28. 促进放松

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28 Facilitating relaxation Some people who are very tense and anxious find that counselling alone does not sufficiently reduce their symptoms to enable them to feel comfortable. Sometimes it’s advisable to refer such people to a medical practitioner or psychiatrist for assessment so that appropriate medication can be prescribed if necessary7. However, for many people who suffer from tension and anxiety» considerable benefit can be achieved through the use of relaxation techniques. Before introducing a relaxation exercise it is important, as with all other interventions, to check out with the person whether or not this is an exercise in which they would like to participate. This might involve summarising the process so that the person is aware of what to expect. Most people find it easy to learn relaxation, enjoy relaxing and can be encouraged to use it regularly. However, there are a minority of people who find relaxation techniques quite threatening. Instead of becoming relaxed during a relaxation exercise, they experience increased tension and anxiety. For some, this can be severe. Be careful to give the people you seek to help permission to stop a relaxation exercise if they find it is stressful rather than relaxing. For such people it may be useful to explore the stressful experience, if this is not too threatening, because it may well be related to other stressful experiences in their present or past. Preferably, a room used for relaxation should be quiet and have subdued rather than glaring lighting. It should be protected, as far as possible, from external noises such as phones ringing and also from the intrusion of others. It is not helpful to have someone open a door and walk in while a person is trying to relax. There are many different ways of teaching relaxation. The following relaxation exercise is one that we use. If you wish to use it, read the following instructions to the person seeking help using a quiet, slow, monotonous tone of voice. Pause between each statement for a few seconds. RELAXATION EXERCISE Lie on the floor with your head on a cushion, your hands beside you and your legs straight. Move around until you feel comfortable. Close your eyes. You will probably enjoy this exercise and find it pleasurable, but if at any time you are feeling uncomfortable and want to stop, you may either cchoose to lie quietly and ignore my voice, or you may speak up and tell me that you want to discontinue the exercise. Notice where your body touches the floor. Move yourself so that you are more comfortable. Be aware of your whole body from head to toe and stretch any part of you that is uncomfortable. Let your body press down on the floor. Notice the floor pressing up on you. It's a good feeling. You are in contact with the ground and the ground is in contact with you. Notice your breathing. Allow yourself to breathe comfortably and naturally. [Long pause] We are going to go through a series of exercises during which you will relax various parts of your body, starting from the tips of your toes and finishing at the top of your head. For each set of muscles, I will suggest that you tighten those muscles while breathing in deeply, and then relax them as you breathe out. Whenever you remember, say to yourself the word 'relax' as you breathe out. In between relaxing each set of muscles, focus on your breathing again. Breathe naturally and say 'relax' silently to yourself as you breathe out each time. By doing this you will gradually become more relaxed. If any intruding thoughts come into your mind, don't worry, just return to focusing on your breathing again. Notice your breathing now. Each time you breathe out say 'relax' silently to yourself. [Observe the person's body, and notice their breathing. When they breathe out each time say the word relax’ quietly. Do this a few times so that the person remembers to do it themselves] Notice your body. If any parts of it are uncomfortable, stretch or move so that you are more comfortable. Focus on your breathing. When you are ready, I will ask you, as you breathe in, to take a slow, deep breath and as you do this to clench your toes tightly and tighten up the muscles in your feet. [Choose the time] Breathe in deeply and tighten up the muscles in your feet. Hold your breath and keep the muscles in your feet tight for a second or two. Breathe out heavily and release the tension in your feet. Continue breathing naturally and say 'relax' to yourself each time you breathe out. [ Wait for a while as the person continues to breathe naturally] Now tense your thigh and calf muscles as you breathe in deeply. Hold your breath and keep your muscles tense. Relax as you breathe out. Breathe naturally and feel relaxed. [Pause for a while] Tense the muscles in your buttocks as you breathe in deeply. Hold your breath and keep your muscles tensed. Now breathe out and relax.. Breathe naturally and notice a feeling of relaxation flowing up your body from your feet to your buttocks. [Pause for a while] Tense the muscles in your stomach as you breathe in deeply. Hold your breath. Relax. Notice your breathing. [Pause for a while] Clench your fists as you breathe in. Hold. Relax. [Pause a while] Now tense the muscles in your arms and stretch your fingers out as you breathe in. Hold. Relax. Notice a relaxed feeling flow up from your feet through your calves, thighs, stomach, hands, arms and chest. Let your body sink into the floor and feel supported by the floor. Breathe naturally. [Pause] Tighten your shoulder and neck muscles as you breathe in. Hold. Relax. [Pause] Clench your teeth, screw up your face, close your eyes tightly and feel your scalp tighten as you breathe in. Hold. Relax. [Pause] Breathe naturally and notice the relaxed feeling moving up and encompassing your whole body. Be aware of your breathing. Each time you breathe out feel yourself becoming more relaxed. [Long pause] Soon it will be time to start getting in touch with your surroundings again. When you do this, allow yourself to feel good, to be wide awake and alert. [Pause] Notice the floor. Move your fingers and feel it. Wriggle slightly, and when you are ready, open your eyes. Lie where you are and look around. Allow yourself to take in what you see, to feel good, and to be awake and alert. When you are ready, roll over sideways and support yourself with one arm in a half-sitting position. Sit up when the time is right for you. 1 he above relaxation exercise can be taught in a counselling session, and the person can then be encouraged to practise it regularly in their own time. However, warn them about the dangers of being too relaxed. It is not advisable, for example, to drive a car in a very relaxed state. A certain amount of tension is useful so that the person’s reactions to danger are fast. 1 here fore, do not go through the relaxation exercise immediately before the person seeking your help is due to drive away! Once a person has learnt to relax by muscle tensing and relaxing they will find it easier to relax when standing up and in a tense situation. Teach them to take a few deep breaths and each time they breathe in to tighten up their muscles and then relax as they breathe out. With practice they will probably find that they are able to let themselves relax as they breathe out naturally. If teaching relaxation methods appeals to you, we suggest that you might like to learn more from the books listed as further reading below.

Learning summary Use a quiet, slow, monotonous tone of voice when teaching relaxation. Relaxation exercises can be threatening for some people. Make sure that the person seeking help understands that the exercise can be discontinued whenever they like. Observe the person's body so that your instructions are correctly timed. Warn of the danger of being too relaxed when attention is required. Further reading Davis, M., Eshelman, E.K. & McKay, M. 2008, Relaxation and Stress Reduction Workbook, 6th edn, Newharbinger, Oakland, CIA. Payne, K.A. & Donaghy, M. 2010, Payne’s Handbook oj Relaxation Techniques: A Practical Guide for the Health Cate Professional, Elsevier, Edinburgh.