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There is a crisis in clinical practiceacross health care professions includingphysiotherapy (Dalley 1999, Higgs et al1999). This crisis can be categorisedinto three facets which are intimatelylinked: the changing clinical role ofhealth professionals (Ewing and Smith2001, Jorgensen 2000), the wideninggap between theory and practice(Hurley 2000, Parry 1997), and thechallenges to professional identity of

Introduction

The educational and practiceimplications of these challenges are thatthere is a need to rethink the status quoby addressing professional knowledge,the professional ideology underpinningeducation and practice, and clinicalpower inherent in practice from anemancipatory perspective. Adopting anemancipatory model of practice wouldchange physiotherapy practice towards amore collaborative and egalitarianapproach, with the emphasis onemancipating physiotherapists as well aspatients. This paper, while focused onphysiotherapy, has relevance foreducators and practitioners of otherhealth professions.

Keywords Emancipatory practice,physiotherapy, critical social science

Prince of Wales Hospital, SESAHS, Randwick,NSW, Australia

2 Faculty of Health Sciences, The University ofSydney, Lidcombe, NSW, Australia

3 School of Health Sciences - Physiotherapy andPodiatry, University of South Australia, Adelaide, SA,Australia

CorrespondenceProfessor joy HiggsSchool of Physiotherapy, Faculty of Health Sciences.University of Sydney, PO Box 170,Lidcornbe, NSW 1825. AustraliaPhone93519070 Fax: 93519323Email: j.higgs@fhs.usyd.edu.au

Abstract This paper explores the notionof emancipatory practice as a model forphysiotherapy. Key characteristics ofemancipatory practice are to questiontaken-for-granted practices, to criticallyreflect on one's current practices, and to

transform practices as a result ofquestioning and reflecting.Emancipatory practice challengesbiophysical-centred meanings andvalues, and the dominant ideology ofphysiotherapy practice. A number ofcurrent trends and findings warrant anexamination of emancipatory practice,including: emerging conflicts betweenpatient-centred and therapist-centredclinical roles; evidence generated fromrandomised controlled trials and casestudies; and professional identities ofphysiotherapists ranging from technicalscientists to caring patient advocates.

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Emancipatory practice: a model forphysiotherapy practice?

FOCUSON HEALTH PROFESSIONAL EDUCATION: A MULTI·DlSCIPLINARY JOURNAL. VOL 5. NO. 2. 2003

F Trede1, I Higgs2, M [onesi, I Edwards3

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clinicians (Centre for the Advancementof Interprofessional Education, 2002,Dalley 1999, Higgs et al 1999).

Practice Issues

Clinical Role

Firstly, there is conflict within theclinical role berween a patient-centredand a therapist-centred approach topractice. On the one hand, there is anexpectation of effectiveness in long-termoutcomes, increased quality of care, andpatient-relevant care which epitomisesthe values of the patient-centredmovement (see Fulford et al 1996). Inthis approach, clinical practice isinfluenced by patients' perceptions andwhat is most suitable for them. Theterm patient is used in this paper (eventhough 'client' or 'customer' could wellsuit the argument better). This is ~n

intentional choice to prompt re­examination of how clinicians interactwith their patients. The emphasis is ongood therapist-patient rapport andinterpersonal skills. The aim of patient­centred care is to be responsive topatients' felt needs (jorgensen 2000) andto achieve patient-centred goals while atthe same time contributing the. ., . .practitioner s expertise to patientmanagement goals, treatment andevaluation.

On the other hand, there is increasingattention paid to accountability andefficiency, which characterises thetraditions of therapist-centredmanagement. In this approach tophysiotherapy practice, decision-makingemphasises considerations of efficiencyand technical achievement. Efficiencyrefers to practice that uses minimalresources (including time) to achieve set

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goals. The goals relate to bio-physicaloutcomes and quantitative measures,and these goals are predominantly shortterm. In their extreme versions, thetherapist- and patient-centredmovements are in direct conflict witheach other. The former has a technicalorientation, the latter a psychosocialone. The key question that underpins.this crisis is: should clinicians bescientific technicians or humanisticpatient advocates? Beyond simplyresponding that the answer should be'AND' - that there's a place for technicalcompetence, scientific knowledgeunderpinning practice, humanism andpatient advocacy in practice, we notethat this question actually asks us to

consider what are the theories, principlesand values which underpin our practice.So ofren these are taken for granted,tacit, unchallenged or unknown. The'and' view also implies that we need to

equip practitioners with a way ofmoving between the various roles withtheir different assumptions, as the needanses.

Professional Knowledge

A second crisis point in health care to­day is the widening gap betweenresearch and practice. Research findingsderived from scientific method researchare not easily applied to the uniquesituations and social contexts of clinicalpractice (Cox 1999). Physiotherapistsmay know what research-defined bestpractice should look like in an idealsituation. However, they are also awarethat clinical environments vary.Technically oriented physiotherapistswho are aware of the many variableswithin clinical contexts face a dilemma.How can they fill the gap between

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research and practice? It appears to themthat generalised evidence-basedknowledge and the holistic andindividual orientation of case studies areincompatible (Camilleri 1999). The keyquestion that underpins this crisis is:should personal and cultural knowledgebe equally as important as technical,evidence-based knowledge in makingclinical decisions? It is critical for thetherapist to utilise the full scope ofknowledge available. Personal/culturalknowledge is essential to apply(Jorgensen 2000), to adapt wherenecessary the research-validatedtechnical knowledge in clinical practice.To do this the therapist must be in tunewith his or her personal knowledgerelating to psychosocial issues and mustbe able to explore the patient'sperspectives, with the patient, in a waythat can culminate in a consensus ofunderstanding and a plan formanagement.

Professional Identity

A third crisis point that results from theprevious two is the unresolved question:what orientation should physiotherapypractice take? Is physiotherapy anapplied science, a social science, or acritical social science? There existsuncertainty amongst physiotherapistsabout their professional identity. AIethey technical experts, patient educators,or advocates for patients? And is thereroom to mix these approaches andidentities?

To describe the above practice crises asdichotomies implies that one wouldhave to choose between the two givenoptions. We have portrayed threeclinical practice issues in their extremecontrast in order to raise awareness of

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the issues and to recognise thefundamental differences in their implicitvalues and understanding of what'constitutes health and health care.However, we assert that limitingdiscussion to extreme views is nothelpful when attempting to findsolutions. An extreme therapist-centredapproach separates facts from values,objectivity from subjectivity, andmedical from social issues in health.Such an approach establishes a hierarchyof knowledge where value-free, objectivefacts rank higher than value-laden,subjective health beliefs (Bithell 2000).An extreme patient-centred approachhas an interest in mutual understandingand in seeking consensus. The emphasisis on interpersonal meaning. Such anapproach is based on working withpeople's perceptions. Various aspectswithin the biophysical model influencethese perceptions. The extreme patient­centred approach does not deal withthese aspects and how they possiblydistort perceptions (Ewerr 1991).

In an emancipatory perspective facts andvalues are converged, and the distortedcommunication is made explicit andtransformed into democratic dialogue(Habermas 1973). In this paper wepostulate that physiotherapy practice is

, complex because it is based oninterpersonal communications and itsdelivery depends on the clinical andsociocultural context. The goal is tocontribute to the discussion comprisingeducation and practice in health care,and physiotherapy practice in particular.We are exploring the notion ofemancipatory practice and how it couldinform physiotherapy practice. Thepaper is of interest to health careeducators and practitioners alike. On ~n

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undergraduate level we advocatediscussion of how having practicephilosophies should impact on practice.On a postgraduate level we want toemphasis greater discussion on ethical,diversity health and practiceimplications The arguments presentedare based on the critical social sciencephilosophy literature, the criticalpedagogy literature as well as on ourcollective experiences.

What is emancipatory practice?

Emancipation means setting people freefrom unnecessary, un reflected, andtaken-for-granted assumptions andexpectations. Assumptions are no longerhidden but are exposed and questioned.This process of becoming aware ofvalues and assumptions enables peopleto question their intentions and interest.Emancipatory practice manifests itselfwhen practitioners transform theirpractice towards more egalitarianapproaches. Emancipatory practicestrives to attain democratic andsustainable solutions by looking forchoices that are realistic and mutuallyacceptable. While emancipatory practicerefers to therapists' emancipation,critical reflection on personalperspectives (e.g, understanding, beliefs,assumptions, emotions and attributions)is equally important for patients in orderto free them from views, attitudes orhealth beh~viours that may have becomeobstacles to improvement of theirwellbeing. Although the democraticprocess is promoted through evidence­based practice and peer review, withoutinclusion of the patient in clinicaldecision-making true democracy is lostand the process begins to resemble abenevolent dictatorship. Sustainability of

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positive health outcomes requirescritically applied evidence-based practicethat is sensitive to patient context andperspective. While being criticallyreflective therapists must not be totallyconstrained by existing 'evidence'.Rather, therapists must make themselvesaware of the evidence and be patient­and context-oriented in applyingevidence. When therapists (and patients)challenge their assumptions and lookbeyond their existing beliefs, newperspectives and new patterns can bediscovered.

The two main agendas of critical socialscience are critique and emancipation(Agger 1998). Critique involvesquestioning and challenging social,interactions and practices, andemancipation refers to seeking to freepeople from oppressive practices (e.g.the highly dependent patient role)(Foley 2000). There are three corethemes in critical social science thatinform discussion of an emancipatorypractice model for the health professionsincluding physiotherapy: the dimensionof knowledge, assumptions andideology, and power and emancipation.

The dimension ofknowledge

Habermas (1971). a prominentphilosopher and critical social scientistclaimed that interests drive allknowledge. Knowledge is generated byexploring questions and questions aregenerated by interests. The kinds ofquestions that practitioners ask disclosetheir interest in a presenting challenge.There are technical, practical andemancipatory interests. Each interestproduces different forms of knowledge.Thus knowledge can be categorised intoempirical/analytical knowledge serving

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the technical interest of control anddomination, historical/hermeneuticknowledge serving the practical interestof understanding subjective experiences,and critical knowledge serving theemancipatory interest of liberatingpeople from unreflected, taken-for­granted domination (Harden 1996).

Technical interest serving technicalcontrol is embodied in practice that isstrongly guided by quantitativemeasures. Technical knowledgegenerated from objective observationand investigation commonly serves toreiterate current practices and powerrelations and marginalise qualitativefindings. Technical knowledge on itsown is too limited to embrace otherways of knowing such as emotional,personal and cultural knowledge.Critical social science starts from thepremise that value-free, objectiveknowledge is a myth. It rejects thenotion that all knowledge shouldmeasure up to a natural science way ofknowing. It claims that such technical,evidence-based knowledge is incompleteand inadequate as the foundation formeaningful professional practice(Cranton 1996). Whilst technicalknowledge plays an important part inshaping professional practice it is notthe all-defining base of it.

Practical interest (which is focused onindividual and group perspectives)underpins consensus building that areembodied in people-centred practice.Practical interest is driven by the desireto understand current situations andpractices. The emphasis is on generatingmeaning from subjective perspectives.Such meaning and agreed understandingcreates social norms and consensus, anddetermines what is acceptable behaviour.

EMANCIPATORY PRACTICE

From a practical interest perspective,knowledge emerges from sharedmeanings. There are two problems witha practical interest perspective. First,shared meaning and knowledge can besubject to manipulation by a moredominant cultural group. Second, tryingto accommodate all interpretations isimpossible. However, we do advocatethat physiotherapists evaluate andattempt to understand patients'perspectives, even though patients'criteria and professional criteria may notcoincide. Understanding theperspectives of others does notnecessarily mean that those perspectivesare automatically accepted as viable orhelpful. Pluralistic perspectives thatvalue all interpretations as equally validcan lead to indecision and paralysis(Ewerr, 1991).

Practitioners may be torn betweentechnically and practically centredapproaches, as both can be appropriatedepending on the clinical context. Aclash in shared meanings is viewed as aconflict in interpretations, whichrequires reconciliation. If we acceptuncritically all interpretations as valid,regardless of their foundation, we fail torecognise that knowledge is a product ofshared meaning and that knowledge isdriven by interests. The critical socialscience perspective starts withperceptions but does not accept themon face value. Rather, it claims that thebasis of people's perspectives needs to beexplored, understood and whereappropriate transformed. Clinicians andpatients need to explore theirperspectives with openness that allowsfor transformation.

Emancipatory interest focuses on changeby moving current practices forward

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towards more humane, egalitarian andrealistic practices. People who arecommitted to emancipatory interestconsider and agree on their intentionsand the dimension of the topic beforemaking statements and developingarguments. The highest level ofcommunication is when people try to

understand each other's subjectivityrather than trying to force their ownsubjectivity and rnotivations into a guiseof objective rationality (Dubiel200l).Therapists cannot just assume that theinteraction they may have with aparticular patient is successful justbecause a patient is saying, 'yes' tocertain propositions. Thinking ofHaberrnas' ideal conditions for discourse(Haberrnas 1984), there may beconstraints on a patient's ability toparticipate in discourse equally with atherapist. For example, patients may notfeel able to explain to theirphysiotherapist how their work situationacts as a stressor in terms ofrelationships with their boss or fellowworkers, or work conditions. They maynot even know the role of stress in painmodulation, or they may feel thatcomplaining about work conditions willbe interpreted as not wanting to go backto work, which is quickly labelled in oursociety. It has been known for sometime that therapists treat (and prefer)acute cases over chronic pain and non­compensable over compensable cases,because of the complexity of thesefactors (Wolff et al 1991).

If one accepts that knowledge is theoutcome of human activity, thenknowledge is seen as being 'motivated bynatural needs and interests', and asoccurring within.a historical and socialcontext (Carr & Kernmis, 1986: 181). A

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critical social science perspective is basedon the assumption that we candifferentiate between genuinecommunication and strategicmanipulation. This discussion ofinterests and knowledge leads us to thenext core theme of critical social science,ideology.

Assumption and ideology

Ideology refers to the shared meaningsand values of a group. It is sociallyconstructed. Therborn (1999) claimedthat a profession is a manifestation ofideological configurations. The waypeople are in the world and make senseof it is influenced by historical, politicaland cultural ideology. As long asunderlying assumptions and ideologiesremain hidden, the status quo willremain unchallenged, stagnant andpotentially oppressive (Welton 1995).By assessing assumptions of currentpractices from a historical, cultural andpolitical perspective, unnecessarybarriers to emancipation are illuminated.Practices that are based on unrellecred,ideological bias may impede and hinderdevelopment. By acknowledgingideology it is possible to question and,transform it (Giroux 1983). If theideology of professional practice remainshidden there must be a reason for it;this reason could be to gain authority,social status and dominance over others.This brings us to the third core themeof critical social science perspective,power and emancipation.

Power and emancipation

.Power and domination are concernedwith who determines what actions canbe taken, what topics can be talkedabout, what topics are to be avoided,

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who can have a say, and who decideswhat is going to happen (Inglis 1997).By questioning who has power and why,the critical social science approach workstowards equalising power relations.Power relations can change in theprocess of human interactions andrelationships. Emancipation occurswhen power relations are madetransparent, and when people freethemselves from unnecessary powerconstraints. It is important tounderstand that critical social sciencedoes not provide a licence for anarchy. Itis accepted that authority is importantfor social public life. However, adoptinga critical social science perspectivedistinguishes between unnecessary andessential authority (McCarthy 1994).

Critiquing what we accept as knowledgeand ideology is the first step in movingcloser to emancipation. Emancipatoryinterest is nurtured by the desire tomature, to lend a voice to the powerless,and to include historical and politicalaspects when analysing practices. Suchan approach consists of critical self­reflection and an interest in searchingfor best possible solutions in eachindividual situation. This brings us to

describe emancipatory practice inaction.

Critical self-reflection.

The tool that transforms an experienceinto learning with the potential ofchange is critical self-reflection. We donot learn just by having experiences.There are many practitioners who havebeen practising for many years who havenot become experts in their field.However, there are others who havebeen practising for a relatively shorttime and who are recognised leaders in

EMANCIPATORY PRACTICE

their field (Trede 2000). To reflect onexperiences means to make sense ofthem, to understand what happened,why it happened and how. The processof reflection will guide us to reconsiderour actions, to understand in moredepth what happened and to askourselves what could have happened. Itwill help us to question our assumptionsand the values that inform our actions.Mezirow et al (1990) focused on criticalreflection and the capacity of people tolearn from their experiences so that theycould transform their actions towardsmore egalitarian, democratic practices.Emancipatory education is defined as'an organised effort to help the learnerchallenge presuppositions, explorealternative perspectives, transform oldways of understanding, and act on newperspectives' (Mezirow 1990: 18). fuclinical teachers we could promotecritical self-reflection in our students so.that they learn to do this with theirpatients.

The word critical can have manymeanings. In the context of criticalsocial science, to be critical is notconcerned with searching for deficitsand mistakes. We use the term to meanbeing aware of the diverse aspects of asituation, an idea or a presenting healthchallenge, and understanding its usesand limitations, e.g. that physicalinactivity does not necessarily compriseonly a lack of motivation or se1f­discipline. Critical thinking examinessources and consequences, andrecognises assumptions and underlyingbeliefs that govern our thoughts andactions. Facione (1990: 2) summed it upclearly as follows:

The ideal critical thinker ishabitually inquisitive, well

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biophysical deficits alone, and equalemphasis is given to the broader socialchallenges. For example, if older peoplewho are not coping at home areadmitted to hospital the issue forphysiotherapy practice is not reduced to

joint stiffness, muscle atrophy and lackof motivation. Physical inactivity isexplored as an aspect of social isolation,circumstances underpinning attention­seeking behaviour, and ageist attitudesof society amongst others. Thistransformation in practice focus is basedon awareness and understanding of anecological model of health in whichhealth is a dynamic and complexphenomenon (Higgs et al 1999). Itsinfluences extend beyond genetics andindividual lifestyle behaviours to thewider economic, political andenvironmental context factors includingsocial justice and social welfare systems(Collins 1995).

Physiotherapists adopting emancipatorypractice would not accept mainstreamapproaches and dominant ways ofthinking and practising withoutreflecting upon them. Their treatmentdecisions would be based on qualitiessuch as collaboration between clinicianand patient, permitting questions, andsearching for options.

Physiotherapists operating within anemancipatory model are first of allthemselves learners. Through criticalself-reflection they become emancipatedphysiotherapists who then becomefacilirarors of emancipatory learning fortheir patients. They help their patientsto learn to think for themselves, act forthemselves and feel more in control oftheir health. Emancipatory practicebrings about an increased awareness ofpossibilities and potentials. Within a

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informed, trustful of reason, openminded, flexible, fair minded inevaluation, honest in facingpersonal biases, prudent inmaking judgments, willing toreconsider, clear about issues,orderly in' complex matters,diligent in seeking relevantinformation, reasonable in theselection of criteria, focused ininquiry, and persistent in seekingresults which are precise as thesubject and the circumstances of" .mqutry permIt.

Critical self-reflection is concerned withassessing the way we pose problems andassess our frame of reference; in short, itquestions our professional identity. Itaims to enable practitioners to rethinktheir ideas and actions. Emancipatorypractice should not be viewed ascondemnatory of current practices assuch. Rather, emancipatory practice isan approach to freeing mainstreampractices from prejudice, habitual ,routines, power games, hidden ideologyand unreflected, unnecessary,barriers to

emancipation. There is no formula foremancipatory practice. It comes alivewith a critical understanding of theinfluences and consequences ofunreflecred assumptions, dominationand ideology in practice (Foley 1999).

Emancipatory practice as a modelfor physiotherapy practice

Adopting an emancipatoryphysiotherapy practice model wouldmean searching for democratic andsustainable treatment solutions bylooking for choices that are realistic andacceptable for both physiotherapist andpatient. In this approach, health'problems are not described in terms of

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democratic relationship physiotherapistsand patients are creators of their owntreatment culture.

It is important to make a distinctionbetween helping patients to comply orpassively cooperate with whatphysiotherapists might think is best forthem, and enabling patients tocollaborate in a way that actually allowsthem to participate in treatment and tofeel more in control of their healthproblem. Compliant patients may getbetter in the short-term but it isanticipated that emancipated patientswill also feel in control, and come closerto reaching their full potential. Anemancipatory approach expandsthinking beyond the one-dimensional,uncomplicated view of healthbehaviours. The implications are thathealth is defined neither in purelybiophysical terms nor in psychosocialterms, but rather in emancipatory terms.Critical self-reflection promotes apractice framework that embracesbiophysical, cultural, social and otherinfluences, and liberates the individual'sthoughts and actions from hidden, oftenunintentional restrictions. Such apractice framework has implications forthe role of physiotherapists, the notionof professional knowledge, andprofessional identiry.

The clinical role

Within an emancipatory approachphysiotherapists would adopt the role offacilitator of emancipatory learning.Transforming the clinician's role to thatof a collaborator, negotiator andemancipator implies democratising theclinician-patient relationship. Ademocratic relationship betweenphysiotherapists and patients means that

EMANCIPATORY PRACTICE

both partners are actively involved indecision-making and consequent action.'Democratic' does not mean equal orthe same in terms of knowledge or skills;it allows for recognition of differentstrengths (e.g, physiotherapist'sexpertise, patient's knowledge of self andcircumstances). We concede that anemancipatory practice model is not aneasy model in which to work; it maycreate quite some discomfort inpractitioners as they need to let go theprofessional authority and power whichtheir education inculcates in them.However, the creation of a democraticrelationship will lead to increasedrespect and comfort, reducedmisunderstanding and better rapport forpatient and physiotherapist.

The notion ofprofessional knowledge

Although physiotherapists have expertisein their field and possess technicalknowledge that helps to define theirprofession, physiotherapy practiceknowledge is not exclusively informedby technical knowledge (Higgs &Titchen 2001). Adopting anemancipatory perspective means thatpractice knowledge is generated with acritical awareness of barriers to realistic,achievable treatment goals and areadiness to act on identified barriers. Itmeans that subjectivity is integrated andnot excluded.

Three forms of knowledge are requiredfor professional practice: that fromresearch and theory, from professionalexperience and from personalexperience. "Blurring the boundariesbetween different knowledges and theirgeneration is an important part ofunderstanding the strength and scope ofpractice knowledge" (Higgs et al 2001:

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3). Practice knowledge is a rich conceptinformed by different ways of knowing.It is not limited to one approach toknowing only.

Professional identity

Professional identity of physiotherapistsadopting an emancipatory model wouldbe firmly based on a critical socialscience perspective. Thesephysiotherapists would accept thatphysiotherapy is a complex, highlyinteractive profession that is based onequality, democracy and emancipation.Physiotherapists would be identified asfacilirarors of a process that strivestowards exploring quality of life with anemphasis on reaching human movementpotential. Physiotherapists wouldcritique the technical, social andeconomic interests that drive theoriesand 'facts'. Such reflection relates noronly to their assumptions about practicebut also to their patients' perceptionsand interests. Physiotherapists adoptingan emancipatory perspective carefullycritique their own assumptions andthose of their patients with regard to

what motivates and drives both partiesto act the way they act, to think andmake sense of their world the way theydo. They would assess a presentinghealth challenge from an emancipatoryperspective of human interests andneeds. Emancipation does not promotedependency by making patients adhereto scientific perspectives, and does notrefer to independence by setting patientsfree from scientist perspectives. Rather itadvocates interdependence. Clinicianswho practise within the emancipatoryparadigm are critically aware of but notlimited to the technical interest whichso easily legitimises clinical dominance.

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They abandon unnecessary authoritarianpower interests but they maintainnecessary authority.

Limitations ofemancipatory practice

Emancipatory practice does not meetwith universal acceptance; it is complex,ambiguous and continually contested(Foley 1999). There are three potentialweaknesses in this approach to practice.First, partnerships where clinicians helppatients to help themselves are 'essentiallyforeign to medicine' (Sasz & HoIlender1956: 588). Advocating a democraticclinical relationship with patientsthreatens professional authority. Second,critics state that once people are madeaware of unnecessary barriers toemancipation they want to change thestatus quo but are not always in aposition to actually do so. Awareness­raising that is not acted upon may lead toa heightened sense of powerlessnessrather than empowerment. Third, criticsof emancipatory practice argue thatemancipatory interest is not realistic butrather utopian, especially in our times ofeconomic rationalism. Emancipatorypractices are based on the assumptionthat most people would like to be moreself-reflective and are capable of meetingon egalitarian terms. At least it isassumed that people could negotiate theirinterpersonal communications. Althoughthis may be perceived as a weakness, itshould rather be seen as a strengthbecause it provides a vision that is drivenby optimism and democratic valuesrather than by profit and domination.While not all will choose this option, it isan option they should at least be given.Emancipatory practice in physiotherapyadvocates a clinical orientation thatstrives towards context-appropriate and

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egalitarian approaches to practice. Suchan approach offers the promise ofachieving sustainable treatment goals.

Conclusion

Emancipatory practice, with itsunderpinning critical social scienceperspective, is well placed to addressunresolved physiotherapy practice crisesas it seizes the opportunity to transformpractice. We need to challengeapproaches to clinical practice and keepa constructive dialogue open in order toprovide appropriate and effectivephysiotherapy services to patients andhelp the profession mature.Physiotherapy practice will reproduce itsstatus quo as long as it is characterisedby technical interest that dominatespatients and restricts clinicians. Webelieve that a major challenge facingphysiotherapy practice is the question ofwhat underpins its interests andideologies. A physiotherapy practicemodel based on emancipatory interestshas the potential to clarifycontradictions, ideologies and tensions,foster critical reflection and result in amature practice. An emancipatorypractice model does not offer easy,simplistic solutions to thecontradictions, ambiguities andcomplexities of practice but it haspotential to address these issues in aconstructive way. To practise critical self­reflection is intellectually demanding forphysiotherapists, but we consider that itis a model that will helpphysiotherapists and their practice todevelop and grow, and gain greaterrespect in society. Emancipatedphysiotherapists and their patientswould emerge as responsible, self- .fulfilled participants in health are.

EMANCIPATORY PRACTICE

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