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Every little thing a nice therapist does is magic

Loyalty to a physical therapist is often misguided and has little or nothing to do with how well treatment is actually working

updated (first published 2007)ARCHIVEDArchived pages are rarely or never updated. Most featured articles on PainScience.com are updated regularly over the years, but not archived pages.
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about PainScience.com

“Everyone has some therapist they swear by, either a chiropractor or a physiotherapist or a massage therapist,” a patient once told me. “Everybody’s got their guy.”

It’s true, almost everyone who has been through a lot of chronic pain has tried several therapists and sooner or later settled on someone as their favourite. Many times in my own career as a massage therapist I became someone’s “guy.” I often replaced the previous guy.

I was never quite comfortable with that, because I know just how misguided that loyalty can be. People like physical therapy whether it works or not. In 2010, researchers dug through thousands of scientific papers, looking for the ones that tracked both the effectiveness of treatment and overall patient satisfaction:

An unexpected finding was that treatment outcome was infrequently and inconsistently associated with patient satisfaction.

Unexpected? Ha! Hardly.

There is a glaring disconnect between the effectiveness of a treatment and how a patient feels about it. Satisfaction is determined by social and psychological factors far more than anything else. The social and presentational skills of the therapist are what influence patient satisfaction, not the treatment results. Every little thing a nice therapist does is magic — or seems like it, anyway.

Consider the widely-reported fact that patients don’t sue doctors they like, regardless of how badly the doctor may have screwed up. The best legal insurance for a doctor is simple, genuine charm. Similarly, a patient who likes a therapist will almost never conclude that treatment was “useless” … even if it was. But it goes much further than that …

Still in pain, still enthusiastic!

Patients are really quite magnanimous: they will often graciously describe an ineffective treatment as “amazing,” as long as they like the therapist providing the service.

Indeed, almost everybody who has “got a guy” seems to still be in pain! This is especially true of chronic back and neck pain. Their symptoms might be reduced, but they still have “bad back,” they are still nervous, they still have days when their back “goes out,” they have a list of verboten activities, they are perpetually unable to wrestle with their spouses, give airplane rides to their kids, or snowboard, or run like they used to, or whatever, all for fear of a fresh attack of symptoms. Not such a great life. Not much of a cure, really.

But they’ve got their guy! He's “totally amazing.” The testimonial falls from their lips without irony.

People can do these mental gymnastics with great skill and endurance. It’s easy for primates: the social dimension is everything to us; we are far more social than we are rational.

I never wanted to be anyone’s guy, or at least not until they have actually gotten better — really better, by a reasonable standard of success, a standard that wouldn’t be a disappointment to anyone outside the box they’ve been living in. It’s true, when you’ve had chronic pain, any progress can be a godsend. But c’mon, people: is it really necessary to “swear by” a treatment that hasn’t done any more than take the edge off? Can’t we just say you’ve “got a guy who helps a little”?

Patients don’t need heroes.

Impulsive clinicians always want the next tool for their toolbox or the latest certification. With time and with careful consideration of what we actually do, no certification in the world can replace the genuine desire to be your patient’s greatest ally during some of the darkest days in their life.

Being an ally means taking the backseat and providing the hero with everything they need to overcome their challenges. There is of course one principle drawback to being an ally: it’s not glamorous. It requires a service mindset. But every hero (both actual and mythological) has an ally.

Too many clinicians want to be Batman. Most of our patients need Alfred.

Roderick Henderson, PT and strength coach, writing from somewhere on the social medias

Demote your guy!

Ask yourself if “your guy” really deserves that status. You don’t have to fire him — or her, if your guy is a gal! — just try to be honest without yourself about the results you are getting. Is the therapy really helping? Or do you just like your guy?

Actually, hopefully it’s both.

Ideally a therapeutic relationship should fire on all cylinders, providing both a rewarding and reassuring relationship and effective treatments. Liking your therapist may even be an essential component of therapy: treatment might actually work better when the relationship is good. There’s probably some overlap … and that’s the sweet spot!


About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.