Category Archives: Compassion

21Jan/17

Engaged physiotherapy for pain

Engaged physiotherapy for pain and the modern world

Engaged physiotherapyEngaged physiotherapy is an approach embracing full awareness of oneself as a clinician, full awareness of the person you are working with, full awareness of the context and past, compassion (self and others), insight, and modern sciences (the facts ~ what we know). I have ‘borrowed’ the term from Thich Nhat Hanh who describes engaged Buddhism, which is the practical use of the philosophical principles such as mindfulness, mindful breathing and mindful walking.

Cultivating our awareness as clinicians and gaining insight into the causes of suffering affords us the opportunity to think clearly about the best action for the individual, in this case in pain. Together with an understanding an use of modern sciences, especially pain science, cognitive science and neuroscience (there is vast overlap of course), and philosophy, we can consider each person’s story and create a way onward that is grounded in understanding, compassion, belief and the right attitude to succeed.

There are simple practices that clinicians can use each day that develop and grow awareness and insight. Here are some examples:

  • The greeting
  • Being present during a consultation using the breath
  • Deep and active listening
  • Compassionate speech
  • The creation of a calm and peaceful environment
The greeting

The initial contact often sets the scene. We can think about how we present ourselves with posturing, gestures, language and the simple smile. I would suggest always going to the patient to greet them in the waiting area, and behaving very much like you are welcoming an old friend into your home.

Being present

Using the breath we remain present and aware of what is happening right now. What is passing through me (my mind)? Any bias? Preconception? Judgement? Being aware allows us to let these go so we can focus on active and deep listening. Practicing mindful breathing each day formally for 5-10 minutes helps us to develop this skill that we can use through the day, every day for professional and personal relations to benefit

Deep listening

One of the most valuable gifts we can give to another person is ourselves and our time. Being fully present to listen to the patient (or colleague or family member or friend) creates the conditions for a meaningful interaction. All involved parties benefit from meaningful interactions as we release certain healthy chemicals in these contexts. In deep listening we can hear and understand the suffering of the other, enabling the best and wisest course of action, which may simply be to continue to listen without interruption. Learning to be comfortable with silence is a valuable skill. Much can emerge from moments of silence. (Reading here)

Compassionate speech

Choosing our words carefully, considering their effects, is an important skill to develop. The words we utter have potent effects on others as they hear, process, imagine, think and react. Of course using kind, compassionate words can create the conditions for calm and insight, enabling the person to see a way forward. A focus on health and being well maintains the desired direction, hence the use of words that encourage this thinking and vision helps the person to orientate themselves towards a desired outcome.

We have the spoken word and we have the inner dialogue. Being skilful with both is important as we need to consider which thoughts we are fuelling, or which seeds we are watering by the way we think and what we say. An example would be the effects of engaging in idle gossip. In the long-term, gossip can create issues of trust and miscommunication that breeds suffering.

As a clinician, we should always be thinking about delivering the right messages based on truth, and that provide a compassionate way forward. Helping the patient develop their skills of self-compassion is frequently needed in cases of chronic pain. Understanding that self-compassion is one of the skills of well being helps individuals to practice and benefit from the nurturing of the care-giving systems in the body that play such a big part in our health and happiness.

Creating a calm environment

We are very responsive to the environment. Consider how you would feel working in an office with no windows and in the basement of a block compared to an office with a view over a park or a river.

Clinicians need to think about how the patient might think and feel coming into the clinic. We seek to create a peaceful space for people to experience feelings of calm and gain insight into how they can be, how they can transform their state of being and how they can use these practices in their day to day lives.

The simple practices are just some of the ways we can use our knowledge and skills to create the conditions for people to get better. We no longer have to think about managing or coping, instead use engaged physiotherapy and approaches to give people the belief, understanding and skills to coach themselves, fostering independence and a sense of agency, restoring choice and meaningful living.

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These practices are part of the Pain Coach Programme, which is a focus upon getting better and achieving success in overcoming pain. The programme for patients is a comprehensive way forward addressing a pain problem by focusing on getting healthy and well, and the programme for clinicians is to develop their skills and knowledge to coach patients. If you would like further information, please email us: [email protected] or call 07518 445493.

20Aug/15

Pain and compassion

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

Pain and compassion are being explored at a forthcoming British Pain Society Conference, so I thought that I would comment on a couple of important aspects.

Firstly, as clinicians compassion plays a role in our desire to guide and treat others in pain and most likely coloured our choice to become a health-carer in the first instance. Secondly, I find that the vast majority, if not all those I see are compassionate people to everyone (or most!) except themselves. Here are some brief thoughts.

Compassion is defined as ‘inclining one to help or be merciful’ (Oxford Dictionary). The Dalai Lama describes compassion from a Buddhist viewpoint: ‘Compassion is said to be the empathetic wish that aspires to see the object of compassion, the sentient being, free from suffering’. There must be an object of compassion that is another individual or of course the one that is often forgotten, oneself.

The feeling of compassion is often described as a warmth across the chest; the type of feeling associated with seeing a small, defenceless animal, or perhaps a newborn child. This feeling enhances our empathy, which drives actions of kindness towards that being. As a clinician there are clear benefits of cultivating a compassionate approach towards patients who suffer the consequences of pain, particularly on-going pain. Certainly compassionate listening and actions are skills to be nurtured as they envelope the therapeutic encounter with essential authenticity. Compassion also creates an environment and a context for effective and skilful communication; an openness that encourages the patient to express themselves as themselves, revealing the challenges that can be surmounted with a joint therapeutic effort. The importance of the clinician being kind to himself or herself is akin to that of the patient. Looking at ways to grow and flourish, to be a better clinician requires acknowledgement of the current standing, acceptance and a desire to improve, yet without self-criticism.

Frequently patients will illustrate their harshness towards themselves. This punishment and criticism fosters angst, frustration, anger and other negative emotions that are draining, damaging and ultimately wasteful as energies are put into everything but clear thought and action towards improvement. At any given time, one does his or her best based on their knowledge and skills — everyone makes mistakes, which the wise learn from and see the opportunity in errors, the opportunity to develop. Learning to be kind to oneself, often breaking a habit of some years (many people I see are perfectionists; but in some arenas this trait is very useful and a strength that enables high performance resulting in success; so let us learn how and when to utilise it), is a vital part of learning how to overcome pain, especially persisting pain.

Here are several videos that are useful to that end:

Learning about compassion towards oneself and others is part of the Pain Coach Programme for overcoming and transforming persisting and chronic pain. Call us to book your appointment: 07518 445493 | Clinics in London | Sessions available on Skype on request

23Dec/13

Thoughts can be threatening

A threat can arise in many forms. Years ago, it would have been a wild animal that posed a potential danger, responded to with a fight or by running away — flight. Nowadays we don’t often face the physical threat of an animal attack, more likely it being the menace of street crime or the risk of an injury whilst undertaking activity. The context of each of these scenarios is very different with distinct and personal meanings that result in varying responses.

The key point about a threat is that is must be interpreted as being dangerous in order to arouse activity in the autonomic nervous system. This system is the link between what we think, the meaning we ascribe to a circumstance and how the body responds. With connections that reach far into the body systems, in particular the cardiovascular system and the gut, the autonomic system is a major player in creating awareness that something is potentially unsafe and hence drives behaviours to approach or avoid.

Most of the time we do not face a physical threat. However, familiar feelings in the body signify anxiety most likely on a daily basis: tension, butterflies in the stomach (actually changing blood flow that triggers neural activity), increased heart and breathing rates and perhaps a sense of panic. Why? Because of our thoughts.

Thoughts can be threatening. A thought that is lived, given significance, engaged with or is considered to be self-defining, will evoke emotional and physical responses. If the thought is one that plays a tape of an unpleasant past experience, fashions an image or a story that is troubling or builds a future of uncertainty, the autonomic system will be aroused. This happening over and over ensures that the system becomes more easily switched on and vigilant to a range of cues, even normal situations that can become threatening in some cases.

Feeling anxious is normal. It warns us that we need to place our attention upon the trigger and take the necessary action. Once this has been done, there is no need to continue to feel anxious, but often the association continues. Automatically there is a response to a thought, or waves of thoughts, and without control over this, the spiral continues. How can we gain control?

Mindfulness is a very potent way of tackling stress. The bodily feelings of stress are triggered by our perception of a situation being negative, risky, dangerous and somehow threatening to our beliefs about ourselves and our world. At the point where a thought or a situation prompts an automatic thought that is negative, these emerging from our belief system that has been evolving from a very young age, this propels us into greater suffering, pain, and sensitivity with increasing impact. Mindfulness practice refines the awareness of this process, maintaining a presence that prevents the dwelling upon the past or a leap into the future. Neither of these actually exist as they are constructs of our mind. The problem is the brain’s response to past or future thinking is very similar to actually being there — a lack of discrimination means that the same autonomic actions are triggered.

In the short-term, the autonomic responses are adaptive and useful. If they persist, the chemicals released over and over become problematic as certain systems are shut down due to the perception of danger. For example, the gut and reproductive system are not needed when we are escaping the clutches of a wild animal. But, similarly, chronic stress from an on-going negative assessment of a situation, thinking, will have the same effect. This is often a feature of infertility when the reproductive system is being impacted upon time and again.

The biological reality then, is that no matter what the situation, it is the individual interpretation that is key in determining what happens next. In developing mindfulness practice and emotional intelligence at the fulcrum point that is the automatic thought popping into consciousness, suffering, pain and on-going stress responses can be subdued and dissolved as presence and awareness rules over.

For further details about our treatment and training programmes for persisting pain and stress, call now 07932 689081

26Nov/13

Buddhist monk Thich Nhat Hanh talks to Oprah Winfrey

Thich Nhat Hanh, a Vietnamese Buddhist monk who has written and spoken about compassion and mindfulness for many years, talks to Oprah Winfrey. There is a great deal that we can learn from him, in particular the potency of breathing and awareness of the breath that anchors us to the present moment, the only ‘real’ time that exists.

Mindfulness is being practiced increasingly as people realise that the simple techniques benefit their health, performance and sense of self. We have been incorporating mindfulness into our treatment and training programmes for persisting pain for a number of years to tackle anxiety, stress and the experience of pain itself.