The Biopsychosocial Filter, Part 2

In part 1 I described how I started referring clients out and went back to the books — and my relationship with the biomedical model fell apart. There are five stages of grief, and I felt each one vividly.

The five stages of unlearning

Denial. Screw it — probably the rest of the industry is wrong and science will catch up. It must be right because I see results. These techniques just make common sense… placebo effect is still an effect, right?

Anger. I know this works and I don't want to change. I built a whole career on it. People still say this stuff and others believe them — that could be me, coining it in. Fine: I'll read up and prove it's all wrong, or I'll be the best at this biopsychosocial bag of crap.

Bargaining. Maybe I can still do a bit of what I did before? Maybe I use more motivational speak to accompany the fascial scraping? This is hard.

Depression. It's all over. Some of the biopsychosocial crowd aren't so great either — I'm reading grown adults tell therapists to treat people well, not scare them, listen, use positive language and not make outlandish claims, as if it were groundbreaking. Maybe I should go back to fitting windows.

Acceptance. Right — I can do this. The values I've always held are more relevant than ever. And a lot of the people shouting about the model are still stuck in their own grieving: impressed by their own gymnastics, posting papers without the reading behind them, then saying something vague about being nice to your client. If this is the arena, I'd better get good and learn it properly.

Rebuilding the approach

First I went back to what I know: sports coaching. That grounded me and sent me back to what I was taught at university — find the right questions, then find research that gives a reasoned answer, in a way that challenges my own bias.

Second, I focused on what I can genuinely influence in a session and across many sessions:

• Skill development
• Performance enhancement
• Exercise choice
• Intensity and volume of work
• And most importantly, the client's experience

Everything I read led to the same place. If you want a result, you need to understand a client's conscious and subconscious values and drives, then read, move and change their emotions through experience. In other words, I'd better get very good at story-writing — planned in advance and on the spot — because I couldn't find a better model for eliciting emotion than cinema, books, music and storytelling.

What the filter actually means

The biopsychosocial model puts the brain's perception, and then the emotional response to sensation, at the centre. Immediate feedback, combined with our rules (knowledge) and our learnt instinct, produces the outcome we call a feeling. That's massively influenced by the environment, the importance of the task, the perceived outcome, and the client's trust in you.

Trainers who diagnose and fix with a purely biomechanical focus get slated — sometimes rightly. But it's more complicated than that, which is where the filter comes in.

The biopsychosocial filter is a way of saying nothing can be delivered in isolation, even if the therapist thinks it is. Pull out a biomechanical solution to a problem you've diagnosed as biomechanical, and that solution is still:

• Delivered by you — social influence.
• Perceived by the client as helpful or risky — the psychological layer.
• Wrapped in an environment, a teaching style and a dozen other factors, even if the exercise itself is dead simple.

Once I got my head around that, I could see the flaw in a lot of the arguments doing the rounds — and understand the love of Olympic lifting and gymnastics that came after people had spent so long pulling down the importance of biomechanics.