Andy and Henry

[Jon Newman]

I saw this rendition of Maslow's hierarchy on The Imaginary Foundation's blog today. It may be first time that I saw that while pain impacts people at the base of the hierarchy, the resolution of pain requires activity from the top of the hierarchy.

I wonder if a more circular or matrix-like diagram might be more accurate.

[Jon Newman]

Gratitude to Old Teachers

Robert Bly

When we stride or stroll across the frozen lake,
We place our feet where they have never been.
We walk upon the unwalked. But we are uneasy.
Who is down there but our old teachers?

Water that once could take no human weight-
We were students then-holds up our feet,
And goes on ahead of us for a mile.
Beneath us the teachers, and around us the stillness.

[Barrett Dorko]

Wonderful story Gerry. As Ovid said: In our play, we reveal what kind of people we are.

This thread might be easily connected to the review of Diane Ackerman’s Deep Play which can be found here.

In part, I wrote this: Ackerman quotes Abraham Maslow; "The great lessons from the true mystics, from the Zen monks...is that the sacred is in the ordinary, that it is to be found in one's daily life."

”Understanding this, I can see how deep play emerges during moments when I am in the presence of a patient as they learn and change and find relief. I know such moments include my unselfconscious engagement, that they are timeless in nature, and that much of my creativity is dependent upon them. When therapy does not include any of this for the therapist, it must be a pretty long day. Maybe they should read this book.”

I looked and found that “Andy and Henry” was written in October of ’99. You have a good memory.

[gerry]

I remember this essay, and am reminded yet again how much I appreciate your writing. Your essays that get me thinking about what I do from many different perspectives. Many of the essays do that through reminding me of instances in my own life and career, and allow those instances to influence me once again in new or stronger ways.

This essay reminds me of junior high school and a “game” played with a friend. It was played at a chalkboard by drawing geometric figures, erasing, connecting things, etc. The unique thing about this game was that we constantly made up the rules along the way. The constant changing and introduction of new rules was the point of game. Either of us could have ended the game at any time by declaring our last move as a winning move, but the fun was the creativity of countering the last move and seeing what the other person would come up with in response. Even though I might have anticipated what my friend might do, I learned to wait for the response and be open to whatever it may be.

Listening to the patient and being able to change and adapt what you do based on their response/actions was mentioned in a course I took several years ago. It was about treatment of children with cerebral palsy, and included many treatment suggestions/options, etc. There was also an attempt to define what delineated expert clinicians from clinicians who are proficient and experienced. Part of the presentation was a quote from Berta Bobath that I believe you have also used, Barrett. “The constant adjustment of the techniques to the response of the patient during treatment will save time, give better ultimate results, and make a more systematic treatment possible.” Having a warehouse full of knowledge, applying that knowledge to the treatment of a patient, then constant assessment of the response and modifying your input was said to be a distinct aspect of expert practice.

I primarily work with children. When people asked me in the past about my work, I used to respond that I get paid to play all day. Now I do more paperwork and administrative type of stuff, but still enjoy it when I get the chance to play.

[Chancellor Mobley]

Me too. Thanks for the writing Barrett.

[Barrett Dorko]

Back when the Internet was new to the profession, probably in about ’97, I wrote weekly columns for the PTHER listserve. Often enough, I caught a lot of heat from a number of people from across the spectrum of therapy. Imagine that! This ongoing conflict is alluded to in my preamble to something I found in a pile today titled “Andy and Henry.”

I like it, and I think it might lead to some discussion of an aspect of manual care that remains immeasurable but essential nonetheless.

Here it is:

In light of some recent posts that were, I guess, about the portions of therapy that might be called “immeasurable,” I initially hesitated to submit today’s essay. It falls roughly into the same category, and in the current atmosphere of the list, it may invite attack, or just go unread. Of course, neither of these would be new to me.

But I contend that whatever physical therapy might contain in the way of reasonable and rational theory behind its practice, it remains a human endeavor. This means that it will always contain moments of unexpected reaction, illogical outcome and, excuse me, mystery, which we can, at best, observe faithfully, and with some measure of human compassion.

So here’s something about two old men and their own sort of therapy.
Barrett L. Dorko P.T.

Andy and Henry

Andy and Henry ran through the yards and alleys of Cleveland back in the 20s. Now both well into their 80s, and no longer running, they visit weekly in Henry’s home and speak of their lives. They are new found friends, recently introduced by one of their children.

Andy tells me that a recent topic was the games they played as children. They reveled in their common memory, telling each other the names and rules of one activity or another. Although it seems their respective neighborhoods had unique nuances built into the rules for each game, they found that “Olly-Olly Relievio” was identical in every way for both of them. I heard my father (Andy) speak of this game, his voice rising a bit and speeding up. He might have been a child again, explaining to some new kid how to play that evening was to be done. “Home base is the circle of light shed by this lamppost. You’re on my team and we get to hide in the shadows…”

If I sit and consider the nature of therapy, I can come up with a number of things that should be present during the course of a successful recovery from disability and pain. There’s education, testing, goal setting, documentation and a few others, not listed here in any particular order. Listening to my father speak of his youthful game, I was reminded of a remarkable book by O. Fred Donaldson I read a few years ago. It’s called Playing By Heart - The Vision and Practice of Belonging. (See a review here)

Donaldson is a psychologist and “play therapist” whose understanding of the nature of play as a way to communicate meaningfully to others and with ourselves transcends anything I’d ever read on the subject. When he speaks of our sensibilities in the midst of true play (which he carefully differentiates from contest) I am reminded of an aspect of therapy that is often ignored or, at least, not given its due.

He says, “Play is trust in a web of relationships of which one is part.” He describes play as “not a matter of effort, but a grace. There is no contest, because in true play, there is only one side.” I’ve been fortunate enough to personally watch both Bobath and Feldenkrais handle patients, and it’s clear to me that they sought play in their therapeutic relationships. Without this trust born of confidence and competence flowing from therapist to patient and back again, much of the profound change and learning they wanted would never have appeared. This aspect of care can’t be written into a protocol, and it is always a part of the “art” of therapy we aren’t going to be able to bill for.

“…and if you could run through the light hollering Olly, Olly Releivio!, your teammates that had been captured would be free to go hide again. We would do this until our mothers called us in to bed, and the game never really ended with a clear winner, just a promise to play again.”

I hung up the phone after my father’s call and headed down to the clinic, down to where at least part of my care, the part I can’t really document, or teach, or even get paid for will include some trust and a few surprises, some humor and intense attention. There will be only one side.

I’m going to go play.