Biofeedback has been talked about quiet a bit lately. It’s talked about as a form of pain management, a way to address stress, ADHD in children, anxiety and trauma, a cure-all really. But what is biofeedback? And does it work?
Biofeedback uses instruments to measure the body’s responses to stress so that these responses can be modified to improve functioning. The stress in question can be physical pain, which the body can express by muscle tension, for example. Stress can also be psychological and be manifested by a rapid heartbeat or sweaty palms when someone is anxious. Biofeeback can measure all of these bodily responses immediately and demonstrate changes as a client learns to control or modify these.
What makes biofeedback so wonderful is that the results are not only fast, they are also demonstrated right there on the screen for the client. If a client is experiencing pain the their lower back, for example, their muscles in that region will be tense and this tension can be measured with the instruments that the treatment utilizes. As the client is able to see how much muscle tension he/she has in the region where they are experiencing pain and are able to relax their muscles, they will immediately feel relief from the pain. This type of treatment usually takes 10-20 session as a client learns the treatment and practices to generalize what they learned at home, between sessions.
Treatment for psychological maladies works similarly, with the client learning to train their body using the feedback they get from baseline readings since we know that psychological stress causes muscle tension in certain areas such as the head and neck, decreases in temperature in the extremities, rapid breathing and hearbeat, and and increase in bloodpressure. This type of treatment can also take a anywhere from 10-20 sessions, with booster sessions as needed.
When someone is considering entering therapy, what is the hardest part of the process? I would venture to say that it’s choosing a therapist. After all, how does one decide who they can entrust their inermost secrets, struggles, and life’s tribulations to? What if you get the wrong advice? In a lot of ways, it’s like starting a relationship. How do you know that the person you decide to open your heart to will not hurt you? How do you know this person is a good therapist?
So what makes a good therapist? Of course you want to know that the therapist you choose is well-educated and state licensed to practice. Those are the basics. But beyond that you want to have a therapist who will hear you and your needs and goals, rather than push their own agenda. A big red flag should be when a therapist begins to prescribe interventions before really understanding and exploring your presenting problem. Another reg flag should be when a therapist who gives advice rather than helping the client to explore their issues and come up with a solution on their own, a solution that would work for them.
What about therapist burnout? How does this affect treatment for a client? Therapist burnout has to do with a therapist who is having difficulty addressing client issues effectively because they are under too much stress, either for personal reasons or because of not having an effective outlet to destress from the stress of taking on the issues of the clients they work with. When a client is working with a therapist who is suffering from burnout, treatment is affected because the client’s issues may no longer be the primary focus in treatment and transference/contertransference issues may come into play for both the client and the therapist. If a client feels that they are not the main focus during sessions in treatment, they need to immediately address this with their therapist as burnout may be the issue.
In summary, finding a good therapist is a difficult process and once treatment starts the client has to be on the lookout to make sure that therapist burnout doesn’t occur. Of course this is always the therapist’s responsibility to ensure that ethical treatment practices are always used, but the client is always their own best advocate as well and should know what to look for to avoid unnecessary issues and ensure a positive treatment experience.
What is the process for change? Change is an uncomfortable thing, after all, and takes a while to get used to. A person first has to get used to the idea that this is going to happen (motivation) and start the process (action), and then the change actually has to become permanent through repetition and practice. This is then a lengthy process and doesn’t happen overnight and is true for both psychological and behavioral change that a person may wish to undertake, as well as any change a person may want to make to their circumstances.
So how does one start this difficult process? One has to first identify what they are looking to change, of course, and how they would like things to be different. Setting goals is very important in therapy as figuring out exactly what a client would like to address will help to focus the treatment and make sure that the interventions are targeting what the client is struggling with. Once the client has set a goal for treatment, the therapist can now create a treatment plan with the client and establish what steps that client is willing and able to take to effect the change and what tools they have to have them do this – what strengths the client has on their own, as well as what supports they have at their disposal (family, community, etc.) This is the main part of treatment.
The last step in this process is to help the client practice the changes that they have made and the new skills they have learned in treatment. The clients need to be reminded that there will be setbacks and they will lose some of the gains they have made in treatment as they implement the changes. As the client becomes more and more proficient in using their newly gained skills, they can slowly begin to transition out of treatment and begin to practice the changes they made independently, utilizing their strengths and supports.
That is, of course, the ideal way that treatment should go and it goes that way very rarely. More often there are setbacks having to do with a client’s difficulty with setting goals, lacking resources, or having difficulty with practicing their newly learned skills. Clients also sometimes return to treatment after terminating if a destabilizing event occurs in their lives. Change is a very complex and individual process and understanding the stages is just the first step in being able to help a client facilitate this change.
In my work with clients I often wonder what motivates someone to effect change in their lives. I work with clients who are mandated into treatment, either by courts, probation, or family circumstances that would not otherwise allow them to return home. But despite this, some clients find the internal motivation within themselves to make changes, while others continue on the same path they were on prior to entering therapy. You can’t save people from themselves, right? You can, however, understand what drives people to the point of catharsis, the point when they gain insight, when they realize that they have to do something differently, not for the systems involved but for themselves.
Some clients arrive at this point on their own, even prior to deciding to enter therapy, when they realize that something in their lives is not going well and interfering with their desired level of functioning. This is the optimal scenario – a client who comes into treatment ready for change and motivated to work to achieve that change. Other clients are motivated by external factors, such as pressure from family, other systems such as the courts, DYFS, probation or parole, etc. What drives them is getting rid of the negative consequences to not changing – e.i. if I continue this negative behavior, then the external systems that are putting pressure on me will put in some consequence that I would really like to avoid - my husband or wife will leave, DYFS will take my children, my probation or parole will be violated. The goal with these clients is to get to a point where they can find something of intrinsic value for themselves in change – feeling happy that they are not having so many problems with their family members, being better parents, or having a sense of accomplishment at successfully completing probation and being able to function successfully in socially acceptable ways.
But what about clients who do not subscribe to social normals, who hold moral values that are conflicting with the expectations of what is socially acceptable. If a client is mandated into treatment due to being on probation for an ssault charge, for example, but is not able to identify any other acceptable way of handling conflict other than fighting, how can this be addressed successfully in treatment? Working with the client to identify what their treatment goals are is always important, as well as letting them know through establishing confidentiality and rapport in the therapeutic relationship that no matter what moral beliefs or social norms they subscribe to, you as the therapist will hold a supportive, non-judgemental attitude. I often challenge my clients in sessions, but not without first establishing this trusting and supportive treatment atmosphere. I also let my clients know that it’s OK to hold the beliefs that they hold and they are not in treatment to change their beliefs but they do have to live and function in a soceity that may not and often does not support those beliefs and attitudes and we work together in treatment to find ways to help the client adjust and improve their functioning.
My current job involves working with teenagers and work with teenagers often involves working on identifying and utilizing coping strategies. The coping strategies focus on any number of things – anger management, impulse control – all things that often elude the growing and developing mind and body. One of the most often identified coping strategies that I hear with adolescents is listening to music. Analyzing why this would work so well with adolescents (and adults for that matter), it makes complete sense. After all, when we are talking about impulse control, we are talking about the brain being focused, preoccupied even, on a thought or an object and when the thought is replaced with something else – music – the focus shifts and the person is able to consider other alternatives. Same goes for anger management, except here the person is focused on an emotion and cannot move past it and listening to music allows the person to shift their focus away from their anger and be able to consider other feelings and alternative ways to address the situation that caused the anger in the first place.
Sometimes clinicians use music in treatment if clients have identified it as a useful coping strategy to get their clients to learn to focus and develop impulse control or anger management strategies. The mistake that is often made is recommending the type of music a client should listen to because it is identified as “soothing” or “calming”. So a clinician may recommend classical music, for example, to get a client to cope with stressful situations. However the problem occurs when a client does not find that type of music appealing and is not able to focus on it. The basic pillar of social work practice, starting where the client is, is always a good thing to remember. So if a client has identified that hard rock is their music of choice, for example, that would be what would be most therapeutic for them and should be recommended as a coping strategy if the client feels that it may help.
When someone experiences stress in their lives, feels depressed or anxious, what are some of the first symptoms that we experience? We usually feel tired, run-down. With anxiety, some of the symptoms we may feel in the body are rapid heart beat, shortness of breath, headaches. With depression, it’s fatique, difficulties with sleep (either too much or too little), restlessness. And just as these symptoms are manifested by the mind in the body, they need to be treated by treating the mind, or so the mental health field has always believed. But what about the body? What about the interconnectedness between the two? Neglecting the body and it’s symptoms can lead to neglecting a crucial aspect of treatment. In trauma treatment, for example, one crucial element is to make sure that the client undergoing treatment feels safe prior to being able to talk about their trauma. Several of the techniques used for this are grounding and relaxation techinques. In grounding the client needs to develop a certain level of body awareness so that when they enter a state of anxiety when talking about their trauma, they can ground literally, physically ground their body, touching the floor, feeling the chair they are sitting on, to remind themselves that they are in a safe environment. Likewise, relaxation exercises help the client to be mindful of their body reactions like their breathing, the tension in their muscles, to help them know when it’s becoming too difficult speaking about their trauma and they need to take a brake and regroup. In these ways trauma treatment is very mindful of the mind-body connection and clients benefit.
I have been considering this topic for quite some time and this is really the reason this blog came into existance. Although mainstream treatment approaches are incredibly useful in addressing all the maladies of the mind and the heart, I can’t help but think that some alternative approaches have validity as well. After all, before evidence-based practice became a corner stone in the mental health field, we as treatment providers knew to use clinical judgment and clinical judgement tells us that relaxation exercises make clients less stressed, as would meditation. I doubt there are any formal studies on that, but maybe I am mistaken… This is partly the purpose for the blog after all – to find out of anything that is not yet a mainstream therapy treatment approach can be considered evidence based practice. So the other purpose of this blog is considering how alternative therapies such as reiki, meditation, the Trager method, Native American or African healing rituals, etc. can be integrated with traditional therapy approaches to successfully be used in mental health practice.