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RUTH: a case study on ME Part 3: How 'a dial on your back' can reduce pain

I've been writing recently about Ruth; a young client with ME whose case study I anonymised for a book by Dr Grahame Browne. As part of the Human Givens series it mainly focused on demonstrating HG principals around pain issues in particular.


 As I mentioned in my last newsletter I had, in reality, by this time already integrated other models into my working practice and developed a systemised approach that made my work so much more efficient. Because the system freed up head space, it allowed me to be really creative and tailor very bespoke interventions for each client session in terms of directed focus, imagery, storytelling and linguistics.


In also integrating holistic life coaching into the model I had, without realising it, connected the two previously separate worlds of coaching and counselling.


The new model had seamlessly and safety crossed the bridge. Turned out it would be two-way traffic with counsellors easily able to integrate advanced coaching techniques and coaches having access to an ethical lens through which to view the mental health of their coaching clients.


I remember Ruth so well. I'm lucky to have a really good memory but some clients stand out more than others. Ruth at that time was the same age as my own daughter and I was struck by their different lifestyles; my daughter so full of energy and carefree and Ruth, so tired and depressed.


By the time I saw Ruth I was in the habit of using the five session system, but for Ruth, I slowed things down in recognition I would have to pace her longer to establish rapport, gain her trust and restore hope of a better future.


By session 3, she was feeling so much better. The breathing technique was working its magic and she looked better, moved differently and dressed differently. Because I use the *continuum of wellbeing assessment every session I could see quite clearly her subjective experience was so much more positive. Working in this way feels so rewarding because results happen fast.


Here's more of the case study I wrote up for Dr Browne.


*The continuum of wellbeing is an assessment unique to the Fusion Model that connects unmet needs to subjective wellbeing


 RUTH: PART 3


By session 3, Ruth stated she was sleeping better, not waking in the night, not crying and felt more positive that she would recover from ME.


 I asked Ruth the magic question to engage her imagination and help her out of negative expectation. The magic question is framed as:


 ‘If you woke up tomorrow and just knew that something had magically changed over night and you felt better, what would you notice?


Ruth said she would notice feeling energised after a good night’s sleep. She would want to get up for school; she would walk there and not go in a taxi. She would be able to be in class and tolerate the noise and activity. She would have lunch with her friends and be looking forward to going out at the weekend with them. She would just feel like the real Ruth again!


 Ruth was a talented visualiser, and so we were able to do some very interesting work in guided visualisation that was to have a profound impact on her pain management.


Once she had relaxed very deeply, I suggested that she imagine she had a dial on her back, like the dimmer switch of a light and that she could use that dial to reduce the back pain to a level that was more comfortable for her whenever she needed to. I suggested that she might like to try this exercise every hour for a day or two, noticing that she could get better and better at it and the results could be more effective as she practised.


 Ruth felt well enough to go on a school trip to London but, on her return, was again very tired and felt she had taken a step back.


 ‘A lapse is not a relapse’ I told Ruth. 'It is not uncommon to feel you are taking two steps forward and one step back. We should build that into the model of your recovery.’


At session 4, we started to focus on the future, identifying goals like going to college and being independent.


 Ruth now said she wanted to get back to dancing again, which she had missed so much.


Between us, we constructed a paced exercise programme which involved daily ballet and tap routines which could be done at home. Ruth didn’t even know where her dance shoes were anymore. They had been put away, along with her identity, somewhere near the outset of her illness as she became ‘Ruth with ME’ rather than ‘Ruth who loves to dance’.


It is essential to dis-identify the illness from the person. We worked on who the real Ruth is. The one she was before she got ill; all those old hobbies and interests and activities that had got lost along the way.


In starting to dance again, Ruth was reconnecting with her old self. It represented her hope for the future and a life without pain.


Also, inactivity itself impacts fitness levels and so gentle and paced exercise would begin to strengthen all those tired and aching muscles.


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