Physiotherapists’ conceptions of movement awareness : a phenomenographic study

This is a self-archived version of an original article. This version may differ from the original in pagination and typographic details. Author(s): Title: Year: Version: Copyright: Rights: Rights url: Please cite the original version: CC BY-NC-ND 4.0 https://creativecommons.org/licenses/by-nc-nd/4.0/ Physiotherapists’ conceptions of movement awareness : a phenomenographic study © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC. Published version Ahola, Sirpa; Skjaerven, Liv Helvik; Piirainen, Arja Ahola, S., Skjaerven, L. H., & Piirainen, A. (2022). Physiotherapists’ conceptions of movement awareness : a phenomenographic study. Physiotherapy Theory and Practice, 38(10), 1438-1452. https://doi.org/10.1080/09593985.2020.1868028 2022 Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=iptp20 Physiotherapy Theory and Practice An International Journal of Physical Therapy ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/iptp20 Physiotherapists’ conceptions of movement awareness– A phenomenographic study Sirpa Ahola, Liv Helvik Skjaerven & Arja Piirainen To cite this article: Sirpa Ahola, Liv Helvik Skjaerven & Arja Piirainen (2022) Physiotherapists’ conceptions of movement awareness– A phenomenographic study, Physiotherapy Theory and Practice, 38:10, 1438-1452, DOI: 10.1080/09593985.2020.1868028 To link to this article: https://doi.org/10.1080/09593985.2020.1868028 © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC. Published online: 04 Jan 2021. Submit your article to this journal Article views: 1307 View related articles View Crossmark data Citing articles: 2 View citing articles Physiotherapists’ conceptions of movement awareness– A phenomenographic study Sirpa Ahola MSc, PT a , Liv Helvik Skjaerven PhD, PT b , and Arja Piirainen PhD, PT a a Department of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; b Department of Function and Health, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway ABSTRACT The phenomenon of movement awareness requires more attention to make it explicit in physiotherapy. The aim of this study was to explore the variation in physiotherapists’ conceptions of movement quality, focusing on movement awareness. The informants were 15 physiotherapists from a variety of physiotherapy fields. We collected data through two group interviews and used the phenomenographic method to analyze them. Four themes emerged from the data: 1) Being in contact with one’s own moving body; 2) Increased awareness of movement experiences; 3) Interrelationship between physiotherapist and patient; and 4) Better understanding of movement awareness. These themes varied by four descriptive categories of the movement awareness phenomenon: (I) Hesitation regarding own movement experiences; (II) Momentary contact with own movement experiences; (III) Presence in movement awareness and (IV) Better understanding of others’ movement awareness. The physiotherapists’ understanding of the movement awareness phenomenon widened through three critical aspects in the descriptive categories: Recognizing one’s own movement awareness, Distinguishing one’s own and others’ movement awareness and New insights into implementing actions related to movement awareness in physiotherapy. These results can expand the understanding of the phenomenon of movement awareness among physiotherapists, although further research is needed. ARTICLE HISTORY Received 26 December 2019 Revised 28 July 2020 Accepted 22 November 2020 KEYWORDS Phenomenography; reflection; conception; movement awareness; movement quality; physiotherapist Introduction Physiotherapists are expected to provide evidence-based treatment of human movement and of the phenomenon of movement quality and movement awareness. Human movement is a wide-ranging phenomenon and can be explored from different perspectives, such as the biomedical, human science, naturalistic, social interaction, or holistic perspectives (Shumway-Cook and Woollacott, 2017; Wikström-Grotell, 2016). The holistic perspective sees human movement as the center of meaning and as happening in a bodily encounter with the world (Merleau-Ponty, 2012). Movement quality has various contents and is used in various contexts in physiotherapy. However, grasping its nature appears to be challenging (Skjaerven, 2019; Skjaerven, Gard, and Kristoffersen, 2008; Skjaerven et al., 2018). The phenomenon of movement quality can be described from different perspectives: the first, the biomedical perspective emphasizes a pathological, mechanical dysfunction with quantifiable terms (Tamm, 1993), aiming to normalize movement (Farjoun et al., 2020). The second expressive perspective emphasizes movement improvisation (Parviainen, 2018; Pylvänäinen, 2018). The third stresses the technical approach to increase movements’ perfection and repetition (Ketelaar et al., 2001; Stephenson and Stephens, 2018) using tools (Thomas et al., 2001), and the fourth perspective explores the movement experience itself (Ahola, Piirainen, and Skjaerven, 2017; Blaauwendraat, Levy Berg, and Gyllensten, 2017; Olsen et al., 2017). The biomechanical perspective focuses on important components for reaching peak quality performance (O’Sullivan, Schmidt, and Fulk, 2019), whereas the biopsychosocial perspective sees that emotional, cognitive, environmental, and relational factors all influence movement quality (Moore and Yamamoto, 2012). The existential perspective sees the phenomenon of movement quality as a two-layered model (Skjaerven, 2019; Skjaerven, Gard, and Kristoffersen, 2008), in which the first layer provides a description of general movement quality, representing a synthesis of all interacting movement processes; and the second layer provides a differentiated perspective-specific structure of movement elements and aspects. Movement quality can be described as an umbrella embracing and constantly interacting through all four biomechanical, physiological, psychosocio-cultural, and existential perspectives of CONTACT Sirpa Ahola [email protected] Department of Sport and Health Sciences, University of Jyväskylä, Jyväskylä FI-40014, Finland. PHYSIOTHERAPY THEORY AND PRACTICE 2022, VOL. 38, NO. 10, 1438–1452 https://doi.org/10.1080/09593985.2020.1868028 © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-ncnd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. human movement, expressed in diverse movement aspects and qualities (Skjaerven, Gard, and Kristoffersen, 2008). Movement awareness (i.e. becoming aware of, identifying and monitoring subtle nuances of movement quality) can be described as how movements are performed and experienced, identifying movement reactions of internal, relational and environmental conditions (Skjaerven, 2019). The definitions of movement awareness and body awareness overlap. Ginzburg, Tsur, Barak-Nahum, and Defrin (2014) described body awareness as sensitivity to bodily signals to become aware of bodily states and to identify subtle bodily reactions. Body awareness is a complex, multi-dimensional construct (Mehling et al., 2011). Mehling et al. (2011) defined body awareness as the subjective, phenomenological aspect of proprioception and interoception that enters conscious awareness, modifiable by mental processes such as attention or attitudes. The phenomenon of movement awareness offers a specific focus on human movement and differs from body awareness, which is more general (Skjaerven and Gard, 2018). According to Brown and Ryan (2003), awareness is derived from human consciousness and experiences, and includes being relaxed and present. Movement awareness is expressed in the body and can be observed through observing movement quality (Skjaerven, Gard, and Kristoffersen, 2008; Skjaerven, Kristoffersen, and Gard, 2010), which in turn expresses bodily self-consciousness (Gyllensten, 2012). Movement quality and movement awareness are closely related (Skjaerven and Gard, 2018). Penfield (2006) described movement as our “royal road” to the unconscious. Being in movement focuses on understanding the value and qualities of human movement from the individual’s perspective (Arnold, 1979; Brown, 2013). Physiotherapists meet clients with multifactorial movement disorders that reveal difficulties in their contact with themselves, others and/or the environment, which affect movement quality, daily function and participation (Gyllensten, Skär, Miller, and Gard, 2010; Skjaerven, Gard, and Kristoffersen, 2008; Skjaerven, Kristoffersen, and Gard, 2010). To optimize wellbeing, it is important to unify physical and mental aspects, which is a core mental health component of (Probst et al., 2016) and needed in all fields of physiotherapy. The aim of physiotherapy is to maximize people’s movement potential for participation in daily life (World Confederation for Physical Therapy, 2017). For physiotherapists, from an educational point of view, it is important to focus on what they can learn through close attunement to the human body (Jensen et al., 2017b, 2017a), in particular human movement (Wikström-Grotell, 2016). The individual is empowered when their physical activity, functional movement and movement awareness are promoted (Probst et al., 2016), as these are essential elements of health and wellbeing, because of their many positive health influences on movement potential and quality of life, such as tension regulation and safety experience (Ogden, Minton, and Pain, 2009; Song and Yu, 2019; Wikström-Grotell, 2016; World Confederation for Physical Therapy, 2017). Biopsychosocial perspective-based approaches, such as cognitive-behavioral therapy and motivational interviewing, are also used in physiotherapy (Guerrero, Maujean, Campell, and Sterling, 2018; Holopainen et al., 2020; Toye, Seers, and Barker, 2017). Human health and well-being, and the interrelationship between health, stress and coping strategies are the focus of the salutogenic orientation (Antonovsky, 1987; Mittelmark et al., 2017). Salutogenic orientation-based approaches such as Basic Body Awareness Therapy (BBAT) are used and needed in physiotherapy to empower the individuals (Gard, Nyboe, and Gyllensten, 2020; Gyllensten, Jacobsen, and Gard, 2019; Skjaerven, 2019; Skjaerven et al., 2018). BBAT is a physiotherapy approach that promotes movement quality through movement awareness (Gard, Nyboe, and Gyllensten, 2020; Skjaerven, 2019; Skjaerven et al., 2018). The therapeutic components to promote movement quality through increasing movement awareness in BBAT are: 1) the physiotherapist’s own movement awareness as a precondition; 2) a platform for promoting movement quality; and 3) therapeutic strategies, such as strengthening the presence of being in movement, when guided through the seven-step Movement Awareness Learning Cycle (Skjaerven, 2019; Skjaerven, Kristoffersen, and Gard, 2010). The promotion of movement awareness involves the whole person, which places high demands on the physiotherapist’s own movement awareness (Skjaerven and Gard, 2018). Through the body’s ability to sense, physiotherapists can express their experiences, which can support their self-confidence in clinical practice with the patient. (Ekerholt and Bergland, 2019). Physiotherapists’ understanding of their own movement quality is important because they must be able to be present and attentive in practical sessions, which are mostly based on non-verbal communication (Hedlund and Gyllensten, 2010, 2013). The physiotherapist’s own movement experience and sensitivity to movement quality serves as a background in the therapeutic situation, encouraging others to become more present and be in contact with their own movements (Covington and Barcinas, 2017; Gyllensten, Skär, Miller, and Gard, 2010; Hedlund and Gyllensten, 2010, 2013; Råsmark, Richt, and Rudebeck, 2014; Skjaerven, Kristoffersen, and Gard, 2010). PHYSIOTHERAPY THEORY AND PRACTICE 1439 Reflection is the process of becoming more aware of an experience, event, state, or perception (Dilthey, 1989; Mezirow, 1998). An important stage in reflection is the step from the first-order to the second-order perspective, when a person criticizes the premises upon which they have experienced a challenge (Mezirow, 1998). The reflection process can be described in different ways. Mezirow (1991, 1998) developed the often-used model of seven levels of reflection, in which the first four levels concern consciousness and the highest three levels critical consciousness. As understanding the processes and premises of a phenomenon such as human movement is important. Mezirow’s levels of reflection are useful when focusing on movement sensations, and may lead to insights into enhancing awareness of our bodies. To understand movement, one must recognize the elementary nature of one’s own movement experience and realize that a reflective second-order understanding of movement quality exists (Mezirow, 1998). In terms of reflection, becoming aware of bodily states with a particular focus on movements, and expressing movement quality sensations orally in words (i.e. verbalizing) can be challenging (Ahola, Piirainen, and Skjaerven, 2017). Previous studies have shown that the physiotherapist’s ability to be mentally and physically attentive is the basis for professional communication through observing, understanding, and promoting movement quality, which promotes transference to patients during physiotherapy (Hedlund and Gyllensten, 2010; Skjaerven, 2019; Skjaerven, Kristoffersen, and Gard, 2010). Physiotherapists’ interpersonal and communication skills (O’Keeffe et al., 2016), their role as part of a multidisciplinary team (Lau, Skinner, Lo, and Bearman, 2016), their motor imagery during physiotherapy practice (Dickstein and Deutch, 2007), and their role in identifying gaps in ethical issues (Swisher, 2002) have all been examined in previous studies. However, there is little research on physiotherapists’ conceptions of movement quality that focuses on movement awareness. The aim of the study was thus to explore the variation in physiotherapists’ conceptions of movement quality, focusing on movement awareness. Methods Understanding and describing movement quality while focusing on movement awareness from the physiotherapist’s viewpoint demands a specific research design and method to reveal physiotherapists’ conceptions. We chose phenomenography as our research design method to study how people understand, experience, and describe a given phenomenon in the surrounding world (Åkerlind, 2005, 2008; Marton, 1981; Marton and Booth, 2013). From a phenomenographic perspective, the ways of experiencing the particular phenomenon are referred to as a second-order perception, and the investigation is directed at the variation in the informants’ ways of understanding their experiences (Marton, 1981). Phenomenographic research focuses on experience at the collective level, the full range of possible ways of experiencing the phenomenon in question, at a particular point in time (Åkerlind, 2005). Phenomenographic research data can be collected using many methods such as written essays, documents, observations, and drawings (Åkerlind, 2018). The most common data collection is interviewing (Åkerlind, 2018). Phenomenography is a data-driven approach, which means that all findings arise from the data (Åkerlind, 2005, 2008). In phenomenographic analysis, critical aspects can be identified within descriptive categories that represent the expanding awareness of the phenomenon under study (Åkerlind, 2005; Marton and Booth, 2013; Paakkari, Tynjälä, and Kannas, 2011). Informants In accordance with the phenomenographic research method, it was essential to recruit informants who had clinical experience as physiotherapists and who were willing to describe their conceptions of movement quality by focusing on movement awareness, which can be difficult to describe in words (Blackburn and Price, 2007). The informants recruited for this study were 15 physiotherapists. They had applied to participate during a postgraduate introductory BBAT, a physiotherapeutic approach well known for its focus on promoting movement quality through movement awareness. We assumed that the informants were curious about movement quality and movement awareness. The course consisted of 40 hours of condensed learning, including theory, seminars, and movement sessions. The informants were all female, registered physiotherapists, aged 27 to 54 (average age 42), Finnishspeaking, and born and educated in Finland. They had an average of 15 years of experience as physiotherapists, ranging from one to 30 years (Table 1). They worked in different fields of physiotherapy: Eight in mental health and psychiatry, three in multi-professional rehabilitation for chronic pain or musculoskeletal disorders, and one in each of the following fields: family-centered rehabilitation, primary health care, special school education, and cancer (Table 1). Four of the 15 informants had completed post-graduate courses of shorter duration on, 1440 S. AHOLA ET AL. for instance, breathing, depression, pain, trauma, lymphatic therapy, riding therapy, Bobath therapy, Neurolinguistic Programming, or mindfulness. Four of the 15 physiotherapists were specialized in psychophysical physiotherapy (Table 1). The study was approved by the committee for educational research ethics (March 20, 2013). Permission for the study was requested from both the educational institution and the informants themselves. The recruitment process took place at the start of the course. All those agreeing to participate signed their informed consent. We have ensured the informants’ anonymity by using pseudonyms when presenting our findings. Data collection The data were collected in two group interviews (Brinkmann, 2013) at the end of the course in the same location. Two groups were formed alphabetically, according to the 15 informants’ last names; one with eight informants and one with seven. Two reflectionbased group interviews (Kvale and Brinkmann, 2009), allowed the informants to describe and reflect upon their movement experiences as much as possible. A group interview can be even more productive than individual interviews when the members of the group feel equal in term of at least one element (Brinkmann, 2013). The informants were all physiotherapists and got to know each other during the week. Awareness of “peerness” and a feeling of “sameness” can enhance dialogue and social support within a group (Skaniakos and Piirainen, 2019), when it is challenging to make the phenomenon under study explicit (Ahola, Piirainen, and Skjaerven, 2017; Blackburn and Price, 2007). The first author conducted the interviews and was a physiotherapist, but otherwise unknown to the informants. The interviewer created a permissive, open atmosphere, listening patiently to the informants´ descriptions (Brinkmann, 2013). The interviewer also encouraged the informants to clarify and to illustrate their descriptions as much as possible. The group interviews, which were conducted in Finnish, had two phases: the first, focused on the informants’ immediate experience of their own movement, and in the second, the professional physiotherapists, invited the informants to reflect upon their conceptions of movement quality by focusing on movement awareness, and asked them to look back on their clinical practice. The interview’s initial question was: How were your experiences of being in movement during this week in BBAT? It then proceed to its main focus: I now invite you to describe your conceptions of movement quality. What does it mean to you as a physiotherapist? The interview continued on the basis of the interviewees’ answers. The interviews were audiotaped and transcribed verbatim, yielding 35 transcript pages (15001 words, font = Times New Roman 12, spacing = 1.5), and forming the research material for this study. The first interview lasted 65 minutes and the second 60 minutes. Data analysis The phenomenographic analysis (Åkerlind, 2005, 2008) was carried out by the first author (Figure 1), and examined the informants’ descriptions of the phenomenon as a whole. Their conceptions illustrate how a group of informants can understand and express their experiences of the same phenomenon in such different ways (Åkerlind, 2005). The similarities and differences between the experiences of a phenomenon have a systemic order, which takes the form of descriptive Table 1. Informants characteristics. Informants (n = 15) Work experience as a physiotherapist (years) Additional PT education Workplace and work sector A 5 s OCPRI B 30 s OCPRI C 18 s OCPRI/OCPUB D 25 l OCPRI E F G H I J K L M N O 2 28 >1 10 13 11 22 13 20 4 24 s l - - l l - - - - - IWPUB OCPRI/OCPUB IWPUB IWPUB IWPUB IWPUB OCPUB OCPRI OCPUB OCPUB OCPUB l = long additional education; s = short-term additional course; IWPUB = inpatient ward, public; OWPUB = outpatient ward, public; OCPRI = outpatient clinic, private; OCPUB = outpatient clinic, public. PHYSIOTHERAPY THEORY AND PRACTICE 1441 categories (Marton, 1981). These descriptive categories illustrate the variation of conceptions of undergoing movement awareness, are structurally and logically inter-related and form a hierarchical whole (Åkerlind, 2005; Marton and Booth, 2013; Marton and Pong, 2005). The presented categories represent the informants expanding view on movement quality, focusing on movement awareness (Åkerlind, 2005, 2018; Marton and Pong, 2005). Figure 1 presents the phases (1–6) of the phenomenographic data analysis in this study. The data presented the informants’ descriptions of movement awareness (Figure 1, phase 5). In phenomenographic analysis, the critical aspects can be identified as descriptive categories of what is important for widening the informants’ understanding of the phenomenon of interest (Marton and Booth, 2013; Paakkari, Tynjälä, and Kannas, 2011): in this study, movement quality, focusing on movement awareness. We identified three critical aspects in the descriptive categories (Figure 1, phase 6). The first author listened to the audio-recordings, read the transcripts several times and made the first draft of the findings. The research group (SA, LHS, and AP) identified the themes of variation and discussed the relations and hierarchies in the descriptive categories. The group constantly evaluated the consistency between the original data and our findings to minimize the influence of their own interpretations. All three authors further elaborated the first draft result, seeking the clearest and most original quote that illustrated the results. The group interviews were carried out in Finnish, by the first author. The first translation was undertaken by the first author and discussed with the coauthors, and finally checked by a native English professional language editor. Results The aim of the present study was to explore the variation in physiotherapists’ conceptions of movement quality, focusing on movement awareness. The results of the phenomenographic analysis revealed that the informants’ conceptions of movement awareness had four widening, qualitatively descriptive categories (Table 2): I) Hesitation regarding own movement experiences; II) Momentary contact with own movement experiences; III) Presence in movement awareness; and IV) Better understanding of others’ movement awareness (Table 2). The physiotherapists’ conceptions had four themes, which varied hierarchically so that they formed four movement awareness categories. The themes distinguishing the descriptive categories were as follows: 1) Being in contact with one’s own moving body; 2) Increased awareness of movement experiences; 3) Interrelationship between physiotherapist and patient; and 4) Better understanding of movement awareness (Table 2). The descriptive categories and the variation of themes are presented below, using quotes identified as be relevant from the informants’ descriptions. The letters A through O after each quote represent the participating physiotherapists. The varying themes within each descriptive category are highlighted in bold. The name •Repeated reading of the transcripts by the same person. •Identification of each theme’s three or four variations. •Identification of the critical aspects of the descriptive categories. •The variation of the themes formed the descriptive categories of the movement awarness phenomenon and assigned a distinctive name to each category. •Based on similarities and differences, the variation of the themes took the from of a hierarchy. •Identification and classification of the date into themes based on informants’ descriptions of their conceptions of their own movement quality, focusing on movement awareness. Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Phase 6 Figure 1. Phases of study´s phenomenographic analysis. 1442 S. AHOLA ET AL. of each variation theme is in italics throughout the results (Table 2). Category I: Hesitation regarding own movement experiences In this first descriptive category, the informants reported that becoming aware of their own movement sensations was challenging. They described experiencing their own movement as a blind spot. Recognizing their own movement awareness was considered a different experience what they were used to in their earlier physiotherapy work. The first identified theme of variation was being in contact with one’s own moving body, which in this narrowest descriptive category, was described as a lack of contact with the moving body. The physiotherapists claimed that it was demanding to be aware of their own bodily and movement sensations and face their own bodily and movement needs. One informant described how they saw their own body movements as automatic mechanical actions. I feel like I can’t listen to my body, I expect my body to work like a machine from day to day . . . I’ve also noticed that it’s difficult for me to let my breath relax and flow freely (C). The second variation theme in this descriptive category, increased awareness of movement experiences, focused on remote experience when moving. The informants said they felt that coming into closer contact with their own movements was a remote experience. They described usually observing only their own vital bodily functions, for example, their heartbeat, and dismissing and lacking contact with delicate sensations in their own movement awareness. I’ve often taken distance from my body . . . In the rare moments when I actually concentrate on listening to my own body, I mainly observe the concrete bodily functions (L). In this first, narrowest descriptive category, the interrelationship between physiotherapist and patient was related to the physiotherapists paying attention to their own body. In this theme, the physiotherapists’ descriptions focused on movement awareness from only their perspective. When I work with a patient . . . Well, like I’ve noticed that even though you work with your own body how strange it is . . . and you have like a very strong relationship with your own body so it will definitely be a lot of work figuring it all out (L). Despite claiming that encountering one’s own movement awareness in physiotherapy was challenging, the informants said that they wanted to achieve a better understanding of movement awareness (the fourth theme). In this first descriptive category, the informants described how learning to be present when moving awakened their curiosity, although it was challenging. The informants also described that it was easier to focus only on doing during physiotherapy (Table 2). As a physiotherapist, I’m learning to be present, here and now, in the moment. It’s difficult; it would be easier to just concentrate on doing (A). Category II: Momentary contact with own movement experiences The focus of this second descriptive category was on an explorative attitude and being curious, when the informants encountered their own movement awareness with interest. Movement awareness was described as an uncertain encounter, and as was sensing that one’s own movement awareness could mean (Table 2). The informants’ descriptions of their own experiences of being in contact with one’s own moving body expanded from the first descriptive category to the second (see Table 2). The informants described their first contact with their own movement awareness as difficult to trust. Table 2. Descriptive categories and themes. Descriptive categories of movement awareness phenomenon Themes: (variation of themes, horizontal) I: Hesitation regarding own movement experiences II: Momentary contact with own movement experiences III: Presence in movement awareness IV: Better understanding of others’ movement awareness Being in contact with one’s own moving body Lacking contact with the moving body Gaining first contact Being in contact Reflecting on contact and how to move Increased awareness of movement experiences Remote experience when moving Recognition of stronger sensing of movement experiences Distinction between one’s own and the patient´s movement awareness – Interrelationship between physiotherapist and patient Paying attention to own movement experiences Sharing personal movement experiences with others Sensing one’s own and others’ movement awareness resources Reciprocal professional interrelationship Better understanding of movement awareness Learning to be present when moving Recognizing movement processes Learning new movement strategies Movement awareness as a base for physiotherapeutic competence PHYSIOTHERAPY THEORY AND PRACTICE 1443 It’s difficult for me to let go and just be guided by my own movement sensation, and not perform the movements correctly and be in control (J). In the theme increased awareness of movement experiences, the informants described recognition of stronger sensing of movement experiences when they started to explore their own movement. They reported not being able to be fully involved in being in contact with their own movements. Despite starting to explore their own movement awareness, the informants described the process of being in contact with and recognizing their own movement sensations as challenging, that it aroused various sensations and was a restless experience. I’ve found it challenging recognizing . . . bodily sensations are difficult and detached from real emotion. It’s not easy . . . I’ve felt it as restlessness in my body (N). In this descriptive category, the third theme, the interrelationship between physiotherapist and patient was related to the informants’ experience of sharing personal movement experiences with others. In this theme, the focus on movement awareness shifted between physiotherapist and patient in the clinical physiotherapy situation. When the informants described the close interrelationship between physiotherapist and patient, they described movement awareness as how bodily sensations of pleasure or fear were similar to those that their patient had experienced and described during a physiotherapy situation. Sharing the same bodily experience as my patient, which I have noticed, bodily experience as a physiotherapist. The emotion, sensation can be joy or happiness but usually with sick people it is anxiety, pain and fear (O). Better understanding of movement awareness was linked to recognizing movement processes. Their understanding of movement awareness expanded further, that the informants reported their own movement awareness with an open attitude toward recognizing the movement process between therapist and patient. Better understanding of movement awareness was described as a target to support their patients in physiotherapy. I’ve found sensing my own body to be important so that I don’t get confused by my client’s bodily reactions and can give them as much as possible as a physiotherapist (M). Category III: Presence in movement awareness In the third descriptive category, being in contact with one’s own moving body expanded from the second descriptive category to the third. Being in contact was described as being more present in the actual moment, when moving. The physiotherapists described how through their bodily presence they felt more connected, both to themselves and to others as their patients or other physiotherapists. They also described their own movement sensations appreciatively with approving description language. My body is a part of me. My body is a tool through which I can live that reflects my emotions and thoughts. My body is also present in various interaction situations; being in one’s own movement, how to appreciate yourself, relationships with others and your living environment (B). The increased awareness of movement experiences theme broadened as the informants described a distinction between one’s own and the patient’s movement awareness. The informants’ noticed being more sensitive to exploring and more broadly understanding what happens in clinical practice. In the interview they started to describe how a process like becoming more aware of their own movements was essential to develop their own sensitive guidance of patients (Table 2). I’ve recently been thinking more about my guidance, how to ask permission to touch, to be sensitive and understanding in situations where the client doesn’t want to be touched (F). The third theme, interrelationship between physiotherapist and patient, was described by sensing one’s own and others’ movement awareness resources. In this descriptive category, the informants reported how the interrelationship between themselves and the patient had often been an exhausting experience, depleting the informant’s own energy. This process made the informants observe their working habits and culture. They described stretching their own limits and having no time to reflect. I’ve sometimes had a physiotherapy session after which I’m totally exhausted. The next client is already waiting their turn and you simply don´t have the time to reflect on or handle the situation (I). The fourth theme, better understanding of movement awareness was described as learning new movement strategies. The informants reported a growing understanding of how important calming themselves down and being present in clinical practice situations was for them. 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