Updated: Dec 21, 2020
During this challenging period of the COVID-19 situation, as someone in the helping profession, you might be seeing more patients with complaints of bodily aches and pains, coupled with increased fear and anxiety. Their sympathetic nervous systems are in overdrive and their sense of certainty and safety might be threatened. Whether it’s the thoughts of potential danger from being infected by the virus, worrying about their loved ones or the financial stress due to loss of income and freedom.
You might also sense your own bodily tension and aches, with your own anxieties and fears. It is during this period, when we are put to the test, that we can learn to thrive and practise skills to make us even better clinicians.
We need to calm the storm, both within ourselves, and regulate ourselves, in order to better help our patients. Hence besides observing social distancing, now is the best time to build up our social engagement skills, and create a safe and positive relational atmosphere with our patients.
The following are ideas taken from the lecture entitled “’Being’ Begets ‘Doing’: Establishing the Conditions Necessary for Cultivating Therapeutic Relationships “ by Dr Maxi Miciak given on the San Diego Pain Summit.1
It is timely for us to put some of her research findings to practice, to calm the storm and create a safe and healing space for our patients. Dr Miciak presents the therapeutic relationship as being a “Safe Container”, something which can be applied to many relationships: relationship to self, to family and friends and to our patients. The ultimate goals of being that “Safe Container” to a person you are interacting with is to calm the nervous system of that person, increase their self-confidence, help them realise their inner strengths and help them implement strategies and make use of resources to thrive.
Ultimately it is to make sure the other person felt seen, heard and most importantly acknowledged and accepted. Though the points below may not be new to us all, it’s the application of these points which may prove to be elusive for us.
1. Be Present (The Floor of the container)
Supporting the other person, like the floor of a container. This forms the most important base of helping to calm the person down. The reassuring presence of someone who is willing to spend time and energy to listen for understanding. As you listen, you watch and you form a complete picture of the person’s presentation, the face and the body posturing. But you watch not as someone who wants to look at postural faults or poor mechanics, but as someone who picks up cues on the person’s emotional state, whether there are signs of sadness, fear and anxiety, frustration or anger. Emotional states which typically occur with pain.
2. Be Receptive (The Walls of the Container)
As you listen, you will need to hold off judgement. You will need to keep an open and receptive attitude to the person. By being open to how they are presenting, you remain unguarded and see them as collaborators, not someone who needs to be fixed by you. You don’t need to see yourself as someone who have all the answers, in fact by being receptive, you see the person as the expert of their own pain experience, and that they have the answers to the situation they are in.
A paragraph from Maitland G (2005) aptly states:
“The physiotherapist needs to recognize and understand that people always have reasons, conscious or unconscious, physical or psychological, for their exact mode of presentation, and that it expresses a need.
The physiotherapist should therefore never be critical of the way a patient presents. The very presentation itself is a message, needing to be decoded just as much as the other findings that the history and examination reveal.” 2 (pg31)
Hence being receptive, would also include being curious. By being curious you help the person uncover their strengths and resources, as well as give them the space to explore their own strategies to overcome what they are experiencing. In order words, by keeping an open and receptive attitude, you will have a more complete clinical picture to help the person.
3. Be Committed (The Covers of the Container)
Having experienced being ‘the floor’ and ‘the walls’ of the Safe Container for that person. You have already begun the process of being committed to their recovery. You don’t see this as a one-sided commitment, whereby you give all the answers or you do all the ‘fix-it’ work. You have already started the process of empowering that person. And interestingly, the person having felt the safe support of ‘the floor’ provided and ‘the walls’ encircling them, starts to open up and commit to the process as well.
You will not view the patient as just a number to your list, but as a human being, to understand and care for. This will further fuel your commitment to help them.
4. Be Genuine (The Covers of the Container)
As you be present and be receptive to that person. You withhold judgement and stay curious and you view them as a human being, not a condition to be treated. You also let go of your guard, meaning you don’t try to present a false picture of yourself. You may also share with the other person your own struggles with pain or physical injuries, or your own fears and anxieties about the current situation. In other words, you can be yourself.
By being the “Safe Container”, you hone your social engagement skills and you create a safe and supportive environment for who you interact with as well as for yourself. You humanise healthcare. and you also modulate pain for your patients by calming their nervous system by lessening threat and increasing the sense of safety.
Would like to hear your experiences in relation to what was discussed in this article. Whether you are already successfully being that “Safe Container” for your patients or whether you perceive or experience barriers and obstacles in doing any of the above?
2. Maitland’s Vertebral Manipulation (7th Ed). 2005 Edited by Maitland G et al. Elsevier: United Kingdom