Treatment stance: Operator or interactor?

[Diane]

It seems to me that a lot of confusion and argument over paradigms, treatment constructs, even conducting of studies arise over which frame of reference one uses.

If we prefer to deal with our patients and their living nervous systems as cleanly as we can, free from assumption and coercion, it seems to me we must assume the interactive mode. Interactive treatment stance allows for shifts, allows a patient's system to respond to our own, allows change to occur, sees practitioner input strictly as input, no great skill set required, but a lot of agility is required perceptually to note changes and assist those, facilitate them. Humility is required, as nothing will be 100% predictable and the practitioner must realize their role is merely to catalyze (...an acceptable and metaphoric "c" word..).

Operator stance is the one we were all taught, training-wheel type orthopaedic approaches and so on, that regard the patient as a bunch of meat and bones to be pushed this way and that, corpse-like but animated, and perhaps not quite so stiff/cold. Otherwise not much different. Operator stance is all about the practitioner doing something marvelous that they have paid a lot of money to learn how to do, to someone else. If there's improvement in the patient's condition as a result, then in retrospect it's all been due to the brilliant technique, never that the patient's nervous system cleverly picked up on some input and learned a new output or learned to inhibit an old one, like pain.

Which one seems more likely to fit with reality? Which one seems to you to be the more coercive and which one less?

[oljoha]

Does it have to be just black and white? Can't there be shades of gray?

[Mary C]

I think the interactive mode would have several shades of gray.

[Diane]

Yes, there are different shades of gray in interactive mode. And there are perceptions of darker gray or lighter gray depending on context, just as there are in perceptual illusions of all kinds.

What I'm talking about is, are you (or anyone) usually on a relatively lighter square, or darker square? Can you tell the difference? Do you prefer one way over the other? Do approaches sift out according to whether they are transmitted/taught from one stance or the other? Are our brains shaped by how they are programmed? How we allow them to be programmed? Can we shift easily from one perspective to another? After a time, can we outgrow one in favor of the other?

[nari]

If a therapist 'connects' with a patient, explains pain physiology in simple terms (it is possible, though not particularly easy) and provides the patient with clear choices, then it's about dealing with greyness. The patient has a choice between obediently doing what the therapist suggests or bailing out because it doesn't appeal or suit him/her.

That choice of bailing out indicates an inbuilt passivity or a clash with the therapist, most likely determined by the patient's nervous system, which is constantly testing the waters in which the therapist and patient interact. Many patients don't bail out, but struggle on in the hope that in the end, pain is resolved. This happens in both arenas - orthopaedic and neural-based therapies.

The grey areas of therapists' changing their paradigms/beliefs/convictions are everywhere on this site and others. Some happily mold themselves, such as using DNM and/or Simple Contact followed by exercises based on orthopaedic 'rules'. I don't know the extent of this, but I suspect both therapist and patient could be happy with results. Perhaps the orthopaedic-based regime can be abandoned because the nervous system is content after the DNM/SC experience alone. Being human folk with complex neocortices, who can say?

Nari

[Karen L]

Hi,

I am writing a paper at the moment that seems to mirror this discussion but from a psychology perspective. I don't see why it cannot translate from emotional pain to physical pain and the relationship formed to effect pain relief.

Both articles are freely available online.

The Necessary and Sufficient Conditions of Therapeutic Personality Change. Rogers(1957)

Coments on "The Necessary and Sufficient Conditions of Therapeutic Personality Change" Silberschatz(2007)

Pernkopf

[Brian Sturgill]

My attraction to the interactive paradigm is exactly the reason that I wanted to become a physical therapist! In fact, for me, it is the very essence of therapy.

That's why SC appeals to me so much.

[Diane]

Brian,

My attraction to the interactive paradigm is exactly the reason that I wanted to become a physical therapist! In fact, for me, it is the very essence of therapy.

That's why SC appeals to me so much.

I think you've found the right place to hang out, in that case..

[Diane]

What is a "noun"? What is a "verb"? We think we know, but do we.. really?

The workshop is over, Nick has left to go on to his next adventure, and I'm no longer playing hostess. It was great meeting Nick and having "fierce conversations" on many topics with him (and with Eric who came by one of the two evenings) over a brew.

The one-day workshop yesterday ended up being different than the others, in that I spent a lot more time drawing bad pictures and talking than I had intended, and less time showing people where to put their hands or working in pairs or threes. The feedback was that it was acceptable, that learning had occurred, integration had happened, even without much practical or lab time. (Nick had some good ideas about how to make the entire thing more of a noun than a verb, so that it could be more easily passed on as a body of information..)

I explained and modeled (as best I could, anyway...) what an "interactive/interactor" stance was, as opposed to an "operator stance", and made an effort to show people how to use perception and move on, rather than fall prey to it or let it harden into any irrelevant concepts. I think we made some progress. I hope we did, anyway.

I want to get back to this thread topic, and topics introduced in post 1, which I touched on in the workshop:

INTERACTOR STANCE

If we prefer to deal with our patients and their living nervous systems as cleanly as we can, free from assumption and coercion, it seems to me we must assume the interactive mode. Interactive treatment stance allows for shifts, allows a patient's system to respond to our own, allows change to occur, sees practitioner input strictly as input, no great skill set required, but a lot of agility is required perceptually to note changes and assist those, facilitate them. Humility is required, as nothing will be 100% predictable and the practitioner must realize their role is merely to catalyze (...an acceptable and metaphoric "c" word..).

I want to reflect on this a bit more from some reflections I have which may or may not have anything to do with anything, but with which for the moment I'm in philosophical congruence:


Existence:

1. "Existence" (anything at all, cosmic or micro) is in and of itself a gradient from "verb" to "noun."
2. Most things (even relatively non-disintegrating objects) are not entirely "noun"
3. Concepts are thoughts we make up and pretend are "nouns" which make us feel better about being mostly nothing but verbs and our passages through the greater mostly-verb of "existence."

Human beings:
1. Mostly a verb, definitely not a full noun. "Life" is probably completely a verb, and unlike existence, not a noun at all, not even a hint.
2. "Life" keeps an organism intact (as an apparent noun) until the day that organism's "job" (to be alive and move about) is over and it can stop, let itself dissipate (i.e., cave to staved-off entropy)
3. Meanwhile it's "being alive" job is to breathe/consume, move the energy inherent in bonds which are contained between molecules of matter about from one form to another using oxygen combustion, i.e. produce greater entropy. ("Nature abhors a gradient", even an oxygen gradient. Maybe even especially an oxygen gradient..)(Into the Cool, Sagan/Schneider).
4. Perhaps the reason "life" has supported our enormous (human) population growth and domination is because it is secretly hoping we will burn up ALL the combustible fossil fuels and oxygen, which would give it a chance to make something it likes better next time round - it doesn't want us to know this or figure it out because then we would get all sustainable and try to figure out a way to prevent our own demise. (Although I doubt we are going to be that smart at the global species level of our "existence" or develop sufficient political will in time. So it's probably not worried after all. And it probably does not think or worry about anything in any case - I was freely anthropomorphizing just then. )

Anyway, back to more mundane topics:

Nervous system:
1. Nervous system function is more of a "verb" than than the rest of the body is: it's structure is minimal (2% of the body) but its responsibility for perpetuating life is maximal (100%) and its fuel consumption disproportional (20% of all available)
2. So, we should extrapolate what it needs (better more efficient function, which would waste less energy overall) and help it "operate" its body more easily.
3. We can legitimately allow a concept (or noun) to extrapolate itself - i.e., we can allow a construct to emerge, that the nervous system itself (function plus structure) is the most verb-esque thing in the body, and aim to treat it.
4. Nervous system function (verb) is in charge of its organism's life (verb), only uses structure (doesn't really care about it), will assess/taste its environment (verb) and will choose to accept or resist novel sensory-discriminative input (more "verb," using something offered it as 'noun').
5. If we are treating something (like nervous system) which is a relatively more significant verb (than mesodermal structure, which is relatively more noun-ish), we have to learn to "dance on shifting sand." I.e., we need to resign ourselves to the fact that we are verbs ourselves, and learn to interact with the verbs who come to see us, rather than first conceptualizing their bodies as a bunch of disparate nouns, then trying to do something to those nouns based on a bunch of treatment concepts which are more nouns, as if the verb wasn't going to have a say or veto power.

Which leads into....

OPERATOR STANCE

Operator stance is the one we were all taught, training-wheel type orthopaedic approaches and so on, that regard the patient as a bunch of meat and bones to be pushed this way and that, corpse-like but animated, and perhaps not quite so stiff/cold. Otherwise not much different. Operator stance is all about the practitioner doing something marvelous that they have paid a lot of money to learn how to do, to someone else. If there's improvement in the patient's condition as a result, then in retrospect it's all been due to the brilliant technique, never that the patient's nervous system cleverly picked up on some input and learned a new output or learned to inhibit an old one, like pain.

Essentially this stance lays bare the proclivity we have, to want to think in nouns, to want to think ourselves as the most important noun in existence (egocentric view, comes online around age 2) which can do verb things, package and sell verb things to other nouns, and to see our patients as a bag of smaller "nouns" that we can do verbs to.

I don't know if this makes things more clear or more murky. All I know right now is that this line of thinking is a bit new and probably awkwardly expressed. Feel free to clarify/add thoughts. Maybe everything is more or less gerund, and there are no such things as nouns and verbs. . E.g., human being.)

[Diane]

It occurred to me today that pain is a verb.

No wonder ortho minds get frustrated and declare that pain doesn't exist. To ortho minds, only nouns exist.. verbs are what they like to do to nouns that they dream up, like "stiffness" or "facilitated segments," etc...

No wonder pain is such a conundrum - most people tend to think outward into nouns, use thinking to grope their way from one noun to another, afraid to let go of the nouns in case they lose reference points and get lost in thought. Life was so much simpler (wasn't it?) when no one knew anything about neuroscience or the brain and pain was based on a tissue that suffered from manipulation deficiency and needed to be stimulated to heal and if that didn't work, clearly the patient was crazy.

Here's what I think: Pain is a verb that impersonates a noun; it spins that noun-ish deceptive perception of itself outward as language, and people who have it and who describe it with noun-ish words that don't even come close, stumble and falter and try anyway, fail a lot, then feel completely isolated from the rest of the human primate troop whom they imagine (wrongly) to be painfree compared to them.

The verb called pain commandeers innocent body parts and turns them into almost-nouns. Fluidity and effortlessness of movement disappear - body parts feel like heavy attachments that "hurt" to lift and move.

Pain certainly "feels" like a noun, i.e., a block, an aporia.... but all along it's just it's a simulation the brain is running, a simulation that has gone wrong and that some other part of the brain is wildly upset over, feels threatened by as if it were an external threat - all the while it's just a verb whose timing is off, a verb which, if it goes on for too long can rip a gaping trench through the association cortex and turn it into its own bunker, where it can hide out and shoot from, keeping healthy neuroplasticity at bay.

Of course, if you think only nouns are "real," you could miss that, couldn't you? You would want to declare pain out of bounds in the Right Straight World of Nouns, declare it null and void if you are an ortho mind, a mystery or aporia if you are a philosopher, and anything from total inconvenience to devastation of your whole personhood if you are a regular human, just being.

[EricM]

Interesting fact. An aporia is also a genus of butterflies. Very fitting.

[Diane]

Over at brainscience podcast a new (native Russian-speaking) member offered a linguistic critique of English. I think he put his perceptual and symbolic finger straight on the problem of this language:

Being a native Russian speaker, I learned English well into my adolescence and I did notice its effect on my thinking. This notice of course is intuitive and based on introspection, there’s nothing scientific about it, which is why I’m interested in seeing results from a formal study. My interest, however, might be a little different than what I heard on the podcast. It sounds to me that Alice is almost equating ‘the way we perceive things’ with ‘the way we think’, and I’m not convinced we can do that. I believe there can be a meaningful distinction between perception and the thought process. Examples provided by Alice, such as the gender of the bridge or spacio-temporal attitudes seem to me to be in the perception category, not “thought processing”. I would agree that, being a Russian, I perceive two colors of blue differently because we have two different words for them, but I don’t see how that *perception* changes my *thought process*. Maybe it would be helpful if Alice defines precisely what she means by thinking.

Here’s what I think would be a different kind of example of how language affects thought processing. This is a pure speculation, an amateur hypothesis, if you will. When I moved to America, I noticed that when people are engaging in philosophical thinking, they’re persistently conceptualizing things as subjects with properties. In other words, when discussing the ontology of let’s say the Sun, folks are not satisfied with merely enumerating the properties, such as hot, shiny, massive, round, etc. They conceptualize it as something in itself to which you attach all those properties. Then of course everybody is wondering about the nature of that thing in itself, trying to get down to the fundamental reality where that thing supposedly exists. This is Rationalism of course. I didn’t notice this kind of tendency back in the Russian culture and I don’t believe such tendency exists in Eastern cultures where things are viewed more holistically. Interestingly enough, I started noticing such tendency about myself, and again, only through introspection. I started wondering about it and it seems to me it might be due to the fact that I started speaking and thinking in English. What’s different about English? Besides the fact that it’s an analytic language (Russian is synthetic), English has the subject-predicate requirement in its syntax. When I say “it’s raining”, I *have* to say “it” because I have to have the subject in the sentence. But “it” doesn’t stand for anything, it’s meaningless, it’s a dummy pronoun. Even if I say “oh, raining again”, it’s an elliptical expression in which the subject is simply omitted but nevertheless presumed. So, my hypothesis is that the fact that I speak a language in which I have to start with the thing in itself (the subject) and then attach properties to it (predicate) forces me to conceptualize abstractions in the same fashion. I can’t think of a star holistically, as simply stuff, as enumeration of properties. I conceptualize it as the thing to which you attach all those properties. I’d love to test this hypothesis in a more rigorous manner.

Pavel

Pavel, thank you for this succinct description of the big problem of English, which has been driving me a bit mad lately. The problem, as it affects the health care profession I work in, is that everyone tends to see, conceptualize and treat nouns, not verbs. Changing one "noun" to another is seen as some kind of operator magic, a commodity to be bought/sold, instead of as normal interactive process which, if simply understood in enough detail and clarity, would explain itself (less profitable maybe).

Please pardon my interruption of the topic at hand. I hope I may quote you elsewhere however.

My bolds.
I think he might agree that everything is more verb than noun, and that we pretend processes and verbs and abstractions are nouns in order to examine, exploit, buy and sell them.

[Adiemusfree]

My preferred description of myself as a clinician is that I'm a facilitator - which has similar connotations to catalyst. I use this term because I see my role as being about providing information and supporting decision-making (resolving ambivalence) rather than 'doing' anything 'to' anyone. In the end I don't live the person's life for them - I don't move their back, I don't lift their hand, I don't and can't 'make' anyone do anything. I can, however, help them become aware of their options, give them information about the consequences of their choices, and help them resolve their ambivalence by helping them become aware of their implicit values and how a choice might affect their values as they live them out in real life.

Intrinsic motivation is a far more powerful motivator than holding a gun to the head. Experiential learning is far more powerful than simply being told 'how'. Learning with emotions attached, and in context with other relevant cues is more easily recalled, and adult learners have a wealth of material to draw on already. So my role is to respect this, and enable the person to make choices and experience the consequences. This doesn't speak to me of being an 'operator' but of being in an interaction where I have certain responsibilities (for example I'm the person 'thought' to know more about pain than the patient, so I'm supposed to give quality information, be somewhat in charge of the discussion, responsible for changing the way I interact when I encounter resistance).
I've thoroughly adopted the Millar and Rollnick 'Health Behaviour Change' model which really has completely revolutionised my practice in so many ways - and patients seem to engage in this readily and make gains that I would never have dreamed possible. Gotta be good for you!

[Diane]

Bronnie, I hear you re: being a catalyst. Exacto.

Further to the discussion re: nouns and verbs above in post 12 and the critique offered of English I thought back to the reality of how impoverished English is in terms of verbs. I used to think it made English simpler. I learned some Spanish 20 years ago (never was very good at understanding it (auditory) but learned enough to get by speaking it). I remember being bewildered by all the verbs - there were different words to learn for every tense, every "person"... it seemed overwhelming. Same thing with French in grade school and high school.

Now I know better - I think if I were a native English speaker with children I'd put them straight into French immersion to build their verb pathways so they wouldn't end up impoverished by Anglo noun-ish grammatical handicaps. Their thinking would be more fluid, freer, and it would be easier maybe, to explain this PT concept kind of stuff without all the question marks or boredom.

Check out this site re: learning Spanish, and all the amazing fluidity that exists around verbs.

The mood of a verb (sometimes called the mode of a verb) is a property that relates to how the person using the verb feels about its factuality or likelihood; the distinction is made much more often in Spanish than it is in English. The voice of a verb has more to do with the grammatical structure of the sentence in which it is used in and refers to the connection between a verb and its subject or object.

It must be hard for the French and Spanish speakers here to try to get across their meanings in the confinement of English without enough verb-ish concepts to bring to bear on discussion. Sort of the equivalent of "Anvil." "Head." "Ow!"

[Diane]

Over in the "This Week" thread I wrote a post on coherence as opposed to cohesiveness, referencing the Daniel Siegel book, The Mindful Brain.

In Chapter 11, titled Reflective Thinking: Imagery and the cognitive style of mindful learning, on page 241 I saw, in a paragraph last night to do with context sensitivity, this statement:

With context sensitivity we engage the big picture and realize the setting in which an event is occurring changes the frame from which we can understand it. This sense is a right mode specialty that seems engaged in mindful awareness as well. We come to see the interdependent nature of reality, the interconnectedness of things and events across time. Much of life becomes verbs rather than nouns: events are happenings, not just unmoving facts.

My bold.

I'm glad to learn I'm not the only one in the world who gets into verb-not-noun perception of life, its objects and events.

Siegel is talking about something called "conditional learning," He quotes an educator, Ellen Langer, p. 232:

"In Langer's own words (1997):

"When we are mindful, we implicitly or explicitly
1. view a situation from several perspectives,
2. see information presented in the situation as novel,
3. attend to the context in which we are perceiving the information, and eventually
4. create new categories through which this information may be understood"

(p. 111). These features of multiple perspectives, novelty, context, and new categories are the essence of mindful learning."

It struck me that this is all completely congruent with scientific investigation, and echoes Burton's book, On Being Certain.