Who is the best judge of number of sessions needed? Therapist or client?

I went to my physio today and we ended up talking about the stages of change after he tells me about the pattern of athletes turning up for last minute tune-ups in final seasons for injuries they’ve been carrying all year. If they win the semifinals they’ll be back for more treatment, but if not they disappear and let it heal without treatment til the next season.

I found out physios are super competitive about treatment. They compare number of sessions to fix a problem to the average. “I can do it in 2.3 on average as opposed to most physios average of 2.5”. We talked about how those comparisons can make a physio feel like shit if someone didn’t change in 2.5 sessions.

I find this interesting but also weird because a lot of therapists like to compete over how long they can retain people. “I keep most of my clients for 20 sessions” may make people who keep their clients for 2-6 to question their ability.

Physios have the same problem that we encounter – where people have ideas about what they want to work on and what they are willing to change. If they’re not ready, my physio said, all your clinical skills and knowledge won’t lead to change because they can’t hear it or won’t do the exercises.

Sometimes over time, they’ll get there my physio says. When you’ve worked on what they want to work on and they trust the relationship, they might say, ok aren’t we going to work on that thing you suggested.

“I really wish I’d listened more to that stages of change lecture in the beginning of my career. It would have led to so much less turmoil when I was a junior clinician.”

I feel like this conversation is a summary of a lot of the points my vlogs.

I’m so glad I don’t have the pressure to fix someone in 2.5 sessions.

I left thinking I really hope my neck is fixed in 2.3 sessions. But I won’t judge if it’s not.

My physio tried to discharge me after the second treatment session. I rebooked and will apologise for ruining his stats when I next see him.

It left me wondering, who is the best judge of sessions needed? While I am all for claiming your expert and making recommendations, as a client if I’m not better, I want to stay in treatment.

We need to have open conversations about goals, what’s working and isn’t and the type of therapy we do and what the client needs. Just as a physio who doesn’t want to see me for maintenance or long term work because that doesn’t fit with their model could refer me to a remedial massage therapist or someone who can meet my need, as therapists we can scaffold clients into better fits rather than discharging them before they feel they are ready.

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2 thoughts on “Who is the best judge of number of sessions needed? Therapist or client?”

  1. How interesting Nadene! I’m having physio right now after a long time without it. My physio is amazing yet very young and she is direct/explains well/ provides strategies and checks in on my progress. I feel so comfortable both with her pacing and my input. I trust her judgement on what is needed because she takes a collaborative yet expert treatment perspective. Likened it to our own therapeutic approaches to encourage client ownership yet trust in us as clinicians. Some will grab it with both hands, some with one, and some who keep them behind their backs because they are not quite ready to be uncomfortable in the short term.

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