Pain therapists perform a job that is intimately concerned with the individual experience. Therefore the care provider’s role is to go far beyond mechanistic approaches and embrace a more interpersonal client/patient relationship. From this truth a very important question arises. Does the provider’s mannerism and general affect have an effect on healing? Can this effect patient outcomes and the patient’s pain experience? The answer is an overwhelming yes.
I have had the opportunity to observe many different approaches to pain therapy and physical rehabilitation. In fact, my own approach has undergone significant evolution over the years. Across that time I’ve observed a sort of balancing act between the need to demonstrate confidence and the need to promote patient autonomy. The proverbial tightrope between provider confidence and patient autonomy is a difficult path to walk but its role in the plan cannot be understated.
We, rightfully, hear a lot about the importance of patient empowerment but the whole ‘confidence’ side of the coin is not emphasized to the same degree. And I understand how the importance of a strong personality may seem a little less convincing. In fact, we have historically gotten into trouble with the idea of charismatic healers, right? Because who is the most charismatic healer you can think of?
The entire concept of a Snake Oil Salesman comes from the image of an old western, pioneering salesman pretending to be medical professional. And what is the image that that conjures in your head? He pulls up to a crowd of people, summons up some charisma and just starts shouting into the air.
So I completely understand. We have a bad taste in our mouth because of the gurus. Let’s also consider that the best voices in the profession are teaching us the importance of compassion, attentiveness and the shift away from care dependency. Don’t misunderstand me, killing an inflated ego and empowering the ‘whole person’ are undeniably essential to any relief plan. But this seems, to me, altogether more achievable than an affect of ‘therapeutic confidence.’
Because in order to be a compassionate guide throughout a course of pain care one simply needs to 1) stay curious about pain science and 2) don’t be an asshole to the person you’re trying to help. But confidence is this other weird attribute where one must make sure not to become an egotistical know-it-all with a curt disinterest in new ideas while also being appropriately forceful and authoritative in their leadership.
This has only worked, in my observations and experience, when there is a kind of “professional” lack of professionalism.. Perhaps a “professional informality” might be the better label but ultimately it just means what we all already know to be true. Communication is important. I’ve spent a career better learning how to avoid invalidating beliefs with clumsy wording. I’ve thought very hard about how to communicate pain science in both a succinct and engaging way.
Discussing pain science professionally, engagingly and accurately is hard...
But perfecting communication skills can’t end there. The experienced healer must convey the message that “I can help you” without making irresponsible promises. Showing off is not often considered to be an attractive quality. And yet the effective healer must toe the line of an outwardly braggadocios manner. Ultimately, its a dangerous line between confident and annoying. But make no mistake about it, anyone looking to guide someone in pain must study that line and then start walking.
I have had an opportunity to work with a peer throughout different stages of my career. He brought me into my practice right out of school (which, by definition, means I didn’t know enough about anything to be useful to anyone. If this describes you, don’t worry you’ll get there…) I came back a few years later after having had the opportunity to equip myself with some skills and some confidence. The most fascinating thing about my experience was how different it all felt.
As a fresh young recent-grad with the stars still in my eyes I lacked the confidence to be the LEADER required to truly coach anyone. And so I can clearly remember doing a terrible job of faking anything while I tried to make it. The fact of the matter is that this DOES translate into results. We humans have evolved to pick up on the most subtle of social cues and facial expressions. We are all able to pick up on any hint that a presenter may not be 100% confident in the plan. Am I saying that it is impossible to be confident without years of experience? Of course not. I am simply saying that I have felt the subtle but important difference between trying to help someone from a place of confident, assured authority and trying to help them by doing my best.
Our brains are impeccable prediction machines. They craft our reality in order to keep us safe and to manage resources. Predictive processing is at the heart of pain onset and pain resolution. Be compassionate with anyone you are trying to help through their pain. Empower them. But don’t forget that confidence and charisma are key factors when trying to re-calibrate movement-related threats.