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  • #16
    It isn't really likely to change until a shift is made out of the boundary-ridden medical model into the much less predictable world of de-causation (sic). But that alone is a threat to the adherence to EBP, as well as the threat to power and control over a patient's CNS.

    Very tricky. But you are not a dead man yet, Barrett.

    Nari

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    • #17
      Might be better to avoid dualism whenever possible - just a 'thought'..
      Diane
      www.dermoneuromodulation.com
      SensibleSolutionsPhysiotherapy
      HumanAntiGravitySuit blog
      Neurotonics PT Teamblog
      Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
      Canadian Physiotherapy Association Pain Science Division Facebook page
      @PainPhysiosCan
      WCPT PhysiotherapyPainNetwork on Facebook
      @WCPTPTPN
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      @dfjpt
      SomaSimple on Facebook
      @somasimple

      "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

      “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

      “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

      "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

      "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

      Comment


      • #18
        I'm noticing that there is a similarity between this and the need for symetrical beauty that is a tendency within us all.

        It seems we often use our clinical interaction to meet our own needs, even if unknowingly.

        Is our job as a therapist, or a manner of growth as a therapist, realizing these needs and learning to overcome them? If that is the case, do we create stressful environments for ourselves because we are living someone else's life?

        Or do we just need to be aware of the over-riding need of the patient and meet our own needs by helping them?
        Cory Blickenstaff, PT, OCS

        Pain Science and Sensibility Podcast
        Leaps and Bounds Blog
        My youtube channel

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        • #19
          Joyce's comforting thought

          Yes Cory, the patient needs to tell their story, but are we obligated to believe it? Are we supposed to make it important?

          No Nari, not dead just yet, but one day for sure. In fact, as Tony Soprano used to say of his mother and Uncle Junior, “They’re dead to me.” Of course, both these people tried to have him whacked (killed). This is what I imagine certain therapists say of me, often soon after hearing that I don’t actually think much of causation as an important aspect of management. I’ve questioned something they cling to for reasons that are primal and enduring. Gee, I wonder why they object?

          It’s a mistake, but I am comforted by a quote from James Joyce in post #2 of the Altering the Ideal thread that Cory has alluded to:

          A man’s errors are his portals of discovery.

          Pinker has some wonderful things to say about this desire to order our universe with the illusion of reality generated by a belief in cause and effect and I’ll get to them, but first a word about the word “illusion.” I checked it out on this site and found that it refers to "a mocking, jesting, irony" which explains a lot about our distaste for it.

          I imagine people thinking, “So this guy’s telling me that half of my assessment reveals nothing more than an illusion? I wonder if my cousin Vinny still knows that guy...”
          Last edited by Barrett Dorko; 22-11-2007, 03:29 PM.
          Barrett L. Dorko

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          • #20
            Hi Barrett,

            Sorry. I'm not being clear, as usual.

            I'm trying to say that, as in looking for symmetry, when we look for a cause we are trying to satisfy a need for ourself. Meeting this need does not necessarily meet the needs of the patient. We therefore need to be aware of this tendency, recognize when it is occurring, and attempt to overcome it.

            My real question is, do we pay a price for this?
            Cory Blickenstaff, PT, OCS

            Pain Science and Sensibility Podcast
            Leaps and Bounds Blog
            My youtube channel

            Comment


            • #21
              Hi,
              Barrett, correct me if I'm off on this...Are you saying that, although it's important for the patient to be able to tell his/her story, to be listened to, the therapist shouldn't buy into the narrative, as there might be 100 causes or no cause at all, and it doesn't matter anyway? (Which I agree with.)
              One compelling distinction for me, between Simple Contact and other methods of treatment, is that SC is about returning power to the patient. I, as the therapist, don't need to know all the "whys" of what brought them to my office. What I need to do is first listen, be interested, then, through the experience of Simple Contact, allowing ideomotion, help them to realize they can trust themselves, their bodies, their instincts. They become their own expert and so the power is shifted from professional to patient, where it should have been all along.
              Cheryl

              Comment


              • #22
                Working toward blame

                Cheryl,

                You're entirely correct. Perhaps the reason so many don't "get" this will be found in the following.

                Cory,

                In my opinion, one of your enduring qualities is clarity. That’s why we allow you to post here (ha,ha). I see what you’re saying but may not have made my answer relevant to the question.

                In any case, Pinker’s basic premise is that the way we use words drives our thinking and understanding – not the other way around. At least, that’s part of what he says. His is a long book, about 500 pages, and its contents may very well extend my capacity to apply it to this subject. I think. I’m pretty sure.

                It seems to me that the unconscious motivation of many therapists, which, of course, is unknown to them unless they become somewhat obsessively introspective, is important here.

                We know that stories are unreliable, often misleading and irrelevant to care. We know that eyewitness testimony in legal circles is distrusted for the same reasons. Still, most therapists insist on emphasizing their importance in an effort to discover cause. Throughout history great thinkers have warned against this linear relationship between what we think we know and imagine we see. I know, it’s spooky.

                But Pinker says this quite clearly: Our concept of causation is indispensable to our attribution of credit and blame in everyday life.

                Is it possible that a therapist’s desperate desire to blame something or somebody (unconsciously there for the most part) for the current complaint is what drives us to search for cause?

                I think you know my answer. What’s yours?
                Barrett L. Dorko

                Comment


                • #23
                  Hi Cheryl,
                  although it's important for the patient to be able to tell his/her story, to be listened to, the therapist shouldn't buy into the narrative, as there might be 100 causes or no cause at all, and it doesn't matter anyway? (Which I agree with.)
                  One compelling distinction for me, between Simple Contact and other methods of treatment, is that SC is about returning power to the patient. I, as the therapist, don't need to know all the "whys" of what brought them to my office. What I need to do is first listen, be interested, then, through the experience of Simple Contact, allowing ideomotion, help them to realize they can trust themselves, their bodies, their instincts. They become their own expert and so the power is shifted from professional to patient, where it should have been all along.
                  I think more like where it always has been, except that the patient lost track of it (came to feel dis-membered) and needed a bit of help with re-membering, and (as you point out) regain their intra-power/inter-power dynamics, about which PTs (mostly) remain completely ignorant.

                  I think on another level, it's the same thing as the patient's "locus of control" that psychologists constantly remind themselves they must not violate. Physical therapy (the way it's taught and practiced by most) violates this all the time in its attempt to be "medically" acceptable AND simultaneously blames the patient if they don't get better, or fall into some unacceptable "category", or if they don't automatically align with some "clinical prediction rule". Hard for a patient whose nervous system can't feel any sense of control within the therapeutic relationship to regain inner locus of control.
                  Last edited by Diane; 23-11-2007, 06:29 PM.
                  Diane
                  www.dermoneuromodulation.com
                  SensibleSolutionsPhysiotherapy
                  HumanAntiGravitySuit blog
                  Neurotonics PT Teamblog
                  Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                  Canadian Physiotherapy Association Pain Science Division Facebook page
                  @PainPhysiosCan
                  WCPT PhysiotherapyPainNetwork on Facebook
                  @WCPTPTPN
                  Neuroscience and Pain Science for Manual PTs Facebook page

                  @dfjpt
                  SomaSimple on Facebook
                  @somasimple

                  "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                  “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                  “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                  "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                  "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                  Comment


                  • #24
                    Diane,
                    Nicely said. I believe the initial listening, truly listening and believing that what they are saying is their story, regardless of and putting no importance on the details of that story, (which are likely inaccurate. As Barrett pointed out--who can pass that test?) is key to establishing a therapeutic relationship, improving the likelihood that the patient's perception of the story as defining them or their experience, will change, empowering them to have a therapeutic relationship with themselves.
                    Barrett,
                    Doesn't casting blame, finding a cause for something, give us the belief that we can control that something, therefore IT CAN'T HAPPEN TO US.

                    Comment


                    • #25
                      Cheryl,

                      Exactly. I thought at the beginning of this thread that perhaps I could uncover two things deeply embedded in therapy, both to our detriment and both unlikely to ever disappear or ever be understood by those who teach us, direct our departments or articulate our future as a profession - blame and control. Not optimistic, not hopeful, not complimentary, of course, but real nonetheless.

                      Our search for cause perpetuates this situation and, I think, the dynamic keeps my students from hearing me when I try repeatedly to teach the origins of pain as an alternative emphasis. That's the failure I mentioned in post #1.

                      It appears that we've arrived, and I appreciate your expressing this so well.
                      Barrett L. Dorko

                      Comment


                      • #26
                        The search for a cause in order to blame someone or something else isn't just confined to therapists. This shift seems to have become inherent in today's society.

                        I think the locus of control is an interesting comparison between psychs and PTs' behaviour. How did it happen that people go to psychs knowing all they will do is offer suggestions, listen closely and provide empowerment to the patient; but people who go to PTs expect to be told a cause or a diagnosis, and a prescribed treatment plan, plus compliance and obedience to this plan...

                        Damn dualism dodo.

                        Nari

                        Comment


                        • #27
                          Nari,

                          PTs encourage the situation you describe even more than patients do. This is why I wrote Body Counseling a few years ago.

                          In a thread as complex as this I often find it useful to sum things up from time to time.

                          1) Even though therapists generally understand that the patient’s story is unreliable and often irrelevant to the care consequently needed, they continue to honor and emphasize the patient’s story and treat the details of history offered as if they were true.

                          2) The resultant “discovery of cause” provides comfort for both therapist and patient, despite its lack of veracity.

                          3) Acting upon the cause derived from the patient’s history and the therapist’s bias, treatment proceeds toward its logical conclusion in a manner that might or might not alleviate pain.

                          4) In any case, this sequence of discovery and management satisfies the therapist’s unconsciously generated need to find blame and exert control. It may even provide an illusion of self-protection.

                          5) Thus, searching for cause, even if not helpful, serves a purpose more important to our unconscious motivations than our conscious and reasonable ones, and it makes learning about the origins of pain difficult, dissatisfying, and, in some instances, nearly impossible.

                          Have I got all this bad news about right?
                          Last edited by Barrett Dorko; 18-04-2016, 02:21 PM.
                          Barrett L. Dorko

                          Comment


                          • #28
                            Sorry, Barrett, I often have hidden agendas which aren't explicitly expressed. When I said patients expect to be told and directed, it is because doctors and PTs want it that way, and transmit that attitude.

                            I think you got all 5 points quite right, and it is bad news. But some of us have known the bad news for a while, in a broad sense. Good to see it 'pointed' out.

                            Nari

                            Comment


                            • #29
                              Pinker speaks late in his chapter about causation from the perspective of a television show. I know, perfect for me. Specifically he cites the wildly popular series Law & Order.

                              …any fan knows that the legal system really does turn up agonizing scenarios that hinge on whether an act may be causing to die, enabling to die, or allowing to die…Given the endless enigmas flowing from our concept of causation with its model of directness, it’s no wonder that episodes of Law & Order seem to fill every channel on the cable, morning, noon and night.

                              Pinker also says: Our concept of causation is indispensable (but) in the full drama of human experience, it will sometimes collide with circumstances that don’t meet its standard checklist.

                              It seems that though we want desperately to assign blame and exert control we also find the inability to do this easily quite intriguing - thus the appearance of Law & Order marathons. We want them and we watch them unless thoughtfulness is for us boring and scary.

                              Some do, and they watch Desperate Housewives.
                              Barrett L. Dorko

                              Comment


                              • #30
                                Jon Newman found this and posted it elsewhere. I think it fits perfectly here.

                                Those who make causality one of the original uralt (age-old) elements in the universe or one of the fundamental categories of thought - of whom you will find that I am not one - have one very awkward fact to explain away. It is that men's conceptions of a cause are in different stages of scientific culture entirely different and inconsistent. The great principle of causation which, we are told, it is absolutely impossible not to believe, has been one proposition at one period in history and an entirely disparate one at another is still a third one for the modern physicist. The only thing about it which has stood... is the name of it.

                                Charles Sanders Peirce, Reasoning and the Logic of Things

                                He said this in 1898.
                                Last edited by Barrett Dorko; 29-11-2007, 12:44 PM.
                                Barrett L. Dorko

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