A Clinical Example of Self-Development

A clinical example of how physical therapy can lead to patient self development:

I had a patient that I evaluated and treated for low back pain from a work injury. She stated that over the last few years she had gained a lot of weight, been depressed from living with an alcoholic for years, and was so fatigued from having to drive so much for work. She faithfully came into physical therapy for manual therapy treatment and exercises. We talked a lot about her finding a room or a space in her house that could be her own space to exercise, do self corrections, and knit. She called it her “happy apartment”.

We also talked about different things she could do to bring more positive people and activities into her life. She was very compliant to her home exercise program and felt good about doing something positive for herself. After about 12 visits she came in and was so proud that she joined a gym and had started attending three times a week. She also stated since coming to physical therapy she is more confident and is feeling better which gave her the courage to ask for a transfer at work to allow less driving and so she could attend her gym more frequently.

She had 24 visits authorized for physical therapy but only used 14 of them before being pain free and compliant with attending her gym 3-4 times a week. She had started going out with friends, playing golf and was enjoying her new work schedule. She frequently stated that she was so grateful to have someone that would listen and encourage her to take care of herself and improve her life. She said she plans to stop by in 4 months to show me all the weight she had lost. Not only did she return to work full duty pain free, but she was able to return to living and caring for herself.

Self-Development a Cornerstone for Patient-Centered Care

Self-development: Improving patients’ therapeutic outcomes by focusing on being the best therapist you can be.

Self development is about growth and responsibility. It is being dedicated and open to learning new things about yourself, willingness to grow professionally and personally, and becoming more compassionate towards yourself and others. It is in this growth that you can let go of your ego and be more present to improve a patient’s experience and outcome. If you are not working on improving yourself it is difficult to help empower others to improve circumstances that may be resulting in their physical complaint. Without a commitment to self-development, it is difficult to see further than your own personal and professional problems making patient-centered care less than a reality.

A Clinical Example of Self-Awareness

A clinical example of how self awareness has improved a therapeutic relationship for me is as follows.  I was performing an initial evaluation of a woman complaining of (it has just dawned on me that in our notes writing of a patient’s complaints or what they are complaining of is a very negative almost condescending way at looking at what they are sharing with us) L hip pain and low back pain. Her past medical history included multiple scelerosis (MS). She presented with gait deviations, balance deficits, decreased range of motion, weakness, and lumbopelvic movement dysfunction. In my mind I was thinking (like many other health care providers before me) that most all of her symptoms are probably related to MS how I can really change the progression of her neurological deficits.

I became aware that my previous minimal experience of successfully treating patients with MS and my fear of not being able to help this patient had potential to make my ears deaf to what she was really sharing with me. I decided to let go of my insecurities, listen, and really hear what she was saying to me. What I heard was that she wasn’t convinced that her L hip and back pain symptoms were results of her MS, but she was struggling to find a health care provider that would listen and look further than her MS. Her reality was she could tell that her pain was from a musculoskeletal source not her MS. She seemed very passionate about what she felt, so I believed her.

I evaluated and treated her like she had an orthopedic problem not related to her MS. After a few sessions she nervously shared with me that she was reading a book called “You Can Heal Your Life” by Louise Hay and that she had found that part of her balance problem had to do with her left side of her body and her right side of her body not working together, her left side being her feminine side and the right sided being her masculine side. I told her I knew exactly what she was talking about, because I was also reading the same book. I then looked at her as she stood with all her wait primarily on her L lower extremity and having to hold on to the table, and said “Yeah, it looks like the way you stand you are two separate people”. She was unable to even weight shift onto her R foot without losing her balance. I taught her a couple of exercises to do to her improve balance and then she left.

When she came back the next week, she said on her way home after the last P.T. session it all made sense. Her left and right side were like two different people and she was so use to her mom (left feminine side) doing all the work for her dad, and men (right masculine side) were never to be trusted or counted on that was why she couldn’t put any weight on her right leg without losing her balance. So she said she wrote an affirmation about her left and right side of her body working in harmony and practiced the exercises I had given her. She then got up to show me since doing the affirmation and the exercises for a week she could now stand on her right leg without holding on and losing her balance. She had a miraculous recovery and after a few weeks was able to walk normally, go up/down stairs without difficulty, balance on one leg, and walk on uneven ground without a cane. I let go of my ego and let her reality and inner wisdom guide me. Throughout the treatment sessions we both became more aware of ourselves and how we could heal.

Self-awareness during Patient Care

Self-awareness: Awareness of your emotional state and nonverbal language during interpersonal interactions is necessary in creating an open successful therapeutic relationship.

A subjective evaluation is all about verbal and nonverbal communication. The better the communication the sooner a successful plan of care can be established and implemented. Parts of a subjective evaluation are performed every time we ask someone how they are doing, feeling, and progressing each time we see them in the clinic.

 What does it mean to be aware of your emotional state and nonverbal language during interpersonal interactions? To me it means being open and present in the moment not judging, but listening and taking note of what the other person is saying, while being aware of how your emotional state or previous experiences are influencing what you are hearing and seeing. It means being aware of your preconceived notions of the patient’s reality, but to be quiet enough to realize the patient’s reality of their pain and/or injury at that present moment.