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common problem. One common trap is "essentializing" traits, whereby a member of a particular culture may be subconsciously stereotyped according to gender, race, age, community, or any number of other subcategories. Though we may assume that by acknowledging an individual's cultural context we are demonstrating respect, we may in fact be imposing our own perceptions on them, thus doing the exact opposite. Equally, expecting that a specific stimulus will derive a specific response (regardless of the evidence) falls into the same trap and cannot have a holistic result. 25 This may be the source of frustration expressed by many physical therapists when they find that their best attempts at applying BPS fall short. 26 Similar issues apply to pain neuroscience education, compounded by the role of inequality, since "the power is all on one side." 27 An individual sits in your clinic, having experienced perhaps months of pain. They may feel some form of shame, frustration, or even anger at their situation, and they don't know the way forward, but they know they want it gone. They're not sure you can help them, but they've come in hope, and perhaps a little fear. For some who are wired that way, offering them education will indeed help; they may grasp at it. But some will feel intimidated and thus shamed, or insulted, or simply exhausted. They don't all want a snazzy PowerPoint and colorful lectures on gate control theory and neuroplasticity. They couldn't give a damn whether you subscribe to the idea that manual therapy is only skin deep or how many weekend courses you've taken in some cool trademarked modality. If they've walked in hoping for half an hour of hands- on focus on their painful back, or neck, or knee, connecting the therapeutic encounter with touch or movement in some form, then a lecture, however gently delivered, isn't going to do that for them. They don't care about your meticulously curated evidence base regarding manual therapy versus interdisciplinary intervention, nor what checkboxes you're trying to tick. It should go without saying that basic ethics along with scope of practice must be adhered to above all else, and a discussion of placebo is also needed here, but the point is that if you want to convince them otherwise, then you first need to "get inside their heads" to work out what the way forward might be. Knowing your audience is a fundamental principle of good teaching— this does not come about only through the standard interview, but by listening to their unfiltered narrative. Thus, according to the principles of narrative medicine, before talking, you need to recalibrate your own position first, and listen more closely than ever before. 28 The act of "diagnostic listening" allows the therapist to acknowledge more fully and help the patient face often unanswerable questions. If they do not, then the "resultant diagnostic workup might be unfocused and therefore more expensive than need be, the correct diagnosis might be missed, the clinical care might be marked by noncompliance and the search for another opinion, and the therapeutic relationship might be shallow and ineffective." 29 Narrative medicine flips the clinical encounter by allowing the patient's narrative to speak for itself, and using all the faculties of the practitioner to meet them as equals: "The narrative ethicist is trained to pay attention to what patients, families, and clinicians say and write about the situation. From literary, linguistic, or social science disciplines, the ethicist learns to recognize the genre, point of view, metaphor, diction, and temporality of a conversation or a written text to understand what the story's content might in fact tell . . . What does this practice of narrative ethics look like? To exercise compassion in adjusting treatment to the particularities of this patient's life story, to remove the blindfold of a universalist principle of justice and attend to a patient's specific needs." 30 Exercising compassion requires embracing uncertainty—not easy to do when all of your training has focused on the opposite. Critically, it means ceasing to consider some patients "difficult" because of noncompliance—if that is a therapist's inner thought, then they may need to reconsider their approach altogether. There is a freedom and a sharing of the burden of responsibility in perceiving patients as people whose narratives unlock the path to improvement. Let us not forget that uncertainty is part and parcel of clinical reality, both in the emergency room, the critical care unit, chronic pain situations, and the everyday clinic. In all those contexts, patients come in and tell their stories, but as demonstrated in the opening quote, garden-variety health-care training teaches you to pick out only those details focused on pathology (the "bio" of BPS), and in so doing, to ignore the individual—which amounts to more than the "psychosocial." The keys to building that therapeutic alliance are embedded in the details normally discarded. Learning to use them L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 45 SOMATIC RESE ARCH The practice of narrative medicine by active clinicians requires some additional training, but it does not require all clinicians to suddenly become literary scholars or psychoanalysts.