Another reason therapists don't know

[John W]

All I've done is argue that a non coercive touch is not necessarily indefensible. That's all.

Patrick,
No, I disagree, you've gone further than that. You've gone on to "point out" that the narrative is sufficient by itself to ensure that locus of control is maintained with the patient regardless of the manner of touch. However, you've provided no support for this opinion; although, you've been asked several times by me and once by Bas to provide support for your position.

Diane posed a suggestion to you, which although very provocative, is a logical extrapolation based on your current ill-defined position. That is, it's possible that a therapist could provide an "appropriate narrative" while at the same time sexually violating a patient with their touch, which is a form of coercion. This is logical because you haven't defined what an appropriate narrative is nor when the threshold of "appropriate" is met. A couple of times you've used the terms "caring" and "guidance" in this context, but both of these terms are very difficult to define, much less quantify, within any therapeutic encounter.

Regarding the definition of what constitutes an appropriate narrative, I provided examples of context-setting that could have a significant impact on the patient's state of mind, which could then impact how receptive the patient might be to any narrative that is provided in the treatment interaction. So, I propose that the "appropriateness" of the narrative is a moving target. Therefore, to assert that there's a quantifiable contingent relationship between the quality of the explanatory narrative and the degree or manner of touch is fraught with assumptions that fail to account for other contextual variables that might render the narrative more or less "appropriate".

My point with all of this is show that your argument, such that it is, contains many untestable and ill-defined assumptions. I suggest that this is because you have attempted to reduce a very complex human interaction down to a set of common denominators that are poorly defined constructs that lack any real operational definitions, i.e. "appropriate narrative" and "passive/guiding" movement.

This is why manual therapy is so difficult, if not impossible, to study using quantitative research methods. This is also why I think we should be particularly vigilant in our application of manual therapy by using it in a way that is informed by a broad swath of the available scientific evidence. I think DNM and SC achieve this, albeit by using the relevant scientific information in varying degrees of depth. DNM draws more deeply from the "hard sciences", like the neurophysiology of skin, while SC draws more of its theoretical underpinnings from the soft sciences, particularly sociology and psychology.

[Diane]

I'd love to hear how you got to that conclusion. Who here moderates the moderators?

I mean c'mon, if yours and johns position is not that a non coercive is more defensible than coercive/passive, what on earth have we been arguing about? It must be the basis, because all I've claimed is that neither is necessarily more defensible than the other.

I'd argue non-coercive is more defensible that coercive passive.
But it would appear you wouldn't.
I do wonder why you belabour these points to death, pounding on them over and over and over. You're smart.. don't you get it?
You? Evan?

[Diane]

Diane posed a suggestion to you, which although very provocative, is a logical extrapolation based on your current ill-defined position. That is, it's possible that a therapist could provide an "appropriate narrative" while at the same time sexually violating a patient with their touch, which is a form of coercion.

My actual point was that coercion (sexual or not) is regarded by a critter brain same as rape might be. As a threat. (Hello?)

[Diane]

The conversation is becoming circular, a positive feedback loop that goes nowhere. :sleep:

[Diane]

Sorry, I dozed off there for a minute in this thread.
Seriously, what are you trying to say? (Patrick and Evan.. Blaise maybe)
What is your point?
That everything is debatable? Yeah, we knew that.
So what else?

I'm all for getting on with what is suggested in this post by Joe Brence.

[nari]

Coercion could easily be seen as a threat, depending to some extent on how it is carried out; passive movement (which Patrick has not been specific about for some reason) may also be viewed as a threat, as the locus of control could be entirely in the hands of the therapist.
LMTs use passive techniques as an essential part of their curriculum; that is expected by the patient and perfectly appropriate.

I am not so sure about PTs passively moving anyone who is ambulant as a choice to resolve pain.

PS - Have just read Diane's latest post re Joe's blog. I agree with the sentiments expressed by Joe.

Nari

[PatrickL]

No, I disagree, you've gone further than that. You've gone on to "point out" that the narrative is sufficient by itself to ensure that locus of control is maintained with the patient regardless of the manner of touch. However, you've provided no support for this opinion; although, you've been asked several times by me and once by Bas to provide support for your position.

You can disagree all you like john. I clarified that comment, apologized and restated it. And the comment that I clarified actually only said that locus of control is "tied to" the narrative. That's not the same as arguing

narrative is sufficient by itself to ensure that locus of control is maintained with the patient regardless of the manner of touch.

Here it is again.

Quote:
All I've done is argue that a non coercive touch is not necessarily indefensible. That's all.

You agreed with with up thread.

That is, it's possible that a therapist could provide an "appropriate narrative" while at the same time sexually violating a patient with their touch, which is a form of coercion.

Ha! Do tell john. What narrative would be congruent with all the science that we agree should form the basis of it, while also providing scope for sexual
assault.

That is, well, pathetic.

[Keith]

I guess you must be all for rape then, Patrick.

I wish a discussion of what is/isn't considered coercive hadn't been conflated with what is/isn't considered consensual.

Many of us have spoken/interacted with Patrick (Diane, Barrett, and myself in person) at length and know his position to be one of a genuine interactor - to imply otherwise is beyond constructive hyperbole, in my opinion.

Respectfully,
Keith

[Diane]

This whole thread turned to pathetic.
Anyone who tries to argue that coercive is more defensible, or just as defensible as, non-coercive, is a bit blinkered in my opinion. Which is why I chose an example of coercion that (as far as I know) is completely indefensible.
Hey, it's hyperbolic, but somebody had to break this positive feedback loop of left brainy-ism (see McGilchrist) and argument for the sake of argument and pointless point scoring.
I don't see the point, that's for sure.

I ask again, is there a point to this thread anymore?

[Ken Jakalski]

I think it's easy for one in this discussion to feel that his/her comments are brushed off, especially if 1. one thinks that he/she presented a sound argument and 2. the person responding refuses to change his/her position but also does not directly address the premises of the argument or does not seem to provide with a sound counterargument (it does not mean that it does not exist). This becomes more obvious if we go back and count how many times the regulars that have been questioning concepts like SC and ideomotion had to repeat their arguments in order for the discussion to progress. I'm not sure if this happens intentionally or not so I try not to blame people or get upset about this

Using Bernard's description of all this as a "pleasant war," what is the mutually beneficial resolution?

[Ken Jakalski]

Might this perhaps be part of a resolution?

I'm not suggesting that you should stop doing what you are doing if it feels helpful to your patients towards resolution, and I'm also not suggesting that my speculations/approach to treatment is 'less wrong' than yours. I just took this opportunity to examine in depth the rationals behind SC for the first time. I'm of the opinion that any method (at least the operational part) can be defended as much as it can be attacked. And just because the 'premise' does not seem to be there it does not mean that it does not exist.

[John W]

Patrick,
At this point, I think I just need to admit that I’m utterly confused about whatever point it is you have been trying to make. And this last revision of your point provides an example of why I have reached this impasse:

And the comment that I clarified actually only said that locus of control is ‘tied to’ the narrative. That's not the same as arguing ‘[the] narrative is sufficient by itself to ensure that locus of control is maintained with the patient regardless of the manner of touch.’

Your original comment that you were referring to here was this from post #646:

But I have pointed out that the locus of control is tied to the narrative, not the manner of touch.

So, you left out the latter part of your assertion that excluded the “manner of touch” as having any influence over locus of control. My opinion is that this defies common sense, but that doesn’t really matter, what matters is that you’ve made no argument to support the point you’ve been trying to make over the course of a 700-comment thread. I don’t know what to make of that.

I will add, however, based on my own observational experience and admittedly superficial reading of what entails primate social grooming that, as far as I know, it doesn’t include anything that we would have defined as “coercive” touch in this thread. I think this ties directly into the concept of the skin as a social organ, as described by Morrison, Loken and Ollauson in their fairly recent paper. So, at least within the area of basic, descriptive science we have some notable and relevant evidence for the plausibility and parsimony of light touch’s defensibility over coercive touch.

With respect to PSG and manner of touch, this comment of yours from the previous page in the thread (post #656) is also bewildering to me:

Passively applied movement can be novel/non threatening input that catalyzes instinctive movement, no? DNM is one such example.

Your definition of passive movement seems to make an abrupt and diametric change here by inexplicably including DNM as a "passive" movement method. The entire thread has been about differentiating passive/coercive movement from light touch/non-coercive movement, and which is a more defensible approach for treating persistent, non-pathological pain. Yet, in this comment you have included DNM within the passive category. My take, for what it's worth, is that DNM is merely an extension of communication through touch for the purpose of calming a nervous system, which is in a vicious cycle of uncoupled sensory input and motor output.

I’m not even asking you to clarify any further because I think the terms of this debate are too ill-defined to do so, and I think that’s mostly what caused this thread to head into this strange and frankly incomprehensible realm of conflation and mutual misunderstanding. I think Diane’s hyperbolic statement was intended to finally blow the cover off of all the relativistic, opinionated mumbo-jumbo that has everyone’s head swimming, and in some cases personal affront being taken.

This thread has been a very interesting one, but I’m not sure how enlightening or edifying it’s been. That might take a while for my slightly above average intelligence to process. I’ve learned a few things, but I think I already knew that the words we use in our profession to describe what we do are inaccurate and insufficient. Unless someone needs a specific clarification of my comments here, I’m going to depart this thread with an answer to Blaise’s question about the science underpinning SC.

Blaise,
I’m not even well-versed enough in these areas of science to know what they’re called. Moral psychology? Cultural anthropology? Whatever it is that explains the nature of the “water” it is that we all are currently “swimming around” in, and how this impacts our need to live authentically within each of our own individual physicalities.

[PatrickL]

At this point, I think I just need to admit that I’m utterly confused about whatever point it is you have been trying to make.

Here are my sequence of thoughts, for whatever their worth.

1. An understanding of the relevant science will determine the content of a PT's explanatory narrative
2. A defensible narrative will be inclusive of concepts such as defense vs defect, the role of skin as a social organ, hpsg theory, catalyzing of instinctive movement, adaptive sensitization, maladaptive sensitization, importance of novel and non threatening input etc
3. I think the understanding that leads to the formulation of a defensible narrative, precludes a decision to deliver sensory/discrim input that is aggressive enough to increase nociceptive signaling
4. I think the understanding that leads to the formulation of a defensible narrative, precludes a decision to touch in an "unacceptably risky" manner with regards to locus of control.
5. i understand passive/coercive movement to include movement of the patient in a direction/speed/range chosen by the PT
6. i don't think it's reasonable to argue that the passive maneuvering of a patient necessarily falls into the category of "unacceptably risky" touch and is not necessarily incongruous with the understanding that leads to a defensible narrative
7. Passively maneuvering a patient can threaten locus of control to an unacceptable degree. So too can light touch

[Diane]

Here are my sequence of thoughts, for whatever their worth.

1. An understanding of the relevant science will determine the content of a PT's explanatory narrative
2. A defensible narrative will be inclusive of concepts such as defense vs defect, the role of skin as a social organ, hpsg theory, catalyzing of instinctive movement, adaptive sensitization, maladaptive sensitization, importance of novel and non threatening input etc
3. The understanding that leads to the formulation of a defensible narrative, precludes a decision to deliver sensory/discrim input that is aggressive enough to increase nociceptive signaling
4. The understanding that leads to the formulation of a defensible narrative, precludes an unacceptably risky approach with regards to touch and locus of control.
5. Passively maneuvering a patient does not necessarily fall into the category of unacceptably risky

All those seem straightforward, except 5.

(..So why is this thread so long?)

Number 5 would depend on speed. As long as speed (of passive movement) is slow enough that the critter brain of a prepared patient has time to make a representation of the passive movement done unto it by the outside world, it should/will be able to interact/defend its organism/do its job of protection/be stimulated/learn something perhaps. Like how to let go of isometric striate muscle output.

[PatrickL]

Number 5 would depend on speed. As long as speed (of passive movement) is slow enough that the critter brain of a prepared patient has time to make a representation of the passive movement done unto it by the outside world, it should/will be able to interact/defend its organism/do its job of protection/be stimulated/learn something perhaps. Like how to let go of isometric striate muscle output.

I agree. Yay