Lessons learned from leaving physiotherapy

Three years ago I stepped away from my teaching job in the physiotherapy programme here at AUT University, in Auckland, New Zealand, to manage a team of psychology and psychotherapy lecturers and researchers.  The secondment comes to an end in a few weeks time and it's given me an opportunity to reflect on what it's like working with people who think and work completely differently to physios.

The first thing that struck me about my time with the 'psy' disciplines is how little time physios actually spend thinking about what they do.  Personal therapy and supervision are absolutely intrinsic to the profession, and no-one here believes that you can be a mindful practitioner without also taking time to think deeply about your work.

Psychotherapy students, for instance, might spend 50 minutes with a client, and then the next hour with a supervisor talking about what they thought.  Each will also then have their own personal therapy, in which their thoughts and feelings are explored.  And all of this is designed to help them be better therapists.

Imagine, for instance, that a student is working with someone who is anxious and depressed because of childhood experiences of a bullying, violent parent.  The therapist might, themselves, have their own experiences of this, as might their supervisor.  So both spend time working through their reactions and responses, so they don't pollute the session with their own anxieties and can focus on offering good therapy to the client.

Of course, this all takes time, and one hour with a client might have 3 or 4 hours of support work behind it.  But I find it interesting that physios aren't encouraged to relate to their clients in this way at all, and that at no time in the history of the profession have we, as educators and professional leaders, really thought this mattered.

Psychotherapy students spend a huge amount of time thinking about, analysing and utilizing transference and counter-transference in their therapy, and these concepts are so relevant to the work of physiotherapists but, again, we do nothing with them.

Transference happens when a client projects feelings about someone (classically a parent, but it could also be a significant other person, like a coach or teacher) onto their therapist.  The therapist has to recognize this and manage it.  Sometimes the therapist makes the client aware of it and opens the space for them to explore why this might be happening.  Sometimes the therapist uses it to model how parents/significant others might behave differently.  At other times they might try to block it.

At the same time, the therapist has to recognize that they might also be projecting feelings of their own onto the client - particularly if they remind them of someone else important to them.

The point is, this is complex stuff and takes time and training.

Think about the times you've been frustrated by a client who won't do what you want, or the person with chronic pain who seems to be demanding or needy.  And what about the practitioner who has an inappropriate relationship with a client, or the supervisor who seems to enjoy bullying their staff or students.  Are these not instances where transference is being played out in the physio clinic?  Are these not things that we could, should, pay attention to?

Of course, the objection will be that the physiotherapy curriculum is far too full already, and there's no space for any new material.  Some might also reasonably argue that things like transference and counter-transference are the province of the 'psy' disciplines, and don't belong in the 'phys'.

But if leaving physiotherapy for a while has taught me one thing, it's that no-one holds a monopoly on these ideas and that if we are truly patient-centred, we'll do whatever we can to help people manage and recover.

Having said that, all of this might just be me transferring my frustrations onto you like a disappointed parent.

I should probably talk to someone about that.