Prevent panic: keep your room cool

Prevent clients from panicking by keeping your room cool. Overheating clients can misinterpret a rise in room temperature as the onset of a panic attack.

Panic occurs when benign physical sensations are interpreted as threatening, leading to a surge of adrenaline which exacerbates the sensations and the perceived threat (eg: a cramped chest muscle causes anxiety and tension, increasing the pain from the muscle and increasing the worry that a heart attack is occurring).

Anxious clients entering a hot consulting room can misinterpret the rise in temperature as a rise in their own anxiety levels. Fearing that they will lose control in front of you, they will produce more adrenaline, further raising their body temperature and beginning the vicious circle of a panic attack.

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Claim your chair with your notepad

Use your notepad to claim your chair before the client enters the room. If you can sit where you need to be, there will be no unease to be misinterpreted by the client.

A prison inmate advised me that I was sitting in the “wrong place”. I wasn’t sure what he meant. He explained that I had naively given him the chair nearest the panic button. Although he had no plans to attack me or hold me to ransom, he was concerned that I might make the same error with some of his less forgiving peers.

There are many reasons why a therapist might wish to occupy a given seat in the consulting room: security (proximity to the panic button and/or the door), easy access to equipment (phone, instruments or tests), presentation (if taping the session) or simply a different view. One GP’s room I used had a skeleton in the corner! I always made sure my clients were facing away from this, particularly in discussions of bereavement and chronic illness.

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Improve rapport by allowing silences

Clients’ perceptions of rapport may be enhanced by silences. Therapists who are uncomfortable with silence should remind themselves that their client’s interpretation of the silence may be much more positive.

A client once asked me not to delay speaking once he finished a comment. He explained that his school report was always sent home in a sealed envelope. He would be forced to stand in silence while his father read the letter, not knowing whether the report was favourable or how his father would react. Three decades later, he experienced the same anxiety during silences in therapy. Agreeing that he was no longer a school child and that a considered response from me was likely to be better than a hasty response helped him overcome his anxiety about my silence.

Therapists may also be uncomfortable with silence in therapy. Time or results conscious therapists may feel that silence is not the best use of the limited time available in a session and may seek to pack as much into the discussion as possible. Other therapists may wonder whether silence means that their question or comment has confused, distressed or even offended the client. Rather than endure the silence, they may rephrase their question or seek to clarify or qualify their comment. Further silence may lead to further rephrasing.

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Relaxation Techniques: A Practical Handbook

A compendium of relaxation techniques. This book supports the clinical practice of physical and psychological therapists seeking to explore the field of relaxation training or to tailor their approach to individual clients.

There are many different approaches to relaxation training. If this book doesn’t have them all, it certainly contains the vast majority.

First publshed in 1995 and now in its third edition, the book covers the physiology underlying tension and stress together with physical and cognitive approaches to relaxation. Each chapter expands on one approach, detailing the theory (if any) behind the approach, then offering scripts, variations on the main approach and benefits and pitfalls of the approach.

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Slow speech makes for clear communication

Speaking more slowly can improve communication between therapist and client. Slow speech is more comprehensible and more considered.

Anxiety is characterised by rapid speech. Therapists, especially trainees, may be anxious in sessions, but may also feel the need to speak more quickly in order to pack more into the time available. This can backfire by making the therapist seem anxious.

Following rapid speech demands greater attention. When listening, we are attempting to make sense of what is being said. The more time we have to consider what is being said, the more likely we are to understand what we are hearing.

Clients are by definition functioning less than optimally. Anxiety, depression, pain, fatigue and medication effects can impair concentration and therefore affect clients’ ability to follow and make sense of what we are saying.

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What is your one aim for any session?

Having too many goals can be as bad as having no goals. This is as true for therapists as for our clients, yet therapists may enter into a session with far too many goals to achieve in one sitting.

Trainees often struggle with first appointments, in which there is so much to do: establish a rapport, take a history, establish a diagnosis or formulation and agree a treatment plan. These would be the achievements of two, three or even more sessions but the impression given by many text books is that all of this must take place in the first session.

More experienced staff may feel the same pressures, but may also feel obliged by waiting lists and the need to demonstrate turnover to look for opportunities to discharge the case. Some may also feel that they must be on their guard against potential attempts at manipulation by the client.

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Relaxed Therapists make better therapists

Relaxation improves our performance, benefitting us and our clients. We promote relaxation in our clients but we rarely apply our approaches and techniques to ourselves.

Both physical and psychological therapists promote relaxation as a way of decreasing disease and distress. Relaxation improves balance, coordination, digestion & sleep. Relaxation also improves concentration, memory, decision making & self control.

Sports coaches and life coaches recommend relaxation as a way of improving performance. A colleague once said that he knew his clients were getting better when their golf game improved. I know my clients are recovering when they don’t need me to repeat the date of their next appointment.

Physiotherapists are usually fit and speech therapists enunciate clearly, but relaxed therapists are rare. Therapists are typically pressured by excessive demand, inadequate resources, wide responsibilities and the need to balance personal & professional life. Not only do we need to practice what we preach, any gains will be experienced both by us and by our clients.

The pressures on novice therapists are primarily related to competence: the fear that this client will be the one who uncovers your inadequacies.

The pressures on experienced therapists are related more to the burden of success: the demands that follow from from having demonstrated your competence and being sought for it.

The pressures on senior therapists are usually related to being pulled away from therapy by the responsibilities of seniority: consultation, supervision, management & service development.

At each stage of our career, we evolve strategies to support us, sometimes effective and sometimes not. These strategies are mostly personal and rarely passed on to anyone other than our trainees and closest associates. This site is an attempt to promote sharing of such strategies across disciplines, across professions and across the world.

We know how to help others relax. By making our own relaxation an explicit goal, we can improve our performance and our services.