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Pursuing Therapeutic Resources to Improve Your Health

Linda L. Bieniek, CEAP, La Grange, Illinois, and
Karen Kennedy, MSW, RSW, Toronto, Canada

Leaders in the post-polio community point to critical factors that can empower polio survivors to manage the effects of their polio and optimize their health. They recommend obtaining reliable information; cultivating strong support systems, including partnerships with health professionals; and developing positive attitudes, new skills and an ability to enjoy the present (Maynard, Headley, 2002).

Even when following these recommendations, people sometimes continue making choices that are harmful to their health and relationships (Thoren-Jonsson, & Grimby, 2001). Why? Research has revealed that unresolved polio memories can interfere with the ability to make changes – physical, emotional, cognitive and even spiritual – that contribute to health and well-being (Westbrook, 1996). Survivors have reported improvements in their health and relationships following successful experiences in therapy.

This is the last in a series of articles in Polio Network News exploring this phenomenon and the value of psychotherapy as an option for resolving the impact of polio memories. This article is designed to assist in the following ways:

For individuals interested in pursuing psychotherapy, this article recommends four steps for identifying and selecting qualified professionals.For individuals currently working with a therapist, these same guidelines can help in assessing the effectiveness of their own therapy.

For survivors with limited financial resources, a separate section contains suggestions about other resources to pursue, including publicly and privately funded services.

Bieniek has created a “Treatment Approach Options” chart that describes various styles of treatment, the benefits and methods of each, characteristics of people who may find a particular approach appealing, and available resources. The chart offers useful suggestions on ways to reduce the stress of physical symptoms and present-day problems.

Understanding the Role of a Psychotherapist

Individuals who choose to explore psychotherapy as a treatment option need to understand the role of the psychotherapist and the importance of the psychotherapist’s training, knowledge, experience and personality in contributing to productive results.

Individuals previously in therapy may have had a disappointing or unproductive experience. As in any profession, the skill level and integrity of therapists varies. Also, a client’s own readiness and willingness to deal with uncomfortable issues can affect the results of the process.

However, when a therapist’s expertise and personality match a client’s needs, the therapy process and relationship can produce extremely beneficial insights and behavior changes for the client (Roberts, 1998).

Therapy is a blend of art and science. The therapist’s job is to help the client make healthy changes to achieve his/her goals. A therapist is a guide and mentor, responsible for interacting with a client in ways that provide a healthy, safe, professional relationship. For people who have had traumatic experiences, this is especially critical. The understanding insights of the therapist’s responses can help transform the client’s limiting beliefs about self, others, and the world that may have been formed in response to traumatic events in the past (Napier, 1993).

A therapist’s role also includes matching the client’s needs and ways of learning with appropriate responses, interventions and available resources. For clients who have had hurtful and harmful life experiences, research offers a number of effective approaches that therapists can use.

Clients are not responsible for trying to make their therapists feel good. Reading about professional boundaries is especially advisable for those who have a tendency to feel responsible for another person’s feelings (See "Boundary Issues," Polio Network News, Summer 2001, Vol. 17, No. 3).

Leaders in the post-polio community point to critical factors that can empower polio survivors to manage the effects of their polio and optimize their health. They recommend obtaining reliable information; cultivating strong support systems, including partnerships with health professionals; and developing positive attitudes, new skills and an ability to enjoy the present (Maynard, Headley, 2002).

Even when following these recommendations, people sometimes continue making choices that are harmful to their health and relationships (Thoren-Jonsson, & Grimby, 2001). Why? Research has revealed that unresolved polio memories can interfere with the ability to make changes – physical, emotional, cognitive and even spiritual – that contribute to health and well-being (Westbrook, 1996). Survivors have reported improvements in their health and relationships following successful experiences in therapy.

Recognizing a Qualified Therapist

Look for a therapist who possesses appropriate knowledge, skill and experience.

Therapists demonstrate their knowledge and skills when they:

• Use strategies that help clients make positive changes.
• Present insights and options for responding to current life situations.
• Explain the reasons for using certain approaches and offering specific advice.
• Ensure that clients do not spend their therapy sessions simply reporting current events in their lives – often a way people avoid dealing with uncomfortable issues. Instead, the therapist can ask questions to help the client gradually confront issues.
• Identify unhealthy, self-protective coping skills in non-judgmental ways, uncover the positive underlying needs, and offer healthy options for meeting those needs.
• Teach clients how to recognize characteristics of trustworthy people and how to develop relationships with them.

For example, when a client slips into an unhealthy coping pattern (e.g., overeating, overworking, etc.), the therapist’s job is to teach the client how to respond compassionately rather than critically (Amada, 1995). A therapist can remind the client to reward him/herself for the smallest changes in thinking, communicating or responding to a situation. Practicing ways to ask for support with the therapist also can help a client gain confidence needed to support and share his/her progress with others.

When therapy involves resolving traumatic memories, it is critical that the therapist possesses the specialized training and experience to do memory work safely and effectively. This means that the therapist must understand the effects of traumas – including how psychological or emotional issues have impacted their client’s life – and how to use research-based interventions that can improve clients’ responses to present-day situations that unconsciously remind them of the past (van der Kolk, 1996). Therapists who intervene inappropriately, or fail to intervene when needed, may actually cause further distress.

Look for a therapist who thoroughly assesses the client’s needs.

The therapist and client need to agree on specific changes the client wants to make and to review the treatment progress on an ongoing basis. A therapist displays respect for the client’s intelligence and intuition by seeking feedback, inviting the client to participate in the creation of treatment plans, and by integrating the client’s needs in the next step of the process (Williams, 1994).

It is important for clients to know that therapists often approach the assessment process in different ways. Some may spend the first few sessions asking questions and having the client tell his/her history. Others will address an immediate need and gradually obtain information throughout the sessions.

Each approach has advantages and disadvantages. What is important is that the therapist asks questions in a respectful and paced way to help the client voice what is troubling and explore the possible causes of these difficulties. The therapist needs this information to determine how to intervene and help the client. Steps of this process include:

• Asking questions to understand the client: What do you think ... How do you feel about ... What do you wish had happened ... What do you consider your options?
• Gathering adequate information before drawing conclusions or making recommendations.
• Asking questions to discover unhealthy coping patterns.
• Identifying problems and diagnosis/conditions accurately.

Linda: As an Employee Assistance Professional, I have assessed clients who have been in therapy for years and yet their therapists had not identified their unhealthy coping patterns. Employees reported routinely overspending, exploring cybersex or having a few drinks each night when I asked them what they do when they feel anxious, overwhelmed or lonely. One employee remarked, “No one has ever asked me those questions.”

For therapy to be effective, a polio survivor typically needs to work with a therapist who understands and can integrate the impact of a client’s disability on his/her life. This means learning how polio has affected the client’s past and also how physical adjustments and emotional losses in the present impact the person’s relationships and life. Understanding the causes of the client’s new weakness, fatigue and physical pain, and the need for pain management and energy conservation, is important for determining treatment strategies and the client’s tolerance levels.

Karen: As a social worker counseling individuals who have had polio, I often indicate to clients that they are welcome to stand, walk or take a short break if that will help them manage their pain and physically pace the session. Upon hearing this, one individual stated, “Thank you for acknowledging that my pain is a daily reality.”

Experts stress that a thorough assessment includes an understanding of a person’s family system and the family’s attitudes toward the person’s disability: differing roles, relationships in terms of power issues, and communication dynamics (Olkin, 1999).

Questions about a client’s family history should address the possibility of chemical dependency and other addictions. The prevalence of addictions is higher in families with a child who has a physical disability. This is important because individuals who grew up with chemically dependent parents or elders are more likely to have experienced physical or emotional neglect or abuse, to have witnessed domestic violence, and to be at increased risk of sexual abuse (Olkin, 1999).

Since studies have repeatedly found the rates of substance use (e.g., alcohol, prescription drugs or illegal drugs) in persons with disabilities substantially higher than in the general population, it is important that a therapist screen for this possibility. Olkin explains that the higher rates stem from chronic pain, social isolation and increased incidence of sexual abuse (Olkin, 1999).

Without this screening, a person may be in therapy struggling with depression and/or anxiety, not knowing that one of the obstacles to progress may be dependency on using alcohol or drugs. If a therapist does not ask questions at a deeper level or if the client withholds the truth, the therapist will be missing vital information that is needed to accurately assess and address the client’s treatment needs.

Continued ...

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