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research and have greatly impacted both physiotherapy and related professions. 10 Criticisms of the BPS model focus largely on the difficulty of implementation. As noted by researchers and clinicians alike, it has not been effectively integrated into medical education as a technique, nor has it been "effectively translated into the practical applications demanded by these domains." 11 These issues are echoed in the most recent feedback from physical therapy in particular, where many therapists express a lack of confidence or skills deficit in implementing the BPS model. 12 Furthermore, as shown in a recent study, although interdisciplinary multimodal approaches to chronic pain with a BPS component have been demonstrated to be effective in the context of physical therapy, the evidence in favor of pain neuroscience education directed at patients remains conflicted, though this may be due to how it is implemented. 13 It is clear from the extensive literature exploring BPS in physiotherapy that pain neuroscience education is becoming firmly established, and evidence so far suggests it is moderately effective—more so when integrated within an interdisciplinary intervention model. 14 This has, in turn, led to discussion of whether manual treatment will become ever scarcer, since the aim of pain neuroscience education is to refocus attention from the painful tissue to the neurological interpretation of stimuli resulting in nociception. 15 Some studies have built strong cases for the integration of both approaches. 16 Other studies focus more strongly on the educational component aimed at altering perceptions of pain and behaviors. 17 An important recent editorial argues strongly for a reexamination and improvement of manual therapy education overall, reiterating what to some may be obvious: "The essential skill of listening and correctly analyzing the patient's account of their experience is a foundational skill within multiple paradigms of MT practice . . . The opportunity to better communicate how the 'bio' of MT integrates within the 'psychosocial' of the intervention model has arrived. Now is the time to update outdated teaching models in MT education and provide leadership for integration of other interventions within the BPS model." 18 It is important to note this is not a call for the abolition of hands-on practice; rather, it is a call to better place the modalities in the therapist's toolbox with correctly implemented BPS as a decision-making road map. PATIENTŒCLINICIAN THERAPEUTIC ALLIANCE The therapeutic alliance (also known as working alliance) refers to the working relationship or "bond" that develops between patient and clinician. With roots in psychodynamics, the concept was expanded to encompass all therapeutic disciplines, and has generally been seen as vital for a successful outcome, client retention, and critically, public trust. At the heart of the therapeutic alliance is trust and a person- centered approach. Specifically, "The concept of bonds embraces the network of positive personal attachments between client and therapist that includes issues such as mutual trust, acceptance, and confidence." 19 This therapeutic relationship has undergone many iterations and shifts to its dynamic over the centuries, and as noted earlier, in the past a strongly paternalistic and authoritarian model dominated biomedicine, largely depersonalizing the patient while ascribing power to the expert physician, reflected both in wider society and the consultation room. Evidence- based medicine brought more physician accountability but few changes to this model until BPS improved it considerably. With the new emphasis on psychosocial factors, it now became the task of therapists to apply their expertise in a way that acknowledges the patient's psychosocial and cultural 44 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 1 context. This is frequently referred to as person-centered medicine. Yet, the therapeutic alliance of BPS may not be as person-centered as it might seem, nor the application of pain neuroscience education, despite the best of intentions. 20 It is revealing to observe just how many studies on the integration of behavior modification programs in health care focus on how to facilitate their acceptance and uptake among patients resisting such interventions. 21 In short, despite warnings to avoid such an approach, 22 the discussion frequently slips into querying how to convince patients you know better and intend to educate them out of their ignorance for their own good. One cannot but wonder whether this contravenes the desired goal of ethical integrity—a point argued in depth by proponents of narrative- based medicine—with a host of supporting literature. Classical medical training does not deal with this in detail; rather, it is the humanities once again where ethics are interrogated to tease out meaning. If patient autonomy is to be taken seriously, then one cannot hold to double standards. And if clinicians are fallible humans despite the best of intentions, can we be certain their expert opinions are indeed objective? Or might it be true that we are all "formed in relation to others and by language and social structures?" 23 In such a case, who is the expert on our patient—the literature, our training, or the patient themselves? Modern ethical principles suggest we should acknowledge the impossibility of certainty regarding our own judgment, recommending both humility and vulnerability as counterweights to the therapeutic encounter, especially in view of the inherent inequality of the medical context. 24 NARRATIVE MEDICINE: WHAT IT ISN'T Dualism is a difficult habit to think our way out of, and despite positive research on BPS when implemented through interdisciplinary interventions, the separation of the "bio" from the "psychosocial" remains a