It is recognised that within the therapeutic process, a physiotherapist may take on a number of different roles like curative, mentor and a counsellor. In relation to counselling, it is argued that physiotherapists may often be involved in counselling situations, without being fully aware of it.
The use of counselling skills may be considered as distinct from acting as a counsellor, the latter being the function of physiologist, social workers or psychiatrist. However, it is recommended that every clinician learns to use counselling skills within their framework clinical practice or physiotherapy clinic.
It appears that over the years of clinical experience, physiotherapists view their roles with regard to patients differently. As junior physiotherapist they may consider themselves to play more of an expert, curative role, providing physiotherapy treatment from the perspective of their professional expertise, while more senior physiotherapist seem to prefer to meet patients’ preferences of therapy and engage more in social interactions with the patients, thus considering themselves more in the role of a guide or counsellor.
Communication with Patients
Communication is an important part of physiotherapy techniques and consists of various components that include verbal and non-verbal components.
It is important that the physiotherapist creates a setting in which a free flow of communication is possible, allowing an uncomplicated exchange of information. Attention to the physical distance to the patient, not too far and not too close, often enhances the process of information gathering.
Attention to these aspects often allows the physiotherapist to perform a psychosocial assessment as an integral part of the overall physiotherapy assessment.
Many details are asked in order to be able to make a diagnosis of the movement disorder, pain (especially chronic pain), their causes, as well as the impact they have on the patient’s life.
Understanding the patient’s needs is a vital part of the upcoming treatment phase, as treatment can vary depending on the location of the pain (such as lower back pain treatment versus neck pain treatment), longevity of the problem (acute versus chronic low back pain), presence of other symptoms apart from the pain (such as stiffness), as well as the patient’s preferences to treatment.
If the physiotherapist carefully shapes the interview, pays attention to details such as selection of words and body language and explains regularly why certain questions or interventions are necessary, the patient will learn what information is of special relevance to the physiotherapist and pay attention to this.
Various Phases during the Interaction with Patients
During the overall series of back pain and neck pain treatment, as well as in each session, it is important that the physiotherapist shapes the interaction deliberately with the patient. Usually, there are three phases of any counselling with the patient:
- Initial phase
- Middle phase
- End phase
The INITIAL PHASE is for developing a good relation between physiotherapist and patient that takes place on a more personal level in order to establish a first contact. The questions of the patients may be addressed with the objective of explaining the types of complains from different other patients. It is necessary that in this phase the process of collaborative goal has started.
Working on the treatment objectives and using interventions is the MIDDLE PHASE of the interaction with spinal pain patients. It also includes regular reassessments to confirm the positive effects of the selected treatment interventions. It is important that all aspects of goal setting and selection of parameters are defined in a problem-solving process between the physiotherapist and the patient.
IN THE LAST PHASE of the session for the back pain treatment, attention to the patient’s questions, recommendations and instructions like self-help pain management strategies can be given to the patients.
It is sometimes very useful to ask the patient to reflect on what has been particularly helpful in the current treatment session and what has been learned so far. Often the information at the end phase and in the last sessions of the treatment series are mostly neglected due to lack of time.
Listening to the Patients
In order to stimulate a safe environment in which a free flow of information can take place, the development of listening skills is essential. Therapists may well hear what they expect to hear rather than listening to the words the patient uses.
Giving advice too quickly, offering a single solution, talking someone into a decision or even commanding may hinder the process of activating the patient’s own resources in the problem-saving process.
If possible, it is better to guide people by asking questions rather than telling them what to do. This is particularly essential in the process of collaborative goal setting in which the patient is actively integrated in defining treatment objectives. In this process it is important to define treatment objectives on activity and participation level which are meaningful to the patient.
Ideally the therapist may offer various interventions from the perspective of professional expertise to reach the agreed goals of back pain treatment, and the decision is left to the patient to decide which solution may be best for the problem.
An aid to many physical therapists is the Spinal Backrack, a wooden device that has been designed to mirror the natural curved shape of the spine and reduce pain, stiffness and discomfort with the help of exercises that are performed while laying down.
Backrack Spinal Decompression Device
Author: Spinal Backrack