Openness to alternative ways to practice

Instances of feedback-seeking also indicate an awareness among therapists that others may or may not practice in similar ways. Not only do therapists indicate different styles or approaches to practice, but accounts also indicate that the relative value or benefits of various approaches to practice are also appreciated; Charlotte wondering about

140 whether there is anything she might need to do differently or Simon checking in with his peers. This openness again signals an acceptable and beneficial background level of uncertainty. Charlotte and Simon are not disrupted by this background uncertainty but their awareness of possible alternative approaches to practice prompts them to engage in the checking step of recalibration. A therapist who lacks either awareness of or is close-minded to alternatives may remain wedded to an approach and is unlikely to consider alternative approaches, seek feedback or see the need or potential to change her practice, even when it may not be optimum in meeting practice demands; like this physiotherapist’s colleague:

‘A band 5 in my previous job, erm we, I used to work in the pulmonary rehab’

team. So first thing is when she walked in and I asked her to take a class for us.

And she was ‘Come on let’s do running. Let’s do this’. So rather than sticking to the old method she, all of a sudden, she adopted a new method to do more exercises. Ok. Which the patients were like ‘What am I doing here?’ OK, some of the patients really liked her and so that was, but the exercises were too much and they couldn’t do anything for the rest of the day. So, again I had to jump in and say ‘Ok, what’s the aim of doing this? And she was like, ‘The focus was mobility and we want to do that.’ I was ‘Fine. I understand but everyone has different capacity. Why don’t you assess the patients on an individual basis and see how these exercises are going to work?’ Physiotherapist Participant

Accounts indicate how some therapists are more open to alternatives than others, as in another physiotherapist’s observation about colleagues at a conference and Charlotte’s willingness to pick up and explore alternative practice approaches from her supervisor:

‘I was at a national conference 3 weeks ago and, so they were talking about inactivity levels and behaviour change and someone quite senior, not within my Trust, asked the question ‘I do therapeutic intervention so why should I look at inactivity or cardiovascular fitness?’ (Laughs) And that worried me slightly and I asked the question ‘If you’re not worried about someone’s level of activity or, how is that not therapy?’ So, I do think there is almost, ther, there is a belief that maybe that could be passed on to other professionals. But personally, I feel we have a role within behaviour change.’ Physiotherapist Participant

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‘having a joint session and sometimes it’s just seeing how they interact with the patient and having a look at their handling. Particularly for me early on, a lot of the cognitive things, the walking wounded type patients I struggled with ido’ ‘I don’t know what our role is here. They look fine. They’re fine, you know?’ And then the supervisor’s like, ‘Well hold on, let’s think about this.’ And actually having the time to sort of problem solve it and go ‘Well, actually have you thought about this? Have you thought about this?’ And then doing a joint session together and putting some of those things into practice I mean yeah ‘It worked really well, I could use that with this other patient that I’ve got at the moment’

And then kind’ve explore it that way.’ Charlotte

A lack of openness to alternatives can create challenges for supervisors and supervisees as Ani illustrates:

‘the older we get the more we think that our ways are ok and it did cross my mind that maybe, I don’t feel he’s listening to me because he is, he has got life experience behind him and potentially he thinks ‘No, what I’m doing is fine and I don’t really need to change.’ Erm, and he does have good rapport with the patients, I mean I, and I have said that back to him so y, you know it’s not all negative by any means, and I suppose the good part is maybe focusing on and thinking that’s the bit that counts. And I can kind’ve see where he’s coming from because that is ultimately the most important but then I feel ‘Oh God! I’m dealing with the rest of it.’ That’s really the boring bit th that that has to be done, that maybe he sees as not being important.’ Ani

Ani also signals the frustration that can arise when the supervisor perceives the supervisee is not listening. Ani attributes her supervisee’s unwillingness to change to personal factors such as wider life experience and recognises that an unwillingness to change in this instance may reflect that the supervisee sees no need to change; an instance perhaps of an absence of practice uncertainty. So, there is a mismatch between the supervisor’s uncertainties about her supervisee and the supervisee’s absence of uncertainty. What this also indicates is Ani’s permeability as the supervisor as she contemplates reasons for the mismatch between her own and the supervisee’s perspective.

Just as indicated in the previous section with regard to the therapist’s receptiveness to any feedback she receives, an openness to alternative ways to practice is not the same

142 as choosing to adopt the alternative approaches she encounters. As with feedback, the therapist will assess alternatives from socio-professional, practice platform and wider personal perspectives for fit in the context of the concern she seeks to resolve and exercise critically informed agency in adopting, incorporating or implementing alternatives in her own future practice encounters.