“The Biopsychosocial model, the missing link or missing a link?”
- Ian Holland-Coulton
- Dec 9, 2020
- 4 min read
Updated: Jul 22, 2022
"The whole is greater than the sum of all its parts in relation to coaching and clinical practice"
Biopsychosocial vs Biomedical model
The biopsychosocial (BPS) model was proposed by George L Engel and Jon Romano of the University of Rochester in 1977. The BPS aims to incorporate biology, psychology and socioenvironmental factors and how they interlace within health, disease and human development. This more holistic approach opposes the standard biomedical model (BM), which has been in use since the mid 19th century and is the central system used by physicians in medicine to this day. The biomedical model approach tends not to consider subjective or social factors or the physician's direction. Instead, it prioritises pathology, biochemistry and physiology.
Pros and Cons
The BPS model has been criticised for lacking completeness and unclear boundaries but conversely praised for introducing aspects and complexities that may contribute to an individual's overall wellness and bridge the gap between philosophy and practice.
The BPS model encompasses an open-ended approach that may border heavily in the direction of philosophy with too much room for misinterpretation. Interestingly the BPS model has gained popularity possibly due to topical discussions in academic realms filtering down through clinical practice. It may merely be that transparency from practitioners who consider a multifaceted approach to practice and less authoritarian treatment methods could encourage a more thorough practice. Moreover, understanding pain science and the potential factors underpinning it might be a more significant bridge between the practitioner and Individual confidence, and reduce healthcare costs from a rehabilitation perspective.
BPS sports performance and rehab (bridging the gap)
The biological and or physiological side of sports and performance have long been analysed and play a considerable role in athletic development and rehabilitation from injury. Sports psychology seems more broadly accepted these days in most cases, and management of this can contribute incredibly to an athlete's wellness and success. Understanding the social aspect could be equally crucial with personal, cultural, and spiritual issues being hugely influential factors in almost every country if we try to understand athletes or individuals to the best of our ability as practitioners. We need to have the tools to apply stimulus and interpret potentially intentional or non-intentional nocebo language and bias. For example, understanding pain science and rehabilitation and how it is perceived would seem essential to any sport practitioner's job. Regarding athletic training and or return to sport, athlete post-injury management can be observed and treated in multiple ways, including assessments, therapy, sports specific training etc, objective and subjective data using devices, general questionnaires and autoregulation to name a few. However, if practitioners from therapists to strength and conditioning coaches aim to effect real change, bridging the gap in trust and communication could demonstrate a more comprehensive approach and overall connectivity between practitioners and individuals to succeed in injury rehabilitation and or sports performance.
Making choices wisely
Determining the best course of action sets apart good practitioners from bad, therefore using tried and tested objective methods that yield results would seem a more appropriate form of carrying out assessments and subsequent rehabilitation processes. We could assume that a hierarchy of knowledge and experience is a crucial driver to many practitioners' success. However, suppose the main focus is driven by a system of objective practice alone to yield results many aspects could be overlooked. This approach may easily misguide practice by those who carry power and confidence in their abilities, raising questions of who's best interests are at the forefront over a broad range of sectors. Even though this could be interpreted in different ways and is an open-ended process, the BPS's core does raise crucial questions even four decades after it was first proposed, but perhaps this is the very point. With the increase in globalisation and population explosions, competition in various healthcare sectors is high; and making it to the top could mean "by any means necessary".
Complete the incompleteness but stay agile
The very framework laid out by the BPS model encourages a systematic but multifaceted way of thinking; it highlights the complexities of the world that we live in and how to organise people situations and surroundings. The BPS can humble evidence-based practitioners and potentially push to explore using better language to create self-efficacy. That said, the BPS model's limitations should also be considered for lack of completeness and within that may miss fundamental theories leaving it open to misinterpretation; therefore, failing to necessitate the best possible practices. The BPS could be praised and criticised but using this type of methodology complete or otherwise may encourage deeper engagement and problem solving within any healthcare and social science sector. Human beings are complex organisms, checking boxes on repeatable areas or tests is part of measuring development; Fundamentally, problem-solving is vital to staying agile around grey areas within that development. When implementing different strategies to handle nuance, it might seem straightforward to exercise this. That said, continually sitting on the fence between making a decision or not due to human endeavour complexities could lead to low management strategies. Guided autonomy might be a useful way to describe a more innovative way to see coach/practitioner athlete/individual relationships and goal outcome.
The parts are as significant as the whole.
Just as one hand washes the other a solid understanding of the "whole" process in an alliance might build a better chance of success, as well as adaptability and innovation adding layers to this continued approach to further development.
All of this might seem obvious from the outset but suppose the practitioner is working hard to be self-critical. They may improve their ability to hold the mirror steady for the individual to enhance autonomously around their methods. This speaks on multiple levels, not just in the way we practice and perform but also how we live as human beings.
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