14 profession regarding o u r profession is very inadequate. It is th e responsibility o f every p hysiotherapist to im ­ prove th is situation. In o rd e r to give o u r students an o p p o rtu n ity of doing research and o f w orking w ith m edical students, o u r th ird year students joined th e medical students in Physiology I I this year. I t is h oped th at they will gain insight into research w hich will stand them in good stead fo r th eir fo u rth year projects and, hopefully, in w orking fo r h ig h er degrees. But, m ore im p o rtan t, they will have learned to w ork w ith others in obtaining in fo rm atio n and in solving problem s. M ethods o f evaluating w hat has been learned are essential and the m ethods o f exam ining a student will have to be modified. H ow can we ensure the m ain te­ nance o f high standards, w hich are obviously assessed in the ex am in atio n room w here th e student is under stress and is not functioning in her norm al capacity? C o ntinuing assessm ent w ould elim inate p a rt of this problem , pro v id in g th at we really know w hat we are assessing. W e have not proved th a t w hat we are m easuring is that w hich we ho p e the student has learned. R ather, we have dem onstrated th a t som e students have better recall than others. M ost students eventually learn one thing, and that is to pass exam inations. W hen students do fail, o r barely pass, observers a re satisfied th at the standards w ere high. A re we then really ensuring th a t these young people are adequately equipped to m eet the challenge o f the tim es? W ill they be able to take th e ir place in society as tru ly professional people? D o o u r train in g centres and o u r professio nal bodies know w hat these challenges are and are physiotherapists doing anything about finding th e answ er? R esearch is at present un d er way at the U niversity o f the W itw atersrand to assess w h at m odalities ar com m only used by the p ractising physiotherapist nr today and w hat skills should be acq u ired by the futur physiotherapist. W e intend to do in-depth research inte som e o f these m odalities and by analysing o u r tech° niques in this m anner we will be able to accept 0f reject these in term s o f scientific evidence. T h ere is m uch th at still needs to be done and our professional Society should be encouraging research into topics th a t have tru e m eaning fo r the profession M any o f th e subjects chosen fo r a higher degree are on obscure o r barely-related topics, w hich do n o t fulfil the needs o f o u r profession. W hat we need are w orkshops and brain-storm ing sessions to w ork o u t w h at is required to “ provide adequate and reliable p h y siotherapy services”. From these we can w ork out o u r objectives o f train in g and of continuing education. References 1. D yer, L., T h e C hanging R o le of the R em edial Pro­ fessions, The Leech, 46, 1 ,1 5 , 1976. 2. F ehler, R., U npublished U n d erg rad u ate Project, 197(5 3. F u m eau x , W . D ., T he Chosen Few: A n Examination o f Some Aspects o f U niversity Selection in Britain. O xford U niversity Press, L ondon, 1961. 4. G lauber, K. A., A N ew R o le fo r Physiotherapy in M edicine, T he Leech, 46, 1, 3, 1976. 5. Johnson, G., In reply to question “W hat direction should Physical T h erap y E ducation tak e in ade­ quately preparing fu tu re physical therapists” P hysical Therapy, 52, 4, 448, 1972. 6. Simpson, M. A., M edical E ducation — A Critical A pproach. B utterw orth L ondon, 1972. 7. W einberg, L., U npublished U n d ergraduate Project 1976. D E C E M B E R 19?7P H Y S I O T H E R A P Y PSYCHOSOCIAL RELATIONSHIPS, TRAINING AND ATTITUDE WITH REFERENCE TO PHYSIOTHERAPISTS* L A U R A W E IN B E R G , H ierdie studie het sekere aspekte o m tren t die benadering van finale jaar studente to t die professie, hu l opleiding, pasi'ente en hulself aan die lig gehring. Vraelyste en 'n opleidingsessie het daarop gew ys dat terapeute opleiding behoort te ontvang in dinam iese sielkunde. “Successful physical th erap y depends not only on physical therapy techniques but upon the psycho­ social relatio n sh ip s w hich th e th e ra p ist develops w ith the p a tie n t.”1 P h y sio th erap y as a fo rw ard look in g profession is becom ing increasingly concerned w ith the psychothera­ peutic p o ten tial o f the relatio n sh ip w hich th e patients form w ith th eir physiotherapists. P h y sio th erap y is m ore than a collection o f techniques — it appears to be a specific type o f interpersonal relatio n sh ip o f which techniques are b u t a part. T h e fu nctional role o f the therapist is evolving into som ething new and diverse, but one com m on facto r in being a p hysiotherapist is th at o f helping o th er persons. * A sum m arised report on a survey presented to the D epartm ent of Physiotherapy, U niversity o f th e W it­ w atersrand during undergraduate training. B.Sc. (Physio) (R and) “T h e first objective o f the physical th e ra p ist is t a help the patients to help them selves.”2 T h e psychological pow er inherent in the role o f the p hysiotherapist can be understood when we consider th at d isab ility represents a n attack u p o n the body, p ersonality and external w orld o f the p atien t. Rush pointed out th at “ in 50% o f adults w ith a physical disability, em otional factors determ ined the success of re h a b ilita tio n : in children, the figure runs as high as 7 5 % .!1,3 In this study, the a u th o r isolated the h elper — the th erap ist — as the key v ariab le fo r survey. In the helping relationship, the helper (who is functioning at high levels of interpersonal dim ensions) can offer a helpee (who is functioning at low levels) the experience of being understood sensitively and deeply. T h e ability of the therapist to have insight, self-aw areness and self- understanding will enable her to develop genuine and congruent p hysiotherapist-patient relationships, and ulti­ m ately both the p atien t and the th erap ist will benefit. It was hypothesised that, after training in dynamic psychology, perception o f self w ould change in the d irection o f becom ing a self w hich w ould seem more com fortable, confident, less anxious and w ith value goals m ore readily achievable. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) p £S E M BER 1977 F I S I O T E R A P I E 15 of Survey t determ ine attitud es and philosophies o f physio- floists T o d eterm ine levels of self-aw areness of Iherapists before and afte r training. f i f t e e n final year students particip ated in the cxperi- nt All subjects w ere E nglish-speaking, w hite fem ale aged betw een 20-23 years. All had cared fo r patients *1 ring their th ird and the preceding p a rt o f th e ir fourth -'sir training. , ' T h e criteria fo r selection o f subjects was experience * * i _l____' x L . . . . . . T *■ Kinn fK rvi i nU t n H i r o n f o n o m ■ C■ Hinical physiotherapy. It was thought advantageous 'n sele~t subjects in an academ ic environm ent because [jjey would be m ore able to judge crite ria fo r education. [Material Xhe study em ployed a qu estio n n aire follow ed by a training session. Q uestions prob ed fo r inform ation bout the subjects them selves and th e ir opinions con­ c e r n in g aspects of physiotherapy i.e. subjects’ attitudes, ceif-awareness w as assessed using a sem antic differential the deviation o f actual self, i.e. the kind of physio- .erapisc I actually am , com pared to the ideal rating, ,"e. the kind of p hysiotherapist I w ould like to be, thereby show ing the degree o f self-deception of self­ insight. Discussion and Analysis o f Results Statistical analysis showed th at the general attitude of the subjects was people-orientated, w ith a 93% posi­ tive attitu de tow ards dealing w ith the public. T h e results dem onstrate that the therapists have insight into the most im p o rtan t m otivations in doing w h at they are doing and a re aw are o f th eir ap p ro ach to th eir work. The subjects’ basic attitudes are those w hich will lacili- iate therapy, because the p rim ary elem ent in the su b ­ jects’ value system is o th er people. One can never be a helper unless one has a desire to help. As im p o rtan t as the th e ra p ist’s attitu d e tow ards h er­ self is her a ttitu d e tow ards her patient. A ll the th e ra ­ pists felt th at the patients had a right to info rm atio n regarding th e ir condition, evaluation and treatm ent process. The p a tie n t’s rig h t to know im plies resp onsibility and authority fo r him self in the care process, therefore decision m aking m u st be shared between patient and therapist, unlik e the tra d itio n a l m odel w here the p atient becomes the passive recipient of services. Even though th erap ists have acknow ledged accep- nce of this different approach, the question is raised /h e th e r these therapists know how to cope w ith the dynamics of this new kind o f person-centred relatio n ­ ship in w hich the p atien t assumes a g reater au th o rity than the trad itio n al m odel allows. Self-ideal R elationship P re-train in g Post-training discrepancy discrepancy Non speaking 9 —1,7 Speaking 14 1,9 T he p re-train in g self-ideal relatio n sh ip showed a. large discrepancy betw een the p erso n ’s im age o f herself and her actual self — a m ean score o f 11,1. F ifty -th ree per cent o f subjects had a self-ideal conflict above the mean score, show ing m inim al insight and considerable conflict. “W hen self concepts exclude too m uch ‘real self’, a person soon experiences certain sym ptom s, viz. vague anxiety, depression and b o red o m .’” Unless th ere is a considerable degree o f insight, the therapist will not be able to recognise situations w here she will be biased by h er own prejudices and em otions. She will not be able to understand why there a re certain types o f patients o r problem s she is unable to treat satisfactorily. The Self Ideal Relationship on Retest All therapists who attended the train in g program m e and voiced an individual statem ent im proved in self­ ideal correlations, or retained the same score. T h e m ean pretrain in g score was 13,8 and the post-training score was 12,1. A m ean difference of 1,7 im provem ent showed a g reater congruency betw een self and ideal in these subjects. T h e ch aracteristic person who com pleted the sem antic differential has a p ictu re of herself w hich is far rem oved from th e concept o f the physiotherapist she w ould like to be. D uring the process of training, sufficient change occurred to result in a n increase in congruence o f self and ideal a t the follow -up test. T his confirm s the hypothesis th at the discrepancy of self and ideal will be reduced over training, changes o f self being in a d irection o f greater self understanding. T h e results indicate th at students will benefit from this type of training. F u rth e r evidence fo r the necessity o f such a program m e was elucidated in the follow up questionnaire. A I the p articip an ts felt th at the sessions w ere o f value. In keeping w ith the generally positive a ttitu d e expressed, students felt th at a person-centred course should be p a rt o f th eir train in g (third and fourth year). R am sden stated th at “ in o rder to translate the helping process inherent in the role o f the physio­ th erap ist into active, effective and efficient use, the student m ust be exposed to the interpersonal o rien tatio n th ro u g h o u t his educational experience. T his exposure should include theoretical and practical experience in the dynam ics of interpersonal relations.”5 D unkel con­ cluded th a t physicians and physiotherapists had a need fo r im provem ent in th e areas of interpersonal relations, com m unications and decision making.*1 Subjects who did not Speak Individually T h e results were greatly affected by subjects who did n o t expound on th e ir personal characteristics. T his g ro u p ’s m ean pre-counselling self ideal co rrelatio n was 8,7 and the follow up m ean score was 10,5 : a m ean difference o f —1,8, indicative of d eterioration. T his has im plications w hich should be applied to teaching. T h e groups m ust be sm all and tim e m ust be av ailab le fo r each person to speak individually. H o w ­ ever, the results could also indicate that these subjects w aited an undue length o f tim e before speaking, thereby resisting exposure and change. CONCLUSION T h e subjects expressed strong sentim ents as to having a course in hum an relatio n sh ip s th ro u g h o u t their physiotherapy training. Such a course w ould m ean realisation of the full potential of physiotherapists. If the 4 th year class o f 1976 is to be regarded as a sam ple o f the potential q u ality o f p h ysiotherapy professionals, it w ould be a waste o f valuable resources not to take up the challenge of providing o p p o rtu n ities to develop the existing potential. R eferences 1. G oldin, G. J.. T he Physical T herapist as “ therapist.” Phys. Ther. 54, 5, 484, 1974. 2. P hysiotherapy C areers Leaflet No. 9. B. L eyton and Co. Johannesburg. 3. R ush, H . A, R ehabilitation M edicine, 3rd ed„ St. Louis, 1971. 4. Jo u rard , S. M ., The Transparent Self, D. van N ostrand Co, N ew Y ork, pp 179-207, 1971. 5. R am sden, E. L., T h e P atien t’s R ight to K now Im p li­ cations fo r Interpersonal C om m unication Processes, Phys. Ther. 55, 2, 133, 1975. 6. D unkel, R. H ., Survey of A ttitudes of A rkansas Physicians and Physical T herapists tow ards P ro ­ fessional C apacity of the Physical T herapist, Phys. Ther., 54, 6, 584, 1974. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )