establish rapport. comfort people. supplant dysfunction.

[flamingsword]

Once you have learned to edit out behaviors that are actively threatening, controlling, or distancing, you can work toward building a sense of shared purpose. This union is the basis of therapeutic rapport. To better illustrate things to say and do, I'm going to translate common things therapists say into their component pieces.

"Hello, _____; my name is _____, and I'll be your therapist today. Our restrooms and water cooler are this way. Is there anything else you need before our session?" = "I have identified you, myself, and our relationship for this interaction and intend to respect the implied boundaries. I am anticipating your needs to ensure your comfort." Speak at a moderate pace. Respecting that new clients need time to orient and adjust themselves in the new environment is crucial in earning reciprocal respect. Rushing through the beginning is not relaxing, and is a disservice to both parties.

"I'm sorry to hear you're not feeling well. Let's see what we can do to fix that." = "I care about your pain. Let us work together to bring you to your normally healthy state."

The phrasing is important here. Saying that you're sorry to hear that someone has pain implies that you are not connected to the cause of it. You care; you do not feel obligation. WE are working on it because while they have come in for your help, your help is something you are accomplishing only with their permission and engagement, thus establishing the common goal. Never say "let me fix you." You are not fixing the person, only the pain. Implying that something is wrong with someone is diminishing and keeps them cut off from their sense of agency. Also it's insulting. Putting the pain in context of it being transitory establishes the premise for leaving it behind.

Orient the relationship.
Anticipate needs.
Respond warmly.
Express concern.
Share agency.
Denormalize pain.

If you master those, you have the fondness of your clients. That's really all you need to garner repeat business in our touch-starved, care-hungry culture. But if you want to reach beyond those into the realm of rehabilitation and improving the lives of clients while they are out of arm's reach, there are a few more skills that I have discovered so far.

Start with gentle pressure to relieve soreness, gradually increase to firm pressure to release muscle fibers. Working deeply into sore muscles before they're ready is painful and may cause clients to tense back up later. Work at the pace dictated by the body's responsiveness. Pick the arm up from a supine position until it is in the same pose that the client uses to type/use mouse/draft. "When you use your arms held out in front of you so much of the day, the muscles of the shoulder stiffen from overuse." Using words with motions provides a link between the posture and the idea that will keep coming back into their consciousness when they use that posture.

Hold the arm in one hand while pushing into the deltoids with the other. "Small muscle groups like this are not designed for continuous use. If you don't stretch the muscles back out at the end of the day it will just stay tense." Slowly stretch the arm over the head and through its full range of motion. "If you have a desk with an ergonomic keyboard tray, then you can sit with posture that doesn't hold the arms so far forward, so you don't hurt at the end of the day." Point out logical consequences of muscle tension. Don't assume that intuition will inform people who are used to ignoring their physical selves of their tension or the causes of it. Mention things like less pain, ease of movement, better appearance, and decreased chances of injury and dysfunction in association with health. Health is a general concept that people don't relate to as an aspiration, but vanity and pain relief are great motivators.

Anesthetize first, re-sensitize later.
Verbally integrate somatosensory habits.
Normalize consequences.
Strategize and inform.
Advocate ergonomics.
Motivate health.

I'm always looking for new ways to respect people and increase our enjoyment. It's why I find my job so fulfilling. Eventually this list will be added to, but it may be a while before I have enough new material to make a decent post.

Comments

[raasalhayya.livejournal.com]

This is amazing.