When the patient walked through the door and nodded hello, I noticed something had shifted.
Her torso seemed longer whilst her shoulders more square. Her face held a resolution of sorts.
Perched on the edge of my seat, I crossed my legs. Left over right, then right over left. Then left over right again.
I felt a stab of pain in my ribcage and noticed my lungs braced in protection. Letting some air out allowed both feet to find the ground.
The space between us was still.
As she spoke, her words walked towards my ears with purpose.
Her voice, her needs as a patient seeking care, led the dialogue. Open, raw, and honest feelings. Hard to hear truths, despite their kind and intentional delivery.
I became aware of my cheeks, as they housed creeping pink streaks. My hammering heart was their supplier.
I noticed the urge to fix was strong and the impulse to please palpable.
My throat felt like quicksand, and my mouth was dry. I noticed a slowness to my mind that felt uncomfortable yet familiar.
Words were not yet required.
And so, I turned towards my body for dialogue; to meet her in the moment, with respect and dignity.
I watched my posture soften, sensed my jaw release, heard myself breathe. I noticed a tension to my legs that kept me anchored to the spot.
Having traversed my body's insides, the words that emerged were messy in shape and heartful in colour. And whilst vulnerable to form, they held my expansion.
I noticed her pause and absorb my response. Her eyebrows smoothed and torso slackened. Her shoulders turned ever so slightly towards me.
A moment of humanness and reciprocity held embodied common ground. A sense of self was felt within the other.
Our bodies were creating messy yet fertile soil; gardening together, unearthing unfamiliar nutrients from which we could both grow.
The patient had come recommended through word of mouth. One of their friends had spoken generously about the way I was approaching care as a collaborator with a whole-person lens, and encouraged they see me for their ongoing back pain.
Learning the referral was word of mouth, I relaxed a little. My shoulders dropped and my abdominals softened.
Perhaps, there might be less confusion to meet if they had some understanding that my job was not about fixing them.
However, as we began exploring her experience, I could sense her desire for certainty and a fix.
Her emergency hospital visit provided no specific diagnosis as her spine was structurally sound upon imaging and her neurological exam was clear.
And yet her pain was disruptive and ongoing. It was pervading her life, blurring the edges and creating internal chaos. Juggling numerous emotional challenges whilst working overtime, she needed me to tell her what was going wrong and how to make it better.
I noticed my own uncertainty build as I listened to hers. My heart quickened and my mouth felt dry as I watched her forehead furrow and hands fall in exasperation.
My own hesitation and not knowing permeated my body. Despite validating her concerns, there was a rigidity to my presence that reflected where my attention existed - in my whirring brain.
It was trying to figure out how to approach the multifactorial, experiential nature of pain to someone who believed it to be something wrong with their spine.
How do I the meet the assumption of simple with the reality of complex?
I could sense an urgency to meet her confusion with my words, hoping they would soothe the looming unknown.
And so I followed that impulse and began educating her about the intricacies of pain. Words tumbled from my mouth at a rate of knots. There was no space for respite.
Designed to reassure, their intention was to cultivate safety through facts.
And yet they were coming from a nervous restlessness inside my body, to which I was not paying attention.
In that moment, the lack of resonance created a significant relational tension.
My body did not attune to hers when her confusion and despair emerged, as I was experiencing my own physiological activation.
Educating her was my subconscious way to distance myself from her distress and settle my own body-based discomfort.
Yet in doing so, it amplified hers.
And weakened our relational ground.
Relational tensions within the therapeutic encounter can be hard to navigate. They can feel awkward, messy, and house many unknowns. They can feel somewhat destabilising, threatening to swallow us whole if we step towards them.
And yet in reality, we tend to avoid facing them, despite their inevitability and normality as part of human interactions.
Historically positioned as experts holding all the knowledge, focus has largely landed on the giving of advice to those who seek our care.
What's more, the way in which we have valued knowledge privileges cognition over the intelligence of the whole body.
In doing this, we are restricting access to somatic knowledge, and impeding therapeutic resources.
This enculturation of a disconnected superiority in healthcare, has subsequently placed little value on the nuances of relationships, both with the self and other.
And despite evidence pointing to the therapeutic relationship as central to meaningful engagement and outcomes, we have given little attention to learning about the intricacies involved with relating.
As that would require turning to face ourselves in a foreign and potentially daunting way.
No wonder we feel confronted and ill-equipped by relational tensions, as they challenge the authority, norms, and intellectual comfort that we have built our role upon.
In a way, they demand that we be whole and human: messy, fallible, and uncertain.
And perhaps most importantly, they make visible that developing our presence - our capacity for our whole self to be fully engaged and receptively attuned with and for the patient - is essential for navigating them.
Despite being in a body-based profession, we are underestimating our own body as a source of therapeutic influence.
The day she returned for her review, I could sense a different energy within the space between us. The non-verbal relational tensions had built to form explicit words.
Noticing a sharper edge to the air, I felt my stomach tighten. I was unsure how to ready myself for the dialogue ahead, meeting her subtle pause with a rush of fidgety energy.
She spoke openly with an honest directness that I had never encountered from a patient before.
Her tone was firm and her posture resolute as she spoke about her experience working with me. She explained how I was not meeting her needs and how that was impacting her confidence in me and the direction we were heading.
I felt a heatwave sweep across my face, prickly and intense. Molten lava seemed to snake down my neck, across my chest, and land in my hammering heart.
My body wanted to run and hide from the building discomfort. It craved to find comfort in rigidity; it wanted to defend, detach, and compartmentalise.
Semi formed sentences bombarded my brain, rapidly leaving as quickly as they arrived. Out of the frying pan and into the fire. Nothing seemed 'right' amongst the strong habitual impulse to fix and please.
I felt stuck in my body's response, unable to form coherent words; unsure what to actually say.
Sitting amongst my inner maelstrom, I noticed a slowing of my mind that felt uncomfortable yet familiar. My torso softened and my lungs followed suit. Their rhythmic movement brought a fluidity that helped shift the heat; I sensed flowing water cooling hot rocks.
I felt my body take charge, not my brain. I met this moment in a way that embodied my transformation. Turning towards her, I replied from a place within me that I did not know well, yet knew I needed to explore.
Uncomfortably unpracticed, precariously open, and yet deeply human.
When we step into new ways of being and relating, one of the largest unknowns we must practice holding is the risk of not knowing how we will be met by the other. There is vulnerability in staying open.
Presence - our capacity for our whole self to be fully engaged and receptively attuned with and for the patient - is a term not often found in the dominant physiotherapy literature.
It concerns the intersubjective space, or the space between. In this space we mutually and reciprocally influence one another. Whether we are aware of it or not, we are part of a complex living system generating rich warm data.
Our experience is always interacting with the patient's experience. We co-exist within an embodied exchange of our multitudes and intricacies.
Presence emerges through attuning to shared emotions whilst having mutual awareness, and united intentions.
It is a beautiful, powerful skill that not only cultivates a relational scaffold to work within, but can resource the practitioner.
Through embracing ourselves we can develop our presence.
Just like the patient, we need to explore our emotions and how we are affected by pain, suffering, joy, healing, and loss.
Unfortunately, presence has not been historically valued, taught, nor supported within the physiotherapy profession.
However, this means we need to consider the relational impact of a lack of presence.
How might that influence the intersubjective space and our relationship with the patient?
How might we be unconsciously contributing to the relational dynamic, understanding its impact on pain and healing?
Noticing and reflecting on the absence of our presence has the potential to cultivate fertile ground for self-development.
And if we intentionally employ an attitude grounded in mindful curiosity, our self-development can unfold within a container generously lined with self-compassion.
To me, this is perhaps the most crucial part of our paradigm shift. Turning towards ourselves with the very warmth, curiosity, and understanding that we want to offer those in our care.
Thick with warm data, the air felt messy yet true.
Absorbing my response, her face smoothed and her body slackened. Her shoulders relished the opportunity to let go. We both shifted in our seats, slightly turning toward the other.
We had found that place where I could meet her and repair the rupture. Embracing the messiness with me, she allowed our humanness to be felt within the other.
In that moment of reciprocity, my body-mind learned how to be human in a healthcare environment.
By trusting in my body's knowledge to unearth what was needed most, I realised my capacity for embodied presence. Experiential learning at its finest, where growth is caught not taught.
As she made her way out the door, my belly somersaulted and landed in a whole new way.
In dignifying me with the gift of honesty, she had clearly defined my next path; it's direction fuelled by aspiration, intention, and curiosity.
Nervous excitement was brewing amongst my discombobulated inner landscape, and when I met it trustingly, it murmured:
I wonder what is deeper inside that we might uncover next?
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