In the last few years of my career as a clinical psychologist I had the joy of working in a relatively unique context – a community-based health psychology department. Health psychology in this context means applying psychological understanding and therapy to help people with serious and chronic physical health problems.
On first reflection this may seem rather strange and misplaced. One might think that people with such physical health problems need physical care, not psychological. However, physical illnesses and injuries do not just affect physical bodies – they affect persons. A person has a life with various aspects to it – physical, spiritual, psychological, social, occupational and recreational – each of which can be adversely affected by physical illness and injury. Moreover, these aspects of their life can influence how well or poorly they respond to, and cope with, illness and injury. There are complex influences in each direction – which need to be explored and, if necessary, ameliorated. So physical care can often be helpfully augmented by some psychological care, with improvement in both mental and physical health as a consequence.
Patients were usually referred to us by local GPs or by specialist hospital doctors. The interventions were typically six to eight sessions of individual psychological care. The department also provided group therapy, including some based upon mindfulness. One of my colleagues had also done some research – she went to a GP surgery one afternoon a week to advise health workers on psychological aspects of care for the patients who needed most ongoing physical care from them. Notably, this resulted in those patients needing less overall input, significantly reducing the financial cost of caring for them. The surgery staff could then see more patients.
Important issues for many patients were chronic pain, fatigue, disability, and managing their daily activities whilst having to cope with these. Anxiety and depression, due to their physical problems, could also be important issues for some of them. As an example, a skilled builder having a chronic spinal injury, after falling off a ladder, was prevented from working. But the injury affected many other aspects of his life. Such chronic injuries can strongly inhibit any activity which involves physical movement, such as someone’s favourite sport, or playing with their children, doing D.I.Y., or doing the washing-up. So daily life can be very much restricted. Add to those restrictions chronic pain, and then consequent anxiety and depression, and the complexity of the disability and suffering becomes clear.
One factor which often led to further problems for a patient was other people’s lack of understanding of their disability and its complexities. This led to expectations which the patient could not meet – which often exacerbated their problems. It seems that many people’s understanding of disability is almost as simplistic as considering a person disabled if, and only if, they use a wheelchair. But there are many forms of disability, which can have far-reaching consequences.
A common theme was people trying hard to keep active as much as possible, and then succumbing to exhaustion. It was clear that they needed to develop a more balanced schedule of activity and rest. Interestingly, once they learned to take appropriate periods of rest, a significant proportion of them could find themselves able to do more than when they had just struggled on regardless and then got exhausted.
Interestingly too, for many people there was a psychological factor which prevented them developing a suitably balanced schedule of activity and rest. This was that they felt they should work, and keep helping others, and that to rest much was somehow selfish.
Actually, what they needed to realise was that self-care is not selfish, and that self-care and caring for others go together. For many people, this realisation was the most important factor in enabling them to cope best with their physical health problems, with the minimum disruption to their daily lives. It is also an important issue for everyone to understand. Other people matter, and so do you.
One helpful intervention for managing physical health problems, and their consequences, is the practice of mindfulness. In this regard it was a delight to introduce people to Vidyamala’s book ‘Living Well with Pain and Illness’. Because of its helpfulness, mindfulness practice has become a common intervention to give people who suffer from physical and mental health problems. For me personally, this situation contrasts very much with the time when I first started using mindfulness as a therapeutic practice for patients, back in 1981. At that time, I did not know of anyone else who used it. I began tentatively to teach it to patients, because from my own practice I had realised that it can strengthen one’s mental state. It was only in the later 1980s that I began to hear of others, such as Jon Kabat-Zinn, using it as a therapeutic intervention. (This was in the days before the internet existed.)
Overall, the lessons I learned from working in this health psychology department were that psychological care is a very important accompaniment to physical care for many people with serious physical illness and disability – and that the possible interactions between someone’s physical problems, their psychology, and various other aspects of their lives, are many and complex. Because of this complexity it is the ‘whole person’ who needs therapy and not just their physical body.
