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

Abstract

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.