I spend a lot of my time at the university these days working with psychologists and psychotherapists, and one of the things I am always struck by is how much of what they learn could be applied to other healthcare practices, especially professions like physiotherapy.
The quote in the title; ‘All feedback is projection’, for example, was told to me by a psychotherapy colleague who was explaining how it is that people will give you feedback from their own perspective but, more often than not, what they’re really doing is projecting their own values and beliefs and its not ever entirely about you.
I’ve thought about that a lot when I’ve reflected on the advice I’ve been given by people throughout my career, or the feedback I’ve given to patients and students. How much of it was really just projections emanating from, but really directed back at myself I wonder?
Ideas like transference (the projection of thoughts and feelings associated with past experiences onto another person), and counter-transference (the therapist’s emotional responses to the client and their issues), have profound significance in the ‘psy’ disciplines but hardly feature in physiotherapy training.
Psychotherapy is very much about insight, both the therapist’s ability to engender deeper insights in the client, but also gain better insights about themselves.
Central to this process is supervision. In the university, students see clients and have supervisors who meet them regularly to review their work and help them explore their growing personal and professional identity. The supervisors, in turn, have their own supervision, to help them explore their own thoughts, reactions and reflections. And on it goes.
Staff and students alike receive support to explore their anxieties and fears, emotional blind-spots, cultural challenges, spirituality, sexuality, experiences of mental illness, relationships, subjectivities, etc., and the whole programme is built around relationships.
By contrast, reflective practice work and supervision are only relatively recent developments in physiotherapy. And while many institutions, organisations and professional bodies appreciate the value of such practices, curricula and scopes of practice remain dominated by the necessity of learning all of the accumulated ‘stuff’ about the biomechanical body that dominates people’s beliefs about what physiotherapy ‘is’. The result is often that the humanistic dimensions of practice, for clients, students and practitioners alike, is sublimated in favour of technical competence.
Most experienced practitioners know, though, that technical skill will only take you so far in ‘real’ clinical practice, and to become an expert practitioner you need to nurture the whole person. It would be nice to think that physiotherapists in the future learnt this because of their training, not despite it.