Honour the outputs
At an Explain Pain course in London two years ago, a psychotherapist on the course commented on my lecture on output and homeostatic systems by saying “always remember to honour those outputs in your patients”. I have never forgotten it.
What a potent treatment metaphor! By honouring the outputs, she meant paying respect and giving acknowledgement of the systems that the self, acting on all available knowledge and interpretations has called upon to protect itself. – these outputs could be thoughts, beliefs, pain, movements, postures, emotions, sympathetic, endocrine, and respiratory responses among others.
To some degree it is a “well done up to date”, or perhaps a “I can begin to understand how you have those ideas, feelings, movements with what you have gone through”. At NOI, we think that acknowledgement, with useful explanation and honouring is necessary before any alterative protective strategies or changes in existing strategies are offered.
David
Glad to read this.
Yes, the patient and all that is “wrong” with him needs honoring. By holding an attitude of “nothing needs fixing”, paradoxically, we offer enormous help to the client. I’m constantly reminding myself of this when I’m with someone.
Other self-talk scripts that assist me with this attitude would be things like:
“Why on earth do I feel a need to fix this problem?”
“Who is it that wants to be of help anyway?”
“Who is asking all these questions?” (a self-reflexive non-dualist technique)
“I feel ….. [insert feeling]” (congruence exercise).
All of these have the same effect; they jolt me out of egoic consciousness so that I can then enter the patient’s world. Won’t be long before Nisaggardatta is required reading for students. He is so far ahead of the curve…or was, when he was alive. Free d/l http://www.holybooks.com/nisargadatta-maharaj-loads-of-short-texts-on-non-dualism/
EG
Wonderful David……..yes, yes , yeeeeessssss……. Maybe, when we struggle to get our message across it is because we haven’t sufficiently listened to and honoured the patients “Story”. Until the patient feels heard -Honoured – they are not ready to listen
DB London
That is so true Cameron, nothing needs “Fixing” as, at that time in space the self is doing it’s very best, be it maladaptive or, in Geoff Mailtlands world “Normally Abnormal”. Change or, in Psychotherapeutic terms “Shift” is what we are after……
DB London
Dear David,
Thank you for your post on “Honoring the outputs”. Too often in this seemingly “objective”, “science based”, and “quantifiable world”, the honor given to the patient’s outputs and to the patient, him or herself, is given short shrift. If a nociceptive source can not be identified on imaging/lab/ diagnostic study or on specific clinical tests, “nothing needs fixing” and nothing can be wrong. The corollary to that is also too often the case. If there appears to be an anomaly on one of the studies, that has to be the nociceptive source of the pain.
If we are truly to honor the outputs of a patient, the most critical place to start is not in our treatment but in our clinical examination and evaluation of their honored verbal, behavioral, and physical outputs. The honoring of the patient’s output starts within the first seconds of the clinical examination and continues right through to the objective explanation of the clinical findings. As far as I am concerned, I give no greater honor to my patient than the performance of a careful, disciplined, full examination and acceptance of the responses that they provide me verbally, behaviorally through observation of non-verbal communications, and physically through their responses to my tests. Our mutual journey through the rehabilitative process begins there. Our understandings of the nociceptive and non-nociceptive processes of the pain experience provide the basis for us to work together and honor each’s responsibilities in the care. If a patient is to come to the realization “that nothing is dangerous here”, they have to come to that understanding themselves. We need to be excellent guides. The evaluation has to be the place where both the journey and understanding start. Johnb
The information humans and indeed animals gather from “Non verbal communication ” is priceless. Thank you for reminding us John x
DB London
Lovely to see these reflections.
Just a quick thought – by referring to outputs are we feeding into linear thinking? Is it the best term and if not what others would you use?
Cheers
Tim
Good point Tim, responses might be a better term thus honouring the being rather than the function…..
DB London
Thanks for all these comments. Yes – usually there is nothing to “fix” – , much of the clinical presentation will be constructed on perturbed outputs defending the self to the best of available knowledge. Guidance towards a better output is probably more apt in most cases. Thanks John for your reminder that a quality evaluation is one of the best ways to honour – even just touching the sore bit judiciously is one way to honour the outputs . ( I hate those dualistic “hands on or hands on” discussions/panels at conferences). Output was never the best word. Of course, any output is sampled and judged by the brain so it’s an almost endless feedback loop. I can’t think of a better word though – “homeostatic system is a bit of a mouthful!
Cheers all
David
David