Working together to get off the medical merry go round
Meet 'Fred', an overweight taxi driver with a diagnosis of type 2 diabetes. He is married with two teenage children, his wife does most of the cooking and Fred does very little physical activity. How would you get Fred to lead a more healthy life? This was the hypothetical case study that Karen Rodham (Staffordshire University) presented to sports psychologist Sarah Edmunds (University of Chichester) and health psychologist, Angel Chater (University of Bedfordshire).
Edmunds outlined an evidence-based 4-stage approach in which she would establish an empathic relationship with Fred, so that she had a deep understanding of any environmental and personal barriers. She likened her role to that of a tour guide, where she would help him to focus on identifying achievable ways to exercise, and enable him to plan ways of integrating those into his routine. Chater also proposed a tailored approach that would explore and resolve areas of ambivalence, linking specific problems with specific solutions. Both speakers highlighted the value of Miller and Rollnick’s Motivational Interviewing technique. As Chater said, 'motivation needs to be stronger towards the behaviour you want to change, than the alternative compelling behaviour.'
Rodham then introduced us to the second hypothetical case study, 'Frederica', a stressed accountant, who used to run and swim regularly but now has chronic pain and no longer gets to the gym. Again, this was tackled by a sports psychologist, Mikel Mellick (Cardiff Metropolitan University), and a health psychologist, Vincent Deary (Northumbria University). Mellick highlighted the bidirectional relationships between stress and chronic pain and explained how he would tap into self-determination theory to reinforce a sense of autonomy and control in Frederica.
There was a lot of head-nodding in the room as Deary opened his presentation with a discussion about the medical 'merry go round', where patients with conditions like Frederica’s are pushed from one clinical department to another and often end up back where they started. This is particularly problematic when psychological experiences, such as stress, are linked to systemic physiological changes. He explained how chronic pain is like burglar alarm in that it can sometimes be set off by the wrong thing, for example the cat! He described how he would build up a collaborative narrative with Frederica and use compassion focussed therapy to improve the balance between work, rest and play.
The purpose of this symposium was to explore the common ground between health and sports psychology, and to look for opportunities to integrate evidence-based practice from the two perspectives. Given that none of the speakers were given anything other than the details of their case study and had no idea what each other might say, there was striking consistency between their approaches and Rodham drew these together very nicely in her concluding presentation.
The common themes were a client-centred approach, motivational interviewing, and the need to look at the big picture and not just the problem. She noted that there was relatively little in the way of education and that it was more about helping clients to find their own way. Most importantly, everyone placed a strong emphasis on using a good evidence base and referenced a range of different theoretical frameworks. Maybe, Rodham concluded, health and sports psychologists need to be theoretical magpies, stealing a bit here and there rather than being a slave to one theory. There was an overwhelming consensus in the room that working together is something health and sports psychologists should do more.
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