Barrett L. Dorko, P.T.
I commonly emphasize the principles behind my application of Simple Contact. This is essential in reinforcing the idea that the predominant event within the course of the patient's change is an enhanced awareness and understanding of their movement along the path of correction. Without this, relief will, in most cases, be absent or short-lived.
If the patient requires something other than repair or alteration of chemical processes, then I feel we need to depend on their inherent, self-correcting ability to produce any sufficiently profound or long-lasting change. Since this change emerges from and is controlled by the patient, the therapist must alter their attitude from the usual, "What shall I do to the patient?" to "How can I act in such a manner as to promote correction?"
Such an attitude does not arise from techniques but rather from the principles preceding and surrounding any actual contact with the patient. As Johnson states, "(Principles) are sources of discovery; once triggered they enable the inspired person continually to invent creative strategies for working with others."
1. No pathology need be presentSince pain is commonly associated with injury, the fact that it occurs regularly in the absence of any identifiable break or significant chemical change in the system is virtually ignored in most clinical settings. There is nothing wrong with testing to identify the presence of pathology, but mistakes arise when someone assumes that negative findings to these tests preclude any anatomical basis for the patient's pain.
It can accurately be said that pain is quite commonly present in the absence of injury and that injury can be painless. This is simply because of the nature of nociceptive depolarization. I refer you to the work of Sunderland, Wyke or Grieve.
2. The system is self-correctiveThis principle arose from clinical observation. Patients regularly state that their pain subsides just as often as it appears. I have the impression that if a single maneuver is insufficient for relief that the patient will instead learn how to create an environment conducive to correction over some period of time.
3. Increased awareness enhances correctionThis is not exactly a revelation to anyone familiar with biofeedback. Simple Contact differs only in its methods of enhancing awareness. This is primarily via gentle tactile stimulation and verbal instruction.
4. Simple Contact allows the system to display its problem and its movement toward correction.Simple Contact would only "work" as a technique if it enhanced the patient's awareness of their already ongoing activity and their predisposition to change in a corrective fashion.
The Weber-Fechner law of physiology is the most likely way of understanding how awareness might be enhanced. Perhaps, as Hanna suggests, we have a strong and persistent preference toward "osmotic openness" i.e. a state of predominant parasympathetic activity, allowing us to possess the metabolic and structural plasticity so commonly lacking in our patients.
5. Specific techniques are not used in opposition to certain signs or symptomsAdherence to this principle is at times difficult to maintain but letting this go would significantly undercut a great deal of my basic philosophy of care. Because I so commonly see distant change with Simple Contact, totally unpredictable active movement of every sort as people correct and subjective reports of various sensations concurrent with this movement, I cannot say that a single technique is going to have any predictable effect. If this is the case, how can I be expected to tell anyone what to do for anything?
If we were dealing with a "thing," I could. But the unique nature of each patient makes this impossible. Ultimately, all technique is correct if it does not interfere with the change emerging, if it makes the patient aware of that change, and if it promotes continued movement along the path of correction. The location of the therapist's hands is not always as critical as the nature of their touch.
This is not to say that location is entirely insignificant; just not predictably helpful. As long as contact remains simple, it has never in my experience proven harmful.
Another significant issue arises whenever this principle is discussed; testing and diagnoses. If testing of the usual sort does not reveal the location or nature of the problem, how can we be expected to know how to proceed with appropriate care?
This question goes to the very heart of Simple Contact and the major change the therapist must make in order to use it effectively. If the usual examination procedures do not reveal pathology, I assume two things; the patient needs to change rather then heal, and the best way to proceed is with a method of treatment that reveals those processes that effectively "hide" when the system is provoked or asked to perform consciously. For me, Simple Contact provides the environment necessary for the patient to reveal the problem and grow beyond it.
If the orientation of mechanical stress in the tissues beneath the surface exceeds the available adaptive potential you have a situation that cannot be clearly seen by anyone else. The process of change is palpable, however, and as it is "broadcast" to the surface what should be done next becomes evident with experience.
When someone asks me what I am going to do when they come to see me for their pain, I say, "I'm going to let you change."
6. All problems, all corrective maneuvering are uniqueI try to remember this whenever I start to predict what will happen next or try to tell people how they got to be the way that they are. I feel that the predominant problem is neurologic in nature and if that is the case, it's not surprising that it displays itself uniquely.
When principles are not stated or used to create a treatment regimen, any discernable philosophy of care begins to disappear. Without principles to follow, care either becomes repetitive and generic or may fly about wildly, embracing every new device or idea or technique that claims to work.
I often hear people state flatly that they don't care how something works, just so long as it does. This type of attitude breeds an indifference to investigation and I certainly don't like it. When the modality or the technique becomes the primary focus of attention in any therapeutic setting, the patient is de- emphasized. Without the patient in the forefront, techniques can reach a level of importance well beyond reason. Working to avoid that requires that principles be established and persistently re- examined.
ResourcesPrinciples Versus Techniques Towards the Unity of the Somatics Field by Don Johnson "Somatics" Autumn/Winter 1986-87
Nerves and Nerve Injuries, ed 2 by Sunderland, Churchill Livingston, Inc.
The Lumbar Spine and Back Pain edited by Malcolm Jayson, Grune and Stratton, Inc.
Mobilization of the Spine by Gregory Grieve, Churchill Livingstone
Sensory Analysis by Donald Laming, Academic Press
What is Somatics? Part Four by Thomas Hanna "Somatics" Vol. VI, Number 3