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Cross Country 71 - Context

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  • Cross Country 71 - Context

    It’s been a quiet week in Cuyahoga Falls…

    Late Thursday night in Syracuse I was wakened by a young girl’s shrill question: “Why are these hallways so long?!!” Right outside my door her friends laughed loudly and several spoke at once, as if it weren’t possible for anyone else to hear them, as if there were no possibility that an old, tired guy like me could be a dozen feet away and sound asleep.

    I startled and thought, “Context” and I knew I had been given this week’s column about my trip.

    This month I’ll increase my teaching schedule from 6 courses a month to 9. I’ll get used to it, and I know that the sheer number of experiences in front of a class will teach me things I couldn’t possibly learn another way. What I look forward to the most is the discovery of a few phrases that others find compelling and that drive their understanding in a direction I’d like it to go. I know a few, but as the course evolves in relation to my reading other phrases show up. Bert Lahr of “Cowardly Lion” fame once told his son, “I don’t know what’s funny – the audience tells me.” For me, good teaching is like that.

    I believe it was Ian Stevens from Scotland that sent me this link months ago. In this short, wonderful essay, Frank Forencich echoes some of the revelations offered us elsewhere by Diane Jacobs regarding the role of embryologic development. Specifically that the ectoderm uses the mesoderm, that ectodermal action is context dependent, and that the culture creates the context.

    Let me explain. If you see a child being admonished to keep their voice down in a restaurant you know that the child’s brain (ectoderm) is being trained to use the muscles (mesoderm) that drive speech in a certain way when in a restaurant. He or she eventually learns that within the context of restaurants there are vast variations as well. As Forencich notes, “What we call “education” is the process by which we learn to recognize context, operate within it, and move fluidly from one context to another.” Forencich calls it “context appreciation,” and, to me, it has everything in the world to do with the effect of manual care. As Cory Blickenstaff has helped us understand in this amazing thread, “Those interventions which allow a movement to be performed in a non-threatening context will be successful.”

    Now, when I touch another I have offered them an entirely new context to sense and respond to. If my handling is non-threatening and my manner implies no judgment or intention their brain now has an opportunity to drive their muscles in a unique fashion. If it’s an instinctive response beyond protection it will be ideomotion; it will be corrective and it will help in ways most have not previously seen or imagined possible. It’s manual magic, and pretty cool, in my experience.

    And this “magical” care has everything in the world to do with context. I say to my classes, “Create a culture between your hands that the patient senses as safe, novel and inviting. Introduce them to their own instinctive inclinations and they will surprise you with what they can do. When the characteristics of correction are evident encourage more of that behavior, especially when you’re not around.” It appears that this explanation about Simple Contact is something the class can relate to and that I’ve recently found the words that compel them to change what they do. Of course, the culture of their clinics rarely encourages such behavior on their part.

    One day that young girl outside my hotel room door will realize that others are probably sleeping nearby and she will change her behavior to fit the context. When the context changes a few moments later she’ll seamlessly shift again and that’s what we call maturation.

    It’s my job as a therapist and teacher to show others how powerful this is, and how we ignore that power at our peril. Like anything else, knowing about it not only helps us control it, it helps us understand when we can’t.

    I didn’t open fling open the door and tell these girls to shut up. I’ve finally learned that this isn’t the best way to teach others. I just smiled slightly at the lesson, turned my head, and went back to sleep.
    Barrett L. Dorko

  • #2
    Failure to honor context is one of the most destructive of all intellectual errors. It is a foundational mistake that inevitably distorts everything that comes after it. A statement that is true in one environment may be completely false in another.

    Frank Forencich

    When I saw this I thought of the first line I quoted from Gregory House in a series of essays I wrote about the show. When asked if we shouldn’t talk to the patient before we diagnose them he barks, “Everybody lies! If we don’t talk to them then they can’t lie to us – and we can’t lie to them.”

    House knows that the mere presence of another changes not only our behavior but our story. It’s hard enough to be true to yourself; being true to others is practically impossible.

    The trick is to create a way of being with the patient that promotes authenticity. You begin by being authentic yourself. Without some sense of that context patients have to guess at what you want from them, and if they sense that their behavior will not help them in the long run they’ll quite understandably hide its actual nature.

    I’ve never done any, but I imagine the therapists doing functional capacity evaluations run right into this regularly. The unmistakable context of the situation invites exactly what the therapist doesn’t want.
    Barrett L. Dorko


    • #3
      The latest from Lance.

      Volume 8, Issue 3, Pages 230-236 (March 2007)


      A Contextual Analysis of Attention to Chronic Pain: What the Patient Does With Their Pain Might Be More Important Than Their Awareness or Vigilance Alone

      Lance M. McCrackenReceived 18 June 2006; received in revised form 2 August 2006; accepted 9 August 2006 published online 19 September 2006.

      It is often believed that to feel greater pain is to experience greater effects of that pain, and that attention and awareness represent the transmission mechanism in this relationship. By implication, it is assumed that if attention and awareness can be lessened, the effects of pain will likewise reduce. Despite conceptual work and data suggesting more complex processes might indeed be in place, these long-standing and intuitively appealing ideas remain, either explicitly or implicitly, in both research and clinical applications. The purpose of this study was to compare the role of attentional processes in chronic pain with a process that is more contextual, functional, and behavior-focused, namely, acceptance. The hypothesis tested is whether it is more important to understand the amount of contact an individual has with pain, in this case awareness and vigilance to pain, or the degree of influence on behavior brought with that contact, in this case acceptance. Data from 227 patients seeking treatment for chronic pain were examined. Results from correlation analyses showed that acceptance scores achieved stronger correlations than scores for the attention variables with measures of cognitive, emotional, social, and physical functioning. When acceptance of pain was taken into account in multiple regression analyses, scores from the attention measures accounted for little or no variance in measures of patient functioning. The value of various mental, mechanical, behavior-focused, and contextual models of attention in chronic pain is discussed.

      PerspectiveAttention, awareness, and vigilance appear immediately applicable for understanding chronic pain. These processes, however, might be incomplete in accounting for pain-related suffering and disability. Acceptance is proposed as a process that expands the framework of attention to include varying cognitive, emotional, and social influences exerted by pain on patient behavior.
      "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris


      • #4
        "It’s hard enough to be true to yourself; being true to others is practically impossible."

        Barrett, not that there's any shortage of great Dorkisms, but this may the most brilliant thing you've ever written. And it explains a lot. It explains the difficulty we may have in allowing patients to be themselves. It explains many of our own aches, pains, and stressors. And it likely explains the resistance to widespread adoption of Simple Contact as a method of choice. We'd have to stop lying.

        Nick Matheson, PT
        Strengthen Your Health


        • #5
          Jon and Nick, thanks for your thoughts. The # of views always grows but I never know how much understanding accompaines it.

          As Nick says, with Simple Contact we'd have to "stop lying." I think this goes both ways. There's no touching in poker because it would reveal too much about the person being touched. Doesn't that include both participants? In poker there's more posing and posturing than on the runway of a fashion show though we rarely consider this. Watch Poker Dome where "Two dealers work the tournaments to maintain the fast pace and players are attached to heart monitors. Players' hole cards and heart rates are displayed for the live audience and in particularly stressful situations like all in bets, heart rates are displayed to the home audience."

          I've never seen a player's heartrate drop below 100 before they start to bet, yet they look perfectly fine. Think that would be hard to feel?

          Again, it's context, and if we don't attend to and understand that what we observe is meaningless. Something more from Forencich's essay:

          Unfortunately, modern culture insists on isolating the human body and treating it in isolation. There it is, strutting and shining on the magazine cover, completely without frame, without history, without environment, without relationship. Like children with scissors, we cut the body out of its background and paste it up on the magazine cover, alone. Even when fully clothed, the modern American body is always naked now, stripped bare from the natural, living world that gave it life.

          I begin my classes talking about the unreality of the media's message and how we doing therapy seem to have gone right along with it. It is as if we hadn't noticed that Oprah Winfrey's face was photo-shopped onto the front cover of her magazine each month.

          Just going for a common cultural reference there.
          Barrett L. Dorko


          • #6
            More thoughts. I found this on the website.
            "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris