I want to start with a simple question, as a therapist are you prepared to stop mid-intervention to listen to the patient?
If not I don’t think you’re ready to treat pain seriously.
That’s a bit blunt you say. Right, well I think this important. The question is how I got to the point of making this judgment. Well it starts with something I have noticed in clinicians throughout the years, which is their disdain for the communicative moments in therapy, especially sessions where the patient is doing most of the talking. After such sessions, the therapist returns to the confines of the office exasperated. “The patient just won’t stop talking about all their problems” It is my opinion, that the hallmark of exemplary clinical reasoning of pain is the therapist’s ability to react instantaneously to a perceived need by the patient to express themselves and to listen attentively.
Let’s start with the fact that we as physical therapist are not groomed with skills of communication. Some of us who are attracted to the profession are good communicators–especially those that stick around for a while. Some of us might be highly relatable within the niches of clientele we have crafted for ourselves. However, communication skills are not requisite and definitely not universal, even if you are relatable. Our schooling reflects doing unto others, rarely it considers listening to others. It is fixated on creating patient centered goals but leaves emotions, beliefs and cognitions conspicuously out of the picture.
The late Patrick Wall states: “If the sequence (of pain) is frustrated at any stage, the sensation and posture remain.” (1)
There is potential for frustration, at the point when the patient may be wishing to express the most important aspects of themself or their pain but our own discomfort with situation causes us to shut it down, divert or distract. Oh! The patient seems uncomfortable and distressed well I must cheer the patient up so we can keep on going, or that is just a psychological problem, not in my wheelhouse–are both potential common excuses of the treating therapist
The expression of pain is both the verbal and non-verbal communication of pain to another person. It is a type of pain behavior that carries emotional valence and demands the attention of the listener. If we take a person’s emotions, beliefs, and thoughts as part of that expression and we choose to ignore it or explain it away, there is a problem. We may be potentially thwarting the patient’s expression and thus frustrating the natural sequence and process of pain resolution. Unfortunately, a patient’s complaint is not going to come in a neat little package: a numerical rating or a common adjective. Understanding it as such might cause the patient to feel that their expression fell on deaf ears. The expression of distress and pain is messy and sometimes tied up with other aspects of the persons being. The more comfortable we are with ourselves and the patient, the better listeners we can become.
So to return to the original question, if you answered yes and are prepared to stop, what do you do during those moments? What occurs during the patient’s expression that contributes to your clinical reasoning and processes? How does your reaction to their expression affect their presentation? Do you know techniques of listening that facilitate the patient feeling supported and cared for?
Before I conclude this post I want to give you two example interviews conducted by Peter O’ Sullivan. He is an Aussie who is developing a clinical reasoning model called cognitive functional therapy. Just as we know there is more to passive movement than meets the eye; there is more to listening than just being talked to. Peter demonstrates this. Can you spot the tricks that he uses?
To be continued…#stopshort ;)
Eric Kruger @Kintegrate
The term stop short in the urban dictionary implies a certain interpersonal gesture as depicted in this Seinfeld episode it more commonly means to stop (or cause to stop) suddenly or abruptly.
Categories: Critical Thinking