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Old 16-03-2005, 09:49 PM   #1
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Default Hypnosis as an adjunctive therapy for physiotherapists ??

Hello, I'm a 3rd Year Physio student

I am currently researching this topic for my dissertation, my interest lies in pain management and how different people are in how they experience pain. I have no experience of hypnosis in itself , but have often wondered if this could some how tap into the ability that some individuals have to experience things that should cause immense pain but dont appear to such as mutilation, laying on beds of nails etc.

Physio's come into contact with all sorts of pain and suffering and we have vast numbers of modalities to help relieve pain, including branching out in to psychological aspects such as with CBT, so could hypnosis be one more modality at our disposal? there's certainly a huge amount of research that advocates it as an adjunctive therapy.

If anyone has any opinion, thoughts on this subject matter i would be really grateful... even if its to say that physio is becoming too dilute and we should not be diversifing any further.

many thanks - Jo
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Old 17-03-2005, 11:39 AM   #2
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thank you for the speedy reply, i neglected to mention i'm in the UK where there is no formal training or standards council for hypnotherapy, i also thought that there'd be reluctance from the hypnosis/psychologist areana , as yet ive only had very positive feedback, which is great cause we're all in this for the one purpose at the end of the day, helping people.

I've not actually come accross any data saying there's a danger to hypnosis, accept caution with mental illness, i'd really appriciate any references or studies if you know of any on that subject.

Im also swaying towards the interpretation of hypnosis as not being a specail state, more an enhanced placebo effect where patients are basically given 'permission' to induce their own ability to reduce their pain.

it's a facinating subject thank you so much for your reply - jo
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Old 17-03-2005, 03:10 PM   #3
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http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15635514

Reg Anesth Pain Med. 2004 Nov-Dec;29(6):549-56.
Clinical hypnosis modulates functional magnetic resonance imaging signal intensities and pain perception in a thermal stimulation paradigm.
Schulz-Stubner S, Krings T, Meister IG, Rex S, Thron A, Rossaint R.

Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 6 JCP, Iowa City, IA 52242-1079, USA. Sebastian-schulz-stubner@uiowa.edu

OBJECTIVE: This study was designed to describe regional changes in blood oxygenation level dependent signals in functional magnetic resonance images (fMRI) elicited by thermal pain in hypnotized subjects. These signals approximately identify the neural correlates of the applied stimulation to identify neuroanatomic structures involved in the putative effects of clinical hypnosis on pain perception. METHODS: After determination of the heat pain threshold of 12 healthy volunteers, fMRI scans were performed at 1.5 Tesla by using echoplanar imaging technique during repeated painful heat stimuli. Activation of brain regions in response to thermal pain during hypnosis (using a fixation and command technique of hypnosis) was compared with responses without hypnosis. RESULTS: With hypnosis, less activation in the primary sensory cortex, the middle cingulate gyrus, precuneus, and the visual cortex was found. An increased activation was seen in the anterior basal ganglia and the left anterior cingulate cortex. There was no difference in activation within the right anterior cingulate gyrus in our fMRI studies. No activation was seen within the brainstem and thalamus under either condition. CONCLUSION: Our observations indicate that clinical hypnosis may prevent nociceptive inputs from reaching the higher cortical structures responsible for pain perception. Whether the effects of hypnosis can be explained by increased activation of the left anterior cingulate cortex and the basal ganglia as part of a possible inhibitory pathway on pain perception remains speculative given the limitations of our study design.

PMID: 15635514 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15554463

Am J Clin Hypn. 2004 Oct;47(2):103-15.

A continuum of hypnotherapeutic interactions: from formal hypnosis to hypnotic conversation.

Teleska J, Roffman A.

jteleska@aol.com

Hypnotherapeutic interactions can be mapped on a continuum from formal hypnosis to hypnotic conversation. Unlike the structured forms of formal hypnosis, hypnotic conversation relies upon utilizing the client's responses, both verbal and non-verbal, to facilitate therapeutic process. In this paper, we illustrate this continuum with a series of anecdotal clinical examples starting with formal hypnosis and moving incrementally towards hypnotic conversation. Finally, we offer an example similar in appearance to formal hypnosis, but now described in the context of hypnotic conversation. We are neither putting forth a theory nor offering a new perspective for those who research hypnosis as a phenomenon. Rather, these ideas and metaphors serve to broaden the framework of what constitutes hypnotic interaction so as to evoke new opportunities for increasing therapeutic efficiency and efficacy.

PMID: 15554463 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15494182

Pain. 2004 Nov;112(1-2):27-36.
Perception and modulation of pain in waking and hypnosis: functional significance of phase-ordered gamma oscillations.

De Pascalis V, Cacace I, Massicolle F.

Department of Psychology, University of Rome, 'La Sapienza', 5, Piazzale Aldo Moro, Via dei Marsi 78, 00185 Rome, Italy. v.depascalis@caspur.it

Somatosensory event-related phase-ordered gamma oscillations (40-Hz) to electric painful standard stimuli under an odd-ball paradigm were analyzed in 13 high, 13 medium, and 12 low hypnotizable subjects during waking, hypnosis, and post-hypnosis conditions. During these conditions, subjects received a suggestion of Focused Analgesia to produce an obstructive hallucination of stimulus perception; a No-Analgesia treatment served as a control. After hypnosis, a post-hypnotic suggestion was given to draw waking subjects into a deep hypnosis with opened eyes. High hypnotizables, compared to medium and low ones, experienced significant pain and distress reductions for Focused Analgesia during hypnosis and, to a greater extent, during post-hypnosis condition. Correlational analysis of EEG sweeps of each individual revealed brief intervals of phase ordering of gamma patterns, preceding and following stimulus onset, lasting approximately six periods. High and medium hypnotizable subjects showed significant reductions in phase-ordered gamma patterns for Focused Analgesia during hypnosis and post-hypnosis conditions; this effect was found, however, more pronounced in high hypnotizable subjects. Phase-ordered gamma scores over central scalp site predicted subject pain ratings across Waking-Pain and Waking-Analgesia conditions, while phase-ordered gamma scores over frontal scalp site predicted pain ratings during post-hypnosis analgesia condition. During waking conditions, this relationship was present in high, low and medium hypnotizable subjects and was independent of stimulus intensity measures. This relationship was unchanged by hypnosis induction in the low hypnotizable subjects, but not present in the high and medium ones during hypnosis, suggesting that hypnosis interferes with phase-ordered gamma and pain relationship.

PMID: 15494182 [PubMed - indexed for MEDLINE]

I bring these three ones for discussion! :wink:
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Old 17-03-2005, 04:25 PM   #4
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Hello Jo,

Since I'm interested by this subject and NLP I found a forum about these knowledges.
I planned to ask some help from these experts?
http://forum.hypnosis.com/
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Old 17-03-2005, 09:57 PM   #5
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Hello , follow the ball , feel your eyelids getting heavy....


Another link for hypnosis related research and pain.

http://www.intelihealth.com/IH/ihtIH...l?d=dmtContent

Also , lavender study that shows links with reducing anxiety, something Leonardo Da Vinci claimed many years ago.

Cheers....Thomas
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Old 18-03-2005, 12:47 AM   #6
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Bernard

I had a look at the hypnosis forum...yikes. I would not call anyone an expert there....be careful??


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Old 18-03-2005, 07:42 AM   #7
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Nari,

Your experience is certainly better than mine on this subject. It is the only forum I found about the subject. ops:

There is subjects about dangers and after effects... But I will read them the eyes wide open. :wink:
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Old 18-03-2005, 08:34 AM   #8
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Default hypnosis

Hi all, I was lucky enough to have recieved a scholarship to attend a twelve month accredited hypnotherapy course here in Australia four years ago. I have added hypnosis to my practice since then . I find it a fascinating and absorbing addition to the usual line of musculoskeletal problem solvings. As to dangers, well there really are very few, most people who are alive can be hypnotised. It is safe and surprisingly effective, though within limits. Hypnosis will not fix everything any more than any other "magic Bullet". It is stimulating for the therapist and I recommend you look around for a fully accredited course. In Australia there are no government restrictions any longer, anyone trained or untrained can call themselves a hypnotist. It is probably similar in the UK.
Good luck with it.

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Old 18-03-2005, 11:15 AM   #9
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Hi Ginger,

I'm facinated, its great to hear of a physio using hypnosis, I feel that ive not been barking up the wrong tree! Are you aware of other physio's in Australia using it or are there very few? Do you have a governing body, in the UK its the CSP (Chartered Society of Physiotherapy) if so what are their feelings about scope of practice, do they cover the hypnotherapy part.

How do you view hypnosis, as a 'altered state/special process' Hilgard & Higard type view or cognitive-behavioural, humans have the ability to activate different internal systems that can modulate pain suppression, some of they ways this can be achieved is by concentration, expectation and attention? or any other view.

If it's appropriate could i have permission to use a quote from here? Just as an information addition to show there are physio's world wide using hypnosis?

many thanks - jo
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Old 18-03-2005, 11:37 AM   #10
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I'm not aware of any physios in Australia using hypnosis, but that does not mean much.

Like CBT, I am interested in the concept, and both have a place in physiotherapy. Courses in CBT are becoming more commonplace, but it is seen more as a tool for insurance purposes, eg trying to return third party/compensation patients to the workforce, and so on. Its potential is almost universal, I think, amongst persistent pain patients.

Hypnosis to me seems to alter perceptions of pain and thus pain behaviour patterns, but I don't know much about it. If it has good carry-over, then it would be very useful.

Any more knowledge on its physiology? Might do a hunt this weekend on the known physiology.


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Old 18-03-2005, 12:55 PM   #11
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Hi all,

Quote:
Originally Posted by Jo
If it's appropriate could i have permission to use a quote from here? Just as an information addition to show there are physio's world wide using hypnosis?
Yes, you have all permissions since you're a member of the board! 8)

Nari,

You're a moderator and then you've got the power to delete, modify... the posts you want!

Just click on the little red cross (between the edit and ip buttons) as in this picture!


But delete a post is an irreversible thing! Being God is a world of Danger! :lol:
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Old 18-03-2005, 10:13 PM   #12
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Thanks Bernard

I did have a cheat sheet of all the Godlike things I can do as moderator, but last night could not find it. Will do a revision and hope my hippocampus can cope.


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Old 19-03-2005, 08:21 AM   #13
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Nari,
Just add this one to your favourites!

http://www.phpbb.com/support/guide/#section5
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Old 19-03-2005, 09:53 AM   #14
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Thanks, mon ami


Nari ops:
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Old 19-03-2005, 11:55 AM   #15
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Some people may argue that most of manual therapy is hypnosis or medical distraction so in effec many of us hypnotise people ?

My favourite(manual therapy) book discusses this issue
http://www.accampbell.uklinux.net/bo.../r/nathan.html
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Old 19-03-2005, 12:41 PM   #16
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This sounds a very exciting book, ian...!
I will have a look around for it. But it would be heresy to many PTs; I wonder what psychologists would think about the concept of touch - I see a couple of psychs every week and I will broach the topic on the basis of nondualism.
They are both quite open-minded people.

Thanks for posting


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Old 19-03-2005, 01:53 PM   #17
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point them in the direction of somatic markers --I think i put a link to this on noi Damasios work bridges dualism !
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Old 21-03-2005, 12:27 AM   #18
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to Jhope and others, my interest in hypnosis began a long time before I became a physio when I was an athlete in training for various events while in my teens and twenties. I used a system known then as self hypnosis , but otherwise could be called covert reheasal. Where the mind engages a situation about to be encountered and practices skillfull movements mentally. I found this to be a powerfull tool for self improvement and wrote a few papers on similar methods for enhancing the skills of post CVA patients in rehab. But that's another story. Hypnosis has been used by Doctors of medicine, dentists and psychologists in Australia over many years until deregulation five years ago. The problem at that time with standards was that these professional could practice without ever having been trained in the method, or its indications contra or otherwise. There are numerous hypnosis practicioners in my area, who seem to keep quite busy. My first patient has arrived so I'll continue a bit later if I can.
Cheers to all.
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Old 21-03-2005, 07:09 AM   #19
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Jhope , you asked about governing bodies in Australia, We are registered with the physio registration board in each state, I'm not able to say what the official position is on hypnosis by physios here in Victoria. Other than to say that we are bound by the same standards of professionalism and safety that apply to any other treatment . It is probably fair to say the board would only become involved in the issue if there were to be a complaint about a physio performing hypnosis made to it. As to the Australian Physiotherapy Association, well it is not a "governing body" as such but a professional association providing services to members for the price of membership.
As a therapist regularly inducing the hypnoid state in clients, I am fond of the altered state explanation for its effects. A fully conscious and awake person will filter information recieved ( verbal and other) via the mind which is geared up to make sense of everything . Most information is not acted upon or downloaded permanently because of an active filtering of information that may be said to act a little like a computers buffer memory. Unless information is repeated or the filter is off, info is only stored temporarily and may not reach the stage of a fully encoded "program". Hypnosis releases the individual from a few layers of this filter. the deeper the hypnotic state( allowed for by the individual) the more this filter is undone. What follows is that beliefs are encoded into the subconscious, to be acted out or to alter perception at a later time.
Some hypnotherapists follow the Ericsonian model , where the script is a metaphorical one, with key words inserted in a storyline that of itself appears innocuous. Others( including myself) favour a straight positive message with kew words and phrases emphasised and repeated.
Perceptions related to what individuals feel to be stressfull can be altered, such that situations become more and more tolerable, anxiety and adverse reactions quiten and the person grows to fill their potential.
Thsi process is also quite positive for the provider . The therapists mind must be fully engaged in the hypnothapy session, voice is a very powerful tool.
I mostly find a call for performance related intervention. Folks want to be better at things and less anxious about others. Sport, business, relationships, sexual function, athletic performance etc. It is a very satisfying therapy to provide.
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Old 21-03-2005, 08:25 AM   #20
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Ian,

I agree with the Damasio's concept of somatic markers helping us to create/recall emotions. And I agree that our brain needs imperatively the body to achieve this task. But are you saying that using hands-on technique is hypnotising brain in kind of manner?

Ginger,
Have you some examples to bring for this self hypnotism technique? Just write another thread?
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Old 21-03-2005, 08:46 AM   #21
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Bernard some types of hands on technique are I feel very' hypnotic'.
Reiki,Craniosacral etc .
The premise of the touch and emotion book is in parts quite Reichian i.e we defend ourselves with body fixations and tension patterns .
Touch may cause profound shifts in the defensive neuropatterning (dependend on the relationship etc ) so I believe we need to be aware of this but steeped in notions of biomechanics the hypnotic element gets overlooked?
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Old 21-03-2005, 10:03 AM   #22
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If hands-on did induce a hypnotic state...that is, hands-on in the sense that it is a salubrious sort of touch and not the oscillating localised boredom of the PPIVM; then..what is the relationship between placebo and hypnosis?

trust me to add a can of worms.......

And Diane, if this is so, you may well be hypnotising your patients? :wink:

I like the sound of hypnosis as a treatment.


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Old 21-03-2005, 05:42 PM   #23
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Salubrious: Health promoting
I think I just fell in love with a word I've never used before! Thanks for improving my vocabulary today Nari!

Yes, I think touch can do it all. Most of the time. Maybe you could call it, hypnosis through mechanoreception.. Strategically affects target areas of the brain, conducive to relaxation, helps open the filters to perception, deinhibits, changes blood flow and pain threshold, all that stuff. I agree that voice is important. I keep mine soft and low. So low that when people are hard of hearing, it has the opposite effect sometimes, they tighten and ask "What?"... (Argh..)

About hyponosis as a formal tool, my sense is that because peoples' awareness levels are in constant flux anyway, we probably use it without even knowing we are using it. More awareness on our part would probably be a good thing.

Once in awhile, if I have someone in my office who is so distressed they seem like one of those tinder dry forests that Nari has used as a metaphor, I do not want to touch them. If they are in complete "overwhelm" to use one of Peter Levine's words, I will use the tool I learned from him, that he calls "somatic experiencing."

It's a quite formal process, done with both of us seated. The patient is asked to take a moment, and let their awareness descend into their body. I ask them to nod once they are fully there. The process involves locating an area of tension, an area that they can't relax through. Usually it will be in their front somewhere, and they are asked to lay their hands gently over that area. Sometimes I will come over and ask them if I can lay my hands over theirs. We work on it.. they are encouraged to come up with any wild metaphor they choose, we go a step at a time, slow it down to a pace they can use to explore/unravel everything including how their emotion is linked or locked into their physical sensations.. ideally we go until they resolve the issue and the end is when they feel a round golden ball of light in their abdomen (this is some sort of kinesthetic image of peace in the bodymind. People always resolve into this. If they don't, they aren't q-u-i-t-e done yet). By then they are completely calm. Then they are asked to take a moment to gently bring their awareness back into the room. (Word of caution to readers, this description is very skeletal.. don't try it without real training of some sort. There is a skill base here that can only be learned directly..)

It's very cognitive, I suppose it is a form of hypnosis, Peter Levine is a hyponotist among other things. It's a great tool, in any case, but I use it only in these people who have overflowed their banks and I can't do anything else with. Maybe once a year or once every couple years I end up with someone who I use this with.

Ginger, kudos, you must have a nice elastic mind if you encompass hypnosis and mobilization in your treatment repetoire! My experience with PTs is that we tend to cluster around poles. Generally the biomechanists aren't so interested in mind things, and the mind people aren't so interested in the biomechanics stuff! My repetoire extends the whole spectrum as well, but I'm not as in love with mobs as you are.
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Old 21-03-2005, 11:52 PM   #24
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Over on NOI, a thread was started on the need (or not) to assess on a molecular level when we treat.

Although the juries will be debating this aspect forever, I wonder if hypnosis is quite ethically dealing with treatment on a molecular level.
It may well be working with hypotheses only, but aren't we largely doing that now, anyway?

Diane, you're welcome - I like certain words, and the great value of writing is that it forces one to search for the 'right' word....

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Old 22-04-2005, 12:09 PM   #25
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Nari provided this one on NOI site =>
http://www.the-scientist.com/2005/03/28/S28/1
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Old 20-07-2005, 07:19 PM   #26
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Hi all, this is my first post on this discussion board.

I'm a physio from the UK and to be honest with you Jo, I'm not really sure if hypnosis is within the physio's scope of practice as outlined by the CSP.

I've looked into hypnosis as a personal development aide and have had basic training in it, I've also done some training in life coaching and am also a practitioner in NLP.

I would say that I have used NLP/coaching techniques with patients in the past where I work with lots of chronic pain patients. A lot of it is based on language and you do not need to put the patient under a formal 'induction'. As such using NLP type language you can use some 'hypnotic' type talk and it integrates fairly seemlessly with physio. When I worked in the hospital with lots of chronic pain, it was a fascinating approach and often some headway was made by the patients.

Unfortunately I no longer work in a chronic pain environment and so do not get to use the techniques as much. I also think that people do come to physio for physiotherapy and not for something else so you would need to be careful as to why you would do hypnotherapy.

As a side note, I think the complementary/alternative therapies out there are way far ahead in terms of the mind-body connection and we in 'conventional medicine' are just catching up slowly. There is a lot we can learn from them.

Just my thoughts!


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Old 21-07-2005, 01:32 AM   #27
nari
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Hi Waiman (not sure which name to refer to you!)

Welcome to SS!

As stated in the above posts, we are trapped in a sense that because of our title (physical therapist, physiotherapist) we must deal with biomechanics only. It's unfortunate.

In Australia, physios are starting to practice acupuncture, employing CBT techniques, and on the fringe, looking at hypnosis as another possibility in the armoury of skills. But the problem remains, I think, that all these different approaches are regarded as separate entities - we still do not
'blend' into non-Cartesian thinking. It is difficult when the entire medical field is specialised and central visioned; and there are countless physios around who look only at segmental pain/dysfunction.
NLP is not widely practised at all - I did a 3 day course in NLP years ago, and it does have some application within clinical practice, to be sure. But the meme that dictates 'I am a physio, not a psych' is very strong.

The UK is certainly blossoming in the field of physiotherapy, and unless we move along as well, we will be left behind. Already there are physios saying here that our previous reputation of 'the best in the world' no longer applies....and I agree.

Knowledge is great and interesting, but our challenge is translating that into clinical practice...and we are not very good at that.


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Old 04-09-2011, 12:00 AM   #28
Jon Newman
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I'm just getting around to listening to the latest All In The Mind podcast that I subscribe to.

A healing imagination: clinical hypnosis for children

I know hypnosis has been discussed here and there at SS but this was one of the earliest threads on the topic and was finished before I even started posting here, I think.
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