Tagged with: awareness coach disability exercise fitness goals health Healthcare Professionals
The Working Alliance:
A Cooperative Strategy, Knowledge, Preparation, and Action
Kerry A. Wiley
Because of my personal and professional interests as a Social Worker, I try to stay current on issues in the Health, Disability, Fitness, and Rehabilitation Fields. I read a phrase in an article recently that caused me to balk. The article was making the case that professionals have a responsibility to create “an incubator”, a controlled environment, for the care and growth of a client. I grimaced when I read that line. When I think about myself in a client role, I want an active role. I am not an egg where given the right amount of warmth and time, I will hatch.
When people come together in a professional-client partnership, it is frequently around a common cause, goal, need, or a combination of the three. In my case, the goal is to improve my mobility. I am seeking to work with a professional who understands neurology, motor control, muscle function, stability, kinesiology (the study of human movement), and knows how to put it all together into a program. I am also looking for someone who can take all of this knowledge and apply it to my unique walking needs and circumstances related to my diagnosis of Spastic Cerebral Palsy.
When I met James House, III, my Movement Specialist and Fitness Instructor, he had the understanding I was looking for. He agreed to support me in my walking goals. We developed a cooperative strategy and an unwritten contract that included specific goals, tasks, outcomes, and roles.
James was confident that he could teach me. James often references the work of Gray Cook, an expert on Functional Movement. According to Mr. Cook, “movement is a system of integrated patterns” [i] and our body, muscles, and nervous system are linked in numerous and complex ways. While I am not an expert in Exercise Science, Functional Movement, or movement patterns, Cerebral Palsy complicates these “integrated patterns” that Mr. Cook writes about. I can expect to have an unforeseen reaction to exercise.
When one or both of my arms go into a series of involuntary muscle contractions during an exercise, I want James to guide me on how to make the contractions stop and stop as quickly as possible. I am more likely to follow his instructions to raise my arms over my head, for example, because I have learned to trust James. He knows immediately what groups of muscles triggered the reaction in my body. I also realize that if I follow his instructions, the unwanted contractions will likely stop. James and I have applied the “working alliance concept” (the relationship between the client and professional); James knows that I trust his knowledge to solve the presenting problem.
James also recognizes that I need degrees of preparation to be able to engage in the expected task, exercise, or program goal. This preparation might be repeated demonstration of a movement or physical task coupled with verbal cues to achieve the expected intent. He is prepared to respond to my two most prominent questions during a session; “What is happening?” and “Why is it happening?” In the client role, I need to fully understand the theory behind what he expects me to do and why a reaction may be happening.
In the action phase of the work, the Movement Specialist has two primary roles; to provide support and to challenge me to complete the new movement or task. In the client role, I am expected to be actively engaged, relate the theory to practice, and attempt to perform the new patterns and movements to the best of my ability. This requires that I take in all of the information I am given such as “Fix your foot position.” “Lift your arm.” “Bend your knee” and apply it.
As the Professional, James has to make constant adjustments based upon his observations, my reactions, fatigue level, duration of the effort, and a number of other factors. In future columns, I will explore more of the dynamics and challenges of the Knowledge, Preparation, and Action framework, client readiness, and the professional and client relationship and their respective roles.
James R. House, III and Kerry Wiley
[i] Cook G. Athletic Body In Balance: Optimal Movement Skills and Conditioning for Performance. Human Kinetics; 2003.