‘Making the jigsaw pieces as you go along’

Chartered Psychologist Dr Will McConn-Palfreyman navigates the Winter Paralympics, with advice for practitioners.

On 4 March 2022, the opening ceremony of the Winter Paralympic Games will begin. A maximum of 748 para athletes will compete across five sports in 82 medal events. One of these sports will be wheelchair curling, and five curlers from Great Britain will travel to Beijing for the Games. I am fortunate enough to support the team as a sport psychologist, part of the performance services offered to GB Curling from the sportscotland institute of sport. I’d like to share my reflections on working with these athletes.

I have drawn not just on my own work within curling, but on conversations with athletes, staff and others working across para sports. My title comes from one wheelchair curler who remarked that the psychology involved in attempting to make it to the Paralympics was like compiling a large jigsaw. And you also had to create and ‘shape’ each of the individual ‘pieces’ as you go along. Each athlete has to make sense of their own psychology as they traverse qualification for the Paralympics, with little in the way of an existing map to guide them. It is such a personal journey. 

In trying to help build a very rudimentary navigating system, I want to highlight five key ‘signposts’ that may help practitioners working in this setting. 

Signpost 1: Knowing their individual biographies

When I first walked in to meet the GB para curling team, I saw them as all in wheelchairs. In essence I mistook their means to access the world with their disability. As you begin to get to know the individuals involved you stop ‘seeing the chair’ and start to see both the person with a disability – congenital or acquired, degenerative or in remission – and then even more importantly the person themselves within their own context (Watson 2002). 

This transition as a psychologist is crucial, in order to move away from the many biases that can hold us captive in how we see para sport athletes (Martin, 1999). An important focus during such initial engagement is to explore how you might unconsciously stereotype those with a disability. I am not even necessarily referring to negative stereotypes, but even the danger of falling into old patronising tropes of such individuals as ‘inspirational’ or ‘brave’, when in fact they are intensely competitive like any athlete (Thomas, 1999). Initially, I engaged in bibliotherapy to help drag out some of my own personal blindspots, whether this included a review of academic literature or stories from Paralympic athletes themselves through books, podcasts, newspapers etc. I also brought a lot of these blindspots to supervision to further explore how they impacted my daily practice and relations. The end result of this process is being able to acknowledge the uniqueness of each athlete and how I may be able to support their individual journey. 

Signpost 2: Fit-or-not?

Within much sport generally there is a dichotomous notion of athletes as either ‘fit’ to play or ‘injured’. Within disability sport this schism falls apart – many of the athletes carry the legacy of their injuries and illnesses with them forever, whether this is a spinal cord injury (SCI) or multiple sclerosis (Hadjipavlou et al., 2016). Yes, other injuries do occur, whether this is a rotator cuff tear of a broken leg, but even then some of these injuries are the result of their disability, with potentially even a bone break occurring from falling out of a wheelchair (Harrington et al., 2021). 

Either way, removing this dichotomous view of athletes as either fit or not changed how I as a sport psychologist interacted with them. For example, such athletes may be dealing with trauma from an original injury, others managing depression that comes from a change in perceived body image, and others navigating anxiety that may come through personal relationships (Harris, 1995). Furthermore, they may be receiving continual operations, treatment, and external support whether this relates to carpal tunnel syndrome or medication for pain. I have had to get much more comfortable with what might be a health psychologist’s role – supporting athletes to manage their health, recovery and rehabilitation plans on a more constant basis (Smith & Sparkes, 2012). Engaging with literature around this area is crucial to understand how you support the athlete holistically rather than simply from a sporting perspective. 

Signpost 3: Stress management

A good chunk of my work over the last year is exploring what stress is with the athletes and how to manage it. Any sport psychologist has to be able to support athletes as they perform on the ice, the pitch or the court (Martin, 2017). Yet, you also want the skills learned in this performance domain to be transferable to other parts of the athlete’s life – to help them thrive as a human being away from the sporting environment. Within this stress management we looked a lot at the role of emotions like anxiety when executing a shot or anger at oneself for an error or mistake. Within para sport, emotional awareness and regulation is more complex perhaps than other settings. Certainly medication plays its part here, but pain and other symptoms also may hamper an athlete’s sleep leading to irritability and so forth (Kennedy & Hasson, 2017). Also it can be a fear of picking up another injury that reduces their independence and increases reliance on others. There may be depression too, which is not uncommon, in relation to body image or future life goals they feel is out of reach. 

All of these elements can create an emotional ‘background’ that impacts what athletes bring to the performance environment in terms of affect (McEwen, 2012). Some of this work around stress has involved group psychoeducation, individual exploration of emotions, and behavioural strategies. Such strategies include ‘mind-to-muscle’ techniques using images, humour, music or mindfulness or ‘muscle-to-mind’ approaches including breathing exercises, body scans or other muscular relaxation exercises (Williams & Penman, 2011).

Signpost 4: Athletic identity as a steep climb

The progression into performance sport is often steeper for athletes in para sports. For example, within GB wheelchair curling athletes with a disability will often have played in club competitions or come through a foundation programme. However, going from this background into being essentially a full time professional athlete training most days is quite a transition, with little time to acclimatise (Bruner et al., 2008). We often talk about transitions in sport whether from junior to senior or amateur to professional, but the crux is how the athlete perceives what is occurring for them (Anderson et al. 2012). So a lot of my work with the curlers looked at developing athletic identity in terms of them viewing themselves as performers and what this looked like – it could be in terms of self care, professionalism on and off ice, or inter personal relationships within the team (Balague, 1999). 

There is an interesting migration here, from identifying mainly as a person with a disability to someone who perceives their main identity as a competitive athlete. Essentially, if the injury or illness is recently acquired there can be a double major transition in terms of identity as someone with a disability and becoming a performance athlete (Martin, 1999). I am not, however, suggesting this transition is a bad thing – a strong athletic identity may have a somewhat therapeutic function here, providing another repertoire of self-expression for individuals to embrace as desired. 

Signpost 5: Embracing the multi-disciplinary team (MDT)

The importance of the MDT cannot be understated within para sport. Within wheelchair curling the medical input is understandably much higher owing to the complex case history of the athletes. They may be managing multiple concerns at once from UTIs, ongoing operations, bed sores and infections, or issues relating to diabetes (French & Swain, 2001). However, the MDT is not simply trying to maintain functioning of the individuals involved, but also support them to excel as performance athletes. In essence it's a demanding double function on any staff member. 

Furthermore, as these individuals are performance athletes there is a strong zeal to work ‘with’ rather than ‘on’ those involved, in order to get the best from each other (Goodley & Lawthom, 2005). The link between staff members must be very tight – for example it may seem useful for me as a sport psychologist to help around emotional regulation on the ice, but it comes to little if I do not consult with medical or coaching staff on what pain medication the athletes are using. Similarly, breathing and muscular relaxation exercises may be helpful but I must work with the physiotherapists to understand what the physical limits are of each athlete based around where an SCI occurred in the body etc. (Martin, 1999). Of course it is never useful for any psychologist to work in isolation, but in para sports it is imperative to touch base regularly with other staff through an integrated biopsychosocial model (Gatchel, Peng et al. 2007). 

Final preparations

As I write, the Games is nearly upon us. In terms of psychology much of the ‘last minute’ prep is around reinforcing the good work done over the last number of years through simple messaging (Blumenstein & Orbach, 2015). This process involves finding ways to remind athletes of the journey they have been on and how much they have learned. This is done through various means depending on the individual athlete but may involve reinforcing mantras, metaphors, checklists, infographics, letters, photographs or stories. Athletes, through their training, often seek out what they don’t have or what is ‘missing’ in order to address performance. During major competitions this approach must be left at the training facility, with athletes focusing solely on their psychological strengths, abilities and skills to deliver their best performance. These reinforcing techniques just aim to top up self-belief and efficacy by reminding them of the incredible learning journey they have come through. 

In many ways, simply getting to the Games feels like an even greater journey than usual, considering the difficulties many athletes have faced through Covid-19. Owing to the complex nature of many athletes’ medical history, there is a requirement for increased vigilance around contact with others and potential isolation (Stambulova et al., 2020). Such health concerns naturally create much anxiety, which is then intensified by the risk of tournaments being cancelled or altered last minute. Many of the athletes’ family members would love to be in Beijing as support, but this is prevented owing to restrictions on foreign spectators. It is even more important, then, that athletes, their significant others, and staff have a plan around when and how best to communicate with those back home (Arnold et al., 2017). Unsurprisingly, after a good day or bad, athletes want to share with those close to them, and being comfortable with the communication process promotes a sense of control. We do ask athletes, however, to ‘pack their patience’ along with their kit, in case communication barriers crop up. 

We will also go through some other specific stressors that may arise during the Games. These are not ‘what ifs’ necessarily, but more how the curlers might use their bespoke coping mechanisms, both practical and emotional, to handle things like luggage that may go astray, delayed flights, or issues with accommodation. Finally, one thing to be avoided is a temptation to ‘tinker’ as a psychologist in these last days. It is a really busy time with media, medical advice, sorting kit etc. I am always conscious of not adding further stress. Simply, the aim is instead to reinforce long established strategies and help athletes enjoy the whole Games process (Hermansson & Hodge, 2011). Returning to why athletes play the sport in the first place, irrespective of the results, can really help those involved savour such a unique experience. 

Dr Will McConn-Palfreyman, CPsychol.

Sport & Exercise Psychologist

McConn Psychology

Twitter @WillMcConn

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