Change and Communication. Long-Term Norwegian PsychoMotor Physiotherapy Treatment for Patients with Chronic Muscle Pain

The aim of the present thesis is to enhance knowledge of processes of change and communication during long-term Norwegian PsychoMotor Physiotherapy (NPMP) treatments for patients with chronic muscle pain located to back and/or neck. In the following three separate studies, different types of change and communication are investigated on the basis of a longitudinal research design, including observations of treatment sessions, semi-structured interviews with patients and physiotherapists and personal notes written by patients. Self-narratives on the foundation of patients’ bodily experiences of movement and breath prior to and through long-term NPMP treatment were investigated based on a multiple case study of two cases. Development and perception of change of movements and breath were explored during NPMP treatment based on a multiple case study of nine cases. Communication about change in demanding NPMP Physiotherapy treatment situations was explored in a multiple case study of eleven cases. Study I highlights the concomitant development of self-narratives and bodily experiences on the basis of the dialogue between the patient and the physiotherapist. The main narratives at the start and at the end of the monitored period describe the patients’ experiences from being divided in body and mind to experiencing the body as awakening. This change appears as a move towards a growing variety of selfnarratives, and is related to an increasing awareness of limited bodily experiences of movements and breath. The slow shift of the narratives – from being detached from the body to being in touch with the body – captures these processes. In study II, the exploration of the patients’ bodily changes during NPMP treatment resulted in four patterns of change connected to movements, breath, reflections and transfer of experiences from the treatment context to contexts outside treatment. The fifth, to be detached from and to be in touch with the body, emerged interwoven in each of the above mentioned patterns. Two patient groups, the limited and the considerable change group, were identified on the basis of the extent of change of the different patterns. Across the particular patterns and groups, the way patients perceived their bodies appeared as the core element for predicting change as well as change in the making. In study III, the investigation of communication with regard to change in demanding treatment situations resulted in the identification of patterns of negotiation between the physiotherapist and the patient. The identified main pattern was: seeking common ground – a demanding negotiation process. This pattern was interrupted by short episodes of challenging obstructions to change; the pattern of ambivalence and uncertainty, and the pattern of impatience and disagreement. The physiotherapist’s sensitivity of the situation and her/his capability of negotiation created possibilities for change. So did the physiotherapists’ and the patients’ capacity to bear and come trough demanding situations. The participants’ negotiation of the physiotherapeutic tasks, the emotional aspects of the tasks, and the nature of the therapeutic relationship, seemed to emerge as processes of change. Change and communication appeared integrated. The studies demonstrate that knowledge about change and communication in NPMP treatment of patients with chronic muscle pain of back and/or neck are built on detailed step-by-step processes of perceiving and creating meaning to an increasing variety of movement and breath. In the study, these processes were closely related to how the patient and the physiotherapist negotiated details by varying their ways of communication. Based on the knowledge-producing processes, the patients explored new ways of moving and understanding. Concomitantly, reflections on the application of new knowledge in different contexts outside treatment took place

Reflekterende skriving som kroppslig erfaring. Erfaringer fra kommunikasjonsundervisning

The aim of the study was to explore how third year social educator students reflect in writing on challenging practice-based experiences of communication, and how they experience the writing process. Based on selected and analyzed research material of students’ texts of reflective writing and texts of comments on reflective writing, following findings emerged: I) Experiences of reflective writing included the themes a) to learn to reflect and to become conscious of lived experiences, and b) to improve reflection on connections between experienced relationships and theoretical concepts. II) Reflecting on participation in challenging relationships in specific contexts of communication: a) the relationship of a student and a service receiver with learning disabilities preparing crossing a road, and b) the relationship between a student, a colleague and a patient with stroke, ordering food in a restaurant. Use of reflective writing facilitates self-consciousness, professional reflection and action

Persevering professionals: dilemmas of relationships and self-determination in work with people with intellectual disability – a multi-method study based on interpersonal process recall

The article focuses on social educators’ reflections on their own professional practice in encounters with people with intellectual disability receiving services. Drawing on Interpersonal Process Recall, a video-assisted method, together with a focus group interview, the study explores the experiences from in-situ encounters of five social educators employed in a Norwegian municipality. The key findings are that they view relationship-building as integral to their work, they grant primacy to the ideal of autonomy and they strive towards realizing this in their daily work. The study however displays how these emphases might lead to dilemmas, especially between the wish to support the service users’ self-determination and the urge to protect them from harm. Of special note was how the service users’ increasing use of social media was perceived as a particular challenge for social educators, who were left with an experience of being unable to protect.publishedVersio

Moglegheiter og fallgruver: ei utforsking av sosionomar og vernepleiarar sine refleksjonar kring deltaking i ein multimetodisk studie basert på Interpersonal Process Recall og fokusgruppeintervju

Interpersonal process recall (IPR) is a qualitative research method employing video-assisted interviews, originating from training in psychotherapy skills. This method strongly emphasises recall and reflexivity, aiming to explore the interaction experience, primarily between clients and caregivers. It is used to study professions emphasising reflexive practice, such as psychotherapy and counselling but has been absent from research on social work professions. This article explores the experiences and reflections of five social workers and five social educators who participated in research applying a combination of IPR and focus group methods. Overall, the findings suggest that the participants, possessing critical and reflective practice skills, found their involvement advantageous. Their capacity for reflection and reflexivity not only benefited the participants themselves but also facilitated the researchers in gaining new insights into professional experiences in professional and service user interaction.publishedVersio

Balancing responsibility, boundaries and time: social workers’ experiences in service user meetings – a multi-method study based on Interpersonal Process Recall

The article focuses on social workers’ reflections on their own professional practice in conversations with vulnerable service users in the Norwegian Labour and Welfare Administration (Nav). Drawing on Interpersonal Process Recall (IPR), a video-based method, together with a focus group interview, the study explores the experiences and reflections of five social workers of in-situ encounters with service users. A key finding is that the social workers, who worked in two different offices within the work and activation field, perceived their professional practice as highly complex, negotiated, and ambiguous. The social workers nevertheless displayed a multitude of knowledge and competences, expressed through practical synthesis in the conversations. The article argues that more attention should be paid to ethical aspects of professional knowledge, such as when balancing contradictory considerations towards national workfare policies and vulnerable service users, and how to set the limits for their own professional responsibility in the work towards the service users. Furthermore, the article also directs the attention to another area of professional knowledge, as it explores time as an embedded and ubiquitous aspect of, and condition for, professional knowledge to unfold.publishedVersio

The ambivalence of losing weight after bariatric surgery

This study is grounded in a phenomenological lifeworld perspective. It aims at providing rich descriptions of lived experience of the process of losing weight after obesity surgery. Two women participated in in-depth interviews four times each during the first postoperative year. Based on the women's experiences, a meaning structure—the ambivalence of losing weight after obesity surgery—was identified across the women's processes of change. This consisted of five core themes: movement and activity—freedom but new demands and old restraints; eating habits and digestion—the complexity of change; appearance—smaller, but looser; social relations—stability and change; and being oneself—vulnerability and self-assurance. These core themes changed over time in terms of dominance. The experience of ambivalence is discussed according to a phenomenological perspective of the body as lived experience

Reflekterende skriving som kroppslig erfaring. Erfaringer fra kommunikasjonsundervisning

The aim of the study was to explore how third year social educator students reflect in writing on challenging practice-based experiences of communication, and how they experience the writing process. Based on selected and analyzed research material of students’ texts of reflective writing and texts of comments on reflective writing, following findings emerged: I) Experiences of reflective writing included the themes a) to learn to reflect and to become conscious of lived experiences, and b) to improve reflection on connections between experienced relationships and theoretical concepts. II) Reflecting on participation in challenging relationships in specific contexts of communication: a) the relationship of a student and a service receiver with learning disabilities preparing crossing a road, and b) the relationship between a student, a colleague and a patient with stroke, ordering food in a restaurant. Use of reflective writing facilitates self-consciousness, professional reflection and action

Retrospective and emergent narratives of embodied experiences

Introduction: The article explores how narrative knowledge can facilitate change from being detached from to be in touch with the body, based on a study of long-term Norwegian psychomotor physiotherapy for patients with chronic muscular pain. Main part: Mattingly’s concept «emergent narrative» was applied to identify how ongoing treatment situations can emerge as potential moments of change. «Emergent narratives» indicate knowledge of the process of becoming in touch with the body. Retrospective narratives seemed to grasp experiences that indicated if/how development of symptoms was intervowen in daily life activities, as well as experiences of change of movements and breath over time. Conclusion: The study indicated that emergent narratives point to potential moments of change and seem to be a useful supplement in physiotherapy

Transferring patients’s experiences of change from the context of physiotherapy to daily life

Purpose: In the treatment of patients with long-lasting musculoskeletal pain, the challenge is to identify causal and sustaining factors and targeted treatment in order to improve function. Norwegian Psychomotor Physiotherapy (NPMP) is an approach often applied to patients with such pain. Long-term NPMP processes from the patients’ perspective have been studied and discussed in the light of phenomenology of the body. The study purpose was to explore what kind of changes patients with long-lasting musculoskeletal pain experience during NPMP and further transfer into daily life context. Methods: A phenomenological, descriptive, and retrospective design was applied. Two focus-group interviews were conducted with 11 patients receiving such treatment. The interviews were audiotaped, transcribed, and analysed inspired by Giorgi’s phenomenological methodology. Results: The analysis resulted in an overarching structure: “To develop embodied ownership of oneself over time”, and two themes describing the essence of change that the patients experienced: (1) “To get an embodied grip on oneself through treatment”; (2) “To give oneself space in daily life”. Conclusions: Enhanced embodied self-perception involving a sense of embodied ownership and agency seemed to be important both to be aware of own bodily needs and to transfer changes from treatment into daily life

Developing self-care in an interdependent therapeutic relationship: Patients’ experiences from Norwegian Psychomotor Physiotherapy

Factors causing and sustaining long-lasting musculoskeletal pain differ between patients, but must be identified in order to target treatment. During physiotherapy, there are multiple factors influencing the treatment outcome. The focus in the present study was to grasp patients’ experiences of how social burdens influence the development and persistence of symptoms of muscle pain, and how the relationship with the physiotherapist influences the process of change during Norwegian Psychomotor Physiotherapy. A phenomenological, descriptive, and retrospective design was chosen. Data were collected through focus-group interviews. Eleven patients participated. They ranged in age from 34 to 67 years. The analysis was inspired by Giorgi’s phenomenological method. The results identified a general, overarching structure; “Caring for others and developing self-care” and the two interwoven themes “Emerging awareness of overload” and “Receiving care from the physiotherapist.” These themes describe the essence of the experiences from the treatment process. To be recognized by the physiotherapist, both through the hands-on treatment and verbal communication, appears to be crucial for patients to develop an awareness of the factors causing and sustaining their pain problems. This awareness seemed necessary for the process of change to take place and for the patients to take more responsibility for their own care