Enhancing the Therapeutic Alliance

In seeking physical therapy for an issue such as chronic pain, there are many factors that can influence the outcomes. Of course, it is important that your physical therapist is knowledgeable, is able to communicate clearly, and is able to provide interventions that fit your unique needs. However, successful therapy outcomes also rely on one more very important factor... the relationship between the patient and the clinician, known as the therapeutic alliance.

By definition, therapeutic alliance is

"the sense of collaboration, warmth, and support between client and therapist."1

Features of a strong therapeutic alliance include mutual agreement on goals and interventions, empathy, compassion, and mutual respect. A positive therapeutic alliance involves bi-directional open communication and kindness between the two. It is the therapist's job to create a safe space for healing, and to actively listen and respond to the needs of the client without judgment. It is the client's job to strive to believe in and implement the recommendations of the therapist, while being open and honest about their needs, as well as response to therapy.

Think back to the teachers you had while in school. Does any teacher stand out that you remember liking a whole lot? You likely have fond memories of this person, and can even recall many of the things you learned from them. They were probably kind and empathetic, and valued creating a safe space for learning. In return, it is likely that you put in effort to respect their wishes, listen to and incorporate their recommendations and lessons, which resulted in a positive learning experience.

Think back to a teacher you might not have liked so much... the results were probably much different! Being in therapy is very similar. A good therapist is like a teacher- we teach anatomy, movements, education about pain and dysfunction, as well as lessons to help you get to know your body better from the inside out. The better your relationship with your teacher, the more you will get out of the experience.

At the Wellness Station, your therapist will always strive to create a supportive healing environment by enhancing the therapeutic alliance. Here are some tangible methods that can enhance this alliance:
• "We" statements
• Open body language
• Eye contact
• Statements of reflection/summary
• Non-threatening touch

What are some behaviors to look out for that can detract from the therapeutic alliance?
• Talking down
• Interrupting
• Speaking for someone
• Lecturing
• Shaming
• Looking away, avoiding eye contact

Here is a quote from one of our clients who understood the importance of a strong
therapeutic alliance:

"I have been working with Jacob for several months on my hip bursitis, and shoulder arthritis. He has a wealth of knowledge, both about traditional physical therapy and Feldenkrais. He was careful to work within the home program that I felt I could manage, and went with the flow when I just wanted to come in and mellow out! Jacob carefully stayed in communication with me, when we had a misunderstanding, which actually improved our communication. I now have a workable home program which helps me relax around the discomfort I have had."

The relationship between the client and therapist can prove to be even more important than the therapy itself. Consider the importance of your therapeutic alliance as you continue on your healing journey in order to get the very most out of this experience.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:
1) https://dptcapstone.web.unc.edu/2020/04/15/enhancing-the-therapeutic-alliance-for- patients-with-chronic-pain/

Seeking Nature for Inner Healing

In our modern lives, there is often a degree of disconnect between us and the natural world.

Many people consider themselves as separate from nature, as if nature is this thing or activity that may or may not be part of one's life. It can be easy to fall into this kind of lifestyle, as so many of our lives are lived primarily inside, contained within boxes that separate us from plants, wildlife, fresh air, and sunshine. By living life in this way, we are depriving ourselves of beauty, novel experiences for our minds and bodies, functional exercise, and even vitamin D from the sun.

Without nature, we lose the balance in our lives, which can lead to very undesirable consequences.

In fact, the word "disease" can be related to loss of balance- "dis" meaning "apart" or "away", and "ease" meaning "undisturbed state", "comfort", or "well-being". Putting these words together describes a departure from the undisturbed state, a loss of balance and harmony.1

How can nature lead us back into balance? We have an innate human instinct to connect with the natural world. Many of us seek nature when we are not feeling well, or may realize we feel much better after disconnecting with screens and reconnecting with what is real in the world around us. Our bodies know how to heal themselves, but sometimes we may be preventing this process by disconnecting with the world around us.

Nature is our teacher, the divine force that can help guide us towards a path of healing.

We look to nature to learn how to solve problems naturally, whether we may be inspired by the supportive community of a forest, the love of a mother bird caring for her young, the dynamic energy of a rushing river, or the geological masterpieces of mountains, canyons, and glaciers.

Connecting with nature and time spent outdoors has measurable health benefits for the mind and body. In fact, many doctors are recommending "forest bathing", which is an ancient Japanese practice that involves immersing oneself in nature using all of the senses. Regular time spent in nature can improve emotional well-being, decrease blood pressure, increase energy levels, and lower stress hormones such as cortisol.2

The eclectic blend of sights, sounds, smells, and feelings can help calm our nervous system. The constantly varying terrain of walking outdoors stimulates our minds and bodies in new ways. This can help to improve balance, strength, reaction time, and will help us avoid loss of mobility and repetitive stress injuries that we get as a result of only interacting with flat, human-made environments. Spending time connecting with nature also helps us internalize the crucial connection between taking care of our planet and taking care of our own bodies, as we are not separate from nature.

Time with nature is our reminder that we evolved with nature, and chronic separation from the natural world is ultimately incongruent with the way our biological systems function.

At the Wellness Station, we encourage our clients to spend more time outdoors whenever possible. What are some easy ways to get more nature in one's life?

1. Make going on a walk a daily practice. Consider walking on a trail away from busy roads, where there may be many trees, flowers, and creeks.

2. Do exercise outside! Take a yoga mat or a blanket to a flat surface outdoors and move your body.

3. Meditate outside. Pay attention to all of your senses.

4. Keep the windows open for more fresh air.

5. Plan a trip or social event with outdoor activities planned, which may include hiking, sight-seeing, swimming, or any other enjoyable activity.

6. Get into gardening!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1)    https://www.semanticscholar.org/paper/The-Wisdom-of-Biophilia%E2%80%94Nature-in-Healing-Huelat/08e18ab071a4a468a3aa820aa2d797e168fe0c59

2)    https://www.nytimes.com/2018/07/12/well/take-a-walk-in-the-woods-doctors-orders.html

Body Scans Can Help You!

Body scans are a very helpful tool that apply mindfulness meditation to the physical sensations of the body. This is an excellent practice for improving mind-body connection, calming the nervous system, and training our mind's ability to bring attention to pleasant, unpleasant, and neutral sensations without judgment.

Improving mind-body connection:

Body scans can improve mind-body connection (aka kinesthetic awareness) simply by bringing attention to various body parts. When focusing attention to an area, we are strengthening neurological connections that regulate the bidirectional flow of information between the brain and the body part. We can also start to recognize patterns of where we hold tension in our body, where we have more difficulty relating to, and where we can more easily focus attention. This can translate to becoming more aware of certain body areas, which can help us improve our self-image and efficiency of movement. As our body is our home for the entirety of our lives, it is useful to get to know your anatomy from the inside out!

Calming the nervous system:

Body scans are a meditative practice that train us to bring our attention to the present moment. Rather than allowing our minds to wander with worries of the future and regrets of the past, we are practicing the ability to focus attention on sensations of the present moment. This can help shift us into a more parasympathetic state of the nervous system, which allows our bodies and minds and relax and restore. This will help to relieve stress and anxiety, as well as improve our health, well-being, and relations to ourselves and to others.

Exploring various sensations:

The intention of a body scan is to bring attention to all kinds of sensations in the body, including those from the skin, muscles, joints, and even our organ systems. These sensations may be pleasant, unpleasant, or somewhere in between. The point is not to assign judgment to an unpleasant feeling, but rather notice the sensation for what it is (e.g. pressure, tightness, ache, tingling) and to recognize what happens when we stay with it without trying to change anything. This can improve our ability to bring attention to real-time sensations through a lens of separation and objectivity, rather than letting emotions such as fear run wild when pain arises during our daily activities.

Here is an example of how to perform a "five lines" body scan:

1. Rest comfortably on the floor or bed in a position. Consider lying flat on your back with your legs extended and arms resting by your sides, or use any props to get more comfortable.

2. Begin to settle in, slow down your breath, and close your eyes.

3. The body scan will involve the five "lines" of your body: each of the four limbs, as well as the spine from the pelvis to the head.

4. Right leg: bring attention to the right side of the pelvis, sensing what part is touching the ground. Sense this space from side to side, back to front, noticing any sensations (e.g. buzzing, tingling, tickling, pressure, temperature, clothes against the skin, skin against the ground, etc). If no sensations are present, notice that too. Then let your attention slowly travel down to the hip, down the thigh, to the knee, calf, ankle, heel, arch of the foot, ball of the foot, and toes. You can then let your attention travel back up to where it came from towards the right side of the pelvis. Take as much time as you need, noticing if it is more difficult to move your attention quickly or slowly.

5. Repeat this process for the left leg. Notice differences between the two legs.

6. Right arm: bring attention to right shoulder blade in the back, collarbone in the front. Let attention travel towards the right shoulder, then upper arm, elbow, forearm, wrist, hand, all the way to the fingertips. Then travel back up in reverse.

7. Repeat this process for the left arm. Notice differences between the two arms.

8. Spine: bring attention to center of pelvis, the sacrum bone against the ground. Slowly travel the attention to the low back, feeling your abdomen in three dimensions. Notice that as you breath, the size of this area changes. Feel what part of your spine is connected to the ground, and what is not. Then slowly travel towards the mid back, rib cage, upper back, base of the neck, neck, head, face, and finally the crown of your head.

9. Rest completely, noticing what the attention is drawn to now. 
 

At The Wellness Station, we ensure that body scans are a regular part of our client's mindfulness practices. We may begin or end sessions with a guided scan, as well as create or recommend a recording for home use.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor

and The Wellness Station Team

Variety is the Spice of Life- And of Yoga!

Yoga can have incredible benefits for the body, mind, and spirit. However, the manner in which you practice yoga, and how you relate to the poses determines the benefits it will have.

Many styles of yoga tend to be hyper-focused on the specific "asanas", the shape the body is in during yoga poses. What is neglected is the movement between and within specific poses, which is where the real magic happens. Adding variations to traditional yoga poses can help deepen anyone's practice by promoting neuroplasticity- thereby improving mind-body connection, quality of movement, and can help yogis avoid repetitive stress injuries.

In some schools of yoga, asanas are taught in a way that is very stringent and prescriptive, which can have damaging impacts both physically and psychosocially. The hidden message is this- "if your body cannot get into this shape, then you should force it to". This can lead many people to steer clear of yoga classes for fear of judgment from others, as well as self-judgment, if they cannot "achieve" a certain yoga pose. Additionally, repetitively forcing the body into the same shapes over and over again to lead to repetitive stress injuries to the joints and other tissues. Yoga means union- union of your mind, body, and spirit. The purpose is to meet yourself where you are today without judgment or comparison.

The goal should be to work with your body, not ON your body, to achieve some arbitrary shape at the expense of injuring yourself. 

This is where variety comes into play. Rather than trying to achieve a particular shape, try exploring the intention of a shape with different variations. Yoga should be about exploring movement, not stagnant posturing. Adding variety into your yoga practice will make it far more functional- how often in real life are we holding one exact position for a prolonged period, rather than moving in and out of different shapes? Variety can also be used as a modification to make a base pose more accessible OR more challenging. Practicing in this way will help nourish your muscles and joints in different ways to avoid injuries, and will lead to greater physical and neurological benefits.

Here is an example of adding variety onto some of my favorite yoga poses:

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When in doubt, add a circle!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Reduce Anxiety Through Mindfulness (Without Drugs!)

Anxiety disorders are the most common mental illness in our country, affecting over 40 million US adults each year.

The prevalence of anxiety has been steadily rising, especially among younger individuals, which may be attributed to societal factors such as lifestyle habits (less movement, poorer sleep quality, work-life balance), social media, the pandemic, and overall existential dread due to issues such as climate change.

When stress and anxiety levels are high, the body releases high levels of stress hormones which can be toxic over time, damaging the body and mind similar to other toxic chemicals found in our environment. The good news is we can learn how to reduce this anxiety naturally without the use of harmful medications. In addition to counseling and psychotherapy, we can all incorporate accessible strategies to help appropriately manage stress and anxiety on a daily basis.

Here are some of my favorite tools that I use and recommend to many of my patients:

1. Breathwork

Breathing practices can be incredibly calming for our nervous system. By slowing down our breath, we naturally shift into a more parasympathetic state of the nervous system (rest and digest). Our breath is always happening in the present moment, and by focusing attention here, we can avoid dwelling on past regrets and future insecurities. A simple breathwork practice is timing the breath while gradually extending the exhale. Start by inhaling for 4 seconds, followed by a brief pause, then exhaling for 4 seconds, followed by a brief pause. Gradually increase the length of the exhale to 6 seconds, perhaps to 8 seconds. Continue for several minutes.

Consider trying a video, such as this for a more "visual" experience:

2. Meditation

Meditation is a practice that can help to calm the inner chatter of the mind to foster a state of peace. Regular meditative practice allows us to be more mindful in our inner world as well as in our relationships with others. Meditation involves bringing attention to an object of the present moment, such as breath, sound, sensations, or even movement. Focusing attention on the breath, or some sensation of the breath is an excellent practice for beginners. Try sitting comfortably in a chair or on a cushion on the floor. Take several breaths, beginning to slow down the breath. See if you can keep your attention fully on the sensation of your belly rising with an inhale, and falling with an exhale. Each time you notice your mind has traveled elsewhere, gently redirect your attention back to the breath.

Helpful tools for meditation include guided meditations on YouTube, as well as apps such as Headspace or Waking Up. Tara Brach is also an excellent meditation coach, psychologist and author with resources on her website: www.tarabrach.com

3. Movement

Gentle, mindful movement can be incredibly calming for the nervous system. This could be a restorative yoga practice, a Feldenkrais lesson, or even just a walk. Try going on a walk outdoors without any distraction- no phone, music, or podcasts. Direct your attention to objects of the present moment, such as the birds chirping, the stunning visual field of blue sky, flowers, and trees, or sensations of the body such as the contact of the feet on the ground, the fresh air flowing in and out of the lungs, or the breeze on the skin. Tap into your senses!

It is important to practice these on a regular basis to build up resilience, rather than ONLY practicing them when stress and anxiety levels are high.

Just as we would not only go to the gym when we are feeling weak, we should not only practice self-care when we are depleted. Practicing these strategies only a regular basis will promote neuroplasticity, sustained behavioral change, and will allow us to access inner peace and calm when we need it the very most.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team