Is behaviourism the future for physiotherapy?

Yesterday, I took part in one of the regular and always enjoyable Physiotalk Tweet Chats (#physiotalk).  This one was on the role of physiotherapy in exercise prescription.  As usual, the discussion ranged widely over all sorts of topics: whether physiotherapists were experts in exercise prescription and what needs to be taught in the UG curriculum not being the least of them.

One thing that came through strongly was a desire to manage the client/patient’s behaviour.  Words like adherence, compliance and motivation kept coming up and people seemed to recognise that all the skill in the world wouldn’t matter to the therapist if the patient didn’t engage.

As someone who’s read their fair share of Foucault, and in the pursuit of a critical angle to the discussion, I thought about how this Tweet Chat reflected a telling moment in the history of our profession.  There was a time when adherence and compliance were largely ignored.  It didn’t matter whether the patient did what they were told; there was a long waiting list of people who would do what we asked, and we were going to get paid anyway.   But these were the days of the welfare state and they are now behind us.  Today, we face much less surety and so have to appeal to people’s inner motivations in the hope that they will like our prescription more than the practitioner down the road.

Which brought me to a brilliant recent series streamed on Vimeo titled ‘The Century of the Self.’  The four documentary films talk about how a growing understanding of human behaviour has been at the heart of our social development in the 20th century.

The first episode is particularly interesting.  It looks at how our growing understanding of people’s behaviour became a tool used by governments to manipulate the masses.  Drawing on Freud’s ideas, active efforts were made to make people want what they didn’t need by linking mass-produced goods to their unconscious desires, and by satisfying people’s inner selfish yearnings, making them feel happy and docile.  It was, as the series points out, the start of the “all consuming self that has come to dominate our world today.”

I suppose two things come to mind.  Firstly, physiotherapy is quite late in its adoption of behaviourism.  And secondly, as a result, we should understand that it has its own specific history and as such isn’t necessarily good or bad, only problematic and worthy of close critical scrutiny before people launch into it believing it is the answer to our profession’s future.

We could also say that the tools of this critique can be found in philosophy, and so people wanting a more critical understanding of behaviourism might seek help from people within this group.  If people do approach us for our thoughts, we could think about selling them something to make them feel happy and less uncomfortable.