Building self-determination in our patients

“What I find so hard to understand is how I continue to improve without seeing you regularly!”These words, paraphrased based on my memory, were recently said to me by a patient. I frustrate new patients when they ask me how frequently they should be seen, and I reply with a non-reply: “when you think it’s time.” I tell them that their improvement should not be contingent on the frequency at which they are seen, no matter how long an issue has been present. This comment contrasts sharply with admonitions by clinicians that frequent treatment is needed to resolve muscle/tissue memory, change habits and patterns, and other rationales. I was taught those scare tactics and passed them on for many years, but long ago stopped. While change sometimes takes time, who are we to tell another what their trajectory path will take?

I believe that one of the most critical aspects of change is not strengthening or stretching but an allowance that chance is possible. While the rituals of exercise and stretching can be helpful, for some, perceiving yourself as capable of change is vital. Tissue/muscle memory may not lie in those tissues but as a construct of our consciousness and view of ourselves. Based on little change or diminishing function in the past, some lose an ability to see themselves as able to change. One of the first things I ask from a patient is to ask themselves if improvement is possible. If we finish that first session and they are experiencing feelings not felt in a while, I ask them to try to envision themselves as capable of retaining or moving on from those new feelings or abilities. Many look at me as if I was crazy. “You want me to think positive thoughts?” they might ask. I respond in the affirmative. Continued growth and improvement is our mutual goal, but for now, can they envision themselves as holding these altered sensations and perceptions and growing from there.

Frequent treatment is a standard model for many clinicians, and many patients expect such recommendations from us. I wonder, who does this regular and frequent treatment serve, them or us? Don’t take me the wrong way; some seem to benefit from more frequent intervention, but when we make those recommendations, question the source. Try as we might, our biases are strong. Seeing ourselves as an objective file cabinet filled with clinical data to make an accurate recommendation on session frequency is lunacy. We see our successes and minimize those failures, an inevitable aspect of clinical life.

My suggestion? Under recommend and work to elevate their potential. Then allow them to do the rest.

Walt Fritz, PT, Foundations in Manual Therapy Seminars

www.WaltFritz.com