Acknowledgement of country
Critical physiotherapy
challenges contemporary physiotherapy theory & practice
works towards a more positive, inclusive, critical future for
physiotherapy
Speakers
Dr Ian Edwards
What is the source of our ethical obligation in physiotherapy practice:
Codes of Conduct or the Levinasian face?
Amy Hiller
‘Insider’ research: Reflexivity as a tool to manage participant
misconceptions.
Blaise Doran
A physiotherapist prepares: Enhancing the therapeutic alliance through
Psychological Realism acting methods.
Dr Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for
researching what physiotherapy was, is and can be.
A/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the
genealogy of a profession.
Speakers
Dr Ian Edwards
What is the source of our ethical obligation in physiotherapy
practice: Codes of Conduct or the Levinasian face?
What is the source of our ethical
obligation in physiotherapy: Codes
of conduct or the Levinasian face?
Ian Edwards
Ethics in physiotherapy sits on a fault line
Codes of conduct:
Regulation of professional
behaviour and practice
standards
To be caring and
have compassion
Delany et al (In preparation)
Josephson et al 2015
Emmanuel Levinas
Ethics as 1st philosophy
Alterity – the primacy of the ‘other’
The Levinasian ‘face’ (Levinas 1969 p 66)
The boy with no eyes
From Edwards, I. The boy with no eyes – an ethics of ourselves with
others. (In preparation)
Edwards et al 2014
references
Delany C, Edwards I & Fryer C. Ethical dimensions of Australian
physiotherapy practice (In preparation).
Edwards I. The boy with no eyes – an ethics of ourselves with
others. (In preparation)
Edwards I, Jones M, Thacker M, & Swisher LL. 2014. The Moral
Experience of the Patient with Chronic Pain: Bridging the Gap
Between First and Third Person Ethics. Pain Medicine 15: 364–378
Josephson I, Woodward-Kron R, Delany C & Hiller A. 2015.
Evaluative language in physiotherapy practice: How does it
contribute to the therapeutic relationship? Social Science and
Medicine 143:128-136
Levinas E 1969. Totality and Infinity: an essay on exteriority.
Trans. Alphonso Lingis. Pittsburgh, Pennsylvania; Duquesne
University Press, p 66.
Speakers
Dr Ian Edwards
What is the source of our ethical obligation in physiotherapy practice:
Codes of Conduct or the Levinasian face?
Amy Hiller
‘Insider’ research: Reflexivity as a tool to manage participant
misconceptions.
Blaise Doran
A physiotherapist prepares.
Dr Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for
researching what physiotherapy was, is and can be.
A/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the
genealogy of a profession.
Speakers
Amy Hiller
‘Insider’ research: Reflexivity as a tool to manage participant
misconceptions.
‘Insider’ research: reflexivity as
a tool to manage participant
misconceptions
Amy Hiller
The University of Melbourne
Contact: a.terry@student.unimelb.edu.au
Who am I? What is my identity?
Health care
professional/
clinician/Physiot
herapist
Researcher
- Dual clinician-researcher identity
- ‘insider-researcher’ (Allen, 2004; Asselin, 2003)
How do I consider what my role is?
Reflexivity
•
•
-
Involves “disciplined self–reflection”
Self-awareness, critical evaluation
Consideration of role and impact on research
Benefits:
Enhances rigor and reduces bias
Provides guidance to manage ‘ethically important moments’
(Doyle, 2013; Finlay, 2002; Guillemin and Gillam, 2004; Johnson and Waterfield, 2004)
What are my role identities?
Health care
professional/Physiotherapist
- Caring and helping nature
- Patient advocate
- Influenced by professional
socialization
- Focus on providing a service
of patient care
Researcher
- Investigational
- Objectivity
- Focus on generating
knowledge and
understanding
(Colbourne & Sque, 2004)
The clinician-researcher
• Dual role or ‘insider researcher’
Benefits
-
Easier access to participants
for recruitment
Easier development of rapport with participants
Familiarity with clinical
environment and terminology
-
Challenges
Managing the different
focuses of the roles
Understanding scope and
boundaries of each role
Managing misconceptions of
participants
Ethical challenges
(Allen, 2004; Asselin, 2003; Colbourne and Sque, 2004; Reed and Proctor, 1995)
Considerations
The therapeutic misconception
in quantitative research
Clinical trials research participants:
•
Confuse participation with personalized care
•
Do not appreciate random assignment to treatment
•
Expect direct benefit
Ethical and methodological issues can arise
(Appelbaum et al., 2004; Dresser, 2002; Glannon, 2006;
Miller and Joffe, 2006; Townsend et al., 2010)
Participant misconceptions
in qualitative research
Patient-participants:
•
Feeling an obligation to participate
•
Expecting treatment
Practitioner-participants:
•
Expecting to receive feedback
•
Perception of being judged
(Hiller and Vears, 2016 – in press)
Conclusion
• The insider-researcher must be aware of his or
her role regarding potential misconceptions of
participants
• Reflexivity is critical to achieving this awareness
• Helpful tips:
• Be aware of the potential for misconceptions
• Talk to other researchers to gain different
perspectives
• Keep a research diary
Thank you
a.terry@student.unimelb.edu.au
References

Allen, D. (2004), “Ethnomethodological insights into insider-outsider relationships in nursing ethnographies of
healthcare settings”, Nursing Enquiry, Vol. 11 No. 1, pp. 14-24.

Appelbaum, P. S., Lidz, C. W. and Grisso, T. (2004), “Therapeutic misconception in clinical research: Frequency and
risk factors”, IRB: Ethics and Human Research, Vol. 26 No. 2, pp. 1-8.

Asselin, M. E. (2003), “Insider research: Issues to consider when doing qualitative research in your own setting”,
Journal for Nurses in Staff Development, Vol. 19 No. 2, pp. 99- 103.

Colbourne, L., & Sque, M. (2004). Split personalities: role conflict between the nurse and the nurse researcher. NT
Research, 9(4), 297-304.

Doyle, S. (2013), “Reflexivity and the capacity to think”, Qualitative Health Research, Vol. 23 No. 2, pp. 248-255.

Dresser, R. (2002), “The ubiquity and utility of the therapeutic misconception”, Social Philosophy and Policy, Vol. 19
No. 2, pp. 271–294.

Finlay, L. (2002). "Outing" the researcher: The provenance, process, and practice of reflexivity. Qualitative Health
Research, 12(4), 531-545.

Glannon, W. (2006), “Phase I oncology trials: Why the therapeutic misconception will not go away”, Journal of
Medical Ethics, Vol. 32 No. 5, pp. 252-255.

Guillemin, M. and Gillam, L. (2004), “Ethics, reflexivity, and 'ethically important moments' in research”, Qualitative
Inquiry, Vol. 10 No. 2, pp. 261-280.

Hiller, A. and Vears, D (2015), “Reflexivity and the clinician-researcher: managing participant misconceptions”,
Qualitative Research Journal (In Press).

Johnson, R. and Waterfield, J. (2004), “Making words count: the value of qualitative research”, Physiotherapy
Research International, Vol. 9 No. 3, pp. 121-131.

Miller, F. G. and Joffe, S. (2006), “Evaluating the therapeutic misconception”, Kennedy Institute of Ethics Journal,
Vol. 16 No. 4, pp. 353-366.

Reed, J. and Procter, S. (1995), “Practitioner research in context”, in Reed, J. and Proctor, S. (Eds.), Practitioner
research in health care: The inside story, Chapman and Hall, London, pp. 3-31.

Townsend, A., Cox, S. M. and Li, L. C. (2010), “Qualitative research ethics: Enhancing evidence-based practice in
physical therapy”, Physcial Therapy, Vol. 90 No. 4, pp. 615-628.
Speakers
Dr Ian Edwards
What is the source of our ethical obligation in physiotherapy practice:
Codes of Conduct or the Levinasian face?
Amy Hiller
‘Insider’ research: Reflexivity as a tool to manage participant
misconceptions.
Blaise Doran
A physiotherapist prepares: Enhancing the therapeutic alliance through
Psychological Realism acting methods.
Dr Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for
researching what physiotherapy was, is and can be.
A/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the
genealogy of a profession.
Speakers
Blaise Doran
A physiotherapist prepares: Enhancing the therapeutic alliance
through Psychological Realism acting methods.
A physiotherapist prepares
• Psychological Realism
Enhancing the therapeutic alliance through
Realism acting methods.
• Psychological
Events
• Objectives and Actions
• Putting it to use; questions
Blaise Doran, BSc Physiotherapy, Grad. Dip. Neuro. Rehab.
“Psychological Realism” in acting.
Konstantin
Stanislavsky
(1863 – 1938)
Maria Knebel
(1898 - 1985)
Sam Kogan
(1946 – 2004)
Kogan,“Psychological
S [Ed. Kogan,Realism”
H] (2010).
TheThe
Science
of Acting,
AKA
Method
Routledge, UK.
Events
That which intensifies our thinking
or
Intensified thinking itself (Kogan, 2010)
Intensity of thought
y
Physiotherapy
Anticipation
Dissipation
C
B
T
Circumstance
t=n
Events ≠ physical happenings
x
Objectives and Actions (Purposes)
Purposes (long term)  Super-purpose
Objectives (short or medium term)
Objective
Birth
Death
Value oriented / goal oriented.
Purposes & objectives:
Happiness:
Actions:
A want; a change we want to fulfil
Achieving purposes…
What we do to achieve our purpose.
Putting it together
Intensity of thought
y Accident
Objectives
What is the want driving them to see you?
Anticipation
Egotistical objective – wanting to change the thinking ofPanother
H
person
Y own
Altruistic objective
– a thought you want to achieve in your
Dissipation
Afterburn
S
head.
I
Can complementary
you teach empathy?
Are your objectives (collectively)
or
O
contradictory?
Questions:
W
Actions
1
2 doing
What
are they
to3
Does a formula lead to
failure?
try to
4
achieve
t = months
Thought  physical behaviour
5 objective?
6
their
C
x
Speakers
Dr Ian Edwards
What is the source of our ethical obligation in physiotherapy practice:
Codes of Conduct or the Levinasian face?
Amy Hiller
‘Insider’ research: Reflexivity as a tool to manage participant
misconceptions.
Blaise Doran
A physiotherapist prepares: Enhancing the therapeutic alliance through
Psychological Realism acting methods.
Dr Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for
researching what physiotherapy was, is and can be.
A/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the
genealogy of a profession.
Speakers
Dr Gwyn Owen
Thinking through the body: embodiment as a conceptual framework
for researching what physiotherapy was, is and can be.
Thinking through the body: embodiment as
a conceptual framework for researching
what physiotherapy was, is and can be
Gwyn Owen PhD MCSP
Background
research developed in response to gaps in the literature
about the evolution of physiotherapy practice and the
uncertainty emerging from within UK physiotherapy during
2000s about its identity and practices
bodies of physiotherapists experiencing and producing
physiotherapy appeared to be an absent presence within the
literature
genealogical study of existing literature, documentary data
from physiotherapy’s qualifying curricula and oral accounts
of practice generated by physiotherapists who qualified
during the 1940/60s.
Embodiment…
is about the interplay between the body and the world
the body lives in
challenges physiotherapy’s dualistic mode of thinking
about the body and bodily practices
understands the body to be a dynamic interface for
exploring discursive practices, lived experiences and
ways of being and doing
Method/ology
Genealogical approach
Data generated from national physiotherapy qualifying
curricula and depth interviews with 12 physiotherapists
who had qualified during 1940/60s
professionalising bodies
1928
1930/40s
1950s
1960s
1977
1991
2015
conclusion
Embodiment offers a conceptual framework for uncovering
relationships between physiotherapy’s identity (being) and
practice (doing). For example:
- what physiotherapists’ bodies can do in a given
time/place
- how physiotherapists/clients/technologies work together
to produce physiotherapy’s identities/practices
- how physiotherapy’s identities/practices multiply as it
moves through space and time
prompts for a conversation
…We all have and are a body. But there is a way out of this
dichotomous twosome. As part of our daily practices, we
also do (our) bodies. In practice we enact them. If the body
we have is the one known by pathologists after our death,
while the body we are is one we know ourselves by being
self aware, then what about the body we do? What can be
found out and said about it? Is it possible to inquire into
the body we do? And what are the consequences if action is
privileged over knowledge?
Mol & Law, 2004. Body and Society 10(2-3)43-62 pp45
Speakers
Dr Ian Edwards
What is the source of our ethical obligation in physiotherapy practice:
Codes of Conduct or the Levinasian face?
Amy Hiller
‘Insider’ research: Reflexivity as a tool to manage participant
misconceptions.
Blaise Doran
A physiotherapist prepares.
Dr Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for
researching what physiotherapy was, is and can be.
A/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the
genealogy of a profession.
Speakers
A/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in
the genealogy of a profession.
Archives
Archives New Zealand
Alexander Turnbull Library
National Library of New Zealand
Papers Past digital archive
Sampling strategy
Primary sources
Published/unpublished manuscripts
Period newspapers
Personal accounts
Legislation
Institutional records
Oral histories
Correspondence
Registers and directories
Photographs
Secondary texts
Existing histories
Search terms
balneo*, exercis*, hauwai, waiariki, ngawha, masseu*,
mirimiri, “Swedish movement cure”, gymnastics AND
correct*, electrotherap*, health AND physical, “hot
springs”
Settler practices
“Ankles, Weak—Treatment: Bathe in sea water;
wear lace boots…use friction at time of bathing.”
“Asthma—Treatment: Inhale chloroform; smoke
from brown paper—Stramonium cigarettes;
blotting paper, soaked in strong solution of
nitre, dried, and fumes inhaled. If no
Bronchitis, give twenty or thirty drops of
laudanum.”
“Bite of dog—Treatment:
Immediately suck the wound and
apply caustic; if dog is certainly
mad, part should be cut out and
washed with vinegar and water, or
burnt with a hot iron.”
A few isolated practitioners
Argument
Physical therapies v popular in Europe and N America in C19th
No evidence of any PTs in NZ at same time – no luxury or surplus
time/money
Māori PTs decimated, settlers too isolated for public services,
atomistic, self-reliant – “just get on with it”
Took political action after 1890 and then birth of welfare state to
make physio possible
Is physio dependent on luxury and surplus?
Not if there is a welfare state…but what happens now welfare state is
being dismantled?
Will PT become a profession only for those who can afford it?
Speakers – Questions?
Dr Ian Edwards
What is the source of our ethical obligation in physiotherapy practice:
Codes of Conduct or the Levinasian face?
Amy Hiller
‘Insider’ research: Reflexivity as a tool to manage participant
misconceptions.
Blaise Doran
A physiotherapist prepares.
Dr Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for
researching what physiotherapy was, is and can be.
A/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the
genealogy of a profession.
Critical Physiotherapy Forum
Panel