Trusting hands — Our hands have many roles, from manipulating tools to communication to soothing another person. We hold a pen and write, we gesticulate, we put our hand on someone’s shoulder. It is the last action that I am interested in here, as we employ touch to make someone feel better by both letting them know we care and changing the sensory activity of the body. There is one aspect of this that is important, and that is meaning. The meaning or intention behind my action and the meaning construed by the recipient. They can be at odds, so setting the scene and making a judgement is important. Certainly in the therapeutic setting, clinicians must judge the right time and the right approach for hands on therapy, especially in chronic pain. Trusting hands is one way to describe them.
In some cases, even light touch can be very painful. Sometimes the pain of hands on treatment can be deemed to be good — ‘that’s a good pain, keep going’ they may say! If the body systems and the person are in protect state, they may well guard the area by tensing up or gesturing to keep people away. They are in fact predicting and expecting that the touch will hurt and therefore put up a defence. There are also people who do not like being touched for a range of reasons beyond whether they think it will hurt or not. This is of course a consideration for the therapist who wants to use their hands.
The notion of trusting hands emerges from a compassionate approach to treating pain. Always beginning with deep and active listening to gain insight into the causes of suffering, the trusting hands become part of the way we communicate our concern and caring before using them to ‘listen’ to the body through touch. This is not an alternative view but instead a way of gaining further understanding of how that person’s body is responding to movement and touch (mechanical forces). We can feel and see the existence of guarding, which demonstrates that protect state is ‘on’ and monitor how this changes as the individual begins to feel safer and more confident. This is in the knowledge that there is no harm or damage associated with the pain, the pain being an indicator of a perception of threat, not a gauge on injury.
The way in which the hands touch the body from the initial contact to the strokes or pressures applied will all imply a certain message. This is why the clinician needs to be aware of their intent and be present when laying on hands. The trusting aspect comes via experience. In other words, the trust results from the recipient knowing that the purpose of touch is to make him or her feel better by changing their experience. They will most likely have some preconceived ideas as to how hands on therapy works and the therapist may have to tweak this thinking in line with what we actually know. In a nutshell, we are seeking to change the way in which the brain predicts the causes of the sensory information coming from the area we are treating. Through this new prediction, or update, as a consequence of an explanation that sets the scene and primes in the right way (think of ploughing a field before sewing the seeds) and then the applied treatment, the person has a new experience, one that is feeling better. I usually explain to people that the feeling better aspect gives them a new reference point so that they know their body can feel different and good. They then use their programme strategies (Pain Coach Programme) to re-enact this feeling over and over as a new habit, which is getting better.
The trust element comes from the whole approach to the person, viewing and treating them as a whole and not a ‘body part’. Respecting their views, beliefs, values and validating their story is vital in creating a trusting partnership. Within this context, the hands play the trusting role of communicating compassion as well as effecting the benefits that have been well studied. Hands on therapies are part of a complete programme of care, and used wisely can facilitate many of the other aspects of the training and treatment.
Each session should result in the person having had a positive experience, feeling inspired and encouraged to practice their training and strategies in their world, their reality. What happens in the clinic is a bubble, often of safety, and then the person needs to take that across the bridge into their world and live. In this way, to resume living a meaningful life requires us to do just that. You get back to living by actually living and knowing how you can do this each day, gradually building up the things you can do and starting to re-engage with things you have stopped doing. With working knowledge of your pain you realise that you can do this with increasing confidence, the fear dissolves and the focus is upon getting better using the strengths that you already have and know. The trusting hands have a role in this science and compassionate based approach to chronic pain.
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