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BODY AWARENESS - applications in physiotherapy

Abstract

Monica Mattsson, RPT, Departments of Psychiatry and Family Medicine, Umeå University, S-901 85 Umeå, Sweden

A point of departure of the thesis was the attitude to the body that characterizes physiotherapists within psychiatric and psychosomatic care. The aim of the thesis was to give a description and to evaluate applications of psychiatric physiotherapy (PPT) within psychiatric and somatic care. Particularly the focus was on physiotherapy within psychosomatic gynaecology. Body awareness is a central concept in this thesis. In articles about supervision this concept was illuminated when working methods and experiences from the supervisory activity were described.

In two articles the working modality and the long run results of the treatment of out-patients at a psychiatric clinic were extensively described. Patients, who had various psychiatric problems, were offered in addition to "traditional treatment alternatives" four sessions of psychiatric physiotherapeutic treatment sessions. As an overall goal these sessions aimed at stimulating curiosity about stress reducing techniques and offering exercises concerning body-mind interactions. The patients were given individual exercises that originated from each patient's individual needs. In a control group the patients were receiving only "traditional treatment alternatives". The effects were studied with qualitative (interviews, field notes) and quantitative (symptom rating scale, movement test, self-image test) methods.

Those individuals who received psychiatric physiotherapeutic treatment expressed high appreciation and at follow-up six months after inclusion they reported fewer symptoms than those patients who were not admitted to physiotherapy. Compared to the control group the patients who received psychiatric physiotherapeutic treatment also had a more normal self-image.

In two articles the co-operation between a female physiotherapist and a female gynaecologist was described while in charge of a body awareness treatment group with abused women. Abuse (sexual and physical) of women has been paid much attention to during the last decade and the aftermaths of these insults and offences may appear as physical or/and mental signs and symptoms. In an introductory paper the background of abuse (prevalence and distribution) is sketched and current treatment alternatives are outlined. Body awareness in this physiotherapist-doctor design has never been studied before. The process of the group was described in three stages that succeeded each other in chronological order. Each session turned out to contain three separate sections and was structured as: (i) preparing movements, (ii) doing movements and (iii) integrating movements. The group treatment displayed a mutual learning process and the combination female physiotherapist - female gynaecologist seemed to be favourable. The follow-up after one year exposed an essential reduction of symptoms and a negative self-image (self-blame, self-hate, self-ignoring) changed to much lower ratings for five out of seven patients. Acceptance of body according to body image test increased also in five of the patients. A sociological interpretation model related to the experience of living with the aftermaths of the insults displayed consequences of the abuse entering the "social room".

One study described physiotherapeutic body awareness group therapy (20 sessions) together with a gynaecologist with women chronic pelvic pains. The treatment modality was described as "triangle treatment" and the active participation of a responsible patient was aimed at. The main focus was on the working method of the physiotherapist and to throw light on managements and interventions. The patients' outcome and "triangle model" were evaluated by using qualitative and quantitative methods and by arranging a focus group discussion. The rating scale used was the Body Awareness Rating Scale (BAS) which is much utilized in Sweden. The scale displays a holistic approach assessing mental and motor symptoms and functions. The women improved with regard to psychomotoric function, symptoms and working capacity. The improvement was related to the relationship between the home exercises and the "desired goals" as originally set down. The "pain as an ally" concept was developed into a model which stresses the polarities and changes in the physiotherapist's work and "the art of adjusting" as the overall method of working.

In two articles the planning, the carrying through and the experiences of professional supervision of physiotherapists in charge of a pain school (group activities with patients with musculoskeletal disorders) were reported. The professional starting point for the supervision was the competence of the supervisor as experienced in psychiatric physiotherapy. By using questionnaires, interviews and supported by three experienced psychotherapy supervisors who studied and interpreted comprehensive documentations from the supervision sessions experiences and concepts were delineated. The physiotherapists in supervision became aware of the role of demarcation, they got hold of clinical skills and acquired extended knowledge in psychosomatic pain treatment. By interpreting the documentations the psychotherapeutic supervisors noticed key phenomena in the physiotherapy profession and these elements were elucidated. The specific physiotherapy experience of perceiving the body and assessing movement quality is highlighted. According to the psychotherapy supervisors' opinion physiotherapists ought to have a deep understanding of the accomplishment of body awareness methods while working with pain-prone patients. Physiotherapy is implicitly communication on a "bodily level". Bodies are never silent and body language is the most important element of the communication. Physiotherapists achieve both tacit and formulated knowledge about the body's way of expressing the individual, and thereby the individual's potential for self-direction. The professional "common language" facilitated the learning process. The data stressed the beneficial outcome of supervision by a colleague.

The basic view of the body is that it expresses our life history and that we live our bodies, and that tensions and conflicts, as well as resources are expressed in psychomotoric function, like in posture, walking and breathing. Central aspects in body awareness therapy are the interactions between psychomotor function and mental attention. As a consequence of this point of view on the body physiotherapists within psychiatry can give additional contribution in psychiatric diagnostics and treatment alternatives.

The thesis demonstrates that PPT and body awareness is applicable in psychiatric and psychosomatic care. In the long term this approach of physiotherapy may have an increased importance within the health-care system. Body awareness has been introduced both into the undergraduate curriculum of physiotherapy and in postgraduate training courses in Sweden as well as in Norway. Future research is needed to be carried out to confirm results.

Key words: Body awareness, basic body awareness therapy, physiotherapy, psychiatric physiotherapy, psychiatric care, gynaecology, abuse, qualitative research, clinical supervision.