I was a bit surprised by this article at first- it was shocking to read some of the comments (especially from the more experienced therapists) and learn how little they understood psychosocial issues and their impact. It did make me reflect back on my first year of practice though and I can honestly say, I wasn’t far off from them.
I learned about “yellow flags” in school which essentially meant listening for these in the subjective. I did learn about the FABQ but I feel like I never truly understood what it meant scientifically to have psychosocial factors influencing recovery. I think for many young PTs, high FABQ scores could be interpreted as the patient was exaggerating, or they had other intent for financial gain, etc. I can sadly say I had this view initially (and I even had some education on this in school)! I think for me, despite being educated in school, there was no carryover on clinicals and in my early clinical practice to apply this material and learn it in a clinical role. My first job was in a very low income, low education area and everyone had 10/10 pain and nothing seemed to fit a clinical pattern. I would listen to the PTs around me joke about these patients and it began to shape a view in my mind that was not accurate about psychosocial factors. This patient would walk in the door and I was immediately frustrated and did not give them the benefit of the doubt- I already knew they weren’t going to get better because they “didn’t want to try”. I think had I been surrounded by good mentors who further educated me how to recognize fear avoidance and psychosocial factors impacting recovery in the clinical setting (not just in a lecture) and how to manage it, I would have been much more successful treating these patients.
I think what differed about the education I received in school and the education I received in VOMPTI was the emphasis on therapeutic neuroscience education. This definitely changed the way I viewed these patients and in turn, made me much more successful with them. In grad school, I was taught about high FABQ, graded exposure, graded exercise, etc. but I did not have an understanding about WHY people had these views. I did not know any of the science behind it- the changes in the brain, etc. I think because of this, I had more of the mindset that these patients had alternative motives, etc. When I finally learned about TNE, I didn’t look at all these patients with frustration. Instead, I was able to be empathetic. I was able to explain to them why they were so frustrated as well and I was able to make progress.
I definitely agree that education in this area needs to be better. And it needs to be comprehensive. If you only receive part of the picture, you’re free to draw your own conclusions about the rest. And if you are not influenced by good PTs/mentors early on, this can be very detrimental.