The BPS — What is it good for?

You may be aware that I’ve had a Masters Rehabilitation Counselling student working alongside us at Purple Co. Its been a fantastic experience and I really enjoy imparting into the next generation of rehabilitation professionals.

I asked our student to reflect on the Bio Psych Social Model of rehabilitation, to impart what she has learned in theory to what she has observed, witnessed and experience on placement. Her response is really insightful and one that I would recommend anyone interested in understanding the limits of the BPS model, or how the BPS model needs to be in action, to read these insights.

Jo

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The BPS — What is it good for?

Natalie Taylor

Ah…. The Bio-Psycho-Social Model (BPS) of health and wellbeing. If you work in Allied Health then you are probably very familiar with this term. But what does it really mean to the every day people whose lives we are trying to improve? And are we even applying it properly in the first place?

The development of the BPS marked a huge step forward in how we conceptualise recovery and other important outcomes for our clients – including “return to work”. When we remove the BPS from our approach to rehab, we are left with its predecessor – the medical model of illness. Applying the medical model and nothing else means that we consider ONLY the physiological, inherent aspects of disease – and then we use that information to draw conclusions about how to best proceed with rehab… and also why our clients may not be progressing as we hoped they would. In thinking this way, we are doing a great disservice to the very people we aim to help (and ourselves).

To think only in medical parameters is to say that a person is no more than their disability. In embracing the medical model we are forgetting about the dynamics of a person’s social life, support system, personality, finances, geographic location and belief systems – not to mention their level of access to system supports such as healthcare, professional guidance, education, transport and on-the-job accommodations. In a nutshell, the last sentence captures the ideas central to the BPS.

I’m sure that most people reading that last paragraph will agree that thinking only in terms of the inherent aspects of disability is a fallacy. Of course, this is what the BPS is built on. Unfortunately, in the broader context of occupational rehab, we can tend to fall back onto the medical model of illness, and I find this to be truer the further we delve into higher levels of medical specialisation. Without a doubt, there are countless medical specialists out there who do not see their clients as living within a bubble, and they use this philosophy to help their clients live a better life. This is admirable, but there is a flipside – I would wager that the vast majority of Allied Health professionals are intimately familiar with the frustration of being told by a GP or medical specialist that their client simply cannot even CONSIDER returning to work in their current physical or mental state, despite an abundance of evidence to the contrary. Potential solutions for our clients often sit somewhere outside the confines of their own “limitations” as we might perceive them – and sometimes, as specialists or experts, we forget to look beyond the client sitting in front of us. Admittedly, this can be pretty hard to do when we have dedicated so much time to becoming an expert in one area – something else has to give. But at what cost?

As Rehabilitation Counsellors, we should know that our clients can achieve so much more if we stop focusing on limitations and start emphasising ability, self-development and reasonable accommodations. It is unfortunate that medical specialties have failed to embrace the BPS in the same way that Allied Health workers and social workers have. At its core, I think this is because specialists, as part of becoming experts in their domain, can lose the ability to see the person and their environment as a whole. And, to be fair, I think a lot of Allied Health professionals (I myself have been guilty of this even as a student) can lose their sight along the way.

To remedy this, I think there needs to be a change in several ways that every professional approaches their work:

1. Redefine Recovery

Along with the medical model comes this notion of “recovery” being equated with the total absence of symptoms. Realistically, for many people, this is never going to happen. Some illnesses have the word “chronic” in them for a reason – they need to be managed and not cured. I have no doubt that this craving for a cure is pervasive among our clients as well, and unfortunately it is a huge barrier to achieving life goals and getting back into work. Recovery-Oriented Practice, a relatively new movement in health care, encapsulates these ideas. I am seeing it starting to be embraced in many clinical settings – and it has become quite the buzzword. Still, I do not always see this translating into every day practice. We need to help our clients understand that they will still have bad days, they will still have flare ups, they will still feel like staying in bed all day sometimes, and that’s OK. We’re here to help with that. What matters is that we both agree that set backs and symptoms can be managed, and you don’t need to put off life until these problems go away. Our clients will be waiting a long time if they do.

2. Accept that the client is the expert

Building on from Recovery-Oriented Practice, it is important that we stop positioning ourselves as the expert. I know that this will be confronting for many practitioners, who are indeed experts in their own right. But the power differential this creates between us and our client is profound. We may be experts in our field but the only expert on the client IS the client – and it is our job to work with them to help them identify what is important to them in the context of their quality of life. We cannot choose our clients’ goals based on how we expect or want them to turn out. We see better compliance and better outcomes when we coach the client on defining their own goals first, and then by utilising our expertise to develop a plan with them to action these goals.

3. Acknowledge the System — Then Work With It

We discussed above the social and environmental factors that impact on someone’s ability to progress. Only when we examine these factors can we begin to address them. We do this by working collaboratively with other professionals (and of course the client). Once we identify, for example, that a person is in need of psychological support, we can begin exploring options with a qualified mental health practitioner to address this. At this stage, we need to keep a strong hold on the reasons why this referral is occurring and the client’s goals we have worked hard to develop alongside them. In this vein, I see a lot of collaboration but not enough common goals between specialists. Clients can become lost in an abundance of specialist referrals, all hoping to “fix” that exact problem rather than the client’s life goals. We need to communicate these agreed upon goals with each other to make sure we aren’t chasing our own tails – or even working against each other! Speaking from a vocational rehab perspective, I would love to see every professional agree on the point that work shouldn’t be a mandate – it should be seen as something that increases someone’s life satisfaction and overall wellbeing if the job is a good fit.

Overall, I am excited to see new movements in client care like the BPS and Recovery Oriented Practice. Too often, I see us sabotaging our own efforts by not communicating effectively and forgetting that we can’t make someone else comply with the goals we have predetermined for them. Paradoxically, I think part of the solution lies in doing everything we can to increase our expertise and knowledge around what recovery and rehab really is… and then learning to accept that at the end of the day, the client’s expertise is what matters most.