Repackaging Simple Contact

[Jon Newman]

Do you really think posting on this forum, which consists almost exclusively of those who share similar thinking on the views of therapy, is really the same as asking those you know to have differing viewpoints? That it is the same as asking the wider therapy world?

This is available to anyone willing to look at it and Barrett apparently introduces the website to his students. And yes, I think plenty of people with opposing viewpoints read these pages without responding or even registering. They don't participate but they could.

[Barrett Dorko]

Randy,

Bias is a consequence of knowledge, and Diane’s bias toward some explanations rather than others is rooted in her reading the research and listening to her patients. I’ve always appreciated the way scientific investigation makes things I don’t initially understand understandable, but even more, I like the way it proves that some entrenched ideas are wrong. To the great consternation of many therapists the neurobiologic revolution has demonstrated that many of the things they have assumed to be true simply aren’t. If they won’t or can’t change their clinical approach in response then one day we’ll have a profession full of bad ideas and irrelevant clinical procedures.

Wait. I think that’s already happened.

Careful reading should result in “similar thinking.” If someone’s thinking is markedly dissimilar to mine then one of us is wrong. Being wrong about one’s philosophy of life or about what constitutes a pleasing aesthetic isn’t uncommon and really isn’t that big a deal because in those disciplines there’s room for different or opposing views. This is not the same in neuroscience, physiology or functional anatomy, all of which follow certain laws they cannot break. I find that when I am in disagreement with another therapist who favors heavy coercion or “energetic” theory that their deep model differs from what is known and/or their theory of effect violates basic laws of physics. In such a case I have to assume that they’re wrong. My own ideas, of course, must be defendable. As you know, I focus upon that whenever I present them. The quote at the top of the thread reflects thinking that is undisciplined, postmodern and, of course, quite popular. Not surprisingly, Dr. Kleinkort has declined comment about his practice in similar forums.

No doubt I think that many of my colleagues are asking for something unreasonable and this thread has again revealed the fundamental flaw in the profession – it is not rooted in basic science to the degree that it should be. There is also the undue influence of a therapeutic culture that does not reward and, in fact, punishes anyone who suggests changes that may prove detrimental to billing.

Again we return to this: Progression in the profession will not result from what we sell or how we package it. It will result from a fundamental change in the way therapists see their role in relation to painful human dysfunction. Given reliable information free of basic inaccuracies, what they see will lead to a certain bias that should be free of the effects of belief or faith or personal philosophy or emotional needs that have nothing to do with nature , which contains none of this.

Today I'm convinced that this isn't going to happen.

[Diane]

Barrett, I agree with the gist of your latest post above, so I went back up and found the quote. Here it is.

“There are so many ways we can touch the person with chronic pain to reduce their discomfort.”

I disagree with it too, that "there are many ways." Yes, a lot of ways to touch patients in chronic pain are carried out, but most of them aren't going to reduce chronic pain, especially if there's a mesoderm target at the end of the touch, which is the way most therapists are touching most of the patients out there, blindly trying to restore some sort of mesodermal function to some moving part, overriding nocioceptive signalling in the process. Pain is a wiley foe, especially if truly chronic and not just persistent. They don't have reduction of discomfort in mind when they touch. Later, if there's a reduction, it's more by fluke than by design, but the therapist takes credit and uses the outcome to bolster their mesodermal treatment approach. Anyone who doesn't improve from these 'therapeutic' efforts, or whose pain worsens, is labelled crazy.

[Nick]

Asking someone to think

Randy,

I think the point in asking the people here is that most of us have lived through a transition in our thinking. Many of us have been assisted by Barrett whose no-holds-barred style of logical discourse forced us to rethink our premises.


Barrett,

I recall our earliest arguments and the gradual change in my understanding. I had been mentally juggling the mesodermal mobilipulation approach held up as the gold standard of care by our profession with a more satsifying (for me anyway) gentle contact that I first learned under the not-so-deep model of craniosacral therapy. I'm not sure how the manipulative therapists have ascended to the top, except by their dissociation from actually addressing the patient's symptom. As long as that twisted/subluxed/hypomobile joint is moving again, they have been successful (in their own minds anyway). Why bother with that messy pain stuff. I've even heard some say that pain doesn't exist while insisting what we treat is biomechanical dysfunction. The gentle approach of craniosacral suited me because it seemed more humane. It allowed me to spend time with the client. It allowed me to begin sensing what was happening beneath my hands (even though the mental constructs that accompanied that sensory info. at the time were woefully inadequate). I was never very comfortable with the airy-fairy theory though, especially on the Level 2 course when they started discussing channeling:embarasse . I struggled with the disparity between the empirical results and the ideas proposed. Enter Barrett Dorko...

I can't remember where I first encountered your writing, but I could not understand how you could disagree so strongly with things like CST and MFR and yet practice in a way that seemed very similar. I wish I still had that first e-mail correspondence where you took my thinking to task. I recall being very annoyed. At first. But then, I slowly began to get it. Finally, I had an acceptable explanation for the phenomena that I experienced. Even more so once I met you and experienced what you had been talking about.

At the second course I attended in New Brunswick I remember being completely shocked by the resistance people had to these ideas. It was overwhelming for many. It was infuriating for others. There was a big CST contingent from that area who I thought would be very happy to hear a sensible explanation for what they did every day. One of them left the course early. As for course evaluations, half of the participants really liked the course (though I wonder if it ever changed their practice) and half hated you and thought you should never be allowed back in the province. Interesting how your dispassionate presentation can become so personal.

It is interesting to speculate how meme-building is changing. I think people need serious inoculation from the ideas that clamour for their attention. A scientific foundation is definitely required. Our profession, however, being so anxious to prove that what we do works, wants to jump over the foundational work and embrace outcome studies alone. Big mistake. In the process, the academics open the door for eroding professional standards and claims made by a PT in favor of anything that "works."

Since you are the Forrest Gump of physical therapy, how about some thought on how the professions memes were constructed and propagated. Perhaps there is a lesson there. On the other hand, we now live in a Brave New World of knowledge propagation. I learn more here daily than I could from hundreds of CEUs.

Nick

[Jason Silvernail]

Begin at the beginning...

Well, in the interest of repackaging the premise and use of SC, I'd like to begin at the beginning (or what Barrett says is early in the course) and I think that might help.

Barrett said that he talks about the fact that strength, posture, appearance, and pain are not related. While I agree, I'd like to suggest an alternate approach.

Instead of starting with telling people that what they think they know is wrong, I think we should start by telling some things they'd like to know, or understand.

Instead of starting with strength and pain are not related, we can start with questions.

"Would you like to understand where pain comes from? Do you want to understand what is required to relieve pain in your patients? Do you want to understand the common reason why many widely differing approaches in therapy today can sometimes be successful for some patients? Would you like to know why adding more "tools to your toolbox" might not be such a good idea? Do you want to know why your patients might complain of such things as: pain increase in the early morning hours, stiffness and pain in the morning that improves with movement, pain which seems unrelated and that tends to occur in different places on the same limb or body area? Above all, would you like to understand the scientific background for these answers, and be able to explain them to your patients and colleagues?

This knowledge will lead you toward a new concept in manual therapy and a gentle approach rooted in science, movement, and patient empowerment. Learn to use Simple Contact."

I think this satisfies many of the need states and pain/fears that our colleagues have. I find I get the most interest from other therapists about these ideas when I let them know that a common complaint of their patient in pain, while mysterious to them, makes perfect sense to me.
I will admit that I enjoy this more than I should.

Thoughts?

J

[Diane]

Jason, that would be about perfect.

[EricM]

Nick and Jason, great posts, thanks. Now we're repackaging!

eric

[Barrett Dorko]

Nick,

I remember walking to the front of that Canadian class for the first time and, instead of greeting them and saying my name, I said, "Two weeks ago I sold my father's house. I sold the house I grew up in..." I always end my courses with this story now. I think it still works for about half the class, but at least for them it works well.

What I'd like to do is take Jason's questions, print them on a separate sheet and put them in the course manual before class. This would begin on Wednesday this week.

Okay with you Jason?

[Bas Asselbergs]

Jason, excellent thoughts! That intro covers the concepts with a selling technique that is familiar AND not (yet) threatening to what some participants will know as their PT-foundation. You slide it in like a scalpel...

[Jason Silvernail]

Barrett-

I'd be honored, go to it.

I think if we approach it like the old honey/vinegar saying, and focus on dangling all this cool neuroscience knowledge in front of people, we'll do better.

Instead of telling them all the things they don't know, and why what they do is wrong (i'm not suggesting Barrett actually does this, as i've never been to his course), I think we should focus on making Paracelsus's quote come to life:

(please forgive the paraphrase, i know we all remember this one) We become physicians only when we see and understand what is invisible and yet, has it's effect.

There's an element of wizardry involved in understanding things that others don't, and though it's cheesy, I think we'd be fools not to realize it and use it to help educate people.

J

[Barrett Dorko]

Jason,

I actually have a collection of wizards that I've come across over the years. Long ago I figured out why, and you made that point again today.

The sheet with your post and name will be inserted tomorrow in Harrisburg, in Allentown on Thursday and Philadelphia on Friday.

I'll let you know how it goes.

Are you now in Germany? Please tell us what you're in charge of there. Nice photo of you in the latest PT Magazine, by the way.

[Randy Dixon]

Jason,

I think your questions were precisely the approach I was advocating. The irony for me, of course, is you presented it to the forum using the same approach, while I was unable to.

Practice what you preach, right?

[Jason Silvernail]

Barrett-

Yes, I'm in Germany, writing from my laptop at the guesthouse, waiting to move in to our new place next week. It should take a week or so from then to get the internet up and running at home. In the meantime, I'll hope to post when I can. One of the side effects of moving is that all my mail hasn't arrived, which means I haven't seen my mug in the PT magazine yet. Mom and dad should love that.
I am the chief of a clinic with 3 FTEs of physical therapists, and the regional supervision of 3 or 4 other one person PT clinics. Keep in mind, the Vegan thing hasn't even come up yet, never mind that I don't play golf, vote republican or play well with others. I'm not sure where in the order of things I should bring up the modern concepts of neuroscience.

Randy-
Precisely. I think your posts and your point of view are very valuable, and I definitely took a page from your book with my suggestion. It was rather off the cuff, so somebody please feel free to make some additional suggestions..

J