CBT in Physiotherapy

This year I was lucky enough to get a spot in a valuable course called CBT Immersion jointly presented through Laurier University and Qualia Counselling Services. This is a condensed Cognitive Behavioural Therapy course for health professionals and I am excited to be a certified CBT therapist once I complete the course in November.


There are several reasons that I chose to enroll in a course that has nothing to do with manual therapy:


The Clinical Interview Process


A huge and integral part of what I do with my patients is LISTEN to them. Although it is a general part of any assessment, many clinicians do not take the time to thoroughly question their patients during the interview process. It is common for clinicians to want to rush right into the physical exam and get their hands on the patient. Although confirmatory information is gleaned from the physical exam, the subjective exam (or interview) can reveal such valuable information on a patient’s views towards the complaint that they are coming to see me for. Their story, and their interpretation of their story is a critical piece of my clinical problem solving. This helps steer my questioning, narrow my clinical hypotheses towards a diagnosis, prioritize my upcoming physical exam and highlight the topics of education that I will give my patients as part of their treatment plan.


My Patient is a PERSON


It saddens me to me know how many of my patients have felt dismissed by other health professionals and perhaps me as well, when I haven’t taken the time to listen to their story. Patients that have seen a gynecologist for long standing pain with intercourse and are told, “Well there are other things that you can do besides penetrative sex.” Patients who visit their family doctor or obstetrician about incontinence and are told, “Oh that’s normal. If it doesn’t go away, you can have surgery later.” Or even patients that had a traumatic birth experience that involved a negative experience within the medical system which left them feeling scared for their life or their newborn’s and yet noone from their medical team acknowledges the trauma that they experienced, simply stating “I am sorry that this has happened to you.”


These experiences and encounters affect a person’s spirit, diminish their faith in the health care system and often make these patients feel very alone. I don’t believe that is the intention of ANY clinician, but it is the reality for that patient. Our choice of words when interacting with our patients can be very powerful.


The Cognitive Behavioural Model (CBT)


Before enrolling in this course, I inherently knew that I was already using some CBT in my assessment and treatment. The cognitive model is a teamwork approach to treatment in which both the therapist and the patient work together. I treat my patients as part of the team at all times, so learning how to properly integrate and have a framework to work within just made sense. CBT is based on the premise that a person’s environment (or data) shapes their thoughts, which affects their mood and in turn directs their behaviour.


My patient is the only one that knows how a situation feels and it is my job to guide them on a journey of self-discovery to help them develop strategies to handle difficult situations as they arise. CBT address automatic thoughts, often based on a patient’s core beliefs, that can lead to assumptions and rules for living that may need to be questioned and changed. We work together towards behaviour experiments to address fears and in turn develop more alternative balanced thoughts and behaviours. These changes can be an integral part of desensitizing the nervous system and the threats that may be perpetuating the ongoing pain problem.


I am a physioTHERAPIST


As I gain more experience, especially in the field of pelvic health, I am learning that the initial assessment with my patient is what sets the groundwork for success in my teamwork approach to treatment. The physical exam, treatment planning and compliance with behaviour modification and exercise programming are the tools of my trade. I am more than just a set of hands. I am an active listener using an empathetic approach. My patient’s story is paramount. I want to know their story and how their problem or complaint affects them and your life. Understanding your patient and what they value becomes is key to appropriate goal setting and treatment planning.


More and more, my interview process can take up the entire hour of the initial assessment. With the permission of my patient, I take the time to thoroughly interview and gain insight into how their physical problem is affecting their life; mind, body and spirit. My patients are people and deserve to be heard and feel validated. Time goes towards education on anatomy, biomechanics and optimal function, the differences between sensory and motor input, their own thoughts and behaviours and how all of these things have contributed to why they are seeking treatment right now. This leads to a follow up appointment where thought and behaviour changes have already been put into process, I can gain feedback from their experience, modify as needed and then delve into a thorough physical exam to gain even more information, further direct our treatment plan which solidify’s the overall patient experience. Most of all, I have gained the most valuable asset in treatment, a strong therapeutic alliance.


It is my hope that all clinicians treat their patients as people. Involve them in their goal setting and treatment planning. EMPOWER them with strategies to achieve their goals and even surpass them, allowing the empowering energy and changes in their thoughts, mood and behaviour overflow into their daily lives. That, in my honest opinion, is good physioTHERAPY.


Written by:

Karen San Andres
Lab Assistant