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Barrett -> How It Will Be (December 26, 2001 7:07:00 AM)
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I was rummaging through my files today and came across a short essay written a few years ago for a now defunct magazine called the "Therapy Student Journal." It got a good response and since nothing like this publication currently exists, I thought I'd reprint it here. This site could use a few comments from the academic community as well as from those of you now in school and maybe this will generate something. If you're here but your classmates aren't, please copy this and pass it around. Maybe you have an instructor who would appreciate reading it and might have something to add or take issue with. Either way, the way it goes out in the clinic is always interesting to speculate upon. I'd like to hear from those of you who are nearly there.
How It Will Be
Barrett L. Dorko, P.T.
I have a hand carved rocking chair in my waiting room that somebody worked a long time to create 150 years ago. I hear about its beauty from every new patient. As a clinician since ’73, I’ve found that my practice is largely composed of small, faithful acts that are neither dramatic or impressive all by themselves, but would often represent many hours of study and years of experience. It resembles carving, and I call it “a practice made by hand.” Like any object similarly constructed, it is unique, irreplaceable, and slightly flawed.
I’m not a big fan of psychic predictions, but I thought I might try to look into the future for you. When all of this happens, it might help to know that you’re not the first to go through it.
So, here goes. In practice, I predict that you will find:
§ while it is always a good idea to test and measure your patients in some way, it is never a good idea to judge them.
§ the greatest lessons about practice arise from circumstances you neither anticipate nor want. You can’t choose the circumstances, you can only choose whether or not to attend to them fully.
§ whatever you think the doctor’s job is, your description may not often match the doctor’s
§ one day, a patient who has proved difficult and unresponsive to every effort, will tell the doctor you were absolutely wonderful and that your care was transformative.
§ one day, a patient with whom you’ve had a wonderful therapeutic relationship, will tell the doctor you were not helpful and, in fact, rude.
§ technique in the absence of knowledge and understanding is worthless.
§ what you choose to truly learn well is up to you, no one else.
§ the effectiveness of therapy may vary wildly for periods, then stabilize, then vary again. You can’t do anything about this.
§ there is several distinctions between training and care. The former arises primarily from what you know, the latter from who you are.
§ real therapy might be best described as that which the patient takes from the clinic and expresses elsewhere. You don’t provide it as much as reveal it.
§ human beings tend to respond to provocation in a non-linear fashion. This is not the problem with practice, it is the basis of its beauty.
§ your patients, in effect, stand on the other side of a door. They control its opening. And if they sense in your appearance and manner that it’s safe to let you enter, you have a chance of helping them. If they choose not to open that door, all the care you provide and all the skillful technique you employ won’t change a thing.
§ the longer you practice, the easier patients are to get along with. This is not because they change, but because you do.
There’s more, but that should be enough for now. Contact me in a few years and let me know how I did. And remember that your practice is yours alone. Like the chair in my waiting room, you can build it thoughtfully, and one day others will admire it long after you’re gone.
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