THERAPEUTIC ABSENCE

Barrett L. Dorko, P.T.


          It might surprise you to hear me say this, but I honestly feel that astrologers do a remarkable job. Notice I didn't say that I believe in the basic tenets of astrology, or that I regularly seek their advice. But I've just got to believe that they're doing somebody some kind of good. Why else would there be so many of them?

          Now, I think astrology itself as a body of knowledge has more problems with logic and coherence then I have space to write on this page. But that's not the issue here.

          I know that physical therapists do some amazing work as well. And I don't have anywhere near the theoretical problems with what they say and do as I do with astrology. Really.

          Given the choice, I can see more reason to visit a PT than an astrologer, although I am tempted at times to suggest to my patients that they might have more luck elsewhere. Maybe with a Capricorn.

          Seriously, I think that astrology offers us a wonderful example of the difference between a body of knowledge and the people who actually employ the theories of their profession.

          When people are seeking someone to listen to them and perhaps give them advice about their everyday problems, all the theoretical knowledge in the world cannot replace some authentically interested human presence. "Astrology" can't help nearly so much as an "astrologer."

          The common practice of applying various modalities and calling it "physical therapy" despite the absence of anyone who went to physical therapy school is deeply entrenched in the medical and chiropractic communities. I understand that it can be quite lucrative to bill like this, and I know that it has been made illegal in some states.

          This never would have happened if we hadn't mistook the use of the modality for the actual practice of therapy itself. I can only imagine that this happened before we understood the worth of therapeutic presence or how that presence grows when we are knowledgeable and skilled. Somebody failed to understand the problems inherent to therapeutic absence.

          Unlike astrologers, physical therapists act as they do because studies have shown that certain behaviors or provocations lead to predictable results. At least, that's the way it's supposed to work. We run into trouble when our theoretical constructs don't match the real world. When we discover finally that what we thought was helping wasn't really affecting the target tissue in the desired manner, the effect of our presence becomes more clearly defined.

          Each day, I am reminded that my treatment techniques might be identically employed by any number of people with only a fraction of my knowledge or experience. The patient's tissues might be altered in the desired fashion, but without my presence, an essential and immeasurable aspect of the therapeutic effect is lost. This would become evident in the way the patient described their care, and in how much they knew about caring for themselves.

          Astrologers don't often predict the future with any accuracy, but a good one offers solace, comforting platitudes and a sympathetic ear. Therapists can do this and a good deal more because our theories of cause and effect are decidedly more plausible.

          But we have to be present to do it.