Talking past each other? Models and interdisciplinary teams

As time passes, therapists can form their own way of working with people – sometimes we get away with this by calling our treatment models ‘eclectic’.  This can be a euphemism for ‘I’ll use whatever I think fits’, or even ‘I like doing this, so this is what I’ll do’!
While this may not be too [...]

Thinking about thinking…

For a long time I thought everyone thought about what they think about, how they think about it, and what their thinking concluded – now I know that some people never do this and live on simply following the rules (and probably having a fun and relaxed time of it!).  I, on the other hand, [...]

Goal intentions or implementation intentions: which one works?

I thought it worth spending a little time considering goals because so many of us work to help people generate goals – but how many are completed? I’m sure I could lay money on the table that most of us have failed to persist with a goal when we’ve set one, and it’s no [...]

On the evidence for decisions about the use of therapeutic interventions

You might have seen a theme emerging this week in my posts – clinical reasoning, evidence-base for treatments, balance between science and art … I came across this rather weighty document today in which Professor Sir Michael David Rawlins presents THE HARVEIAN ORATION Delivered before the Fellows of The Royal College of Physicians of [...]

When should we adopt a new therapy?

When should we adopt a new therapy? This is a vexed question for me. New therapies should be more effective, less time-consuming, have fewer negative effects or take less effort than old – or at least offer something positive – before they’re adopted.
I’ve been critical of the way new therapies have come and [...]

Personal musings on acceptance, mindfulness and valued action

I’m a long way from being anything other than a novice when it comes to Acceptance and Commitment Therapy (ACT). It’s a new-but-old approach, and like most therapies, seems to work best if the therapist actually uses it personally.
There’s no doubt that bad things happen to good people.  That’s challenging, and people who are seen [...]

Feeling the fear – and not even thinking about doing it

Anxiety sensitivity (AS) is basically the fear of feeling anxious, or feeling anxiety-related symptoms. Typically, when people are fearful of their own symptoms of anxiety, they’ll work to avoid getting into situations where they may experience these symptoms.  AS has been shown to be a predisposing factor in some anxiety-related disorders such as panic attacks.   [...]

Overdoing or Underdoing: Activity levels in chronic pain

By a strange coincidence, after writing about regulating activity levels yesterday, I came across a pre-print editorial in the European Journal of Pain discussing exactly this: avoidance or persistence.
We’ve become quite familiar with the avoidance idea – avoidance leading to deactivation, leading to disability, loss of roles, depression and so on. There have been [...]

Which came first: pain or disability?

‘It’s my back, the pain – I can’t do anything because I’m so sore…’
The cry of the weekend gardener! I’m one of them – I spent a good part of my Sunday out in the garden, lugging really heavy (20 litre) bags of compost about, bending, weeding, carrying – and by the end of [...]

Protected: Clinical reasoning and science in occupational therapy

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