Tag 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.

****

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.

Pain and Communication

The problem of pain

Pain and communicationCommunication has a large role in pain from the perspective of telling someone that you are suffering but also in the treatment of pain. At the BASRaT Symposium last week I outlined some of the key features that I will summarise here.

Before discussing communication I highlighted what is the one of the most significant and costly problems on the planet: pain. There are vast costs to society and individuals as the numbers of people suffering chronic pain are enormous. The British Pain Society recently called it the ‘silent epidemic’.

It is thought that 20% of the population suffer on-going pain, including 1 in 5 children. Whilst we can say that the former is a significant number necessitating action, the latter absolutely needs to change. We must understand why this is the case. What is it about modern living and culture that is creating a generation of pain and anxiety? There are some obvious candidates: pressure to achieve at all costs, a lack of self-esteem, narcissism encouraged by popular culture, and obsession with social media at the expense of developing connections and communication skills (including addiction to devices).

One of the main reasons for the scale of the pain problem is the misunderstanding of pain through society. The biomedical model still predominates when there is the search for a structure or pathology to explain the pain and extent of the pain. The preferable biopsychosocial model takes into consideration the important psychological and social dimensions, but often the ‘bio’ receives most attention. Modern understanding of pain would suggest that actually, a better framing would be a sociopsychobiological model because whilst understanding the pathophysiology and molecular aspects of pain is important for scientists and clinicians, the person in pain just needs to know what to do when they are in pain. They need a process to follow with an understanding as to why this is important. Neuroscience education has a place in the treatment of pain, but not a primary one.

Pain is a subjective experience emerging in the person, influenced by a range of social, cultural, contextual and environmental factors, past experiences and beliefs, in the face of a perceived threat. Pain is about protection and survival.

Pain & communication

With the size of the problem in mind alongside the understanding that pain is poorly related to injury and tissue health or pathology, we looked at some important aspects of communication.

One of the communication streams that is often forgotten is the inner dialogue. This is the story that you tell yourself about you and life; that little voice that is so familiar and if not trained can be so disruptive. This is the inner dialogue that can cause such suffering when we berate ourselves for not being good enough. This is relevant for the person with chronic pain as self-criticism is a common feature when in fact kindness and self-compassion is a key driver in getting better. Equally, the clinician’s inner dialogue will affect his or her approach and decision making. Think of a scenario when you are tired, you were late for work, you stubbed your toe on the bed and then you are faced with your first patient who has not improved. You need clarity of thought to approach this situation, not a mind cluttered with annoyance and frustration.

What are you telling yourself? What are you convincing yourself? How are you choosing to think?

How we communicate pain to the person has an impact on their understanding, which is paramount in validating their story to date, and in helping them engage with the programme. Firstly we must listen deeply so that we can know the person as much as the condition ~ the two are not separate. Listening deeply is a skill allied with active listening when you are fully present, in contact via body position, your eyes and expressions (verbal and non-verbal), and allowing them the space and time to tell their story. This narrative holds many clues so our full attention is required, jotting down key points and phrases. In sum, there are different communication dynamics co-existing: the inner dialogue of the person, that os the clinician and the (outer) communication between the two.

Compassion and empathy

Cultivating compassion and empathy as a clinician is an extremely worthwhile exercise. Those who have chosen the caring professions have already demonstrated these characteristics by the very nature of the choice ~ we care and want to help others to live their lives. It is interesting and reflective to consider the question: why do I care?

Not only is this important for the clinician, but also for the patient to learn such skills, especially if they are hard on themselves. It is very easy to pick up on this when they speak to you. The problem with being a self-critic without control is that it is very threatening and hence is provoking the self-protect systems that exist to make sure we survive. These systems have a significant role in pain and hence we are aiming to do the very opposite: active the care-giving systems and effect parasympathetic actions. In a sense our job is to help the person realise that they are safe, how they can safely build up their meaningful activities and adapt in a way that means they are living meaningfully.

What are compassion and empathy?

  • Empathy ~ the capacity to share the feelings of others
  • Compassion ~ feelings of warmth, concern and care for the other…with a strong motivation to improve the other’s wellbeing (Singer & Klimecki)

These will be familiar to clinicians and therapists, but what may not be so familiar is the fact that we can train and practice simple skills to improve our capacity.

It will not be a surprise to many that our brains change when we practice and learn, and this is no different for compassion. Neuroscientists have been looking at these mechanisms for some years now, gathering data on these brain changes and how they manifest in the person. Aside from the science, developing a compassionate society has obvious benefits for all:

Love and compassion are necessities, not luxuries. Without them, humanity cannot survive ~ Dalai Lama

These are skills that should be practiced from an early age with purpose, in homes, schools and workplaces. And just to be clear, compassion is not characterised by weakness or femininity as can be said; not at all. Compassion takes courage and is for all.

Simple practices

There are a range of practices that clinicians and therapists can use for both themselves and their patients. Remember that there is an interaction between the care-giver and receiver, both benefitting from a kind action on a chemical level. Fostering and nurturing every opportunity means that we set the scene: the welcome, the greeting, the opening question or comment, the engagement, the demonstration of care, the calm environment, and much more. Being aware of the present moment and crafting each unique session is a skill to be fostered.

It is beyond the scope to describe the following in detail, but as an indicator, these practices are easily started, often a challenge to continue, but immensely worthwhile for the individual and society:

  • mindfulness
  • lovingkindness meditation
  • the practice of gratitude
  • cultivating an ability to control the wandering mind
  • purposefully generating positive emotions

It is worth remembering that as a clinician, you are the treatment as much as any approach you apply. There is no separation. Developing your capacities hence will have a significant impact on your clients and patients as you increasingly set the scene and communicate in such a way that the person feels trust towards you, a sense of being cared for and a belief that they can get better.

Here is a great video from one of the foremost researchers in the field of compassion, Richard Davidson

For further information on the Pain & Wellbeing Coach Programme or clinician/therapist 1:1 Pain Coach Mentoring contact us below or call 07518 445493

12Sep/16

Mindful commuting

Mindful commutingMany people commute to work creating a great opportunity to create calm, focus and prepare for a top performance, simply with mindful commuting. In London, a huge number of commuters use the tube, which is rammed with people (in a rush), often smelly and particularly hot in the summer. How can one create calm and focus in those circumstances you may wonder?

As a commuter you join thousands of others, some of which push you, breathe on you, lean on you, rest their paper on you (I once saw a woman rest her newpaper on a man’s back, which she quickly moved when he turned, only to put it back when he looked away — it was quite amusing), stare at you and nudge you. Today there was a small space next to me and a man forced his way into it creating discomfort for everyone, including himself. So there are just a few incidences that could challenge one’s patience and yet what a great opportunity to develop the skills of patience and compassion towards others. In doing so, you feel better versus feeling anger, frustration or annoyance. We can choose.

Over and above developing a compassionate outlook for the day ahead by looking deeply at a situation (we can consider that the other person may be suffering for a range of reasons and hence behaving in a certain way), we can use the following practices to orientate ourselves towards positive emotions. Being aware of and acknowledging positive emotions broadens our thinking and receptiveness as well as enhances our resilience in the face of a challenge, all of which impact upon our performance at work based on how we communicate with ourselves and others.

  • each time you find yourself becoming irritated on your commute, take 3 breaths and in particular notice your out-breath
  • walk mindfully, paying attention to each step and just be curious as to what is going on around you. Notice how it makes you feel and return your attention to your walking
  • if you cannot get through the crowd because it is busy, return your attention to your breathing to create calm and then walk mindfully
  • be aware of those around you and wish them well in your thinking, noticing how this makes you feel and how the world then appears
  • as you pay attention to your breathing, think kindly about your colleagues and boss so that when you encounter them, you communicate with skill and not on a background of feeling stressed and anxious
  • if you feel stressed and anxious it is because your thinking (embodied) has drifted into the past or future, thereby flavouring the present. Take 3 breaths and see things for what they are; be aware of this moment
  • listen to a mindful app on the journey
  • practice mindful breathing when you simply pay attention to your breath that holds you in the present moment

There are many more ways of practicing but in essence just using one or two will help you create calm and focus. Try it and see!

Mindfulness is a very practical way of being that creates calm, peace and allows you to to see things for what they are as you are consistently aware of the present moment, you listen deeply and speak with skill to communicate understanding and compassion. This is transformative in all situations and achievable for all.

Mindfulness practice forms part of the Pain Coach Programme for pain and chronic pain | t. 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

15Feb/14

Bear traps and how to avoid them

My old headmaster would warn us not to fall into bear traps. By this he meant pay attention to what you are doing so that you do not make a simple mistake. He would set a few bear traps and see if we were concentrating or if we were on autopilot. It was also a way to note tomfoolery.

As clinicians we can also fall into bear traps by not attending to or challenging our own thinking and beliefs. This is especially true with pain, where we can so easily rely on our own beliefs about pain and what we should do in response to pain. We know for example, that GPs can give advice about back pain according to what they would do if they suffered back pain — rest or remain active.

Cultivating awareness of our understanding, beliefs and noticing the messages that we give to patients is a simple habit. It takes practice but allows us to ensure that we are giving the best possible advice and information, perhaps in the form of a metaphor. This includes the mode of delivery: body language, tone of voice, timing of the message and the environment in which the message is given.

Here are a few simple tips:

1. Before each patient, gently notice your breathing — in, and sense the chest rise and expand; out, and feel the body tension ease. This helps to create an awareness of what is happening now, including preconceptions and thoughts that could flavour the coming session.

2. Listen deeply — by continuing to breath, remaining present and listening to every word and noticing the patient’s body language, we can learn all that we need to intervene in the right way. The most potent way for that moment.

3. Speak with compassion — our brains are wired to thrive on kindness. We can create an effective session by both listening and communicating in a mindful way without the clarity being lost by intrusive thoughts that obstruct effective messages being passed.

The Specialist Pain Physio Clinics in London provide treatment and training programmes for pain and dystonia based upon the latest neuroscience of pain, brain and mind. The approach is comprehensive, addressing the problems and influences in a compassionate and encompassing way. If you are suffering with chronic pain, call us now to book your first appointment: 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.