Biopsychosocial Filter - Part 2

There are five stages of grief, and I have to say that as I started to refer clients and got back to the books (see the last article where I describe how this happened to me and my relationship with the biomedical model), I felt each one, in a vivid way.

Denial –
Right screw it, probably the rest of the industry is wrong, perhaps science will catch me up. It must be right because I see results. These techniques just make common sense…<sob>…placebo effect is still an effect?

Anger –
Shit on it, all of you just get lost as I know this works and I do not want to change. I made a whole career on this. It is not fair, people want me to teach them how to release tissue and I am so upset it is all crap. Plus other people are still saying this stuff and people believe them, that could be me, coining it in, talking bollox, and having people follow me. Arrrggghh, I hate this, I give in, right I am going to read and prove its all wrong and I am right, or I am going to be the best at this Biopsychosocial bag of crap!

Bargaining –
Perhaps I can still do a bit of what I did before and it will be okay? It is funny anyway, plus some of the others seem to be stuck in this place too. Can I maybe use more motivational speak to accompany my fascial scraping? This is hard!

Depression –
Its all over, the Biopsychosocial people are not all so great. There is a cool Aussie guy, and then this clever bloke who keeps slating trigger points, however, there is also a lot of crap. I am depressed at reading fully grown adults, let alone therapists, tell other people that they have to treat people well, not scare them, listen to them, help them find compelling reasons to move, use positive language, do not make outlandish claims and other really common human things. If these people are really sharing this as groundbreaking, then perhaps I could go back to fitting windows (the last job I had before Uni).

Acceptance –
Right, I can do this, I see that some of the big values I have always held close are more than relevant. Furthermore, a lot of people who are shouting about the BPS model, Pain Science and applications to training, are still in the middle of this grieving process and they are not letting go. You can see it a mile off, holding on to lifting, impressed by their own gymnastics, posting papers without consideration to the amount of reading that needs to go into a statement, then saying something vague about being nice to your client and so much more. If this is the arena I get to play in, then I better get good and learn this properly!

Right, so this is what I discovered as I started to rebuild the way I approached everything to do with training.

First I went back to what I know, which is Sports Coaching. This helped me ground my thoughts, and also revisit what I was taught at University. I need to find the right questions, and then find the research to give me a reasoned and well-researched answer. This needed to be done in a way that challenges my pre-conceptions and bias.

Second I needed to focus on what I can have a true influence on in a training session and over many training sessions. Those factors include skill development, performance enhancement, exercise choice, intensity and volume of work, and most importantly, client experience.

Everything I was reading and everything I have read keeps leading me to the same conclusion. If you want to get a result with a client, then you need to understand conscious and subconscious values and drives. Then you need to be able to read move and change emotions through experience. Meaning I better get very good at story writing, on the spot and planning in advance. This is mainly because I could not find a comparison for cinema, books, music and storytelling/experience as a way of eliciting emotions in a client.

Reading about motivations and what some authors call the human condition, I started to go back to the loud voices in our industry. The quotables I call them, which are the leading authorities outside of researchers (although some have papers published), who seems to be shouting about how to apply the Biopsychosocial model, or they are shouting down anyone who does not use it.

The result is that in my mind the only way I can interpret the information in the research is through the idea of a BPS filter. Once I got my head around this fact, then I started to see a flaw in a lot of the suggestions and arguments going on through facebook. It also helped me understand the love of gymnastics and Olympic lifting (plus the other training modalities that people were pushing, after pulling down the importance of biomechanics).

Essentially the BPS model puts the brain’s perception and then the emotional response to sensation, at the centre of our focus. All different immediate feedback, combined with knowledge (our rules) and instinct (our learnt knowledge) will then give us the outcome we know as a feeling. This can also be massively influenced by the environment, the importance of the task, the perceived negative or positive outcome from the task as well as their trust in you.

In our industry at the moment, people who diagnose and then fix with a biomechanical focus, are slated quite heavily and in some cases quite rightly (is rightly a word? It is now!). However, I think that it is more complicated than that and that is why I can up with the following analogy –

The Biopsychosocial filter is a way of expressing the thought that nothing can be delivered in isolation, even if the therapist thinks it is. So even if you pulled out a biomechanical solution to a problem that is diagnosed as biomechanical, the resultant solution will still be delivered by you (social influence), it will either be recognised (or not recognised) and so have to be perceived by the individual as helpful or risky (Psycho) and the environment, teaching style and many other factors will all be present, even if the exercise given is super simple.

In order to try and explain it more, and in better detail, I made this video to show you what I do and how I do it.