Saturday, February 18, 2012

New treatment encounter III

See Part I
See Part II

This series is all about container building. You are constructing a treatment relationship with a new patient, and you only ever have one shot at it. It's important for each of us to learn how to do this properly, from scratch, every time, and not screw it up.

This is the only thing you are entirely responsible for.
Everything else about getting better is completely up to the patient, and whatever sort of "relationship" they can then go on to build with their own nervous system. (Their brain will use the one you are building with the patient as a template for the relationship that emerges two nanoseconds later between the patient and the patient's own nervous system, the very same one that brought them in with a pain issue. And it will let the patient think it was all his or her own idea! How clever is that?)

Can you see now why it's important to talk to them about all this? In Ectoderm-ese? Brains do nothing but predict, construct and test models. They construct a version of "reality" and try to get it to match what's coming in every second of their existence. And they are pretty good at doing their job - brains have been around a LOT longer than humans have. So, your patient's brain will automatically model something new based on what you are saying, so whatever you're saying better be something half decent: truthful, relevant, science-based. Otherwise you'll just (at best) confuse them more, and (at worst) alienate them further away from themselves, from their own survival machine, operation system, threat detector, their own nervous system. You have to figure out how not to do that! They NEED that system, and they need to learn to befriend it, help it, instead of blaming their meat body for pain, the usual story that has gone on far too long in the Mesoderm-ese language that evolved outside the understanding of what a nervous system is and does and needs.
In the treatment room, everything you are, say, do, think, every way in which you respond, act, dress, smell, becomes some sort of raw material for the patient's brain to throw into its predictive machinations. Therefore, I cannot stress enough how important it is to simultaneously remain contained, responsive, and be strategic, and thereby as effective as possible with your teaching.

Anyway, we've explained in broad brush strokes to our patient the story of this operating system they have/that has them, what it consists of, what it does, and what it needs. We moved the story out to the periphery, out to skin, where we'll be working. The patient has new pictures in their mind, now, about what's going on in their "body". When you handle them, they will be much more aware of their sensations and will be able to help guide you. You can fill in more detail as you go along, after you start treating, but you and the patient are not quite ready to start just yet. There is an assessment to conduct, and a few more pictures to look at.

The assessment should be done in Ectorderm-ese as well: this means, when you look at the patient standing and moving, all the usual asymmetries commonly noticed by human primate social groomers will no longer be viewed as defects in mesoderm. Instead, they will be viewed as outputs, or defenses, of ectoderm, of the nervous system, trying to protect itself from its own meat suit.

Let's get one thing straight here, because this is a common mistake therapists make all the time - viewing meat or any other kind of mesoderm as some kind of bad guy, troublemaker, villain, root of all evil. Mesoderm is NOT a bad guy, most of the time. It is space filler, anti-gravity-suit, often usefully contractile, but it has no "behaviour" of its own, particularly..  - it's an E-ffector puppet way at the far end, the output end, of a nervous system which (usually) has learned to use it improperly, to its (the nervous system's) own detriment, for whatever reason. In Mesoderm-ese, it is suspected of having committed all sorts of crimes that have resulted in "pain" right off the bat. In Ectoderm-ese, we know better - we know mesoderm is to be considered innocent unless/until proven guilty. Which is really rather rare.

It's likely a good thing to explain this to your patient. It is usually welcome news to them.

The assessment will give both nervous systems involved, your own and your patient's, more time to get to know each other on a level that is much less verbal, way more visual, and kinesthetic. All the senses will be wide open. Your patient's brain will be acutely aware of you looking at it. It's a precarious time for a new patient - they are coping with tracking you intently, trying to understand what you're saying, feeling a bit weird perhaps, because your language is so unfamiliar to them, yet so interesting and makes so much sense on so many levels that they want to know more. You must never ever ever breach this tender trust they are extending to you. Ever. Be careful. Be honourable. Be gentle. Together the two of you are setting out to tame some frantic creature the patient never even knew existed, and your next job is to show them how. So be kind, move slow. Always have smooth warm clean light intelligent responsive and effective hands.

At some point you will get a sense of what you need to do, which nerves you will want to address first. Often they will be the ones in the zone the patient has complained to you about already. There might be others elsewhere, maybe on the other side of the body that you also want to look at (with the little eyeballs at the ends of your fingers), but it's usually a wise (and courteous) move to physically examine the part the patient is most worried about, first.

Before we start treating, though, I pull out another binder full of pictures of nerves to show the patient, pulled from anatomy books. I want them to know that each nerve has a name, a place in the body, that maps of them exist, that they come out to skin, that when I touch them, I'll be visualizing these yellow (usually, in anatomy texts) noodle-y looking strands that are woven through their meat and around their joints and out to their skin and down to their hands and that they are layered, like shingles on a roof. I tell them which one I'm going to visit first, and why, so they know. Then we start.

I treat horizontal people. I want my patients relaxed into gravity. I want them comfortable. I want them warm, so I offer them a light warm fleece blanket, which they accept unless they protest because of feeling too hot. Most people who have persisting pain feel cold, so they are usually happy to have a warm blanket. I tell them "a warm nervous system is a more cooperative nervous system", and they usually agree.

I land carefully. Remember what I said about their nervous system being on high alert. You are a new person to them, so there is a lot of anticipation mixed with a lot of novelty mixed with some dread, probably. Try to make life easy for them - they've got a lot of mixed-up emotional stuff to stay on top of, to stay contained in their end of the treatment relationship. Plus, their nervous system is going to have to check you out again, this time using its kinesthetic capacities. Who is that touching my organism? Is it a bear? Do I need to get ready to fight? Flee? What?

If you have set up the treatment relationship properly, the patient doesn't have to fight any urge to flee, or hit you. You have told them to tell you if any contact you are making, any way you are gripping them or handling them is uncomfortable. You've explained why that would be counterproductive, how this acutely sensitive learning machine called the nervous system already is way too good at constructing something called "pain" out of something else called "nociception", so you do NOT want to add more nociception to the mix. They feel they can trust you, that if they indicate discomfort you'll back off. So they're calm. Instead they can focus inside themselves on their own interoception, appraise their own sensations and the turmoil from a detached calm place, let it roll by. They will be able to observe their own nervous system running its own threat detection operation without getting involved in it, or flooded by it.

More to come, suggestions about what to do "if".. 
New treatment encounter Part IV
New treatment encounter Part V
New treatment encounter Part VI

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