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Using Emergence in Physical Therapy

the Emergence Explorer

Questions for the Week of September 25, 2006

Emergence Character Type Babies 9-AI-2

This Week's Questions

[posed by Jen F.]
  • Where is the basic starting point for doing emergence?
  • How would a P.T. use Emergence in Physical Therapy?
  • If we are not meant to stay connected, but if disconnecting is so painful, what are the options?

Do you know?

[Question 1] When a P.T. patient discloses to me they have a BLock or an injury, how can I facilitate an emergence in them when I cannot picture how to use Emergence to help them in the first place? Is my inability to picture using Emergence to help them because I am in shock? Am I perhaps over-sympathizing and in Layer 7? I am concerned about over-stepping my boundaries as a P.T. Physical Therapist), versus an LCSW, or a Psychologist.
[Answer] Leave it to you, Jen, to ask a king-sized question; how do you use Emergence in physical therapy? All kidding aside though, your concerns are real and professionally sound. In fact, I commend you for asking these questions. Let's start, then, by paring down your questions to a tangible starting point. How might you, a physical therapist, use Emergence Therapy in your practice?

To begin with, you have a P.T. license. So you are licensed to physically help people in a professional capacity. This includes a clear knowledge of peoples' physical ranges of motion. This also includes knowing how to ask people questions with regard to defining their injuries and the progress of their healing. In addition, you have a wonderfully sound intuition. Thus, I'm sure you already, intuitively and professionally, know how and when to do these things.

Jen, my point here is, you already have a professionally sound base into which to add Emergence into your practice. How would you go about doing this? It's pretty simple, really. You'd begin by learning how to incorporate the three most basic Emergence skills into your therapy practice, one skill at a time. These three skills are [1] monitoring for visual blankness, [2] watching for over or under reactions, and [3] letting pleasant surprise be the evidence of healing.

Thus, for anyone wishing to add Emergence Therapy into their work, the most basic and viable practice to use would be the first one; learning to monitor the injured person's eyes for blankness. Or for "flat eyes," if this image gives you a better picture. Said in psychological terms, you would be watching for signs that the person went into shock. Said in medical terms, you would be watching for the literal lack of eye focus per the parallax view. And in Emergence terms, you would be watching for the person's "screen of the mind" to empty.

How then, in your profession as a P.T., would you use this practice? First, you would use it to define the point of injury. Then you would use it to guide the healing process. How?

Say you are working with a patient who has injured his right elbow while playing tennis. You might begin the healing process as you normally would, by gently moving this person's arm through a slow, careful bi-directional arc. You would then add to this that you would be monitoring this man for visual blankness.

What are you doing here? You're looking to "book end the injury," by locating the "before," "at," and "after" the injury points.

How? By using your observations of visual blankness to define an arc. This arc begins before the proprioceptive point of injury, extends through the proprioceptive point of injury, and continues beyond the proprioceptive point of injury.

Note that to do this well, you'll have to initiate this arc from both directions. Once you've defined this arc then, you're ready to help the person to emerge from this injury.

So what makes me call this process, "book-ending the injury?" To see, imagine you have ten or so books on a bookshelf, held upright with two book ends. Now imagine one of the books represents the actual point of injury. How would you identify which book this was?

Well, assuming you knew how to rule out books, you'd rule them out, one at a time. As you did then, you'd remove these books while sliding the book ends toward one another.

In the end then, what you'd have would be one book left, still held upright by the two book ends. This book would represent the point of injury.

In real life what you do is, you move the injured person's arm through the approximate proprioceptive range of motion for this injury, all the while watching for visual blankness. Of course, at first, you'd have only a rough approximation of this arc. Gradually, though, you'd refine your sense of this arc, from the "before" point in the arc (the "before" book-end), to the actual point of injury within the arc, to the point in the arc past the point of injury (the "after" book-end).

In Emergence language, what you're doing here is, you're "drawing the lines around the hole." How? By monitoring the person's eyes for blankness or flatness while at the same time, monitoring the person's body for the anticipation of pain.

What if you cannot see the person's eyes though? Well, if you can't move the person's arm and at the same time, see the person's eyes, you can use your own body as the "point of injury monitor." How? By first creating a Layer 9 / 10 connection between you and the patient and then, by watching for emptiness in your own body. Here, you'd be watching for an emptiness to occur at a point right below your rib cage, in the center of your diaphragm area.

In other words, while moving this person's arm through your guesstimated arc of injury, you'd watch for an empty feeling or a hollow feeling in your "third chakra" area. You would then note where in the client's injury arc this hollowness in you occurred.

What comes next? Well, keeping in mind the already good P.T. practices you would normally employ, you would then begin to use the second basic Emergence skill, watching for over and under reactions. In most cases then, what you'd be watching for would be for the person to anticipate pain. What I mean is, right before the onset of the proprioceptive injury point, most people physically and psychologically anticipate pain, by both physically tensing up and by going visually blank. Note this usually happens on both sides of the point of injury.

Employing Emergence here would mean your goal would be to keep moving the person's arm back and forth through the now defined arc of injury until you see the person get pleasantly surprised by a painless movement. Once this surprise occurs, then you would expand the scope of your working arc, all the while looking for "peripheral anticipations of pain."

Eventually, then, you'd have completely replaced the visual block, and all accompanying symptoms, with the healing experience of delight.

What makes this "delight" so important to watch for? Because whenever people get injured, they, at some point, experience pain. Afterwards, they then try to anticipate this pain and so, avoid it recurring. How? By tensing up.

Of course, over time, this tensing up actually exacerbates peoples' symptoms. Sadly, few people realize this, let alone make use of this knowledge.

So what happens when people get pleasantly surprised by the fact that there was no pain? They begin to anticipate this pleasant surprise. Which eventually allows them to remain lose rather than tensing up. Over time, this looseness then leads to a noticeable decrease in the person's symptoms and eventually, to a complete recovery.

In truth then, this pleasant surprise signals the onset of actual healing, because it means the person has begun to anticipate surprise rather than pain. This then leads, first, to physical symptom relief and then to genuine healing, visual and otherwise. Moreover, what makes this process so different from what you'd normally do is that no current medical treatment, P.T. included, uses the awareness of surprise to guide the healing process.

So there it is, a simple, three part sketch of what you might add to your current practice:

  • Use your observations of blankness to bookend the proprioceptive arc of injury, the "before," "during," and "after" arc.
  • Next, while staying connected to the patient, use gentle bidirectional movements through this arc to promote healing.
  • Finally, watch for the conversion moment; meaning, the moment in which person's anticipation changes from pain to anticipated surprise. This is the "evidence of healing."

[Question 2] I often find myself at a loss in our group, or with a patient, in leading an emergence. Where is the basic starting point for doing emergence? Should things be left open ended as Steve often does in sessions? Will this provoke continued emergence in them? Push them towards Layers 8 / 9 / 10, or towards Layers 1 and 2?
[Answer] You've asked several questions here. Let me take them one by one.

Where is the basic starting point for doing emergence? It seems I've answered a lot of this question in the previous answer. The basics, anyway.

Should things be left open ended as Steve often does in sessions? Will this provoke continued emergence in them? Push them towards Layers 8 / 9 / 10, or towards Layers 1 and 2? Yes. In fact, here is where being well grounded in Emergence Personality Theory comes in. Because I know the basics of human nature, I can have faith in the process, especially with regards to believing in what my intuition tells me to do and what it tells me to leave open. I often wonder, in fact, where therapists who wouldn't know an injury if it bit them in the ass find it in them to rely on pure faith.

Then again, perhaps this very blindness is a good part of what drove me so hard to define injury empirically.

[Question 3] A patient has disclosed to me that she has a history of severe childhood physical abuse, both from her father and her brother. I know there is connection between this history and her severe fibromyalgia. However, I have no idea how to use emergence to help her with this. In fact, I would feel much better referring her to you or Ed. Cowardice on my part? Perhaps. In any event, how would I go about helping her to make a more conscious connection between her abuse and her fibromyalgia? Knowing her, she will most likely resist revisiting this injury except in Layer 2 or 1.
[Answer] To be honest, I think your intuition is right on, and that you should refer her out. Jen, in these kinds of cases, people usually need help from both professions. At the same time, I think you could also learn to use Direct Emergence to help her to heal some of the physical / visual threads of her injury. In fact, the process I've described in my answer to your first question would be exactly the kind of intervention you could use to address the physical aspects of her injuries.

Of course, you'd then be left with how to actually suggest she call a therapist, and to be honest, many P.T.'s have trouble making these kinds of suggestions. Some even struggle to acknowledge to themselves that the person needs to go, which is sad, really. If this is you, then what I'd suggest is that you call one of us and let us talk you through how to best go about making this referral. This way, you'd have covered yourself as far as what might be missing from your P.T. training and at the same time, you'd have used Emergence, both in your physical interventions and in your psycho spiritual referral.

[Question 4] I feel that my unborn son and I are "one being." Thus, I know any self-depreciating thoughts and guilt I may feel are experienced by him as well. Because of this, I am doing my best to stay conscious, and when I can't, to come out of shock as quickly as I can so as to avoid distressing my baby. My questions is, if human beings are not meant to stay connected one hundred percent of the time, and yet if being disconnected is the most painful thing to endure, what are my options? To get the hell out of shock and reconnect as soon as possible? Or to try to regain consciousness while I am in Layer 7? Is this even possible?
[Answer] We all live in ten Layers. All of us adults, anyway. Your unborn son, on the other hand will remain in Layers 9 / 10 up until he is born. He, in fact, doesn't even have any Layers yet, other than Layers 9 and 10.

So can he get injured? Yes, he can. But not from your being distressed. Why not? Because he cannot experience your stress alone. He literally cannot be startled by it, at least not by your visual distress.

You being shocked in a major way would be another thing entirely though. Realize though, by "you being shocked," I don't mean just ordinary shock. I mean things like being in a major car accident where you get seriously injured.

Even here though, Aidan has less chance to sustain the kind of blocks already born humans sustain than just about anyone we know, including you. So stop worrying and try to relax. You and Aidan will be fine. Of this, I'm certain. Why? Because you already know a lot of ways to minimize his chances for being injured, and you also know a lot of ways to help him to heal any injury he might incur.

[Question 5] I am worried as to how I'll be able to meet both my new son's needs and my own? For instance, if he is crying and in Layer 7 / 8 and my three year old, Jack, is also needing me, what are my priorities? And what about my husband who is just as important in this picture? Where will his needs be? And where will my own needs go, because I am a "two?" Excuse me, but I am getting depressed just thinking about all of this!
Jen, you've already done a heck of a good job just by clearly defining the problem. Aidan will be a "one"; you, a "two; your husband is a "three"; and your three year old son, Jack, is a "four." Welcome to the circus of character types <grin>.

In all seriousness, though, you've already done a really good job identifying potential problems with meeting your own needs, including through the healing work you've done in and around the birth of your first son.

You've also done a world class job meeting these needs up to now. Remember? Beginning with how we used Emergence to address your post partum the first time around. After that, you seemed awesome.

I guess the thing to remember here is that no one can learn ahead of time. At best, you can remember to use what you have already learned. This means the main thing to focus on here would be to be both open to new learning. And to ask for help when you've exceeded your capacity for new knowledge.

Do this and I'm sure, you'll be fine.

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