Barrett L. Dorko, P.T.

There are PTs in this country who never use their hands to manipulate, never measure muscle strength or range of motion, never employ electrical or thermal modalities for pain relief.

Still, these therapists "move" their patients, encourage hard and sometimes painful work, and are often a catalyst for change in rehabilitation that is profound and persistent. Their methods of care can be employed by the patient on their own at home, and commonly prove useful for future problems.

I am not speaking here of physical therapists, but "poetry therapists," trained and certified through The National Association for Poetry Therapy,[1] established in 1981. The association has grown steadily since its inception and anticipates 250 professionals will attend its 1995 convention in Baltimore.

The use of metaphor to help patients understand a complex process is nothing new to physical therapy. Poetics are in most instances merely a refinement of the communicative skills we develop over the length of our careers. When our words begin to reveal multiple layers of meaning, enhance insight or elicit a palpable physiologic shift in others, we are expanding the therapeutic environment. Oderwald [2] suggests that the poetical art enhances change by an "indirectness" that invites the person hearing it to neither agree or disagree, but to stop and consider the unusual elements of what they are hearing (and feeling). They might find that poetics offers them a language with which they can now describe their experience. Simultaneously, the one who speaks the poem implies an understanding that transcends the medical jargon that previously had formed a barrier between patient and therapist.

Poetry therapy seeks to do this within an ordered yet creative atmosphere where a person trained to appropriately apply this modality can promote change in the safest possible way.

John Fox, certified poetry therapist (CPT) and lecturer at The Graduate School of Psychology at John F. Kennedy University writes "...poetry at once pulls me inside and connects me with my world. The nuances of metaphor and image are like revived capillaries that relieve numbness and return feeling to my life." [3] These are words remarkably reminiscent of the things physical therapists attempt to do when faced with a patient that lacks sensory awareness.

Looking hard for some entryway into the patient's inner world often lies at the heart of what both our therapeutic communities do. When faced with complex problems that will not respond predictably to provocation, we need an approach that is gentle, potentially harmless, and that will only take the patient so far as they can allow themselves to go.

In the world of manual care such thinking is analogous to the least coercive methods of handling such as strain-counterstrain, functional integration or simple contact.[4] Paradoxically, such techniques often lead to profound and prolonged changes via the reflexive rather that the mechanical effect they have on the body.[5] Similarly, the words spoken by the poetry therapist begin their effect literally by mechanically deforming the tympanic membrane of the patient with a temporal and spatial pattern that may alter them profoundly once the reflexive response is sensed and processed.

An example of a simple poetic line I use regularly in my own practice comes from "Love After Love" by Derek Walcott:

The time will come

When with elation

You will greet yourself

Arriving at your own door...

Whatever else these few words may mean, I say them to emphasize "somatic autenticity"[6] and unconsciously directed movement toward correction. The diminished posing, the shift in autonomic tone and the softening of the musculature that commonly accompanies such movement is the most important effect of manual care.[7]

When the words that accompany handling reflect depth of understanding, compassion and empathy, when these words encourage the patient to search within for the unique and multiple meanings of their discomfort, they enhance recovery in ways beyond measure.

Perhaps it is not necessary to use poetry when we speak to patients, but our most effective words are always poetic. Once we understand this, our maturation as therapists reaches a stage those without it can only wonder about. For me, poetry in all its aspects offers this, and I pass it on to my patients.

1. The National Association for Poetry Therapy

P.O. Box 551

Port Washington, New York 11050

2. "A Different Story: When the Medical Story Meets Itself: by Arko Oderwald Ph.D. The Journal of Medical Humanities Vol. 15 No.2.

3. "The Smallest Sprouts; The Restorative Power of Poetry" by John Fox, CPT The Journal of the Healing Health Care Project Vol.2 No.4

4. "The Use of Simple Contact: by Barrett L. Dorko, P.T. P.T. Forum April 18, 1988 Copies available from the author

5. "Manual Contact and Reflexive Effect: by Barrett L. Dorko, P.T. Physical Therapy Today Winter 1989 copies available from the author

6. Specifically, this is the bodily expression of our desire to move unencumbered by cultural expectations, external direction of willful intent. See "The Lady in the Lace Gloves" by Barrett L. Dorko, P.T. copies available from the author

7. "Sustained Sympatheticotonia" in Neurobiologic Mechanisms in Manipulative Therapy (Plenum 1978) by Irvin Korr He states:"The most critical clinical effect of manipulation is the (reduction) of sympathetic tone."