The psychology of 'normal'

In the previous Blog I outlined the rationale underpinning The Wellness Programme and gave an indication of the content of the programme.  In late 2009 I conducted a small pilot study to work out how long it takes to deliver and evaluate each session.

From the pilot study a number of important issues were identified and I want to let you know about these. 

I soon found that, for several clients, even two hour sessions were not enough to address all their health needs and concerns.  This immediately begs the questions - how realistic is it to attempt to meet all health needs?  How should needs be prioritised?  Who decides which needs are most important?  However, If time with clients is to be used effectively then priorities must be established at the outset through discussion between the client and the practitioner. 

Last time I mentioned the example of a single parent with a body mass index (BMI) of 48.  This degree of obesity increases the risk of heart disease, stroke, diabetes and particular cancers.  It can also be a serious risk to mental health by reducing self esteem and self confidence and can even affect the ability to work and to enjoy social activities. 

It’s well known that for most people being overweight is the result of eating more calories than are used in physical activity.  If it was easy to simply reverse this balance, lose weight and improve health people would do it.  Motivation and mind set play a huge part. 

Using the example above let’s call this person Pat.  Pat belongs to a family in which her parents and her siblings are all very overweight.  The mind set then is 'I am normal' and this is despite media messages and clinical advice to the contrary. 

Changing the mind set is the first thing that must happen and this will need to come from Pat herself.  Being told or encouraged to change is not enough.  Pat must come to the recognition that being 'normal' in this sense is not good for her health.

Once the mind set changes Pat becomes open to motivation and encouragement from others.  But there is still a long way to go because unhealthy and weight gaining bad habits have developed over many years.  Breaking the bad habits of grabbing high fat fast food such as pies, ready meals and take aways requires planning, energy, money and determination which may all be in short supply and which other family members may resist.

Furthermore, a common cause of excess calorie consumption is ‘comfort eating’.  Is food meeting an emotional rather than a nutritional need for Pat?  If so, before embarking on any weight loss plan Pat must explore what purpose food is serving and deal with the emotional or psychological factors involved. 

My point here is that this example demonstrates the need for an integrated approach to a specific problem which takes account of the interplay between the complex physical, emotional, social and genetic factors which may predispose a client to obesity.

Spending considerable time with people regularly, listening to and acknowledging their fears and concerns, runs the risk of creating dependency.  I became aware of this during the pilot study and I was very careful to maintain the professional, therapeutic relationship while also being, I hope, warm and empathetic.  Important aspects of this issue are to exercise active listening skills throughout each session but never to self-disclose personal experiences.  Some may feel that self disclosure helps put clients at ease or shows empathy.  It works in social settings but not in a professional relationship and self-disclosure can damage a therapeutic relationship.

The Wellness Programme as it was piloted used a lot of documentation some of which has subsequently been simplified and refined.  I feel strongly that if Integrated Health Care in general and The Wellness Programme in particular are to be credible then good record keeping is essential for client safety and for auditing our practice so we can constantly be learning and improving.  This, of course, raises issues of client confidentiality and data protection which I’ll mention next time.

It’s very exciting to develop a programme with breadth and depth and which can be measured objectively but the downside is the ever increasing cost of delivering such a programme.  Cost can easily put a programme beyond the reach of clients who need it most and of funding bodies who have many demands on limited funds. I’ll be going into more detail about funding issues later.

Last but not least It’s important to be able to share experience of good practice with other professionals but, more importantly, to discuss aspects of practice where there is room for improvement.  Furthermore, discussion between professionals can highlight areas where there may be risks to clients that are not immediately apparent to lone workers.  Building working relationships with other practitioners, either in orthodox medicine or in complementary medicine, safeguards both client and practitioner. 

 

Food for Thought

Let me know what your thoughts are regarding

• The benefits of good record keeping
• The importance of avoiding self disclosure
• How can good working relationships be fostered with other professionals