruiters for various facilities however. I’ve heard the words “dire need” several times and realize that I’ll eventually land somewhere. I don’t think that it’s going to be that place where they insist upon “an immediate 90% productivity rate” though.

In the early morning hours I waken, my mind full of my experiences the past four years. Of course, I’m trying to remember which student(s) did me in but I’ll be honest, this isn’t coming to me, and I’ve noticed that the things I can remember rarely occur in a place I can name. Mainly, I can’t remember where I’ve been.

Lessons learned:


The therapeutic communities are often proud of their commitment to service and caring.


The therapeutic communities cannot agree upon what commitment entails or what constitutes “caring.”


If you’re ever overnight in Jackson Mississippi don’t stay at The Renaissance Hotel (gee, I guess I do remember that place).


Many members of the therapeutic community appreciate something about critical thinking, but they find it very difficult to express what it is they like about it. Generally, it’s not the “critical” part, and that’s for sure.


Nothing of any interest whatsoever exists on the highway between Ft. Smith and Little Rock Arkansas.


Dependence upon a “keeper,” whether it’s a spouse, a boss, a corporation, an office manager or an enveloping routine of behavior that does not include change isn’t something we should tolerate or seek forever, especially if we are committed to the changes that scientific thought ensures. I won’t be “kept”again.


There’s a therapist somewhere in Southern California who wants to wring my neck and another in Missouri who wants to cut out my liver.


Many therapists prefer sameness, words that only encourage them to never change and continual praise for simply maintaining their license and smiling through the day. I’m not personally like this, and I have difficulty understanding how such an attitude will ever lead to progress in the profession.


There are thousands of wonderful therapists in this world, and they want desperately to help others and grow intellectually themselves. They have heaped praise upon my writing and teaching for years. My problem with them, when I have one, is always the same – they are silent and passive. They are scared, and I guess I can’t blame them.


I’ve been many, many places the past four years, but I’m most likely to be understood and tolerated in only one – here at Soma Simple.


That's where I've been most consistently, and wherever I go from here, it will be with me there.

[Diane]

I’m most likely to be understood and tolerated in only one – here at Soma Simple

Funny, I feel the same way.

[Barrett Dorko]

I wrote the following in an essay titled Circling ( http://www.somasimple.com/forums/showthread.php?t=2392) almost two years ago:

It is when I stand before my colleagues and speak that I feel most alone. This is when I’m least like everyone else in the room. I almost never sense in my classes the thrill a short passage from a text can produce in me, and when I show them that a single idea from a source seemingly unconnected to physical therapy explains so much about clinical life and wait a moment, well, what I get from some is a combination of indifference, annoyance, confusion and even fear. That’s an interesting thing to project all at once, by the way. The absolute silence I get to nearly every question only amplifies the nonverbal message.

On this trip I overheard one therapist say to another, “I don’t want to answer any questions. I thought this course would be like a day off. I just want to sit here and relax."

I wrote this after doing 147 workshops and I got to 285 before enough dissonance accumulated, which I guess isn’t bad considering its power.

I’ll be back out there again before too long and intend to make this my living again. Between now and then I have to think about how I might soften the message without losing it, and without becoming something I’m not.

Any ideas?

[Jon Newman]

Hi Barrett,

Since I'm still a bit like the kid in the videos (that's a confession, not a point of pride) I don't have much to offer in terms of how to soften your message. However, it might explain some the problem (I don't think it's just dissonance) and you can go from there.

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[Barrett Dorko]

Jon,

Your new ability to link the videos here is a wonderful example of how we seek at Soma Simple to address all sorts of learning styles.

We can agree, I think, that increased science education is needed in primary education, and now it’s clear that the arts have a lot to offer our sensibilities as well.

Assuming both of these are inadequately taught, what’s left to blame?

[Jon Newman]

Blame?

I'll work on the ideas part.

[Barrett Dorko]

Jon,

You’re right. Looking to blame something probably isn’t going to help, but I am comforted by the fact that seeking to do so is a very human thing and since some therapists apparently feel that I’m not quite human enough for them, well, maybe this is a good thing.

Intermittently, I am sent postings to the MFR listserv by one who lurks there. This person is violating in several ways the long list of agreed upon behaviors that membership to the list requires and they have to be very careful about revealing this, I guess. Isn’t it ironic that a method of management that continually espouses freedom and individual expression is so repressive when it comes to dissent?

Anyway, in recent references to their leader they call him “The Sweet One,” “The Ancient One,” “The Great Warrior” and “Oh Brave One” (This is all well-documented, and, believe me, I couldn’t make this stuff up).

How can we deal effectively with a community like that? There are therapists in there with many advanced degrees; they serve as instructors in our schools and actually pour this “theory” into the minds of patients in pain and desperate for any help they can find. I don’t think they’re bad people, but they have a bad idea and have decided to behave in a fashion that has proven harmful in the clinic, mainly because The Sweet One has told them to. Again, all well-documented.

My choice was to speak of my problems with all that openly and you can see what they’ve done in response. They scared my boss away from offering an alternative to this stuff. Is there anyone else out there in a position to take over now that I’m not traveling?

At least I take this from what’s happened; no more drives through that part of Arkansas.

[Luke Rickards]

they call him “The Sweet One,” “The Ancient One,” “The Great Warrior” and “Oh Brave One”Is that for real? I had no idea it was this bad. It may not be long now before they start doing ritual sacrifice.:rolleyes:

[Barrett Dorko]

Luke,

I'd suggest this to anyone: Go here (http://www.myofascialrelease.com/home.asp), click on "Myofascial Release Talk," sign up and then listen in for a couple of weeks. You'll see what I mean.

Having been "sacrificed" by this bunch recently, I send you there with that fair warning.

[Nick]

There are thousands of wonderful therapists in this world, and they want desperately to help others and grow intellectually themselves. They have heaped praise upon my writing and teaching for years. My problem with them, when I have one, is always the same – they are silent and passive. They are scared, and I guess I can’t blame them.


I think the problem and the solution lies here. These people don't necessarily want a keeper, but they do need support to stand against the culture. They need community. They need learning opportuniities. They need to learn how to think. They need support in changing things in their own corners of the world.

We have the extreme of "artists" who feel it is most humane (or perhaps godly) to embrace alternative garbage that sounds nice. It is nothing short of a cult that brings bad repute to anyone attempting to use soft tissue manual therapy. Deprogramming is desperately needed. They will react violently or not react at all to anything that challenges their beliefs. There is NOTHING that even resembles science or critical thinking in anything they do or talk about. They get by on being perceived as extraordinarily caring and powerfully intuitive. Theya re neither in my opinion.

We also have the extreme of "scientists" who insist on outcomes-only evidence. They are reactionary to the artists above (rightly so) and hypersensitive to anything that pushes the boundaries of their accepted knowledge base. To the degree that it is valid and reliable, their evidence should inform a scientific theory. If it exists in the absence of theory, than it is not really science (http://en.wikipedia.org/wiki/Scientific_theory#Science). It is fundamentalism.

Complicating everything is the profit-driven business of insurance which powerfully influences behavior of practitioners and makes anything but the billable status quo unattractive. It is the bottom line that determines productivity and this, sadly enough, is not concerned with the well being of the patient in pain.

Barrett, your work is an idea worth sharing (http://www.ted.com). And, for me at least, that has nothing to do with how sweet you are. Like many of the other great minds on that link, it is hard to get others to think. Although it is slow and frustrating, think back 5 years or so, and consider how the formation of this community at SomaSimple is growing toward becoming a catalyst for change. You are doing your part writing and teaching. Luke and Diane are researching elements of this work and expanding and challenging the ideas. Shared reflection on new developments is reshaping the theory - just as science should. It is happening. I feel like I'm about to break into my I Have A Meme (http://www.somasimple.com/forums/showthread.php?t=2768&highlight=I+Have+a+Meme)speech. You know how that one ends, right O Brave One?:D

[Nick]

Here's a great link (http://www.edge.org/q2008/q08_12.html#ewald) that I think belongs here as well.

[Barrett Dorko]

Perfect Nick. If an explanation has been widely and broadly accepted and convincing evidence still cannot be mustered, then it is quite reasonable to expect that the experts are barking up the wrong, albeit cherished, trees.

That point made several times in that short, brilliant essay should be posted all over the place.

Long ago in a rather fractious thread I wrote this: I commonly hear this from MFR apologists: "I know there's a lot of crazy and potentially harmful stuff done by those who fully embrace Barnes' ideas and practice but I don't go in for that. I've just taken what you have identified as ideomotion and leave it at that."

I suppose I should be grateful for this and on some level I am. People leave my workshops saying, "You've explained how it is what I do works and I appreciate that."

But if a member of a profession hears another theorizing in a way that literally invites laughter from those who know better shouldn't they say something? Something about the theory, of course, not the person saying it. When the actual practice has been shown to be dangerous in any way - and "recovered" memory certainly qualifies - something needs to be said.

Today I'd add: Say anything like that at your peril.

[Nick]

I guess what the Blakeslee book shows us is that it is very difficult for people to separate when something is being said about their theory and when something is being said about themselves. This is the issue that needs to be solved if you are to leave the room with fewer arrows in your back - and more teaching invitations.

[Barrett Dorko]

Nick,

I think you mean Mistakes Were Made (But not by me) by Travis and Aronson discussed here (http://www.somasimple.com/forums/showthread.php?t=4119).

Am I right?

[Diane]

I posted this on another current thread, but maybe it should have been put here: post (http://www.somasimple.com/forums/showpost.php?p=43954&postcount=48)
about the article, "Skepticism" and Ignorance by George M. Felis (http://www.butterfliesandwheels.com/printer_friendly.php?num=291).

[Jon Newman]

I guess what the Blakeslee book shows us is that it is very difficult for people to separate when something is being said about their theory and when something is being said about themselves.

Hi Nick,

In the video featuring Robert Salposky and referenced here (http://www.somasimple.com/forums/showpost.php?p=43741&postcount=6), Salposky summarizes four points that influence the concentration of stress hormones in the blood.

Can you tell the difference between threatening behavior and non-threating behavior?
Do you start the fight or wait for someone else to start it?
Can you tell who won a fight?
If you have lost, do you have a social outletYour observation and number one on the list above sound very closely related.

[Nick]

Yes Barrett, you speak to the theory, but I don't think you are always heard that way.

[Jon Newman]

I don’t think they’re bad people, but they have a bad idea--Barrett Dorko

Something I need to remember.

[Jon Newman]

I just received the MFR brochure today. I noticed that they continue to leave out the claim that there is no such thing as disease. That's good. The brochure starts with the ubiquitous mantra, "Reach Your Full Potential." Learning MFR will Increase "Effectiveness", "Income" and decrease "Burdensome Paperwork".

Why do traditional and alternative therapy techniques only produce temporary results? Because everything we have learned in school about the fascial system was wrong, because research was performed on cadavers. Dead people are brittle!Are they advocating vivisection here?

Traditional science and the resultant techniques based on this incomplete and erroneous information focused only on the fibrous web. This obsolete information then led to techniques that unfortunately produced the temporary results of traditional and alternative therapies.I wasn't aware that there was a "traditional science". Where would the new data informing the neither traditional nor alternative therapy come from?

Science ignored the fact that trauma and thwarted inflammatory responses dehydrates the ground substance of the fascial system which leads to crushing pressure on pain sensitive structures. My approach to Myofascial Release is "Authentic Therapy" because it treats both the biomechanical aspect of the fibrous web and the fluidity of the myofascial system for consistent and profound results.So if science ignored (assuming that science is a thing that ignores stuff) this "fact", how did the "fact" come to be known?

[Barrett Dorko]

There's a really good interview with Dr.Steven Barrett (http://www.pointofinquiry.org/) on Point of Inquiry this week that addresses this sort of thinking.

You'd think that after all these years of making such claims the objections from our professional colleagues would grow, but I see no evidence of that. Actually, Barnes takes advantage of ANY objection by telling his "tribe" (and I quote) "Our society taught us to be victims...always worrying what others may think, never daring to be
different..Our society tried to homogenize us, ridiculing our
uniqueness, stamping out our creativity and intuition,
our most important attributes were taken from us."

This is an old and well worn tactic used by leaders of marginalized groups. Nothing new here.

[Jon Newman]

From the brochure:

Patient Perspective:

After spending 24 years searching for resolution to a severe case of fibromyalgia and being continuously disappointed beyond words, I became afraid to hope that I would ever find healing...Nothing Worked...As a last resort, I had a pump inserted into my abdomen which fed narcotics through a catheter directly into my spinal fluid.

Then last year I discovered the miracle of John F. Barnes Myofascial Release. The concept of the fascial web network made perfect sense to me and I realized that over the years my body had become glued together from the inside out by a straightjacket of fascial restrictions. I have been able to release the pain from fascial restrictions. As I write this, I am recovering from surgery to remove my pain pump because I no longer need it. Miracles really happen!

I'm wondering how this patient came to have this perspective? I'm sure if you quiz some of my patients that they'll explain things in a way I never meant to convey but some of the language above seems not to be misinterpretation but rather seems to have been derived from the therapy itself such as the phrase "straightjacket" of fascial restrictions.

I'm also wondering (out loud) what connotation the twice mentioned use of "miracle" was meant to carry.

[Jon Newman]

From the Junkfood Science blog (http://junkfoodscience.blogspot.com/2008/01/buy-my-product-it-works-honest.html)

[Jon Newman]

Here's John's blog (http://massagemag.com/massage-blog/myofascial-release/) if you'd like to read what's on his mind these days.

I'm glad to see John state the following because I agree in principle.

The other word that I have problems with is “healer.” We can’t heal anybody. Although it is odd that two posts later he talks about therapists getting into the healing zone to help their patients and his brochure offers the Myofascial Healing Seminar and provides a link to a site called "get well healed" among numerous other healing references.

Ok. I think I've got that rant out of my system for now. Thanks for your patience.

[Bas]

John Barnes trains his students to move into "channel 3" the “hypnagogic state”
Umm: from Wikipedia: "During the hypnagogic state, an individual may appear to be fully awake, but has brain wav"es indicating that the individual is technically sleeping. "

From The Sceptic's Dictionary: " The hypnagogic state is that state between being awake and falling asleep. For some people, this is a time of visual and auditory hallucination."
I absolutely LOVE that last word in connection to MFR.....

It is obvious that in order to be successful and effective as a course conductor, one has to almost put one's students to sleep.....And maybe supply 'shrooms to enhance their learning.....

[Nick]

Lest we complacently believe that the problem is only with MFR, here is a copy from an e-mail I received today:

"Here we are just beginning '08

Already, you're probably thinking about what you want to accomplish
this year

So am I

Here's how I can help make '08 a year you'll remember for years to come

It's simple

Join the 2 dozen practitioners who've already signed up to attend my
PRRT™ Intermediate for the end of February.

I promise you'll begin to see your patients entirely differently

What you won't need to do that most other seminars require of you
is to give up anything you're already doing and good at.

What you'll get when you're here with me in Poway is:

A fascinatingly revealing 2 Minute Exam

24 exciting new techniques to treat virtually any problem you'll face

Learn why some of your patients don't respond to anything you do
and what to do to help them heal

Learn a dozen areas where you'll be taught a fascial release which
is done at reflex speed.....this is painless and saves your energy
and is comfortable to your patient

Learn how a reflex hammer can be one of the most powerful tools
you have in your practice.

All this and much more.....

Last but not least.........

I'm so sure that you'll be blown away by what you'll learn that
I'm going to offer you an unheard of guarantee.

If by the end of the first day, you don't feel thrilled by what you've
already experience, I'll give you a full refund and even buy you
dinner before you head home. Is this a guarantee you've ever
been given from any other seminar you've ever attended?

Join the nearly 400 practitioners who've been to a prior Intermediate
and now find themselves getting faster results with more patients
than ever before."


It's all in the pitch.

[Barrett Dorko]

I hear you Nick.

Who would have guessed that this is what it took to thrive in the con ed business?

[Jon Newman]

I guess incredible claims are hard to avoid when trying to attract attention. Where should the line be drawn?

Does anyone have other examples that rub them the wrong way or, conversely, examples of marketing they like?

[Jon Newman]

Not surprisingly, here's some promotional information I like. (http://www.ampainsoc.org/meeting/)

I especially like this point.

Raise questions, debate the implications, plan follow-up studies, and discuss results.

I've also included the brochure.

[Diane]

Anything that embeds con ed ( the emphasis thereby on "con"..) in terms like "amazing", "exciting", "fantastic", "practice builder". In Nick's example, "you'll begin to see your patients entirely differently" sounds like a watered-down "you'll-never-see-your-patients-the-same-way-again" (BAM andthedirtis GONE!) type advertising. Doesn't everyone see their patients entirely differently after every course?
"Reflex speed" has me a bit troubled. "Blown away." "Fascinatingly revealing." "Thrilled." "Fascial release." Buy you dinner, full refund... The list goes on.

[Nick]

I agree Jon. Much better. Likely makes this kinds of motivation more difficult:

On this trip I overheard one therapist say to another, “I don’t want to answer any questions. I thought this course would be like a day off. I just want to sit here and relax."[/B]

Which raises another issue in the therapeutic community: apathy.

[Diane]

So the way people think apathy must be overcome is by words that are superstimuli.

[Jon Newman]

Hi Nick,

I think apathy is not a surprising end product of being an unsuccessful influence for change. Patience and persistence is the only solution I know of at this point. Becoming a better influence too I suppose.

[Jon Newman]

So the way people think apathy must be overcome is by words that are superstimuli.

Hi Diane,

Marketing usually has a target audience in mind.

[BB]

Does anyone have other examples that rub them the wrong way or, conversely, examples of marketing they like?

The list of what rubs me the wrong way is huge. Marketing in general is filled with those things that work, are a means to an end, to gain a customer. They are filled with fear mongering, manipulative approaches, testimonials, attractive models, etc. Of course, manipulation is inevitable in many respects, but there is responsible and irresponsible manners of marketing.

Those that rub me the wrong way the most at present are those that scare people into thinking they have a need. Most of the TV commercials for medications fall into this camp. "Hey, I sometimes feel tired, have no drive, headaches, and am forgetful. Maybe I need ___________."

Also, the newspaper ads of "cure for back pain" which usually end up being a chiropractor with a traction machine that they say is not traction. Instead it is the backonator 23000, or some such crap. The scam, I mean ad, works like this.
1)You call to answer the ad.
2) They send you "literature" on the product, which is actually a paper full of claims of what causes back pain and how the backonator cures it that is "supported" by single sentences taken from dozens of research articles taken completely out of context. A colleague of mine answered an ad to see what it was. I read it. I was appalled. I recognized many of the articles cited and statements they had listed as actually being a statement the paper goes on to refute. It had statements from NASA even! Also included are statement of why the medical community wants to keep this well established information from everybody to foster their "sick care."
The second half of the literature is several testimonials.
3) You come in for an appointment to see if you are a candidate for the backonator. Of course, everyone is. The evaluation is long, consists of many shiny lights and computer screens.
4) You schedule another appointment to find out your results.
5) You come in for treatment.

I like non-manipulative marketing's potential:

methods used in selling where a salesperson, rather than trying to force an unwanted product on a customer by high-pressure means, works with the customer to identify a genuine need and to provide a satisfying solution

I say potential because the same issues can be inserted in the process of identifying a need and solution finding.

I think Shacklock, NOI, and Barrett have done a nice job of keeping the crap out of their marketing. The issue with the responsible approach is that it can become very informational and lengthy and therefore not particularly catchy or viral as they say in marketing.

[christophb]

Marketing... don't really like it but this is what practicing PT in an environment that is heavily marketed by OMT has gotten me:

1. MD's not referring because they don't understand what I do and feel I don't get good results (my patients may not have 0/10 pain at D/C but usually I see colleagues keeping their patients a few extra months to get to that level... uh prove it was the therapy, not the time please)

2. Employer's telling me not to educate patients on basic pain science (Butler/Mosley/Melzack/Wall) because it confuses them and the doctor.

3. Employer's telling me I'm not allowed to tell patients to move how they feel. (Of course they don't ask me why I say this and don't really seem to want me to talk to the doctors about it either)

At this point I don't know what to do and my stress levels are barely at manageable levels.

[Barrett Dorko]

I revisited the thread from last summer titled Health, happiness, comfort or survival? (http://www.somasimple.com/forums/showthread.php?t=4022) and found something that fits here.

We never relinquish the idea of survival. When a herd of antelope flees from a lioness, the main adversary of the slowest animal is not the lioness, but the faster antelope. However, antelopes are not concerned about their health, but about saving their lives. When our ancestors froze in their tracks when faced with a hyena attack, this was the optimal posture for having a chance of not entering the animal’s visual field. They were not thinking of their health but of survival.

From Punset

A reasoned approach to manual care, given what we know today, will include teaching a number of things that, when considered carefully, actually threaten the therapist’s survival. This is especially true if their survival is dependent upon a theory as flimsy as the one behind MFR.

No matter how gently that fact is presented, it will always be seen as threatening in the extreme. No wonder they react as they do.

Others more adept at marketing than I recognize that as well, and they behave in a way that takes advantage of that fear. I try to appeal to their desire to provide reasonable, defendable care.

No wonder I'm a dead man.

[nari]

Chris, your story is just astounding.
I cannot believe (but I do, really) that there is so much interference from others about what you should or should not do. It's so foreign to PTs here...

Solution? Cash practice (but that would not solve the doc's confusion problem much) or emigrate? I'm not being flippant; I admire anyone who can happily survive the Big Brother mentality in health that seems to be so rampant in the US.

I also noted the comment made by the therapist about wanting a day off to sleep through a course. How these folk get through a day's work without thinking about what they do continues to be surprising.

Nari

[Barrett Dorko]

I think they get through much the same way I endure travel - I grow numb. I'm pretty sure that those with me on a plane or in an airport would say our contact was an empty experience.

I didn't carry that into the classroom and others do. This disparity between our ways of being was, at times, irritating, I'm sure. But I don't really have a choice given my actual interest in the work.

[nari]

So, is that numbness part of the adaptive potential process? Others, say in class, become stiff and maybe painful - but you don't. I find that, if it's true, an interesting phenomenon.

Nari