Barrett L. Dorko, P.T.
Like many of you, I see patients that have been through care elsewhere before coming to me. I know that a certain percentage will leave my practice and end up with another therapist as well. This kind of movement does not, in my opinion, mean necessarily that some caregiver along the patient's path was not doing their job properly. The nature of illness and the management of health care are far too complex to draw that conclusion.
But I'd like to think that the stop people make in my office is at least near to the last they need for their painful problems. I want to give them things to do that they can use effectively on their own outside the treatment room. I tell them, "The really good stuff is the knowledge, understanding and movement you take from here, not the few things I can do to you."
That might not sound like something that a therapist who emphasizes manual care would want people to know, but I concluded long ago that the materials of the body were phenomenally resistant to forceful change in my hands, and that my job manually was to reveal things, not create them.
Most of you have probably heard that some carvers will maintain the attitude that the figure they seek to carve will emerge from the wood or the stone. In a very real sense, they "see" the figure within and do no more than is necessary to reveal it. I'm sure they handle their materials with unusual care.
For me, manual care is largely a matter of handling people in a way that encourages their posture and processes to move toward poise and parasympathetic dominance. Precisely how I do that is best left for a workshop, but I think I can speak here of how I verbally encourage patients to do this when I'm not with them.
It might be logically assumed that most of the patients we see hurt because they are mechanically deformed beyond their tolerance. They needn't be injured for this to occur, so methods of management that promote healing are not usually going to help.
This being the case, movement, is the key to correction and relief. Such thinking boils therapy down to a single issue; Which movement?
A metaphor I use when speaking to my patients about corrective movement involves how anyone might make progress when trying to leave a dark, cold, thick forest.
I can get them to agree that the path out would not include movement directly into the truck of a tree. I tell them that effortful motion represents hitting a trunk, and that when movement effortlessly occurs, that is what will carry them out into the light, where they are warmer, and their options for easy motion increase.
It has been my experience that this motion can rarely, if ever, be imposed upon another by a therapist. It would be really nice if this were easily and quickly done, and I spent a few years looking for techniques that would "carve" my patients into the shape I wanted, but I never found any that lasted. Maybe I wasn't pushing in the right way. Maybe.
I found one day that corrective maneuvering, that which ultimately softened and warmed the body, was present almost without exception, but it was not predictable in its direction or length or force. I couldn't see it any more clearly then I might see the path in the forest once it wound around the trees before me. I also found that, at times, the path had a few brambles in it and, though painful, it was still effortless and warming.
If you can get this metaphor across in an acceptable and understandable way, you have just one more job to do. You have to make it clear that the patient is capable of sensing the path, but only if they allow their unconscious inclinations to grow. They must stop posing and posturing and trying to decide how to fix themselves. They must simply let themselves express their desire to move, not look for correction in the hands of the therapist.
Maybe while making the trek from one office to another, the patient will wander into a place where the caregiver sees a healthy individual inside them. When this happens, the hands of the therapist do no more than reveal the painless shapes that the patient has simply not yet expressed. And then they are encouraged to continue to walk that path when out of the clinic.
Of course, a therapist can't really do this unless they have gained a sense of their own corrective tendencies.
Perhaps learning to move through my own forest is what makes my office the last stop. At least, sometimes.