What I don't do

[Barrett Dorko]

Thirty spokes converge at the wheel’s hub, to a hole
that allows it to turn

Clay is shaped into a vessel, to enclose an emptiness
that can be filled

Doors and windows are cut into walls, to provide
access to their protection

Though we can only work with what is there, use
comes from what is not there

Lao Tsu

My method remains a mystery to many despite the fact that a YouTube video displays it pretty well.

Perhaps emphasizing what I don’t do will help. I don’t take people anywhere but, unless they’re dead, fully expect active, unconsciously generated movement that leads to the characteristics of correction. I don’t coerce them in the sense that they feel compelled to follow my lead. I don’t do this because I don’t know which way that would be. I don’t continuously ask them if what is happening “feels good.” Correction is far more complex than that.

We are all of us in a vessel, and we’re not alone in there. What I do is simply empty this place of the cultural constraints placed upon movement.

I remain.

[Barrett Dorko]

Has anybody here watched the video?

What do you suppose is going on?

[CDano]

I've watched many times now, it's fascinating. I've been letting the concept sit in the back of my mind for a while.

I wouldn't mind more 'explanation' about what's going on treatment wise.

But what i think i get is that you create a social situation that allows his natural ideomotion to not be repressed and it does it's job of resetting the mental circuitry.

I'm really interested in this from a movement therapy perspective as well, and wonder how it would work in the context of a yoga like situation, without moving into the realm of the weird or sensual.

That's not in any way meant as a jab BTW Barrett as i think you have already brought up many times the problem of 'socially acceptable' movement.

The other thing i am reminded of watching that is the kind of 'silly' movements i'd do a as kid. And improvised movements i played with in my martial arts period.

Is the improvisation the key element here?

Not sure this is the kind of feedback you're looking for, but someone has to take the first bite.

[Barrett Dorko]

I wouldn't mind more 'explanation' about what's going on treatment wise.

I appreciate your asking.

He's moving correctively and notes the characteristic of that motion as he and I speak. EVERY portion of his nervous system is affected.

I presume he's moving through resolution.

Surely you don't presume that I'm treating a certain part or that I wouldn't work with the patient in other positions.

Simple enough?

[byronselorme]

I'm with Cole on this Barrett.

I have been thinking about how to create this kind of environment for a group (if that is what Cole is thinking). One of the main reasons being that I understand many people with Chronic Pain also aren't usually in a strong financial position. A group setting helps make a reasonable living for the provider and gives access to those who couldn't manage one-on-one sessions.

Maybe it is completely unrealistic. I see this almost happening in Feldenkrais except the movements are choreographed (as far as I have found) and the instinctive is still not accessed.

[Barrett Dorko]

I've never done this with a group.

Arguably, improvisational dance is the least painful and ballet the most.

[CDano]

Originally Posted by Barrett Dorko

I appreciate your asking.

He's moving correctively and notes the characteristic of that motion as he and I speak. EVERY portion of his nervous system is affected.

I presume he's moving through resolution.

Surely you don't presume that I'm treating a certain part or that I wouldn't work with the patient in other positions.

Simple enough?

Yes that's really simple and pretty much what i've understood. My question more relates to what are YOU doing when you touch him, it's clearly a very light touch, so you're not pushing him to move a certain way. What is the role of touch though? I also notice you move the contact point. In this case first the upper back and then neck as i recall.

Is it all basically spontaneous?

[CDano]

Originally Posted by byronselorme

I'm with Cole on this Barrett.

I have been thinking about how to create this kind of environment for a group (if that is what Cole is thinking). One of the main reasons being that I understand many people with Chronic Pain also aren't usually in a strong financial position. A group setting helps make a reasonable living for the provider and gives access to those who couldn't manage one-on-one sessions.

Maybe it is completely unrealistic. I see this almost happening in Feldenkrais except the movements are choreographed (as far as I have found) and the instinctive is still not accessed.

I don't think it is unrealistic Byron, i'm seriously thinking about it. Of course the marketing side is always going to be my downfall. Right now i'm just thinking of how to experiment with making it a small say 5 minute part of a class. Improvisational warm up, i don't know...

First i need to understand it more, Barrett i'm glad your asking us to ask you!


Feldenkrais has become an organization, if it's anything like Iyengar or Ashtanga, it's no wonder that things have become fixed.

I do think that there needs to be some sort of context to doing it but it also shouldn't be a contact improvisation session.

I have used ideomotion on myself and am really amazed at how it works.

I also think that the same could be done with DNM.

I'm with you not everyone can afford treatment, and this kind of thing could also serve as a kind of tertiary care or just a neural tune up.

[Barrett Dorko]

The deformation of the skin is sufficient to bring attention to the part.

Sequence is arbitrarily chosen.

[CDano]

Originally Posted by Barrett Dorko

The deformation of the skin is sufficient to bring attention to the part.

Sequence is arbitrarily chosen.

What if it were say lower limb pain?


Is the deformation necessary?

Do you have any qualms with trying a ideomotion in a group setting? Any recommendations?

[Barrett Dorko]

Do you think location tells you what to do? Don't you know that a change anywhere in the nervous tissue is a change everywhere in the nervous system? Do you think the model's legs didn't change? Do you think if I handled his legs he would change mainly there? Do you think handling people for a certain location of pain in a certain sequence is ideal? Do you think that this is like changing the oil in a car? Don't you think that if I knew what an ideal sequence of handling would be I would have written that down somewhere?

Am I getting through to you here?

[nari]

Cole,

I suspect that many PTs have difficulty letting go of the control thingy: that PTs have some control in eliciting their patients' responses to therapy. PT gives directions on how to do, say, an exercise routine and when the patient feels better for it, they think: OK, what I physically did with them helped, so I'll continue prescribing.

It really helps if you tell yourself that with SC the PT does nothing.
No hints, no coercion, no talking, no pushing or suggestions. OK, touch is often employed, but ideomotion can occur without touching. When Barrett says:

....that a change anywhere in the nervous tissue is a change everywhere in the nervous system?

you have to think of a global response, not one country at a time. A submarine earthquake off the coast of Chile causes destruction in Japan and all that.

Enough rambling...

Nari

[Barrett Dorko]

Nari,

You've got it.

Without exception, people will ask, "But what if it hurts over there? Where would you start? What sequence should I use? What's the best way to proceed? What if nothing happens? What if I don't perform miracles? Why don't you just tell me what to do? Suppose the patient doesn't like this?" And on and on.

Can you tell I'm sick to death of this?

[keithp]

Originally Posted by Barrett Dorko

Can you tell I'm sick to death of this?

In the context of what Nari mentions, this simple (contact) line of thinking is just so foreign to most of us US-trained PTs. You know we have been taught to be analytical, understand the mesoderm and to trust in our analysis. Have you ever seen the episode of House where he gets shot and he is trying to cope with hallucinations? I saw this last weekend for the first time and thought that my practicing Simple Contact must be similar to him purposefully killing his patient with the swollen tongue (hoping someone gets the reference...if not, sorry).

I remember, when I first began working with peds and working with an NDT approach (as a student/new grad I took a couple of courses with Lois Bly), people used to remark on how "good" my hands were and I had a sense of how to work with a patients, gently. Even then, though, I was guiding...there were certain movements that I was looking to coerce from my patients, developmentally. That, of course, was before transitioning to the world of all things "orthopedic".

Now? I have lost all that was once intuitive (the culture stripped it from me, with my consent), and wonder how I will find my way back to something that is less contrived (not contrived at all). I know that this will involve shutting up, being simple and letting go of the control that I have been taught for years that I need to display, but it continues to be challenging...especially when you don't want to look like a fool in front of your patients (who are part of a culture filled with preconceived notions and expectations of what your role should be in their rehab experience). Then there are the bosses that we don't want yelling at us (for any number of reasons)...

I think the questions on technique are born from fear and insecurity. with the hope that the method will become apparent to the therapist with a few "success stories" (in no way am I speaking of Cole directly, more to the questions you are often asked from above). I understand that this is not how it works, but fear remains a powerful thing, does it not?

If it helps, I take a little bit more from every thread like this one, and I am glad you continue to answer our questions.

Respectfully,
Keith

[proud]

At the risk of perhaps exposng myself a bit...

I have had a number of patients who have been through the Physical therapy ringer so to speak and I have made some feeble attempts at ideomotion in these cases.

Here is the problem I encounter and I hope I can be guided a bit:

Patients generally haven't a clue what the hell I am doing (despite my efforts to provide the patient with some context prior). They just sit (or lay) there as if waiting for me to do something.

They seem to stiffen up rather than softten. If they do start to move it's always most certainly not ideomotion....then they say...."like that?"...."I don't understand what you what me to do?" I had one patient with chronic upper trapezius pain ask me "should I twirl me feet?" I said "sure"....and he did....he got stiffer....no characteristics of correction that's for sure.

I feel lost....they feel lost....and nothing happens. Ship abandoned.

The video was helpful but may I suggest a video where we can see ideomotion in action under actual clinical conditions (ie..not a presentation where the students are being taught while in the process).

I just would like to know a bit how the stage might be set to elicit this motion.

[Barrett Dorko]

"Setting the stage" begins with the way you tie your tie in the morning.

Work on that, the rest will take care of itself.

[nari]

Can you tell I'm sick to death of this?

Barrett, yes you sound a bit frustrated (euphemism) but you have had a very long exposure to the concept of ideomotion.
I might end up digging myself into a hole here but here goes:

1. Simple Contact is simple in application but its neurophysiology is complex. The brain rules over the blob at the end of its stem; it knows about the patient's pain experience better than any PT could.
2. Surrendering years of study and work concerning the human blob is no mean feat.
3. It helps to be dissatisfied with what we do to bodies in clinics and to be on the lookout for something which "works" better. My background in neurology for about 14 years probably helped me with that conversion from dissatisfaction.
4. What bothered me were the persistent pain patients I didn't help much in the orthopaedic arena. There had to be something better.
More specifically:

Keith,
I appreciate your concerns over bosses and patients thinking you have lost the plot. It's much easier here in Oz because we have no bosses, only heads of departments and we have total autonomy to do what we think best. It is clearly a different system in the US.

I used SC first with those patients who had been through the mill of docs, PTs, reiki, psychologists and mind-benders (OK, I made that last one up). They were willing to try anything but had misgivings about anything to help them resolve their pain. First up, some pain ed to clear up myths about pain in the tissues. I even wrote on the whiteboard with one doubting patient: Brain rules, OK? That cracked her up and she was all attention after that. One can be lucky.

Proud,

Setting the stage depends on how the patients present. They can be depressed, meek and apologetic or just pissed off.
Do you find out a lot of history first?
There are drawbacks with that approach (I'm not saying you do) because they relive their anxieties, fears, misery all over again, so by the time it's over they are possibly more in a tizz than before. Pain ed will assist in setting the context of allowing instinctive movement to arise, and with that new information, you may have more success.

They seem to stiffen up rather than softten. If they do start to move it's always most certainly not ideomotion....then they say...."like that?"...."I don't understand what you what me to do?" I had one patient with chronic upper trapezius pain ask me "should I twirl me feet?" I said "sure"....and he did....he got stiffer

Hmm, they are looking for direction and orders of the day, and if not, they make it up with conscious random movements.
Try, beforehand, to ask them not to think about anything or do anything. Just stand (or lie, or sit) and wait. A hand placed on the forehead or sternum (if it's a male pt!) or anywhere, really, will be picked up by the pt's CNS. Talk tends to interrupt the CNS' business.

Context is crucial; quietness, confidence and interaction mode.

Nari

[Barrett Dorko]

I think we're into the realm of "telling another how to practice" (at least, that's what I call it), and I don't do that.

Screwing that up is each individual's job.

I've certainly done it often enough and will continue to do so until I stop seeing patients.

[nari]

Hmmm....What I figured were generalised examples of 'practice' apparently don't help an understanding of what is going on within the patient's and PT's mind.

OK.

Nari

[Diane]

Originally Posted by nari

Hmmm....What I figured were generalised examples of 'practice' apparently don't help an understanding of what is going on within the patient's and PT's mind.

OK.

Nari

Nice try though.

[regnalt deux]

Originally Posted by Barrett Dorko

"Setting the stage" begins with the way you tie your tie in the morning.

Work on that, the rest will take care of itself.

I agree, Barrett. The stage is our very own personal construct of reality. It’s important, IMO, to enter into therapeutic relationships with this notion in mind. At which point, this subtle shift in context creates the possibility for an authentic interaction and, quite possibly, the unfiltered expression of an individual’s nervous system.

[CDano]

Originally Posted by Barrett Dorko

Nari,

You've got it.

Without exception, people will ask, "But what if it hurts over there? Where would you start? What sequence should I use? What's the best way to proceed? What if nothing happens? What if I don't perform miracles? Why don't you just tell me what to do? Suppose the patient doesn't like this?" And on and on.

Can you tell I'm sick to death of this?

But of course we are going to ask this Barrett.

I'm sometimes get sick of teaching triangle pose. But i realize it's often because many students don't want to be taught.

When one comes that does, i'm suddenly very enthusiastic again, and don't mind if they don't get it the first of fiftieth class. I don't care if they are slow learners.

I want to learn, that doesn't mean i know now, or ever will.

What you are saying is about as far out of the rabbit hole as one can get. I think i'm getting there theoretically but not yet practically.

Compared to SC, DNM seems to be very area specific, so i suppose i was somewhat mixing them. That said how do you and Diane get along so well considering your different approach? Is it not so different after all?

Is the video a typical example? What are some other situations that have arisen in treatment. No matter that they are arbitrarily chosen.

Do you sometimes not touch the patient at all?

You're not doing anything but it starts with how you tie your tie in the morning? Do you mean it starts with the attitude you have, that you get that you aren't doing anything, are confident in that fact, and somehow that is communicated via your very demeanor?

And maybe the most difficult question, please don't slap me too hard. If you aren't doing anything, why isn't enough to shake someone's hand, or get a hug....?