Category Archives: Thrive Pain Campaign

8 TIPS to Help Clients Do Homework

Posted June 6, 2018

 

Dr. Lane P.: Hi, I’m Dr. Lane Pederson. One of the most common questions I get from participants in my seminars is, How do I get clients to do homework? In this short video, I’m going to share with you eight tips that I find to be very effective.

Dr. Lane P.: Now, the first one is simply changing the name. I often times say the word “homework” when I talk to other therapists, but I rarely use that word when I’m working with clients. Instead, I might say, “Let’s do a task.” or “Let’s do an experiment.” Sounds kind of fun. Or I might simply say, “Let’s do our skill practice.” Sometimes, just changing the name can make all the difference. I’ve met so many clients who are just simply allergic to the word “homework”.

Dr. Lane P.: The second tip is really important. At the beginning of therapy, I always want to orient and educate my client about why homework is important to them. Why do they need to practice these skills, or why do they need to practice what we learned in session between sessions? An analogy I like to use is: To not practice between session is a lot like going to a personal trainer and talking about exercising but not actually exercising between those sessions. You’re just not going to reach your goals. It really is about plugging into what’s important to clients. Where do they want to be in life? What does recovery look like? What do they want to accomplish? You explicitly make that connection between skill practice and what it is that they desire, what they want.

Dr. Lane P.: The next idea is to always include clients in coming up with ideas for skills practice or tasks, or experiments. A lot of times, we therapists think that we need to generate all of the ideas, but our ideas for what might be helpful in terms of homework might not resonate with some of our clients. So, instead of doing homework to clients, I like to think about doing homework with clients and spending some time with having them come up with what they think would be helpful to do between sessions.

Dr. Lane P.: Which leads us to the next tip, which is: if you want clients to do homework or tasks or experiments between sessions, it’s good to initiate that skills practice in session. So for example, if I want a client to practice guided imagery, we’re going to practice guided imagery in session. If it’s important for a client to fill out an application before the next session, I might have the client just start to fill out the first parts of the application in the session with me. There’s something about breaking the ice in session with homework that gets clients motivated to complete and to finish it between sessions outside of our time together.

Dr. Lane P.: The next idea is to take one problem or opportunity and play it off of another. So for example, let’s say that you have a client who would like to walk to get some self care exercise in and the client also would like to socialize more to decrease isolation. You can set it up so if you don’t do one, you need to definitely commit to doing the other, so in this case, if the client didn’t go for the walk, he or she would definitely need to call a friend or to get out and socialize in one way or another. It’s a strategy that works really well.

Dr. Lane P.: Related to this strategy is another one which is simply making it a game. So, if you have a dichotomous choice like doing a fun activity versus taking care of a task at home, more of a responsibility, you can simply flip a coin. Heads you do one, tales you do the other. Or if you and the client have brainstormed lots of ideas, simply draw a cards. So, one skills practice might be associated with hearts, another one with clubs, another one with spades, and so on.

Dr. Lane P.: The seventh tip that I have is using the Premack principle. The Premack principle means that you make performing a high probability behavior contingent on performing the low probability behavior first. We sometimes call this grandma’s rule. Grandma’s rule is this. When you eat your vegetables, then you can go out and play. So with the Premack principle, let’s say I have a client who turns on the television every night. He or she really loves to watch evening television. I might say, “I want you to do your skills practice and then you can turn on the television.” Of course, many of us naturally do this Premack principle. You know, I need to return my emails and then I can surf the internet. It’s such a great strategy because the reinforcement is built-in.

Dr. Lane P.: And now, for the very last tip … and this one I think is the heaviest hitter. It is so important to simply schedule it. A lot of clients don’t complete their homework simply because they haven’t thought about where and when they’re going to complete it.

Dr. Lane P.: There was a study that happened many years ago and in this study, there was one group of people who agreed to do a task. They were committed to doing it. The second group of people were also committed, but that group also determined when and where they were going to complete the task. They completed it 80% more of the time. Hey, think about you or me. A lot of us don’t complete what would be important to do in life simply because we don’t write it down, we don’t commit to it in the schedule. So, taking a little bit of time to schedule homework is going to make all of the difference for your clients.

Dr. Lane P.: I hope these eight tips help you out a lot and, more importantly, help out your clients.

Dr. Lane P.: Thank you for joining me.

 

Relaxation Script for Pain

Posted December 13, 2017

Studies indicate that up to 50% of individuals diagnosed with chronic pain will also meet the DSM-IV-TR diagnostic criteria for anxiety. This is because many individuals who experience chronic pain describe anxiety and pain distress as a circular fashion: pain contributing to stress, which leads to muscle tension, which leads to more pain. It is important to practice relaxation strategies to cope with anxiety which will release tension in the body. You will find one example of a relaxation script below. In addition, use your mindfulness skills to pay attention to your body’s needs and shift the relaxation script as needed.

Breathing and Body Relaxation Script:

  • Begin by resting your body in a comfortable position. You may close your eyes, or if you are more comfortable keeping them open, stare at a fixed focal point in the room. Start grounding your awareness into your body. Feel your feet firmly meeting the floor, your back supporting you in your chair.
  • Once you have physically grounded yourself, slowly bring your attention to your breath. Notice the patterns of your breathing- the inhalation, pause, and exhalation.
  • Observe the rise and fall of your belly as you are breathing. If you notice that you are breathing from the chest, work to slow your breathing down, with slower and deeper breaths from your diaphragm. Allow for a few more rotations of this breath, going deeper and deeper into your core.
  • The goal of this breathing exercise is target a slower breath, a soothing breath. Perhaps counting allows you to pace your breathing. Try this experience, perhaps starting with intervals of 4 seconds.
    • Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4. Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4.
  • Repeat for a few more rotations.
  • It is natural for distractions to pop up in your mind. If you observe a distraction, identify it as just a thought and redirect your attention to your breathing.
    • Inhale, 2, 3, 4. Pause, 2, 3, 4. Exhale, 2, 3, 4.
  • Continue this breathing until you have found a natural rhythm of inhalations and exhalations that work for your body today.
  • Continuing to move with this rhythm, consider the idea of releasing tension with your exhalation as we expand into meditation with the breath. Feel yourself working to inhale calming energy, and exhaling muscle tension.
    • Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4. Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4. Imagine your body slowly releasing all of the built up tension.
  • As you work through your muscle groups, observe the experience of feeling lighter in your muscles are you work to cleanse your body of the tension.
    • Inhale calm, 2, 3, 4. Pause, 2, 3, 4. Exhale tension, 2, 3, 4.
  • Continue this process for as long as you find meaningful for you. When you are ready, you may begin the process of orienting yourself back to your surroundings. Feel your back against the chair, your legs against the chair, your feet resting on the ground. When you are ready, you may start to shift your body and prepare to move on to the next part of your day. Remember that you can return to this place, to ground yourself and release tension in your body, at any time you choose.

Asking for Help With Pain

Posted November 21, 2017

It can be challenging for individuals with chronic conditions to find the balance when asking for help. Many people have experienced barriers with everyday household activities and responsibilities as well as occasions of cancelling plans due to pain. It is common for individuals to feel like they will upset their support system by asking for help.  This leads many people to keep their needs to themselves. It can be easy to think that other people will automatically know what you need, and frustrations can result when they don’t get it.

Even though it may feel this way, keep in mind that we don’t know what other people are thinking.  Other people cannot read your mind to know what you need. It is appropriate to ask for help, and doing so builds self-respect. Use this idea as motivation to prepare and reach out

  • Start by identifying your different support needs. This includes emotional and physical needs.
  • The clearer and more specific you are, the better.
  • Communicate with your supports ahead of time. Ask them what kind of help they are willing to offer. For some, it may be help with chores like carrying laundry. For others, it may be help with getting to appointments or providing emotional support during challenging times.
  • Make sure to reinforce others for jumping in.

It may feel challenging in the moment to follow up and ask for help. Remember that your supports have shared with you what they feel comfortable with, and to trust their word and intention with what they offered. Use mindfulness to work on balancing the acceptance of help from others with the things you can do independently to enhance your quality of life.

Being Your Own Care Advocate

Posted November 6, 2017

Don’t get lost in the shuffle.
When you have chronic pain and mental illness, it is easy to feel like your sense of self gets lost in the shuffle. Between all the appointments, lists of diagnoses, and varying treatment opinions, it is common to feel overwhelmed as you wonder how to become your own care advocate. Pair this with limited appointment availability and you have a recipe for reduced advocacy as you feel unheard and shut down.  It may also lead to treatment burn out and turning to your providers as the directors for your treatment.

You are the expert!
It is true that your providers may be the experts in certain assessments and interventions. This does not mean that they are the experts in your day-to-day experience. Keep in mind that you are not only the consumer and advocate for your care, but also the expert in your daily life. YOU are the one who lives in your body and the only one who knows how this truly feels. You are your own advocate. Hold on to this idea so it empowers you to ask for help as you advocate and direct your care. If something doesn’t feel right, speak up. Ask questions. The goal is to advocate and collaborate with your team—you as the expert in your life meeting with the provider in the middle, to develop the best plan for you based on your experiences, goals, and values.

Thrive for Mental Health and Chronic Pain Management Care Advocate

 

Written by:
Morgan Cusack, PsyD
Program Coordinator of Thrive for Mental Health and Chronic Pain Management at MHS

Preparing for a Provider Appointment

Posted October 23, 2017

It can be sometimes feel daunting to get all of your goals met during your provider appointment. Between your questions and goals, the treatment planning of the provider, and limited appointment length it can feel like there isn’t enough time to get everything accomplished. This can be frustrating and disheartening for individuals who experience chronic pain and medical conditions. To avoid feeling shut down during your appointments, it is important to take active steps in preparing for these meetings. This planning can help to build confidence and sense of control, in addition to working towards efficiently meeting your goals.

Prior to your appointment, take some time to plan ahead. Write down your list of questions and goals. Gather any medical history, medication lists, and any symptom tracking details you have been collecting. It can be helpful to store these details in a folder or binder. Plan out your transportation, and make sure to allow for plenty of time for unexpected traffic or road construction. Will there be parking on or off site? What is the schedule or call ahead policy for scheduling transportation? When you arrive at your appointment, ask your provider to establish the timeline, and share the tools you have gathered and your top priority goals for that meeting. Bring a notepad and pen, and make sure to write down any questions or next steps recommended by your provider. These tips can allow you to not only increase your experience of feeling heard during the appointment, but can also increase your ability to understand the treatment and to follow through effectively afterwards.

Written by:
Morgan Cusack, PsyD
Program Coordinator of Thrive for Mental Health and Chronic Pain Management at MHS