There are a lot of people in the rehabilitation professions who go about their work quietly, always thinking, always pushing the envelope with individual patient relief with satisfaction their goal – not for them the PhD, the international lecture tours, the politics, the managerial positions, going off on the latest treatment fad, or even toeing the line in some clinical algorithm. They reek clinical honesty. They are the kind of person you would want your mum or daughter to go to.
My mate Anton Harms is one of these people. Never was there a more inappropriate surname!
I completed a year long manipulative therapy course with Anton in 1985. There were 9 of us on the course. Anton and I came bottom of the class. I like to think now that perhaps we were ahead of the field already! Anton certainly was – he was the first person to do his assignments on a computer. How we mocked him! The rest of us lumbered away with our hand written assignments. Anton was never too sure about joint manipulation. We laboured for hours to get clicks out of joints, Anton preferred the gentle touch and a good chat.
When the first international pain conference came to Adelaide and probably Australia, Anton was the only one of us in the course to go. We couldn’t understand it – why go to a pain conference when there are necks to crack, the golden click to elicit, fascia to unload, nerves to tweak and muscles to rev up. Anyway Anton came back after listening to a young Clifford Woolf lecture and said “Guys – its all in the brain”.
I have “borrowed” lots from Anton over the years – he introduced me to the word ”allodynia”, he showed me how theratube could be used to educate people about how nerves glide and slide and how the nervous system is a mechanically continuous structure, his shoulder brace is absolutely brilliant for severe neuropathic pain. I will even plug it here –www.nerveprotectionbrace.com . He was one of the first to really “get” Graded Motor Imagery. The manual technique for notalgia paraesthetica (entrapment of thoracic cutaneous nerves) which I will present in forthcoming blog pieces came from Anton. He has given me an awareness of effective compassion. On reflection, Anton was probably a phenomenologist before anyone knew what it was. Anton rings me often- sometimes once a month, full of ideas, some weird but some brilliant . Many of you may remember him as the guy who did a strip at the NOI 2010 conference in Nottingham as he demonstrated his shoulder brace. Quite hunky for a 60 year old!
In my previous blog I talked about finding your moral compass as a therapist. Anton has always known exactly where his moral compass pointed, he has always been on the side of his patient. He has not followed the crowd and seems comfortable in his own skin. We should celebrate the Antons of this world- you won’t find them on the Australia’s 200 richest list (just out – no physios amazingly!) –but perhaps that’s where they belong, as they carry with them a very different store of riches.
Can you say more about Anton’s ideas on compassion? This is such a key clinical skill and I think it needs to be carefully differentiated from its ugly cousin “feeling sorry for someone” (which is not helpful). How does compassion differ from empathy (if at all), and which is more helpful to the patient?
I’d also be keen to hear some of his (or yours) experiences with this.
I guess you weren’t looking for more questions at this point. No problem.
I’d like to quote Jeff Foster. I think this encapsulates compassion well and can be used to help those with chronic pain.
“Let people go through what they have to go through in the present moment! They are tired and they want to rest. They are exhausted from the fight, from the pretence and the lies, from having to hold everything in and hold everything together and hold everything up, and great waves of energy are now being released throughout their body.
Stay present with them. Waves of sorrow, hopelessness, fear, shame and guilt are surging now. Let the energies rise up, let their whole body vibrate and shake and quake if it must, let them wail, scream, roar, laugh, cry, shit themselves if they have to. Offer them nothing but the greatest gift of all: your fearless presence. Stay with them through each breath, each motion, in every moment. Hold their hand, but don’t try to fix them, change them, stop them experiencing what they are experiencing, or give them premature answers.
If you become uncomfortable, or feel like you want to rush in and ‘heal’ them, or ‘save’ them, or ‘fix’ them, or prevent them from feeling what they are feeling, or make everything ‘okay’ for them, own that – it’s your need, your discomfort, your fear, not theirs. Do not treat them like a victim or an invalid. Do not confuse them with who you think they are. Honour the power that moves in them; validate their experience totally. Trust the unpredictable intelligence of healing, and know that their ‘symptoms’ may get worse before they get better; energy may become more intense before it dies down. What appears now as chaos and disintegration may in fact be necessary release and intelligent reorganisation of a blocked system”.
Hi Cameron, interesting questions……pity, compassion, empathy……..? Maybe just try to be altruistic and helpful without judgement …….
I have been brewing on your question about compassion for a while and have had some initial discussions with Anton. I am hoping he will respond here. My initial thoughts were based on a willingness to help past current accepted levels of help. This is a broad willingness – whether designing a piece of equipment, seeking a deeper knowledge about a person’s lived pain, chasing up health professionals, giving the same to all, letting a patient “know you are there”, etc.. But I realise I have just scratched the surface with compassion and Anton’s brand of compassion in particular.
Well Dave, Anton here – I don’t remember having any weird ideas! But I can remember my Clifford Woolf experience. Thank you for prompting me to ponder a little about the way I regard my work; we are servants; the servants of the people who come to us for assistance and advice. We have been afforded the privilege of the opportunity to learn and to then using our learning and knowledge to explore the wonderful ‘creation’ of the human experience.
I grew up in the home of a Pastor who was a good Samaritan; I saw the way he and my mother worked with people and I guess I have taken their attitudes with me to my work.
I found it astounding when I heard you years ago quote a study which found that so many therapists did not believe what their patients said; to not believe what people were telling me never occurred to me. If I did not understand how the story or experience could be so; then the fault lay with my understanding; not with what they had experienced or how they regarded their experience. That is why I was at that pain conference; the pain paradigm with which I graduated did not really make sense in the clinic.
I like to keep my therapeutic ideas and suggestions as simple as possible; and practical. Sticking up for patients has got me into some stressful situations with insurance company representatives and I have wondered sometimes if I have been too much of an advocate for my patients; but I would rather err on that side than the opposite.
So Cameron I am not sure if I have helped you with your question. Does compassion differ from empathy? It probably does; but I don’t really know how; both are important and needful.
“Does compassion differ from empathy? It probably does; but I don’t really know how; both are important and needful” Anton….
Hi Anton I’ve always thought that empathy could be seen as the ability, in both humans and animals to recognise that the other is “In trouble”.
Compassion is the desire to act on that recognition and to offer to help.
As Cameron suggests, this might just be in the form of being there for them…………..therefore I don’t think we need to start analysing our feelings too much as long as a desire to help emerges……If it doesn’t then you’re probably in the wrong job…..!
This brings me back to a quote I have used before “The art of medicine is to keep the patient amused – held – while nature takes it’s course” I can’t recall who but the insert is mine …..,
DB, the “desire to act” is an interesting thing. Desire/intent is always a reflection of fear; they are aspects of the same energy. Do you agree? I actually find myself trying to stop this energy coming into the picture, because I’ve noticed it has a dulling effect on the potency of the treatment. The moment I let go of my need/desire/intent, then spontaneous action usually follows, which is – paradoxically – helpful.
Anton, what you say about not believing what patient says makes me think about how I handle what patient’s say and do in treatment. There’s so many levels and aspects of communication (ie. verbal and non-verbal, superficial and deep) I can get quite overwhelmed just keeping up with everything that is happening at once. I even pay attention to where a patient sits in the waiting room, because there’s information right there! eg. Sitting right next to reception tends to indicate a dependent/submissive personality. Parent and child sitting one or two chairs apart… obvious. A patient who can sit still without constant stimulation of reading/ipad/music is usually much easier to treat. And then all the things that happen in treatment.
David, I understand that you appreciate the willingness to go the extra mile. I do too, so long as it’s delivered without a desire to be ‘extra helpful’, if you catch my drift. A cheap restaurant will pile massive amounts of food on your plate, but it’s usually to disguise the fact that no one in the kitchen can cook. The better the chef, the more likely he is to show off this fact by using miniscule amounts of food, knowing that what he produces still has high value. There’s probably a happy medium somewhere.
Hi Cameron, interesting that , in your reflection, a desire to help equates with fear. I can only see that happening when the practitioner is more screwed up than the patient……….. I think in this world of a greater understanding of the realms of psychology we need to be careful not to over analyse life and try to stay grounded in the “Real World”. It’s a sad place when you ask “Pass the salt please” and the response is “Why”?
On his first croissant 😎
Congrats Anton on wat u do we need more therapists like u in Adelaide not that i am biased cousin