PSYCHOSOCIAL RELATIONSHIPS , TRAINING AND ATTITUDE WITH REFERENCE TO PHYSIOTHERAPISTS

profession regarding our profession is very inadequate. It is the responsibility of every physiotherapist to im­ prove this situation. In order to give our students an opportunity of doing research and of working with medical students, our third year students joined the medical students in Physiology II this year. It is hoped that they will gain insight into research which will stand them in good stead for their fourth year projects and, hopefully, in working for higher degrees. But, more im portant, they will have learned to work with others in obtaining inform ation and in solving problems. Methods of evaluating what has been learned are essential and the methods of examining a student will have to be modified. How can we ensure the mainte­ nance of high standards, which are obviously assessed in the examination room where the student is under stress and is not functioning in her normal capacity? Continuing assessment would eliminate part of this problem, providing that we really know what we are assessing.

"Successful physical therapy depends not only on physical therapy techniques but upon the psycho social relationships which the therapist develops with the patient."1 Physiotherapy as a forw ard looking profession is becoming increasingly concerned with the psychothera peutic potential of the relationship which the patients form with their physiotherapists. Physiotherapy is more than a collection of techniques -it appears to be a specific type of interpersonal relationship o f which techniques are but a part. T he functional role of the therapist is evolving into something new and diverse, but one common factor in being a physiotherapist is that o f helping other persons. * A summarised report on a survey presented to the D epartm ent of Physiotherapy, U niversity of the W it watersrand during undergraduate training.
The first objective of the physical therapist is ta help the patients to help themselves."2 T he psychological power inherent in the role o f the physiotherapist can be understood when we consider that disability represents an attack upon the body, personality and external world o f the patient. Rush pointed out that " in 50% o f adults w ith a physical disability, em otional factors determ ined the success of rehabilitation: in children, the figure runs as high as 75% . ! 1,3 In this study, the author isolated the helper -the therapist -as the key variable for 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. The ability of the therapist to have insight, self-awareness and selfunderstanding will enable her to develop genuine and congruent physiotherapist-patient relationships, and ulti mately both the patient and the therapist will benefit.
It was hypothesised that, after training in dynamic psychology, perception of self would change in the direction o f becoming a self which would seem more com fortable, confident, less anxious and with value goals m ore readily achievable. f i f t e e n final year students participated in the cxperint All subjects were English-speaking, white female aged between 20-23 years. All had cared for patients *1 ring their third and the preceding part of their fourth -'sir training. , 'The criteria for selection of subjects was experience * * i _l_ _ _ _' x L . . . . . . T *■ Kinn fKrviinUt nH ironfo 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 criteria fo r education.
[Material Xhe study employed a questionnaire followed by a training session. Questions probed for inform ation bout the subjects themselves and their opinions con c e rn in g aspects of physiotherapy i.e. subjects' attitudes, ceif-awareness was assessed using a sem antic differential the deviation of actual self, i.e. the kind of physio-.erapisc I actually am, com pared to the ideal rating, ,"e. the kind of physiotherapist I would like to be, thereby showing the degree of self-deception of self insight.

Discussion and Analysis of Results
Statistical analysis showed that the general attitude of the subjects was people-orientated, with a 93% posi tive attitude tow ards dealing with the public. The results dem onstrate that the therapists have insight into the most im portant m otivations in doing w hat they are doing and are aw are of their approach to their work. The subjects' basic attitudes are those which will laciliiate therapy, because the prim ary element in the sub jects' value system is other people. One can never be a helper unless one has a desire to help.
As im portant as the therapist's attitude towards her self is her attitude towards her patient. A ll the thera pists felt that the patients had a right to inform ation regarding their condition, evaluation and treatm ent process.
The patient's right to know implies responsibility and authority for him self in the care process, therefore decision making m ust be shared between patient and therapist, unlike the traditional model w here the patient becomes the passive recipient of services.
Even though therapists have acknowledged accepnce of this different approach, the question is raised /h eth er these therapists know how to cope with the dynamics of this new kind of person-centred relation ship in which the patient assumes a greater authority than the traditional model allows.

Self-ideal Relationship
Pre-training Post-training discrepancy discrepancy Non speaking 9 -1,7 Speaking 14 1,9 The pre-training self-ideal relationship showed a. large discrepancy between the person's image of herself and her actual self -a mean score of 11,1. Fifty-three per cent of subjects had a self-ideal conflict above the mean score, showing m inim al insight and considerable conflict.
"W hen self concepts exclude too much 'real self', a person soon experiences certain symptoms, viz. vague anxiety, depression and boredom .'" Unless there is a considerable degree of insight, the therapist will not be able to recognise situations where she will be biased by her own prejudices and emotions. She will not be able to understand why there are certain types of patients or problems she is unable to treat satisfactorily.

The Self Ideal Relationship on Retest
All therapists who attended the training program m e and voiced an individual statem ent im proved in self ideal correlations, or retained the same score. T he mean pretraining score was 13,8 and the post-training score was 12,1. A mean difference of 1,7 im provem ent showed a greater congruency between self and ideal in these subjects. The characteristic person who completed the sem antic differential has a picture of herself w hich is far removed from the concept of the physiotherapist she would like to be. D uring the process of training, sufficient change occurred to result in an increase in congruence of self and ideal at the follow-up test. This confirms the hypothesis that the discrepancy of self and ideal will be reduced over training, changes of self being in a direction o f greater self understanding.
The results indicate that students will benefit from this type of training. F u rth er evidence for the necessity of such a program m e was elucidated in the follow up questionnaire. A I the participants felt that the sessions were o f value. In keeping w ith the generally positive attitude expressed, students felt that a person-centred course should be part of their training (third and fourth year). Ram sden stated that "in order to translate the helping process inherent in the role of the physio therapist into active, effective and efficient use, the student must be exposed to the interpersonal orientation throughout his educational experience. This exposure should include theoretical and practical experience in the dynamics of interpersonal relations."5 Dunkel con cluded that physicians and physiotherapists had a need for im provem ent in the areas of interpersonal relations, com m unications and decision making.*1

Subjects who did not Speak Individually
The results were greatly affected by subjects who did not expound on their personal characteristics. This g ro u p 's mean pre-counselling self ideal correlation was 8,7 and the follow up mean score was 10,5 : a mean difference of -1,8, indicative of deterioration.
This has im plications w hich should be applied to teaching. The groups must be small and time must be available for each person to speak individually. H ow ever, the results could also indicate that these subjects waited an undue length of tim e before speaking, thereby resisting exposure and change.

CONCLUSION
The subjects expressed strong sentiments as to having a course in hum an relationships throughout their physiotherapy training. Such a course would mean realisation of the full potential of physiotherapists. If the 4th year class of 1976 is to be regarded as a sample of the potential quality of physiotherapy professionals, it would be a waste of valuable resources not to take up the challenge of providing opportunities to develop the existing potential.