Abstract
Purpose and background of the study
When talking to patients about pain, it has been shown that practitioners can positively or negatively influence health beliefs and treatment outcomes. Multidisciplinary physical and psychological interventions have demonstrated better outcomes for patients with long-term pain. Acceptance and Commitment Therapy (ACT) is a form of ‘third wave’ Cognitive Behavioural Therapy (CBT) that has been shown to promote resilience and wellbeing. A qualitative auto-ethnographic case study design was used to explore the communication processes and therapeutic outcomes associated with developing an innovative course integrating ACT interventions with osteopathic treatment, delivered by a single practitioner.
Methods
Six individual consultations with four patients were audio-recorded, transcribed verbatim and coded. Linguistic Ethnography was used to identify pain discourses and analyse links with clinical decisions and patient responses. Transcript extracts were analysed at three levels; micro-level Conversation Analysis of communication processes; Interactional Sociolinguistic Analysis of changes in patient-practitioner roles; and macro-level Discourse Analysis of the wider biomedical and biopsychosocial context.
Results
Two distinctive forms of discourse were identified. In predominantly ‘mechanistic’ communication, the ‘expert’ practitioner role was focused on fixing ‘broken’ parts and relieving pain. In ‘facilitative’ discourses, the ‘collaborative’ practitioner focused on promoting patients’ body awareness and active coping. Challenges included learning how to shift between discourses, which required mindfulness and willingness to tolerate uncertainty.
Conclusion
This new inter-disciplinary approach enabled an osteopath to re-frame pain discourses to promote patient agency and resilience. Findings were subsequently used to design the OsteoMAP study (Osteopathy, Mindfulness and Acceptance-based Programme) to test outcomes with practitioners in other clinical settings.
No conflicts of interest
No funding obtained
