How to build confident and compassionate dementia care teams

confident-compassionate-dementia-care-teamsLuke Tanner, author of Embracing Touch in Dementia Care, writes here about the importance of touch and physical contact when caring for someone living with dementia.
What happens when we deprive this type of comfort from those in need of it? How do we build confident and compassionate teams of carers? 

Whilst researching my book on touch in dementia care, I observed professional carer’s with exceptional skills in their use of touch. These carers were not trained in any fancy massage techniques or procedures. They were merely doing what came naturally to them. It was as natural as seeing a father cuddling up on the couch with his child, children playing together, partners consoling each other, a mother soothing her baby, or friends congratulating each other. Upon discussing their use of touch I discovered that they had learnt these skills simply through living their life. Their ability to offer tender loving care grew from the tenderness, love and care they had received themselves. This loving and comforting touch is universal, which means it is shared by all humanity.

Closeness speaks volumes in every culture. We tend to try and keep the people we love and care for close, remain distant from the people we care little about and push the people we dislike further away! You don’t have to be very clever or have all your cognitive faculties intact to understand this language. It is a primitive language that all mammals share: a language that relies upon the faculty of empathy; an ability to identify with and respond appropriately to the feelings and needs of others. This faculty is absolutely crucial to care-giving as well as human kind. Without it we would be lost and alone. Mammals are social animals because they are born with this seed of empathy. Loving and affectionate touch is the water that helps this seed grow strong. Touch and empathy are so closely bound that many forms of touch are actually experienced as empathy. This is because we first came to know empathy through touch, in the very first days or even moments of our life. Lessons in empathic touch start early, before words begin.

Given that touch is such a natural and effective way of caring, you would think that professional care providers would cherish this exceptionally powerful caregiving tool. Sadly this is not the case in many care settings. Many of the forms of comforting touch described above are often viewed upon with suspicion, doubt and mistrust. Discussions with professional carers about their attitude towards touch often reveal a great deal of uncertainty about what kinds of touch are acceptable in care settings and a lot of concern about how other people (peers, family members, visiting professionals, local authorities etc.) might perceive their touch. In short there is a lot of fear about “getting too close” and a great deal of uncertainty about how close “too close” is. A professional carers use of touch is further affected by lots of other issues ranging from beliefs about “the elderly” and people with dementia, staff uniforms, the furniture and layout of a care home lounge, concerns about infection control, to task orientation and routine bound systems of care. Unless directly addressed, these issues often add up to an extremely confused or touch-averse culture of care. Confident and compassionate care teams cannot exist in these cultures of care because such conditions actually function to suppress empathy. Care without empathy is not only meaningless but inhumane; it is the kind of care that one might accept from a machine but despair over when it is from a person.

Whilst human contact can also be intrusive, abusive and exploitative and people with dementia can be more vulnerable to this kind of treatment, there is another greater and far more prevalent risk, and that is the risk of no contact at all. In protecting people with dementia from invasive or hostile physical contact, care providers can end up depriving them of any meaningful contact at all. This kind of deprivation is just as harmful as any other form of abuse. When we become overly fearful about carers getting ‘too close’, people with dementia can end up being kept so far away from other people that there is no longer anyone close enough to share their lives with. This is a desperate situation particularly during times of loss, uncertainty and pain.

Over the course of researching this book I have worked with care teams that effortlessly offer tender loving care as well as disempowered care teams, demoralised from years of having to suppress their own empathy and deprived of their own humanity. The result of this research is a book that will help care providers restore trust in touch and identify and remove the obstacles that stop human beings from being human to one another. I urge care providers to use this book to build confident and compassionate care teams that can communicate naturally and effectively in a language that people with dementia will always understand.

Luke Tanner is a massage therapist, body psychotherapist and dementia care trainer. He specialises in the use of touch and non-verbal communication to support the wellbeing of people with a dementia living in residential care settings. His book Embracing Touch In Dementia care was published by Jessica Kingsley Publishers in May 2017.
For more information about Luke’s work please visit www.touchincare.com
To register your interest in Luke’s next workshop for Dementia Carers on 13th September 2017 visit 
www.luketanner.co.uk/staff-training

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Summer Holiday activites for younger children with Autism and other learning difficulties (Day 4).

We want to highlight activities that you can do without having to spend any (or that much) money in order to have fun. This game is a perfect example of ‘no-money fun’ that you can have just using everyday household items and a little bit of imagination.

MONKEY TOES

Primary learning focus

  • Balance, motor planning, crossing the midline.

Materials needed

  • Unbreakable bowl, bucket or tote bag.
  • Cotton balls, pompoms, or other small, soft objects.

Description
Scatter the cotton balls or other objects around a small area, and then have the child remove shoes and socks and collect the objects to place in the container using only his/her feet. If a cotton ball is too far away, have the child retrieve it and then hop on one foot to get to the container.

Variations

  • Use different size or colour pompoms, and have the child collect items according to size. Colour or pattern.
  • Have the child sit on his/her bottom, and use two feet together to pick up objects.
  • Have the child trap a beanbag between both feet, then jump on two feet to get the container without losing the beanbag.
  • Challenge balance skills by doing this activity with arms held over the head, hands in pockets or behind the back, or on a slightly unstable surface (for example, sofa cushions or air mattress).

 

As featured in Simple Low-Cost Games and Activities for Sensorimotor Learning by Lisa A. Kurtz

 

Summer Holiday activites for younger children with Autism and other learning difficulties (Day 1).

We realise the importance of keeping children occupied over the summer holidays and with that in mind will be featuring a different activity that you can do with your kids every day this week. These will be interesting, low-cost activities for parents with younger children – first up today is a drawing exercise that can involve the whole family (including the family pet).

 

MIRROR DRAWING

Primary learning focus

  • Auditory perception, visual-motor integration

Materials needed

  • Paper and markers or crayons
  • File folder or other object to use as a visual barrier

Description

In this game, the child attempts to draw a picture that looks the same as the adult’s picture, given only auditory clues. The adult and child each have paper and drawing materials. Place the file folder or other barrier in between the child and the adult, so they cannot see each other’s paper. The adult then draws one item at a time, giving a verbal direction for the child to do the same thing. For example, the adult might say “Draw a large square in the center of the paper, with a small circle inside the square. Next make a smiley face in the top left hand corner of the paper.” After several directions, remove the barrier and compare the two pictures, discussing how they are different or similar. Let the child take turns being the one to give directions to the adult.

Variations

  • Use lined paper and give directions to copy sequences to encourage memory skills (for example, “Let’s draw circles to make this pattern: red, blue, green, red, blue, green”)
  • While shapes and colors are easier to describe, this game is also fun when you make it more creative. For example, give directions for drawing the family pet, but add silly directions, like making a green tongue, or wearing dog mittens.
  • Draw while lying on your belly, or at a vertical surface to strengthen upper body skills.

 

As featured in Simple Low-Cost Games and Activities for Sensorimotor Learning by Lisa A. Kurtz

With eating disorders and action therapy, slow is the way to go

JKP author Karen Carnabucci, a licensed clinical social worker and board-certified trainer, educator and practitioner of psychodrama, sociometry and group psychotherapy, discusses pacing of eating disorders and actions therapies workshops and training sessions for clients—With eating disorders and action therapy, slow is the way to go. Karen is the co-author of Healing Eating Disorders with Psychodrama and Other Action Methods: Beyond the Silence and the Fury.

When we work with people with eating disorders and dieting struggles, we suggest going slow—very slow.

Some of our clients, trainees and others are surprised about the pacing of our workshops and training sessions where we encourage meditative Healing Eating Disorders with Psychodrama and Other Action Methodsbreathing, mindful movement, frequent pausing during meals and dramas that proceed step by step and scene by scene. After all, psychodrama is supposed to be “dramatic” with lots of lively action—right?

Although it is true that psychodrama has sometimes been labeled with a reputation for a rat-a-tat style of dramatic scenes – which certainly can be useful in dramas that focus on play or take place in educational and theater settings – such a speedy pace is not always helpful for eating disorders treatment.  

In the case of eating disorders, slow is the way to go. In our book Healing Eating Disorders with Psychodrama and Other Action Methods: Beyond the Silence and the Fury, we encourage thoughtful pacing as we seek to model to our clients another option for living.

Here is why:

  • Our culture favors a certain kind of body shape and weight and level of attractiveness that is not realistic for most people to meet. This same culture promotes quick fixes and fast food at the expense of learning how to savor food, the experience of eating and the process of living. Women are encouraged to try faster dieting techniques for losing weight—28 pounds in 30 days!—and men are given quick-time promises for products and gadgets to bulk up their muscles or carve those abdominals. Being able to invest time in recovery can be an important relief for our clients who may have felt pushed and pressured most of their lives to look a certain way. When we take our time, recovery becomes not a wild race to the finish line but a slowly evolving process as the person learns to improvise new ways of responding to life’s challenges.
  •  The natural rhythms of the body have been greatly disrupted by disordered eating.  Appetites are skewed for high or low, and the sleep cycle is often disrupted along with other basic body functions. All body systems—circulation, respiration, digestion and elimination plus the reproductive system, endocrine system and the nervous system—have subtle rhythms of their own, and we must give permission to our bodies to learn how to return to these natural rhythms. Experiencing moments of slowness with meditative walking, quiet reflection, gentle yoga poses and periods of listening interspersed by periods of action are a few of the many ways to support and integrate the experience of slowing down.
  • People with eating disorders and body distress are likely to have a history of trauma, whether it is sexual abuse, childhood maltreatment, early disruptions in attachment to caregivers, such as separation from mother due to premature birth, early illness, death of mother, and intergenerational pain. When we encounter trauma as professionals we must be careful that we do not rush our clients into re-experiencing the trauma bare of strengths and resources. We like the Therapeutic Spiral Model, a modification of psychodrama for trauma survivors, which focuses on identifying and integrating personal, relational and spiritual strengths before trauma material is addressed. As the person actually experiences these strengths and resources, he or she will be able to consciously and effectively address the trauma in a manner that leads to genuine healing.

Of course, there are times when our dramas with eating disorder clients became raucous with laughter and cheers, and there may be singing and drumming or stomping of feet when the client, the drama and the developmental stage of the group properly calls for these experiences. The skilled psychodramatist will be able to move between all of these scenes and experiences to guide the client to a new life.

New Post from JKP author Linda Ciotola—Learn to Love Your Body Through Yoga

Linda-Bio-PictureJKP author Linda Ciotola, M.Ed., TEP, ACE Certified Health Coach, Personal Trainer, Fitness and Yoga Instructor shares her experience and expertise from a recent 90 minute workshop—Learn to Love Your Body Through Yoga. Linda is co-Author, with Karen Carnabucci, of Healing Eating Disorders with Psychodrama and Other Action Methods—Beyond the Silence and the Fury.

In our book on healing eating disorders we emphasize the benefits of a holistic approach to the treatment of issues such as disordered eating, body dissatisfaction, related mood disorders and more.  Action methods which involve the body as well as the mind, heart, and spirit are particularly effective and lend themselves to collaboration with several other modalities which we explore in our book:  art, music, mindfulness, Reiki and other energy work, acupuncture, yoga, and more.  Case studies and a variety of examples illustrate a number of creative options.Healing Eating Disorders with Psychodrama and Other Action Methods

In a recent 90 minute workshop given at a yoga studio, I combined action methods, education, mindfulness, poetry, art and yoga so participants could experience the power of integrating these modalities.

Following introductions and group guidelines (confidentiality, self-care, freedom to choose one’s level of participation and an overview of class, and so on), I introduced the class to the concept of “the Witness Role”—the part of the self that can step back and observe thoughts, feelings, and behaviors without judgment and with compassion.

Prior to class, I had blessed the room with Reiki and placed a selection of artistic photograph cards (spring landscapes*) along the window sills.  Group members were invited to select a card that could “ . . . hold the Role of the Witness for you throughout today’s workshop.  Share the card and reasons for choosing the card with one other person in the room whom you do not know.”  Then, cards were placed somewhere in the room where each card could “hold the role of the Inner Witness” for the time of the workshop.

Then, returning to our circular seating arrangement, class members were instructed to look in their folder for a copy of a poem which I selected related to the theme.  After reading, members shared verbally which lines of the poem resonated with them.

Following this, was the teaching of basic yoga principles specifically as they apply to issues around making peace with food and the body and developing “the Self-Care Role”.  Topics included “Yamas” of non-harm to self and others; truthfulness to self and others; being authentic; discerning the difference between needs and wants; moderation; and releasing attachments to outcomes.  Next, the “Niyamas” for cultivating a healthy inner life:  external and internal purity; “the body is a temple of the spirit”; practice of contentment and maintaining equanimity—responding to life with love and faith, not from fear; cultivating passion for health rather than obsession with weight or appearance; practice of self-observation (i.e. Inner Witness Role) by taking time to pause and breathe to understand one’s reactions and triggers; and the practice of surrender.

Next, ways of incorporating these into life were explored, beginning with the breath and the experience of noticing one’s breath mindfully followed by yoga breathing.  Following this was meditation on and off the mat, both with movement and in stillness.  And following was brief teaching about the power of positive affirmations; journaling; the necessity of movement balanced with stillness; getting support and practicing gratitude.

All teaching points were covered in handouts including the research supported benefits of Hatha Yoga such as the elevation of serotonin, helping alleviate depression, ADHD, anxiety and yoga’s multiple physiological benefits.

The class drew to a close with members each returning to the space where “the witness card” had been placed.  “Take the role of your witness and look at ‘yourself’ (envisioned on the mat or bolster where they had been seated) and in a few sentences from the Witness Role, tell yourself what you observed and the ‘take home’ message from the workshop.”  After each participant did this, the circle re-formed and each person stated his/her name with a hand on heart re-affirming the pledge of confidentiality and self-care.  For closing, the word and gesture, “NAMASTE” which is a slight bow, hands held in “prayer pose” by the heart, meaning “The Light in me honors the Light in you.”

The workshop feedback forms showed a consensus of the group members’ experiences as:

. . . inclusive, thoughtful, gentle, non-judgmental . . . loved the learning and the helpful reminder of how to incorporate yoga into my recovery . . .

*Thanks to Landscape photographer and poet Alma Nugent for providing these.

For more information or to buy Healing Eating Disorders with Psychodrama and Other Action Methods, please visit our website.

Psychodrama and constellation work remind us of the value of groups

By Karen Carnabucci, licensed clinical social worker, practitioner of psychodrama, sociometry and group psychotherapy, and author of Integrating Psychodrama and Systemic Constellation Work.


Both psychodrama and systemic constellation work happen in groups – which brings new emphasis to the function and value of groups.

So much of today’s psychotherapy happens in individual sessions that we can easily forget about the magnificence of groups and their enormous possibilities of healing. We like that the new constellation work reminds us of the value of groups, along with psychodrama, which has championed groups for decades.

Let’s look at the status of groups today and how psychodrama and constellation work look at groups:

Most recently today’s groups are often volunteer support vehicles for people fighting addiction, like 12-step programs, or supports for the more chronically mentally ill and their families. There are an endless amount of voluntary groups for a host of people facing particular mental or physical problems and illnesses – people who need others they can identify with and exchange with, and get support from.

There are still professional talk group therapies, but they are difficult to find and often viewed as socialization or re-socialization mechanisms to supplement individual psychotherapy. They are generally designed for people needing help with social skills, to get feedback from others on how they come across, as well as training in effective reciprocal exchanges. These groups also are seen as adjuncts to individual psychotherapy. Talk group work is certainly not considered the meat and potatoes of professional therapy help. The decisive move toward making an internal change and achieve self-betterment is still seen as primarily to be accomplished in individual psychotherapy

In contrast with talk therapy groups, experiential group psychotherapy is seen as the gold standard of experiential work, with individual therapy the supplement. Here is the most potential for therapeutic change, and where the difference can be experienced first hand, in contrast with individual therapy.

It is always the “experience” that makes the difference for a experiential therapist, and that experience comes best in the context of group, the cradle of a client’s history, the place where his or her socialization began.

J.L. Moreno, the originator of psychodrama, and Bert Hellinger, the originator of systemic constellation work, extol that the possibilities for therapeutic change are their greatest in experiential group psychotherapy. Although both methods have now been adapted to individuals, couples and families, it is still best to understand the exploration of clients’ issues and process in terms of the original group work before adaptations to other settings.

Whatever the applications, they are still seen as most potent in the group context with great effectiveness for their members However, there is one the major difference between group experiences. Historically, psychodrama has been seen as a group therapy and as a living laboratory for human relationships. Its group process springs out of dynamics among participants and the common relationship connections that we call sociometry. Each session’s focus usually explores one person’s situation, as one after another emerges from the group as the “protagonist,” the one who best reflects the central concern for the group at any given time. The protagonist, then, does his or her work not on their own behalf but as a result of the dynamics of the group.

Constellation work is not based on what is happening with the group’s members. Rather, the group is the arena for participants to present individual issues, with bonding among participants as secondary. Connection is not based on identification with others’ experiences or reciprocal sharing but rather on, assisting others and being assisted by others in the search for answers. We might even say that systemic constellation work is not really a group therapy but rather a therapeutic group experience.

Participants in a systemic constellation group often feel a warm bond with each other, but the bond is based on collaboration with the mutual task at hand. The goal is not really improved relationships with significant others in one’s life or even others within the group. The goal is to help each other figure out what lies beneath the dynamics of each one’s family system, in each person’s intergenerational history, exploring what may have gone wrong, when, and then in learning how to go about healing it.

Copyright © Jessica Kingsley Publishers 2012.

Compassionate care through touch – An interview with Niamh van Meines


Niamh van Meines
is a nurse practitioner, currently self employed as a nurse consultant. She is also a licensed massage therapist, and a skilled clinical leader and educator in oncology, homecare, hospice and palliative care. Together with Barbara Goldschmidt, she has written the new book, Comforting Touch in Dementia and End of Life Care: Take My Hand, published by JKP imprint Singing Dragon.

Here, Niamh explains why touch is so essential to care.


Can you tell us a bit about the paths that led you to massage therapy, and to its applications in integrative health and palliative care?

I was a homecare nurse and wanted to offer therapy that would be comforting to my patients in ways that nursing did not routinely provide care. While massage therapy is within the scope of practice for nurses, I did not feel prepared to perform massage effectively, especially with patients who had chronic and terminal illness. I decided to go to the Swedish Institute of Massage Therapy and my interest in incorporating massage into nursing practice came from there. There are multiple studies that show the beneficial effect of massage therapy on the symptoms associated with disease, so I believe massage can be utilized as a symptom management technique. This is very useful in palliative and hospice care where multiple therapies, treatments and modalities are used to alleviate the distress that patients experience.

How did the new book come about, and what is it about, generally?

Barbara asked me to join her in writing this book as she had developed the hand massage protocol and implemented it in a nursing home. My expertise in hospice and palliative care and perspective on providing comfort for patients through multiple avenues resulted in a wonderful collaboration with this book. We both had an interest in providing ways for caregivers to help and to feel that their efforts are effective in providing comfort, so teaching hand massage to caregivers is a great opportunity to change not only the patient’s experience, but also the caregiver’s experience too.

How does the book reflect your general philosophy about care?

I believe that caring for any person who is ill begins with compassion which can be delivered in many ways. Touch is one of the most fundamental ways to offer support and caring and is often underestimated or disregarded in healthcare settings. Touch is often mechanistic and task oriented, so teaching healthcare practitioners to incorporate hand massage redirects their actions to that of a caring activity, which also has an affect on their perspective on helping to “heal”. A hand massage is a wonderful, easy introduction to using touch. From a caregiver’s perspective, they often feel disconnected from the person who is ill or weary of touching them, so it’s a wonderful way to approach the ill person and provide care in a manner that is satisfying to the ill person and to the caregiver, and safe. The hands are the most logical place to start as it often is the first place that we touch when communicating with and meeting people for the first time.

What are the benefits of touch as a way of connecting with people, as opposed to other methods of communication?

Touch can convey so many things that other forms of communication do not. Touch can be directed in many ways. It can have a calming effect or a stimulating effect that can be tailored to the goals of the touch experience. The hands are one of the easiest ways to approach someone; merely by shaking hands, you can have a dramatic effect. Touch can be more powerful than other forms of communication especially when someone is sick. Touch directed in a caring way can have more meaning than words, which makes it a useful tool when teaching caregivers to express through touch what they cannot often express through words.

What are some common obstacles people encounter when trying to use hand massage?

Caregivers often feel inadequate or unprepared to do massage. They have fears of being awkward or ineffective. They are not sure if they are doing it right. The beauty though, is that any touch whether awkward or not, can positively influence the giver and receiver. People often have difficulty slowing down and paying attention to energetic influences. This also comes with practice, so people need encouragement to keep practicing and over time, how they feel about the massage will change.

How can the book help caregivers overcome this and other obstacles?

This book touches on many areas that most people do not think about, especially from an energetic perspective and from an eastern approach to touch. It teaches people about the simplicity of touch and how it can have a dramatic effect. We hope that the framework in the hand massage protocol allows people to take the first step towards incorporating massage into their everyday caregiving.

This book can be used as a guide to doing a hand massage protocol. We encourage caregivers to have the book with them when doing massage, so that they can reference the steps and view the illustrations. It can also be used as a teaching tool in a classroom setting.

What are some examples of best practice?

Best practices always put the receiver’s needs first. Safety and comfort are a priority, so the giver must ensure the receiver is not suffering or in distress before performing massage. We also encourage caregivers to discuss the use of massage with the healthcare team to obtain permission, but also to find out if there are cautions and contraindications to massage. Because the receivers often have significant illness, it’s always best to err on the side of caution and pay attention to the receivers reaction to massage. This is truly a client-centered approach. And lastly, don’t take it too seriously. Massage should be light-hearted and friendly, an experience to be enjoyed not just by the receiver, but by the giver too.

Next blog post: Encountering the Radiant Sea – An Article by Barbara Goldschmidt »

Copyright © Jessica Kingsley Publishers 2011.

Touch as a way to share the radiant energy of care

By Barbara Goldschmidt, teacher, researcher, licensed massage therapist, and co-author with Niamh van Meines of Comforting Touch in Dementia and End of Life Care: Take My Hand.


My passion for integrative health care began 30 years ago, when I travelled to California to recuperate from a car accident. I was a seeker, looking for solace and a new path. Southern California offered warmth, reasonable rents, and ways of living that seemed open to many possibilities. It was commonplace there to focus on fitness, and easy to find gyms, yoga teachers, health food stores, and book shops filled with Eastern philosophy and self-help. Then there was the Pacific Ocean, like a big glittering mirror, reflecting who you were and at the same time inviting you to look deeper.

This was all very different from life in New York City at the time, where a focus on fitness was not so commonplace. In fact, friends on the East Coast often looked down on some of these pursuits. They’d ask, ‘Why is California like a breakfast cereal?’ Answer: Because it’s full of fruits, flakes and nuts! Maybe they thought it was foolish, but I felt I was finally becoming sensible.

During my seven years in Los Angles I completed my bachelor’s degree at UCLA, but my most meaningful studies were outside of traditional academia. I explored ‘alternative’ therapies, as they were called back then, because they were not part of the mainstream. Fortunately, I found reliable teachers who were masters in their field. I practiced yoga every day in Bikram Choudhury’s classes. Thanks to Jack Gray, whose energy work was studied by Dr. Thelma Moss at UCLA’s Parapsychology Lab, I learned how to direct my thoughts to help the healing process and to use my hands to do what Mr. Gray called ‘transfer of energy’. Dr. Grace Brunler demonstrated how she had used color light in her medical practice with her husband Oscar Brunler. With Jon Hofferman, a grad student from the UCLA film department, we made a short documentary about her work.

It was an exciting time, because it felt like a real movement in personal well-being was taking place. It wasn’t being led by doctors, but by ordinary people who were looking for more than symptom relief. They wanted therapies that were natural and non-toxic, and a way to be involved in the healing process. That was a key—becoming an active participant in wellness and illness instead of being a passive recipient of care. The quest for ways to be involved in the healing process, and for tangible ways to share it, became the continuing thread of my studies, writing and teaching.

When I moved back to New York City I wondered if I would be able to maintain the gentle practices I’d learned. As it turned out, I discovered deeper and more specific ways of practicing. With Catherine Shainberg, director of the School of Images, I studied body-centered imagery for many years. Dr. Shainberg doesn’t give answers, but leads students to the answers within themselves. My sessions with her led me to study massage therapy at the Swedish Institute, a college of health sciences in Manhattan. This allowed me to go from just writing about this field to becoming a practitioner.

After working for a few years as a licensed massage therapist, a desire for a more effective ways to engage with the body led me to Jeffrey C. Yuen and the study of Chinese medicine. I began to understand that energy, or Qi, infuses all of life, and that it is fundamental. Qi is our energetic program; it creates the body and directs our growth, development and everyday processes, including healing.

While I appreciate that there exists some controversy around the idea of Qi—it has no standard definition, it’s not readily visible, and can’t be quantified—I embrace its usefulness as teachers and practitioners have done through the ages. Directing Qi through the use of meridian points became the foundation of my practice, which often included teaching people to move their Qi from within through imagery.

Today, ‘alternative’ therapies are not just for Californians and even in New York City there are plenty of gyms, as well as stores selling organic food. Yoga, massage, meditation and acupuncture are now part of an integrative approach to cancer care, palliative care or chronic conditions in medical institutions around the world.

Comforting Touch for Dementia and End of Life Care: Take My Hand, is an integrative approach that will hopefully inspire people to explore touch as a way to share the radiant energy of their care. I was fortunate to have as co-author Niamh van Meines, who brought in her expertise and passion as a massage therapist and nurse practitioner working in hospice and palliative care. In the book, we introduce people to the idea that their touch involves the physical aspects of skin, muscles and bone; the energies of warmth, electromagnetism and Qi; and the inner quality, or spirit, which they bring to it. All will have beneficial effects for both the giver as well as the receiver. And in the spirit of integrative care, we encourage caregivers to become part of a team—whether with a doctor, nurse, social worker, psychologist, massage therapist, acupuncturist or pastoral advisor—so they will not feel alone, inhibited by initial awkwardness, or unnecessarily fearful.

I was happy when our book proposal was accepted by Jessica Kingsley Publishers, because they are so dedicated to the healing arts and to books that people can use to help one another. When Lisa Clark, our sponsoring editor, told us we would be part of the Singing Dragon imprint, it seemed especially fitting, because the energy of nature and the Eastern philosophy that teaches ways to engage with it have been a big part of my life. I hope that this book will be useful for the many people caring for someone with dementia or at the end of life, and that it will provide a meaningful way to discover both a tenderness and a power that we all have in common.

Next blog post: Compassionate care through touch – An interview with Niamh van Meines »

Copyright © Jessica Kingsley Publishers 2011.

Integrating Psychodrama and Systemic Constellation Work – An Interview with Karen Carnabucci

Karen Carnabucci, MSS, LCSW, LISW-S, TEP, is a licensed clinical social worker and board-certified trainer, educator and practitioner of psychodrama, sociometry and group psychotherapy. She has trained with Zerka T. Moreno, J.L. Moreno’s widow and collaborator in psychodrama, and Heinz Stark, a leading trainer in systemic constellation work. Her private practice in psychotherapy and teaching is based in Racine, Wisconsin, USA.

Karen and her colleague, the late Ronald Anderson, MDiv, LPC, TEP, are the authors of the new book, Integrating Psychodrama and Systemic Constellation Work: New Directions for Action Methods, Mind-Body Therapies and Energy Healing.

Here, Karen discusses the profound impact that using psychodrama and systemic constellation work together can have for clients struggling with emotional pain.


Why do psychodrama and systemic constellation work complement each other so well?

Psychodrama and systemic constellation work – sometimes called family constellation work – look very similar yet have some specific differences. Psychodrama explores the conscious story that we tell ourselves about what has happened in our lives or what we wish would have happened. Constellation work goes deeper, delving into the distorted unconscious energies in the family system and allows love to flow more fully through the system.

Because we may have various levels of consciousness about various parts of our lives and the lives of our family members, it’s helpful to be able to choose different methods for different situations.

Can you describe a particular case in which this integrative approach was especially effective and led to outcomes that would not have been possible using either approach alone?

We have so many examples in the book of how the meshing of these methods can offer so much to clients.

We briefly share the vignette of Louise in chapter 4: “Assessment: An Adventure into the Being of the Person”. Louise initially clung to her identification as a victim and had a very hard time admitting that her alcoholic mother’s family background may have been difficult. What we do not say in the book is that Louise slowly grew to have a more complex understanding of her mother’s emotional pain with the use of role reversal, which is a psychodramatic technique. As she was able to shift from her role of victim, she was able to become more compassionate about her mother’s troubles. She became more curious about her mother’s life and began to wonder what had happened in the larger family system. The new roles of “compassionate one” and “curious one” finally led her to participate in a constellation session where it was revealed that her mother suffered some kind of severe childhood trauma. She watched her mother’s representative tremble and weep and found respect for her mother’s suffering within her. As she acknowledged the mother’s suffering, she felt a genuine love for her mother and now thanks her for the gift of life.

How did you and Ron come to write this book?

Our decision to write a book was very spontaneous. Ron had just received the Innovator’s Award from the American Society of Group Psychotherapy and Psychodrama at its 2010 conference due to his pioneering work in integrating the two methods. As we passed Ron’s plaque around our table to admire, he and I realized that although a number of psychodramatists were beginning to combine the two methods, we were the only psychodramatists we knew who had actually written about the integration of these two methods in our training group handouts, articles and blogs. I suggested that we write a book that would introduce psychodrama to constellation facilitators and constellation work to psychodramatists. Ron agreed, and we began writing the book.

Experiential psychotherapy is truly the psychotherapy of the 21st century. Cutting-edge research tells us that our brain is constantly changing as we have new experiences. Certain experiences have changed the brain in ways that involve distress and pain. However, the experiential therapist can facilitate new experiences for the person that continue to change the brain – this time not for distress but for healing.

Experiential therapy recognizes our wholeness as human beings. This wholeness is not just a concept or a theory; it means actually working with – and working through – our experiences, which encompasses our thoughts, feelings, sensations, energies, and conscious and unconscious knowings. So, with experiential therapy we are working with the whole person, not just a part of the person.

This is the first book to discuss and compare these two experiential methods that are growing around the world.

How does the book reflect your general philosophy?

I believe that the experiential psychotherapy is a psychotherapy that is more complete, more holistic, than traditional talk therapy. It is the experience that makes the shift within the person – the knowledge and insight can be important but it is often not enough to instill permanent changes within the person.

What are some common obstacles that practitioners in this field have when trying to apply this particular intervention or approach?

Many constellation facilitators are misinformed about psychodrama, if they even know of it. They often think of psychodrama as simple role playing, although role playing is just one part of the method, which involves a complex theory of human development as well as the practice of sociometry, which observes how people connect with each other in groups. Psychodramatists may have difficulty in understanding that we can discover wisdom within ourselves simply by listening to the nuances of our moment-to-moment body experience – without the drama and the theater-type activities – that helps others.

As more practitioners in one field learn more about the theory, practice and applications of the other field, all of us will have more tools to work with people who are struggling with painful situations. And, of course, I endorse and encourage training in both modalities so that people are using these powerful methods in ethical ways.

Copyright © Jessica Kingsley Publishers 2011.

How to Incorporate Wellness Coaching into Your Therapeutic Practice – An Interview with author Laurel Alexander

Laurel Alexander is a complementary therapist, coach, trainer and widely published author with over 20 years of experience in the wellness industry. She runs Wellness Professionals at Work, providing business coaching for healthcare professionals and a range of accredited wellness courses. She is a qualified reflexologist, nutritionist and stress manager and is currently the business coach for the Association of Reflexologists, the International Stress Management Association and the National Council of Psychotherapists. She is based in Sussex, UK.

Here, Laurel answers some questions about her new book,
How to Incorporate Wellness Coaching into Your Therapeutic Practice: A Handbook for Therapists and Counsellors – published by JKP imprint, Singing Dragon.


How did you come to the field of wellness?

When I left school, I wanted to be a nurse (that was either my mother’s fantasy or mine). With the contrariness of teenage years, I became a window dresser in a fashion shop instead. Over the following years, I developed an interest in self development and this became my working life. The next few years saw added work with career management and a fading link with self development. At 39, I was diagnosed with breast cancer and this reconnected me to my intuition and passion for wellness. For the past 13 years, I’ve worked solely in the area of wellness; writing, teaching and as a therapist/coach.

What experience(s) motivated you to write the book?

Much of my working life as been as a wellness professional. Many moons ago, my students suggested I added the teaching of life coaching to my courses which I did. Over time, this has evolved into teaching of wellness coaching. Writing of course is another way of teaching – so here I am today.

The book is designed to be used as building blocks in terms of underpinning knowledge and skills development. Therapists can take ideas from the book and develop themselves both personally and professionally.

I would hope therapists would take away information, ideas and inspiration for their own wellbeing and that of their patients and clients.

What are the key characteristics of wellness coaching that make it a useful addition to a counsellor or complementary therapist’s toolbox?

As healthcare professionals move into the 21st century, coaching offers a highly effective skill set which can complement a therapist’s practice. Key characteristics include:

  • being non-directive (thereby empowering clients);
  • questioning and listening skills (useful to gain information so that we are better informed);
  • integration of coaching skills into a variety of therapeutic approaches (offering an eclectic toolbox approach to healthcare)

Let’s not forget we are in the “business of healthcare”. We may come to wellness as a vocational calling. We may feel motivated and inspired to work with others in a healing capacity for the highest good. However, we are business people and if we are to stay in business, we need a range of transferable skills which are marketable and useful. Coaching is one of those key skills.

Can you describe a typical client who would benefit from wellness coaching techniques, or a particular case in which the use of these techniques has proved effective?

The best of scenarios with a wellness client is someone who is pro-active in their healthcare, who is a seeker of self knowledge and who is willing to embrace all possibilities.

How does the book reflect your general philosophy about wellness?

My philosophy about wellness is multi-faceted. There is rarely one route into, and out of, wellness. There are often several contributing factors including lifestyle and mindset. We also need to bear in mind that wellness may not mean “no disease” or “less pain”. It may mean pathways of acceptance or transition.

Copyright © Jessica Kingsley Publishers 2011.