Another reason therapists don't know

[PatrickL]

You've said that if touch isn't included Simple Contact isn't present. Where on earth did you get that idea?

Sc is still sc even when you don't touch the patient? I would have thought it would be more appropriately labeled nc (no contact)

[Diane]

There are plenty of exteroceptive neurons in the ear, in the eyes.. context context context.

[PatrickL]

There are plenty of exteroceptive neurons in the ear, in the eyes.. context context context.

when these are the only exteroceptors being stimulated during the clinical encounter, surely you agree you're no longer performing SC??? To be clear, I understand that touch is not necessary for resolution. But lets not kid ourselves... when touch isnt involved, its not simple contact anymore.

[Mason]

Barrett,

If your method is the creation of a context that promotes culturally suppressed ideomotion/self-corrective movement then this implies that you have knowledge of the cultural contextual variables and social norms affecting the patient and how the context needs to change to undo or suspend that suppression. In other words: to change from context A to context B you must have an idea of the starting and end points and how they differ.

For your method to be plausible it seems you would need to define what those contextual variables are that inhibit self-corrective movement, how they need to be changed in order to remove the suppression to catalyze self-correction, and how your method changes them. Have you stated this somewhere? When I searched I found this that you wrote:

In the presence of touch that accepts us, as opposed to the typical judgment of exam or coercive care, ideomotor activity is almost always immediately visible. It is always palpable.

How is this not supposition?

Following that, I don't see how you can determine that the movement catalyzed by your method is inherent self-corrective motion being freed from the restriction of social norms instead of simply movement that is suggested to them by the context created by your interaction, or something else entirely, unless you are certain that the context you created has removed the cultural variables inhibiting movement. How would this be tested?

[Mark Hollis]

If your method is the creation of a context that promotes culturally suppressed ideomotion/self-corrective movement then this implies that you have knowledge of the cultural contextual variables and social norms affecting the patient and how the context needs to change to undo or suspend that suppression. In other words: to change from context A to context B you must have an idea of the starting and end points and how they differ.

If pain is related to threat then would not one of the determinants of the initial context A be that the client is expressing that they are in pain or have concern of future pain upon movement (detect a threat component in their internal and external environment or their anticipated internal and external environment) and that they want context B to be that they are in a less threatened position which correlates with less of a conscious pain related experience which in turn entails the therapist to try and express a position and action of non-threat?

Do you need to know cultural context to know how to act nonthreatening?

[PatrickL]

Do you need to know cultural context to know how to act nonthreatening?

no. but doing so won't necessarily affect the cultural variable(s) that constitutes the threat state that is driving the pain for a given person. i.e. If the culturally driven mechanical deformation of nervous tissue arises from the wearing of high heeled shoes for example, acting in a non threatening manner wont necessarily help a patient with pain related to such mechanical deformation

There is a vagueness that accompanies the apportioning of blame to the culture as a cause of mechanical deformation. You can't really ever be wrong if/when you blame the culture... but without attempting to dig deeper to discover what those specific variables are, I don't think we learn much either.

[Mason]

If pain is related to threat...

Threat may be a component of the patient's pain experience, but Barrett states increasing neural blood flow to mechanically deformed nerves as the mechanism of pain relief with his method. If socially imposed norms are impeding self-corrective movement as proposed it does not follow that acting non-threatening/creating a non-threatening environment decreases the restriction those cultural variables have on self-corrective motion.

Do you need to know cultural context to know how to act nonthreatening?

The aspects of the cultural context inhibiting the expression of movement need to be specified to claim that the therapist is able to create a different context that elicits culturally-suppressed movement.

[Barrett Dorko]

Context

•Threat
•Prior Experience
•Stress
•Depression
•Sleep hygiene
•Family history
•Genetics
•Gender
•Lifestyle factors
•Smoking
•Expectation
•Coping strategies
•Interaction with health professionals
•Personality variables
•Intelligence
•Emotional responses

This is a list of 17 factors that might influence the patient's response to context. More could easily be considered. It's from a slide in my power point presentation.

Can/should all of these be known and specified? Isn't our understanding of how the brain functions constantly growing? Shouldn't the PT department be designed to first and foremost make it easy for the PATIENT to change?

[Barrett Dorko]

Patrick says:

If the culturally driven mechanical deformation of nervous tissue arises from the wearing of high heeled shoes for example, acting in a non threatening manner wont necessarily help a patient with pain related to such mechanical deformation.

I recall hearing a pharmacy rep telling me immediately that she didn't want to hear anything about her high heels. I also recall reading that it took Mariah Cary three weeks to get used to wearing flats for a movie role.

Simple Contact, which you seem to have forgotten is BOTH an understanding and method, leads to ideomotion that MIGHT, via instinctive motion, make it possible for us to tolerate the hoops the culture makes us jump through. There also seems to be a convenient forgetting that the culture both helps and hinders us, though I've said that numerous times.

Some people lie and some tell the truth, and your job is to figure out who's who.

Said by a psychologist to a detective on a police drama promo.

[Bas Asselbergs]

Let's not get ridiculous:
"when there is no touch, it is not simple contact anymore".
Really?
I can not believe that all the non-MANUAL aspects are dismissed as not being "contact".

Every time we meet with a patient, we are on contact.
SC is not SMC (simple MANUAL contact).

[Barrett Dorko]

Patrick says:

...without attempting to dig deeper to discover what those specific variables are, I don't think we learn much either.

I'm sensing a certain discomfort when we don't know enough about the entire history. This is, to me, an old story and one that is related specifically to our search for cause and, ultimately, something to blame.

If cause is what you seek, go ahead. Not only will your findings reveal that you've simply stopped looking at some point, they will imply that human beings aren't even animated. This is what Taleb's book about being fragile reveals. There are links to it in Range of Motion.

I'm a PT and I see people for their problems until payment is exhausted. I'm not a psychiatrist seeing a private payor for years on end. This doesn't mean "I don't learn much." It means I learn what I can.

Don't we all?

[PatrickL]

I'm sensing a certain discomfort when we don't know enough about the entire history. This is, to me, an old story and one that is related specifically to our search for cause and, ultimately, something to blame.

Yes. When a patient asked me what's causing their pain, I think we can do better than saying "the culture is suppressing your corrective movement".

[Barrett Dorko]

You think that's all I say? I'm amazed.

Speaking of the cultural influence is a tactic, helping people understand the nature of the brain's output of pain is a strategy.

[Barrett Dorko]

Evanthis,

In post #788 you say that I thanked you for stating what a premise consisted of. No, I didn't. I thanked you for seeing how corrective movement wasn't always painless.

I still don't think you know what a premise is or how to defend it with an argument, a deep model and clinical reasoning.

[PatrickL]

No, of course I don't think you say that to patients. I know you use story and metaphor relevant to the patient to get your message across'. But the message is that the culture inhibits corrective movement, and that this generates a threat state that leads to an output of pain, no?