Treatment stance: Operator or interactor?

[Keith]

I thought that Karen Litzy's most recent podcast with Adriaan Louw (and his remarks quoted below) was pertinent to this thread:

What we may find is that if you do something to the tissues [the patient] may feel a little better right there; they will often get worse afterwards or they have these latent periods of flare, because what happens is if you work on those tissues with soft tissue or manual therapy (or whatever you do), you are giving input to the system, but remember that input gets magnified/amplified and the nervous system is a very tricky thing. It doesn't hurt when you are there - in the clinic - it will hurt this afternoon, tomorrow or tonight. It flares and patients go through these flares - they go up and down the boom-bust cycle. So tissues that are super sensitive will feed the brain and if the brain doesn't understand it (we go back to Lorimer Moseley) the brain is going to produce pain. Pain protects.

We talk about a top-down effect and a bottom-up. The bottom-up effect is what we do from the tissues towards the brain. The top-down is from the brain down and you really need to start with the brain, so when you do soft-tissue [work] that message ends up towards the brain and if the brain understands it, it will not amplify [the message], it will actually say, "We're gonna be okay. Lets calm you down."

The most important thing is to turn on the brain-part of it. We need to be careful. We need to think of all of the manual stuff that we do - that is all very good - and put it in the right context for the brain before we do those.

Respectfully,
Keith

PS: Great interview, Karen!

[Curious One]

Thanks so much for that chart you provided above. I like that you also added Music Therapy.

We have a Music Therapy Center in our city and for anyone who is no familiar with it (I have only recently connected with them and am just starting to learn a little more myself), it is described this way:

"The American Music Therapy Association defines music therapy as an established healthcare profession that uses music to address physical, emotional, cognitive, and social needs of individuals of all ages. Music Therapy improves the quality of life for persons who are well and meets the needs of children and adults with disabilities or illnesses.”

I am not sure how that helps this thread, but maybe it becomes useful along the way.

[Diane]

Link to "Shared Space" thread.

[Diane]

Here is another letter to the editor, from a year ago, by Cory Blickenstaff. It should go in this thread too. Therapist as ‘contextual architect’

[Diane]

I stumbled over this, while looking for the Bialoski paper on pubmed, and was glad to see it was open access. It's the letter Jason drafted last year, and we submitted together. It's in print, and citable, and open access. Therapist as operator or interactor? Moving beyond the technique.

(I got to admit, it's kind of fun/I kind of like seeing this come up in pubmed. )

[Diane]

Thanks Ian, it's a nice digest.

[ian s]

interaction

Exactly Diane ....I feel the 'woolliness' , the often cited comments like 'psychobabble' and the general reluctance to engage in the less measurable but possibly most important aspects of health care are increasingly being teased apart and worthy of study.....One concrete reason other than the sensible reason that people have much better outcomes with empathic and extended consultations see enclosed article on Rheumatology outcomes and homeopathy for example is the fact that some of the most costly complaints are due to arrogance and attitude rather than procedures i.e. a lack of care.

http://rheumatology.oxfordjournals.o...eq234.abstract
http://rheumatology.oxfordjournals.o...gy.keq265.full

Deric Bownds (as usual) has a whole series of article that are relevant to some of the factors you might be interested in under the embodied cognition link....http://mindblog.dericbownds.net/sear...ed%20cognition
One brilliant article was on metaphors http://opinionator.blogs.nytimes.com...-on-metaphors/

No doubt you have read all of the above or they have been posted before but apologies if this is the case!
ian

[Diane]

About treatment, and about our role as interactionists.. on Facebook, Will Stewart linked to this nice open access paper, The Effect of Arousal on the Emotional Memory Network Depends on Valence, about which he says this:

Negative information affects the limbic systems and its input to the neuromatrix while positive information decreased amygdala output.

How do you as a trainer or therapist disseminate information to those in front of you? The way we communicate (verbally as well as non-verbally) affects them in ways we are just beginning to understand. Thoughts???

"For negative information, arousal increased the strength of amygdala connections to the inferior frontal gyrus and the middle occipital gyrus, while for positive information arousal decreased the strength of these amygdala efferents. Further, while the effect of arousal on memory for positive information was restricted to amygdalar efferents, arousal had a more widespread effect for negative items, enhancing connectivity between other nodes of the emotional memory network. These findings emphasize that the effect of arousal on the connectivity within the emotional memory network depends on item valence."

Nice thought! How we interact with patients will affect how their brain takes on what we provide them in terms of information. Providing pain ed needs to be done in a way they can hear, in a way that won't scare them, in a way that helps them be less scared. Same with any sort of contact, especially physical contact, from manual therapists. Explain explain explain is my default approach.

[Diane]

Updated version with a "locus of control" feature added.

[Diane]

New version, more stuff.

The Reiki on one end and religion on the other? They aren't really as far apart as they look: The image is more like one side of a big circle, with Reiki and religion touching each other somewhere behind the viewer, belief systems that don't bear up beneath any sort of careful scrutiny.

[Diane]

I made a new slide, just a draft, showing where I put things on a continuum in my own mind. Feel free to disagree, discuss. That's what the forum is for.

[Diane]

Helena Cronin on interaction-ism, answering the 2012 Edge.org question, "what is your deep explanation?"

"aren't we anyway all interactionists now?"

[Diane]

I think it ends up with the patient inwardly not enjoying the contact or even actively disliking it but not wanting to say anything because after all, it's their own fault they're there in the first place, in their own mind, and, they imagine, in the mind of the therapist, so they convince themselves to be grateful for any form of human primate social grooming they get no matter how uncomfortable it may be and will perform incredible mental somersaults to hold their therapist blameless, faultless, perfect and themselves in pain/to blame for it.

[gollygosh]

If the patient were the better interactor, he/ she would be questioning, seeking clarification, perhaps seeking metaphor to further understanding. The therapist could be either threatened/angered frustrated by this, or perhaps enlightened by the experience. In other words the patient may become the catalyst that elicits a more interactive experience. Or the therapist could get all huffy, and try to shut the patient down.

[Jon Newman]

So it takes two to interact. And there are patient-therapists that participate on this board. What advice would you give the patient side of the interaction. That is, can patients interact their way to better care? If so, how best should they go about it?

If some patients are better interactors than their therapists, what does that end up looking like in the clinic?