Tentative steps into relational embodied physiotherapy
My ongoing experience of shifting worldviews; of taking the next step towards something unformed, yet deeply known; of surrendering, has lovingly taught me about the necessity of the space between.
A space where we do not know yet; a trusting in the vastness without necessarily grasping for the next thing.
I used to find these moments bare and excruciating, whilst simultaneously craving their experiential wisdom.
Leaning in, I found myself unearthing support in delightfully relational places, where an embodiment of the in-between could feel uneven and rocky, yet somewhat ok.
For me, trees swaying in the breeze with ease, ocean tides swimming with pride, and suns setting on my heart became my constant companions; a way of being that sought refuge in a deeper dialogue, where a wordless relationship could emerge.
And so, delightful reader, in honouring the in-between, I hope you can gently digest the first part of this blog series, and notice what resonates for you inside.
My invitation is for you to take some time for contemplation, perhaps a discussion with a lovely friend or colleague about what you noticed, before engaging with the next part of the series.
ps you will have to wait alongside me in the writing-of in-between ;)
More than a decade ago, I was six years into a lifetime career of caring for people and their painful problems, and all I felt was the weight of their worlds on my shoulders.
I felt desperate to help them, yet alone in how, as my physiotherapy degree had not imparted skills for coping with the totality of the human condition.
We were taught how to ‘fix’ people, not truly understand them.
We were taught how to examine and treat people like machines, not embrace them for being complicated, heartbroken, and fallible humans.
We were taught to look for problems and find certainty in solutions, not hold space for complexity and expect uncertainty.
I was dumbfounded no one was talking about how incongruent these worlds were. What we were taught in our physiotherapy bubble was not matching up with what the world was about.
In my confusion, I just assumed that I was wrong. I must have missed something. Everyone else seemed to be managing, and managing really well.
In order to cope with my feelings of confusion and inadequacy, I tried to hold it all.
I held the fear that was unexplored; I held the pain that couldn’t be explained; I held the feelings that had no box in which to categorise them; I held the labeling of patients as ‘faulty’ whilst craving to give permission for wholeness.
I held it all, and it slowly burnt a hole in my heart.
Awareness of the practitioner's embodied and relational experience has been given little to no attention within the physiotherapy field.
Its invisibility in our learning and clinical environments is impacting our capacity to be truly present with patients and can impede practitioner nourishment and care.
Ongoing work on the beauty and wisdom of our different brain hemispheres and how they emerge in an embodied cognition, supports a pathway to seeing and being within healthcare in a different way.
It is crucial that we acknowledge each hemisphere relates to the world differently. And it becomes essential for our integrated understanding, that we make space for their interweaving, relational dance with each other.
The dancing itself; the sense of interconnected movement between them, embodies the relational paradigm.
Neuroscientist, Iain McGilchrist's research shows that both hemispheres of the brain perform the same basic functions, yet the difference is in how each hemisphere perceives and then creates the world.
He argues they have different styles, different values, and care about different things.
The left meets the world through a lens that disconnects relationally.
It thinks linearly and methodically and is designed to take the enormous collage of present experience and pick out all the fine details.
It thinks in language, connecting our internal world with the external world, whilst separating and fragmenting people and things into neat, orderly categories to manufacture and produce.
It organises and categorises the information, associates it with all that has been learned from the past and projects it into the future to create potential possibilities.
The right hemisphere is right here, right now, in this present moment.
It thinks in pictures and learns through our sensory systems and the movement of our bodies.
It meets the world relationally and kinaesthetically, where it understands context and the big picture.
The right values relationships with others and seeing how we fit into a non-linear, complex world in which everything is connected.
Research consistently demonstrates that we are immersed in a world that values the perspective of the left hemisphere.
This left-shifted brain posture, with little value on how to include and interweave with the right, pervades our physiotherapy undergraduate ethos and healthcare culture.
We are distracted and seduced by how to do physiotherapy, armoured with apparatus and scripts, delivering information as knowing conquerers in need of a win.
Little time is spent on how to be in relationship with another, in an embodied and embedded way.
Emphasis is placed on cognitive processes that analyse and diagnose in order to solve patient problems. We are taught to intellectualise course content and deduce through external observation.
We identify with this way as containing all the answers, as it is modelled and embedded from our university teachings.
Emerging as newly anointed practitioners into an inherently complex pain world, we have a deep need to recreate this disconnected posture in order to belong and succeed.
Interactions can be shaped by reductionism, productivity, and efficiency as pressure is placed on the practitioner to be the expert, and to know the best treatment pathway.
This can lead to a calculative, even automatic approach where scientific expertise and technical competence are viewed as more valuable than skills of humility, softness, intuition, and openness to uncertainty.
I remember, as a new graduate, feeling a collective persona emerging from a place of expected expertise.
I sensed a building ascendency among us, a donning of impossibly-sized shoes.
Putting mine on, I kept tripping on their ballooning bigness. I felt lost and small. I wanted to reach out to others and check if this was right, yet my voice faded as my feet floundered.
Attempting to convince others and myself of my outward importance, drained my reserves and took priority over what was happening inside.
If I feel into my experience back then, I remember an intense panic around not-knowing, yet perceived it as an in-built flaw; a hypervigilance of brokenness that was to be kept in the dark.
As health professionals, we believed bodies were flawed machines in need of fixing, so how could I be any different?
The mechanistic pathologizing culture in which we were embedded passed through my skin by osmosis. I could feel myself cultivating automated responses, the external robotic functioning protecting a whirlwind underneath.
Moments with clients took on a performative interaction, where I used superficial banter to lull my racing brain and thumping heart into a, not-so-real, sense of security.
My assumed intention was to direct, diagnose, and dictate, which felt spikey and spiritless. My need to perform lived in my gripping abdominals and halting speech, often morphing into a hurried offload of extraneous explanations.
My insides doubted most words that I spoke, whilst layers of holding became the norm. I was stuck between the expectation of an opinion and doubting the one I had.
Often immobilized, I could not find a pathway forward with ease.
And yet, I could feel something deeper requesting inclusion. Something that took me away from what I had been taught, and brought forward the part of me that had stayed dormant throughout my undergraduate experience.
It lived in the in-between.
In the spaces between stories, the micro gaps and bare silences, the halted speech and reddening faces; in the embodied nooks and crannies of moments that invisibly stitched a shared experience together.
It felt real and raw, and graceful in its awkward nature.
It was fluid and moved organically; it was wise and connected and knew where it was needed.
It asked to be seen; to be welcomed and invited to stay, as we explored together.
In simple terms, it was a humanness, a deep sense of human relationality.
And yet, as I felt into it, its inherent complexity emerged.
I could sense there was a depth to my being that communicated differently, that spoke in images and body senses.
Despite being shaped to see the world a particular way, I noticed it's exquisite and delicate expansive nature.
Once hidden pockets of possibility shined with warmth and choice. Subtle movements felt cajoling, rhythmic, and playful.
It had my attention and it was emerging in such a way that I could no longer contain it.
The beauty of leaning in and sensing a dearth of words to adequately describe it felt fitting and true.
It was here, staying with the vastness in the space between, without grasping or searching, that I arrived somewhere new, yet somewhere known.
*The original 3 verse haiku poem that inspired part of this blog, was written by my beautiful son, Fergus Larkin. His generosity of spirit gives me space to be.
Trees are tall not small
They sway in the breeze with ease
They breathe just like me
Oceans are vast seas
The waves splish splosh in my face
The tide swims with pride
The sun rises up
It meets the world with brightness
It sets on the sea
Kit is a physiotherapist who embodies a relational approach. She has a masters in wellbeing science and is currently training in hakomi mindful somatic psychotherapy.
She has a keen interest in interpersonal neuroscience and its role in pain and healthcare, in particular, the relationship between the practitioner and the client and the emergent intersubjective space.