It is recognized that within the therapeutic process, a physiotherapist may take on a number different roles like curative, mentor and a counsellor. In relation to counselling, it is argued that physiotherapist 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 frame work clinical practice. 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 more in an expert, curative role, providing treatment from the perspective of their professional expertise. While more senior physiotherapist seem to endure 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 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. At times a gentle touch will allow a quicker exchange of information, for example when the physiotherapist would like to know which areas of the body are free of symptoms. The physiotherapist may gently touch, for example the knee of a patient in order to interrupt their somewhat garrulous dialogue, so they can highlight an important aspect of the information given to seek further clarification.
Congruence of verbal and non-verbal communication essential eye contact is important, as in a safe environment in which not too many outside disturbances hinder the establishing of an atmosphere in which patients can develop trust to disclose the information which they think is might be compromising. It is important that the physiotherapist paid attention not only to what is said, but also to how it is said. Often the body postures or the intonation of the voice or certain keywords and phrases gives indication of the individual illness experience, especially if certain words are used which may have a more emotional content. These may be clues to the patients’ world of thoughts feelings and emotions which may be contributing factors to on-going disability due to pain. 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 and its impact on the patient’s life. 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 treatment, as well as in each session, it is important that the physiotherapist shapes the interaction deliberately with the patient. Usually three phases of any counselling with the patient during the treatment that are:
- Initial phase
- Middle phase
- End phase
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 back 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, 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-management strategies can be given to the patients.
It is sometimes very useful to ask the patient to reflect on what has been particularly useful 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. However when the more complicated procedure of the session are completed, the patient reveals information on the individual illness that may be highly essential for the therapy. If patients reveal personal information, it is essential that they are given the freedom to talk as much about it as the feel necessary.
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.
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