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Polio Network News (ISSN 1066-5331)

Vol. 18, No. 4, Fall 2002

Pursuing Therapeutic Resources
to Improve Your Health (continued, pg 2)

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

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

Therapists demonstrate their knowledge and skills when they:

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:

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.

Look for a therapist who creates a safe environment.

Creating safety is one of the primary responsibilities of a therapist who helps clients resolve traumatic memories (van der Kolk, 1996). Van der Kolk warns that the failure to approach trauma-related material gradually, with safety measures in place, may intensify trauma symptoms, such as sleep disturbances, digestive problems and anxiety attacks. For this reason, therapists need to teach clients skills that will enable them to stay present to reality while managing their reactions to their memories. Preparing clients, before exploring memories, will help prevent them from relapsing into unhealthy coping patterns when they begin to deal with their stories (Napier, 1993).

An important part of healing from polio memories takes place when a client tells his/her stories and the therapist responds with empathy and understanding.

A therapist conveys compassion through tone of voice, facial expressions, body posture and comments. These characteristics, combined with strong listening skills, helps to create a safe setting that encourages the client to tell his/her truths.

When a client experiences emotion such as fear, shame, guilt, anger or sadness, feeling safe, understood and accepted is needed in order to openly express and discuss these feelings. The therapist is responsible for encouraging healthy expressions of feelings and for suggesting safe ways to release them (e.g., art therapy, letter writing). By contrast, if the therapist changes the subject when a client begins to cry, the client may interpret the therapist's response as disapproval or discomfort, and may shut down his/her emotions – replaying an unhealthy and even traumatizing coping pattern.

Look for a therapist who tailors the process to the client's needs.

Therapists should explain available treatment options, including their intended purpose, benefits and limitations. This information will empower the client to collaborate with the therapist in tailoring the process to his/her specific needs.

Experts say that therapists need additional skills to understand and work through the complexity of issues related to a client's disability and need to know how to modify the diagnosis and treatment depending on the disability (Olkin, 1999). Clients need to pay attention to how a therapist responds to their disability. If a therapist focuses solely on the client's disability or ignores it, this can be detrimental to the therapy process.

Karen: When I meet with individuals who have respiratory problems, I sometimes initiate relocating the session to a spacious office with a window in order to accommodate the client's need for "breathing space."

Look for a therapist who develops a trusting partnership.

From the very first interaction and throughout the therapy process, a therapist builds trust by communicating empathy, compassion and integrity. Examples include:

Continued ...

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