Maggie McCarthy
Muscular relaxation reduces the effects on the body of stress and tension and, once relaxed, guided fantasy can help to create a more positive and confident state of mind for the Client. For those Clients who are experiencing long-term stress, it may be the case that their body seems to have become the enemy. Learning to relax helps them to accept their body again and to work with it, instead of against it.
Since Relaxation is a skill that can be learned, and can be improved upon, Clients will find it increasingly easy to enter into a relaxed state, and the more they practise the Relaxation Exercises, the easier this will become. Guided fantasy can aid relaxation and also help in changing behaviour. We can use images to lessen the stress and tension by creating the image that the desired change has already occurred. Such fantasy work has been successful in the treatment of cancer.
Learning to use guided fantasy to produce relaxation helps to strengthen the belief that Clients can use their minds to support their body. Relaxation Training and guided fantasy can enhance the immune system so that those Clients at risk from stress-related illness, and those already suffering from stress-related illness can alter the course of the disease or prevent the disease from occurring.
Guided fantasy works in inducing deeper relaxation because the mind and body react in much the same way to imaginary experiences as to real experiences, which is in fact why stress often builds up in the first place. We can use this same process to induce relaxation instead of stress. Thus we focus on awareness of internal states. This change in a Client's perspective entails a learning process that must include a new and healthier degree of self-awareness in the Client, and an acceptance of the possibility of change.
When practising Relaxation Training with Clients, you must ensure that you will be free from interruption, including interruptions from the telephone, as these can be very disturbing to the Client. You need not worry about external noise affecting the Client, just give them an instruction to ignore it. The room where you work needs to be warm; cold is the one thing that will interfere with a Client's ability to relax.
If possible, the Client should be lying down. However, sitting in a comfortable chair is permissible. The Trainer should sit fairly near to the Client. Tone of delivery should be fairly monotonous, as this helps to produce relaxation. Repetition of key words and phrases also helps to produce relaxation, as well as emphasising ideas of relaxation. Because it is almost certain that a Client's attention will drift, it is useful to include this in the Relaxation exercise, so that the Client will accept your suggestion that they can bring their attention easily back to the Exercise.
When working with individual Clients, the Trainer may match her own breathing with the Client's and gradually slow down her breathing and her delivery. The Client's breathing will begin to match the Trainer's and deeper relaxation will occur.
Pauses in the delivery are very important, as it is during these pauses that Clients drift deeper into relaxation. Quite long pauses should occur at points when you are asking Clients to imagine a place or situation. However, a new Client should be told that the Exercise is not over until you actually say so. It is anxiety-provoking for Clients if they are not sure whether or not a long pause is the end of the Exercise or not, and this interferes with their ability to relax.
Images of moving downward are very useful for deepening the relaxation, and I use images of going down a hill, going down steps and going down an escalator to this end. Some Clients, however will dislike some images, for example, lifts can be an unpopular image - possibly due to a fear of getting stuck in one.
Whether or not you have any physical contact with the Client will depend on your own 'style' as a trainer. (Though in a brief therapy such as Stress Management Training I would generally advise against it). However, once the Client has begun to relax, you should never touch them without warning, this, together with unexpected silence, can be disturbing to the Client.
Some Clients may suffer from jerking, muscle spasms and rapid blinking as they begin to let go of tension. They may feel strange, experience tingling, or go to sleep. If they do sleep, just wake them gently at the end of the Relaxation exercise. Holding on to tension is very tiring and Clients dropping off to sleep is not uncommon when working with stressed individuals.
Occasionally, Clients may feel in distress as they begin to relax. It may be possible to include what is happening in your script, but if not, just reassure the Client that these feelings are normal and will soon pass. Sometimes Clients will continue to feel sad after the Exercise, as relaxation may have loosened rigid control over a situation of past pain. In this instance Clients allow the feelings to occur because they are ready to let them go. Again, reassurance that the feeling will soon pass is necessary. On rare occasions Clients may suffer a strong emotional reaction as they relax. In this case, reassure the Client of your continued presence, and suggest they slowly discharge the distress within the Session without any attempts at further exploration, unless you are qualified to undertake such work. Sometimes it is useful to get a distressed Client to lie on their tummy for a short period, as this feels 'protected'. It may also be useful to do an awareness shifting exercise to bring a Client out of distress. For example, ask their name, age, address, favourite colour, song, film etc. in order to distance them from painful feelings.
Although a closeness can develop between the Trainer and the Client during Stress Management Training, transference and counter-transference are less likely to occur, with the co-operative effort that is necessary between Trainer and Client in this type of work, than in some therapies.
If you do undertake Guided Fantasy with Clients, it is worthwhile practising the style of your delivery. When Clients are taking an exercise away to practise at home, it is useful if you can manage to inject 'empathy' into your voice. Deep relaxation always involves some degree of regression, and clients need to feel supported. Another way of providing support is to use the word 'good' often in your delivery, as though you were praising the Client.
Some of the techniques presented in this Training are similar to techniques used in hypnotherapy. The main difference is in terms of the way we use Relaxation Training. Normally, the only suggestions we make to relaxed Clients are those relating to feelings of relaxation and self-confidence. Hypnotherapy has a much wider agenda, involving suggestion and regression therapy which would be inappropriate in Stress Management Training, and unethical for unqualified practitioners to use.