Disclaimers
1. This post may be controversial and ruffle some feathers
2. It is important to remember the different scopes of physio practice around the world
Over the last 15 or so years physiotherapy and rehab have moved from a biomedically informed model where pain is due to postural, structural and biomechanical dysfunctions to a biopsychosocial model where biology, psychology and sociology. This is great to see given the increasing issues of mental illness and chronic pain in society as well as the issues of fragility and dependence coming from a biomedically focused practice.
As much as I'm for both psychologically-informed physio and for mental health care ... I do fear that the world of psychologically-informed care has turned into a bit of a "Wild West" with very unstandardized training, mixed & conflicting messaging and care ranging from basic reassurance and pain education all the way to rehab clinicians directly treating the comorbid mental health conditions of the people we work with.
While I'm happy to see more of a focus on psychology I fear clinicians
- Breaching and overstepping scope of practice
- Getting in trouble legally and/or with insurance companies or regulatory bodies
- And simply providing substandard care. It's important to remember that a few odd courses don't replace years and years of schooling & supervised practicum work that psychotherapists, psychologists and psychiatrists go through.
I also get that it's not easy for rehab clinicians as
- Mental health conditions can be some of the biggest predictors of poor outcomes + biggest barriers we deal with. I've said that mental health can be as big if not a bigger barrier than money.
- Not all of us have the luxury of great mental health professionals to collaborate with.
- Clients aren't always ready to work with a therapist.
- Education and support from schools and regulatory bodies needs a lot of improvement
What there needs to be is
- Consistent and clear messaging as to what our scope of practice is and isn't with managing psychosocial factors
- Appropriate training in said areas along with interdisciplinary care
- And appropriate supervision both during placements/practicums and appropriate monitoring by regulatory bodies
...and it's also important to bear in mind that different countries, provinces, states and territories have different scopes of practice & training.
I've done courses in Motivational Interviewing, Cognitive Functional Therapy and Acceptance and Commitment therapy as well as more informal education in Mental Health First Aid, MI, ACT and working with people with PTSD.
To me my role is to support, listen to, build rapport with, get moving, have a safe space for, refer out with, improve pain & function and increase activity in the clientele I work with ... it's not to diagnose treat someone's psychological trauma or grief depression. There's a lot that physios can do within their scope to help.
I'm eager to see where the field of psychologically informed care goes - however we have many steps to take.
If you've read this far and aren't ready to point a rifle at me - thank you for reading.
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