Last month, I completed the Cognitive Functional Therapy (CFT) course at the Evoolve Pain Care Academy, taught by Ian Cowell.
CFT was developed by Peter O'Sullivan and his international team, primarily for clients with persistent/recurrent (back) pain complaints.
This first course is the beginning of a three-part training program at Evoolve. There's still plenty to learn in that regard!
One moment during the course particularly stuck with me: a different perspective on graded exposure.
How we as physios often view graded exposure is 'doing a little more each appointment/week'.
You give your client homework/exercises, they get to work on them – at least, you hope so – and next time you evaluate how that went.
Ian showed something different. Graded exposure can, and often works better, during the appointment itself. Not as homework, but as a behavioral experiment in the treatment room. You explore boundaries and possibilities together and guide your client through, for example, the fear this might evoke.
If you explore certain limitations and challenges together (in a safe way!), the client can experience in the moment that what they feared turns out differently than expected.
So, 'learning by doing'.
Of course, this doesn't mean all your clients will magically be rid of all their complaints after just one appointment.
However, it does open up a discussion about how (the experience of) pain during certain activities that are self-evident to others can have a hell of a lot of impact on someone's life. We all too often overlook this.
"But shouldn't a client try this themselves without you holding their hand?"
Yes, ultimately, of course. But if you've been living with pain for years, it can be incredibly difficult at first to find where the discomfort lies and then challenge it yourself. As a therapist, you can create a safe setting and together rebuild trust step by step.
Many clients that I and the team at EBP Studio | Physiotherapy, Pelvic Physiotherapy & Personal Training have already gone through countless physiotherapists without (long-term) results. For them, this extra attention to what pain does to you and your environment truly matters.
Thanks to Ian Cowell for all the conversations and good energy during the course, and to Peter O’Sullivan, Kieran O'Sullivan and the Evoolve team for the work this builds upon.
(Photo seems to have been taken with a brick, at least not AI-generated;))
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