Reflecting on the term psychologically informed care has taken me down a rabbit hole!
Isn’t EVERY person’s presentation and recovery influenced by how they are responding to their situation (body sensations, thoughts, emotions and behaviours)?
Doesn’t EVERY interaction therefore have a psychological impact?
Isn’t it therefore essential to be providing psychologically informed care? Psychologically uniformed care doesn’t inspire confidence!
As a physio new grad years ago clinical presentations from the viewpoint of my physical training were often confusing and frustrating. I did what I had been taught at uni but I didn’t understand why two people with the same problem could respond very differently to the same treatment. What mysterious component was I missing? Looking back from a viewpoint of years of clinical experience and learning about the body-mind connection there is much more clarity. I can find my way out of the rabbit hole!
Look closely. The role of patterns of thoughts, emotions and automatic responses is illustrated in these typical clinical scenarios. Understanding the whole person, bigger picture leads to greater confidence and work satisfaction, an ability to simplify the complex, and to enhance your own wellbeing in the midst of others pain. This comes with experience but is too important to leave to chance and there should be a greater focus of Physio training.
I think the problem is that we haven’t yet defined what psychologically informed care looks like for physios. Complicated templates and frameworks designed for psychologists contribute to more complexity, time burdens and reduced confidence. We need our own body-based model that meets and builds on our unique skill set. Psychologically informed care for physios means we work with the person from a body-based perspective that enhances positive psychological and physiological change. Answers lie in how we teach movements and lay our hands on, how we listen, ask questions and explain in meaningful ways that relate to the person’s body-based experience. It’s about taking both a narrow (eg knee pain) and a broad systems (eg sympathetic reactivity) perspective.
Expanding awareness in this field begins with learning more about your own body – mind. It may take you out of your comfort zone initially but in time it provides a pathway to offering simple solutions for complex problems.
More about the clinical presentations later!
Clinical scenarios
Barry and Tom work in the same job and both have back pain. You provide a similar treatment plan for both but only Tom gets better. What did you miss in Barry’s history and presentation?
Jenny fractured her knee cap. Her knee is swollen and has a nasty raised scar that she hates. She is doing her exercises, but is not improving. What is it about her response that is activating an immune and inflammatory response? What do you do?
Kylie has a long history of pelvic pain, headaches and shin pain. How can you address all these issues in a clinical session?
You have clients who are not following your advice. Why aren’t they listening?
Rebecca is an elite netballer. In the year the past year she’s had a hamstring strain. Achilles tendinitis, and intermittent shoulder pain. Why is she so injury prone?
Jo has had back pain for over a decade. She is very anxious and becomes panicky at the suggestion of moving. Where do you begin?
Ralph has had a number of falls and his gait is slow and guarded. How can you help reduce his fear and build confidence?