Sunday, March 04, 2012

New treatment encounter VI

New treatment encounter I
New treatment encounter II
New treatment encounter III
New treatment encounter IV
New treatment encounter V

The "new treatment encounter" series has been about how to set up a treatment relationship with a new patient. The manual therapy part is probably the least important part of the encounter, yet, for persisting localized interfering pain that presents as mostly mechanical in nature, it seems to be necessary most of the time. So I do not think we'll be getting away from providing it any time soon.

Here is a link to a public post on SomaSimple. If you have burning curiosity about this method of treating someone manually, I have posted a link there to a pdf of a slideshow I use to teach other human primate social groomers what I expect is going on in a patient's nervous system during treatment. It shows a couple samples of techniques, but really, the slideshow is about the underpinnings, as outlined in the previous post, Dermoneuromodulation, the diagram of the conceptual scaffolding. I'll do another series on the various parts contained within it, but first, I want to develop the idea of the neuromatrix model a bit more.

In summary, the all important setting up of the treatment relationship, and the physical side of the treatment, is all about "entering the left side of the neuromatrix," as my massage therapist colleague, Carol Lynn Chevrier in Quebec, likes to say.

Here is the new updated model by Melzack:
As you can see, there are domains on the left where input enters a patient's "Neuromatrix", that always-moving, more-a-verb-than-a-noun aspect of brain function that gives rise to sense of self in a physicality, in a humanantigravitysuit, that fuzzy border zone between critter brain and awareness of being human too, social-self-awareness. What we are striving to do, is assist a transformation of a favourable sort, in that center part, in that part with circular arrows, busily, constantly, churning away. We want different output. But as therapists, we have no control over that transformation. Only the patient, inside his or her own brain (including spinal cord), can make that transformation happen. Only then can there be different output on the right side of the neuromatrix.

We want to see the pain domain shrink, and the action/motor output domain improve, enlarge, soften, become effortless, become warm.
This is what every authentic human primate social groomer under the sun wants to see happen, in our heart of hearts: This is what motivates us - we want to help - we want to see improvement in the life of another human primate who is experiencing physical pain, by interacting with them, physically, manually. By "grooming" them. We want to ease suffering. (OK, I'll stop this train of thought before I get too carried away.)

Usually, if the treatment crucible has been well-prepared, and the various input domains considered in advance, i.e.,  the teaching has been congruent with the patient's own reality (top left domain), the handling has been a pleasant, or at least not unpleasant, experience for the patient (middle left domain), and they were primed to expect to take part themselves, develop a sense of self-efficacy in their own improvement (bottom left domain), it pretty much turns out just like this, every time. Just like water rolling down a hill. It's that easy.

But, like I described in New treatment encounter IV, there are some patients who just do not get it. And if that happens once in awhile, it's nobody's fault - there are just some oceans that can't be swum. When you spend a lifetime doing this, you get better at it, and eventually you enjoy way more hits than you endure misses. But everyone will still have misses. They are inevitable. And... we move on. Keep trying to improve.



Katie Schopmeyer said...

Ms. Jacobs,

I just discovered your wonderful blog yesterday and have gleefully devoured several posts. I so appreciate your perspective, your wit, and your clear compassion for sufferers of persistent pain. I am a PT in San Francisco, newly inaugurated into this challenging and rewarding world (going on 4 years now, a tiny tot compared to you). Thank you for sharing your insights and your expertise!

Diane Jacobs said...

Thank you for finding and reading my blog, Katie. It's not hooked up to any aggregators (that I am aware of).
And a warm welcome to the wonderful world of human primate social grooming, still in its conceptual infancy. :-) It takes a long time for us to figure out what it is we do, especially since there is so much un-learning and deletion of mis-learning that has to be done first, before re-learning can commence.
All the best.