Therapy
Interventions in focus
Never underestimate the impact of the therapeutic relationship
How had I gone from spinning around Blackpool’s legendary Ballroom, to desperately clinging on to my hospital bed because the room was spinning around me?
I am Danyelle Clarke, a 35-year-old Traumatic Brain Injury survivor. Four years ago, I was involved in a horrific road traffic accident, where a lorry overturned our car, dragging it along on top of the crash barrier, before projecting it in to oncoming traffic. I was the front seat passenger (thankfully wearing my seat belt) ending up unconscious and trapped hanging upside down in the car. I have no memory of the actual accident, only the conversation with my Mam moments before, where we were chatting away excitedly about the ‘girlie day’ that lay ahead of us.
Six weeks later I woke up in hospital having been in a coma, to the most horrifying experience of my life! I was completely paralysed down the right side of my body, with limited movement in the left side. I was unable to hold my head up, or retain my tongue in my mouth. I couldn’t speak and had blurred and double vision. I was however aware of my family and the people around me, and I knew I was in hospital. I was trapped inside my broken body, unable to communicate, absolutely petrified and isolated. I just couldn’t understand how or why I was in this state.
Prior to the accident I was a professional Latin dancer, regularly competing in national and international competitions. I was a dance and fitness instructor and was also in the final stages of completing an English master’s degree. A far cry from the position I now found myself in!
And so the long and complex recovery journey began.
“How long does it take for these
pain killers to work, and this
awful stabbing in my stomach and
back to subside?”
I’m laid in my hospital side room looking out on to the car park, willing my parents to come. The door bursts open and I look round hopefully, expecting to see them, but in come two physios. “Come on Danyelle, let's have you up and sat on the side of the bed” one of them says.
I tell them that I'm in a lot of pain today, to which the other one barks “Look you’ll be in pain whether you do this or just lay there, so you might as well do physio and be in pain!” They spin me round and position me on the side of the bed. The room is spinning, everything is blurred, and I feel sick. Panic sets in, I think I’m falling, I’m so dizzy.
By this time I’m crying, and desperately trying to tell them that I’m going to vomit. They lay me back down, and a sharp irritated voice snaps “well we tried!” I’ve never felt so vulnerable! The door opened again, thankfully this time it is my Mam and Dad, they heard the commotion and came in to see what was happening. In a much nicer tone of voice the second physio informed them “Danyelle’s refusing to do physio, she said she’s in too much pain. We’ll come back tomorrow...”
…WOW – COMPASSION AT ITS FINEST! Can’t wait for tomorrow!
This is a prime example of how a poor therapeutic relationship fails both the
patient and the clinician. The foundation for a good therapeutic relationship can be as simple as getting to know your patient. Whilst this may seem like an idealistic approach in such a fast paced, time restrictive environment, spending those extra few minutes learning about the person, could be of significant benefit in the future.
Had the two physios’ treating me, actually known anything about me – the fact that I am a strong willed, determined person, with a disciplined sporting background, they might have taken my comments more seriously. If they had listened to me, they would have realised that I had a real problem. Instead, they underestimated me, wrongly assuming that I was making excuses not to engage in physio. Therefore, a very clear vestibular disorder went undiagnosed and untreated for several weeks and left me spinning.
Situations like this can be avoided simply by approaching every patient with an open mind. Assumptions are effectively ear plugs they can often lead to miscommunication between the clinician and patient. Knowing someone’s
clinical condition or diagnosis, is only part of the picture. Knowledge of the persons background, personality, intellect, awareness, capability, emotional state etc, are also major factors. Key information of this nature can be gained by connecting with and listening to the patient, whilst also talking to the family or carer, particularly if the patient is unable to articulate well, or at all.
Making assumptions, no matter how well intended, often leads to underestimation. The patient may become demoralised and disengaged. Therefore, they are less receptive to the treatment or therapy that is intended to help them, resulting in missed opportunities. I experienced this first hand in one of my appointments in hospital, when my therapist presented me with a pre-school jigsaw puzzle.
I noticed on the box it was recommended for age 3+. She then told me “I know you like dogs, so here’s a ‘Hello Kitty’ puzzle”.
I was acutely aware that in a matter of weeks I had gone from sitting at a desk in the University library, researching ‘the evolution of romance literature from a feminist perspective’, to sitting at a desk in a wheelchair in hospital, doing an infant's jigsaw. And ‘APPARENTLY’ I could no longer tell the difference between a cat and a dog!!! This completely shattered my already diminished self-confidence, making me question my own intellect, and how I was actually being perceived by others. I just wanted to go back to the ward, get back in to bed and hide from the world. A world in which I’d previously held a valuable role, compared to this inferior being – with the suggested intellect of a 3 year old. Where do I fit in this world now?
Assumptions can and do create metaphorical barriers!
Connecting with the patient and showing genuine empathy will enable them to express their; fears, concerns, worries, hopes, wishes etc. By respecting the patients feelings you will build trust, and potentially break down any barriers that have inadvertently arisen. Therefore, emotional and psychological
issues can be addressed before they have a negative impact.
Person specific treatment and therapy can be far more productive than a generic ‘ticking boxes’ approach, as my recent experience with my current therapists has proved. They have taken the time to get to know, and connect
with me on a personal level, and don’t just view me as a series of problems that need to be worked on.
They are aware of my strong dance connection and use dance analogies as a therapy tool, i.e., my physiotherapist and occupational therapist ask me to liken physical movements to specific dance moves, they then adopt the dance terminology and use it in relation to the tasks they are asking of me. They often play competitive dance music during my sessions, which I find emotive and inspiring. Obviously this is a very personal adaptation to therapy which has been tailored around me. Someone else with a similar background, in this situation may not find this helpful at all, and may even find it distressing to ‘tap in to’ the dance theme. Which is why patient led treatment and therapy, using the right approach at the appropriate time, is absolutely crucial!
Throughout my ongoing recovery journey, I have experienced some very dark days. Fortunately, I now have an exceptional team of therapists, who all excel in their own specific field. The one thing they all have in common is, they appreciate the importance of a good therapeutic relationship, and have taken the time to develop this. I feel confident that my therapists know me ‘Danyelle, the person’. Which is why they are able to offer me support and ‘pick me up, dust me off, and put me back on track’ when I’m struggling. It is thanks to their knowledge and caring approach that I have been able to make the progress that I have so far, and hopefully will continue to do so.
Any clinician working in the field of neurology knows that all brain injuries are different! All recoveries are different! Therefore, they should be mindful that, all patients are also different!
With insight in to the patient's personality, background and history, the clinician has a clearer understanding of who, rather than what they are dealing with. Meaning they are ‘treating the person’ as apposed to ‘treating the condition’.
Contact Danyelle at danyellesrecovering@gmail.com
63-year-old former judo instructor who was told he may never walk again after suffering life-changing aneurysm is now well on track to achieving his dream of living independently again
A man who was left with no movement in his left leg and limited movement in his right following a life-changing aneurysm, is well on track to independent living after he was told by doctors that he may never walk again following surgery — a rehabilitation journey that has tested his physical and mental guise to the limit.
Brian Walker, a 63-year-old former heating engineer from Norfolk suffered an abdominal aortic aneurysm in November 2021 which caused immense swelling in both legs and admitted him to theatre for emergency surgery. As a former Judo instructor, Brian was used to pushing his body to the limit, yet a year ago, his life was turned upside down.
The first step was to get Brian back on his feet again and against all odds, and thanks to the specialist rehabilitation services of Askham Rehab, he was able to stand with the support of a frame within just a matter of months.
Brian arrived at Askham in February 2022 with a sense of determination that matched that of his care team to overcome the seemingly impossible task of regaining his ability to live independently. Through a combination of specialist physiotherapy, hydrotherapy and mental health support, Brian started making progress far sooner than anyone anticipated.
One of the biggest hurdles in Brian’s journey was the anxiety induced by his situation — which was only heightened due to family bereavement at the time. Despite this, he never lost hope and thanks to the specialist mental health services available, he was able to persevere and see that there was light at the end of the tunnel.
Soon after his aneurysm, Biran was unable to carry out the simplest of domestic tasks and relied heavily on a hoist to help him. Thanks to the specialist rehabilitation he received, he
was soon able to cook, garden and move
around independently with the assistance of a walking frame — something that symbolised a changing of the tide in his journey to recovery. With a strict rehabilitation structure and the encouragement to act independently, Brian and his care team are now confident he will soon be able to live independently.
Commenting on his journey, Brian said: “I didn’t know which way to turn when I was met with the news that I might never walk again. There is nothing more alarming than the prospect of not being able to be independent and I think that's what has motivated me on this journey. I have always been a resilient character, yet this has been the biggest challenge of my life. Mentally, it has been exhausting and I have been met with an immense amount of anxiety. I feel like this is something that is often forgotten about in rehabilitation, yet the effect it has on your emotional wellbeing is massive. Thankfully, Askham has built its services around me, and the mental health support
has been just as valuable as the physical treatment I have received.”
Throughout his time at Askham, Brian engaged with advanced robotics including the Omego lower limb trainer for strength and endurance. He also took part in gait re-education through hydrotherapy and parallel bars — as well as plinth strengthening with weights and resistance bands.
Askham Village is a family-run community with a rehabilitation service that has transformed the lives of many individuals, and its remote setting and person-centred approach is the perfect
place to approach any personal challenge — big or small. With the latest robotic equipment and state-of-the-art gym and hydrotherapy equipment, it is leading the way in the local area for rehabilitation services — which, in Brian’s case, have restored his hopes of independence.
Sara Neaves, Clinical Lead and Outpatients Service Manager at Askham Rehab, said: “When Brian first came to us in February, it was clear he was a determined and quick-witted man. Our relationship with him has blossomed and he has thrown himself wholeheartedly into his treatments. This has been evidenced by the immense progress he has made, which has far surpassed the expectations of us, the clinicians involved in his case and Brian himself. He is an absolute pleasure to be around and has integrated into the Askham community effortlessly. Community is what it's all about here and there is a sense of togetherness for every case that comes through our doors.
When you suffer a life changing condition or injury, it is easy to lose hope, and this is one thing Brian never did.”
Commenting on his care team at Askham, Brian said: “My carers have been amazing with me, and nothing has been too much trouble.
They have kept me motivated since the day I arrived, and I am truly grateful for this. We have such a good laugh and growing up in a rugby environment, I didn’t think they would be able to keep up with my humour — but how I was wrong!”
Sara continued: “He is now walking independently and engaging in everyday domestic activities. We are in no doubt that Brian will achieve his dream of living independently and to be part of his journey is a real privilege.”
For more information on Askham Rehab, please visit https://askhamrehab.com
Alternatively, to watch a video of Brian’s journey at Askham Rehab, visit
Askham is always welcoming new residents
and staff into its growing community. For further information, please contact 01354 740269
Chroma therapists
are adapting to
provide more
targeted support
to families
By Seren Grime, senior dramatherapist therapist and diversity lead, Chroma
Choosing a therapist is one of the most important parts of a therapy process. Children are more likely to open up to a therapist if they can identify with that therapist in some way.
Children are referred to therapy for a number of reasons, for example, behavioural issues. A child’s behaviour may be particularly volatile and the parent and child may struggle to understand each other at home and therefore struggle to connect. Often a child’s behaviour is actually a form of communication, which needs to be understood by the care-giver adults in their life.
Connection is important as it allows the child to feel safe and secure in their environment.
Identity is a common theme during therapy sessions with adopted children. More often than not, there is an identity struggle that needs to be addressed. This may be difficult for parents to discuss but Chroma therapists know it is important to be able to be open and talk about it as a family.
For example, in trans-racial adoption, a black child may struggle to identify with their white family. Having a black therapist could help the child better connect and improve therapy outcomes. Similarly, a transgender child may respond better to a therapist who is also transgender. The bottom line is, if the child can identify with the therapist sitting in front of them, they will be more comfortable to speak their mind.
Commonality is key because then the child can just ‘be’ with that person. This can be difficult for parents to admit but if families do not have these conversations, how can we understand each other and have an attachment?
Through data from the Adoption Support Fund freedom of information coupled with their own data capture of clients, Chroma recently discovered a high percentage of their adoption referrals were for white children aged between 0-16 years old. In addition, a recent internal survey of Chroma therapists revealed that their workforce was predominantly white females aged between 45-54 years.
As a company, they recognise there is work to do to become a diverse workforce, and have put new processes in place to help achieve that, so future clients and therapists from minority groups feel included.
Chroma’s referral team continue to make careful judgements taking into consideration new diversity information when matching therapists to families. The referral and clinical teams are supporting therapists to become more knowledgeable about diversity and the issues that can arise surrounding it.
The next step is to help support therapists to have difficult ‘diversity’ related conversations with the families because helping therapists to develop their practice and knowledge would ensure diversity is integral to their work.
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