In our Summer issue of International Therapist magazine (Issue 133), we published ‘Man Kind’, a feature looking at the benefits of physical therapies on supporting male mental health.
Beverly Chilson, MFHT, contributed a case study to this feature. ‘Working in palliative care is not for everyone, but it is rewarding and far removed from the doom and gloom you may expect’, writes Beverly. ‘It is such a privilege to be able to work with people at such a vulnerable time in their life knowing that what you are doing is making a difference and helping them to maintain a measure of independence, control and dignity.
‘My client, who is in his early 60s, initially came to me with neck and shoulder tension. He was also struggling with a poor sleep pattern. The initial assessment showed forward, kyphotic posture and an equal range of neck movement on both sides, though limited by tension. We agreed on a treatment plan of massage for his back, shoulders, neck and arms, with some home rehabilitation work, including neck and shoulder stretches and a five-minute back extension to help let go of tension and stress.
‘On his second visit the client mentioned his recent bereavement and associated anxieties. With my background as an occupational therapist in palliative care, this was an area I felt comfortable discussing and a rapport was soon established.
‘Within three months of regular visits, the client reported reduced tension, increased range of movement, improved sleep and reduced anxiety levels. This may have been part of the natural grief cycle, however the client reported that having someone to discuss feelings with in a safe space every few weeks had a massive impact on his coping mechanisms, and of course he looked forward to the massage treatments.
‘Being able to explore a person’s feelings and link this with the impact of an injury or problem is not something that comes naturally to everyone, but it is something that can be learned and reflected on to hone your skills and feel more comfortable with every step you take. I have been fortunate in my NHS career to have had the opportunity to complete an Advanced Communications Course and nurture these skills over my years as a therapist to develop them into what they are today. These skills enabled me to encourage conversation with my client about his feelings and to know when and how to close a discussion safely if it isn’t going in the right direction.
‘The main thing is to be honest with your clients about your limitations and if any conversation is having an impact on you as well. We all relate to people and situations based on personal experience and we need to be mindful of this when exploring difficult conversations with our clients. Most importantly, remember this is just having a conversation about an emotive subject in a safe space and not in any way a counselling session.
‘Having a good network of people that you can signpost to, should you feel out of your depth, is so important. I was able to signpost my client to his GP and the local NHS Wellbeing service for further support, but in the end, he didn’t feel this was needed as both his physical and mental wellbeing were improving with each session.
‘Without a doubt, mental and physical health are strongly linked. The key elements of holistic assessment consider the physical, social, environmental and psychological needs of the person you are working with. Everything is interlinked and you can’t really make progress in one area without considering them all. There is a closely linked concept of ‘total pain’ which was first defined by Dame Cecily Saunders in 1959 where it was noted, ‘Much of our total pain experience is composed of our mental reaction.’ (Saunders, 1959).
‘In this case study, the bereavement increased tension and anxiety which led to a pain response along with a reduction in movement. Being in the home environment of constant reminders and an immediate impact on social norms also amplified the situation. Being able to talk about experiences at his own pace and in a safe space, the client’s
’ presenting condition improved to enable him to think more clearly, return to work and to start thinking about what the options were for his future. I’m happy to report that 18 months on, the client remains a regular and has a renewed social life.
‘We all approach problems differently, so there is no perfect formula for every client you work with. However, in my experience as a massage therapist, it can be easier for people to speak to someone outside of their social circle, and it might help that you are never looking directly at each other, for example when they are lying on their front speaking through a couch face hole! This means that complementary therapists can play a key role in dealing with the mental wellness of our clients, as well as the physical.’
Beverly Chilson is an occupational therapist who has been working in a palliative care ward since 2003. Beverly also qualified as a Level 4 Sports Massage Therapist in 2017 and runs her own therapy practice, Milestone Therapy Centre.
FHT members can access the full Man Kind feature at fht.org.uk/international-therapist-archive