Aquapoetics blog: In the Flow

Feedback after aquatic bodywork: It makes me really happy

2009-11-14T08:52:35-06:00

As a complement to the previous post 'Facing feedback after aquatic bodywork: pain' here is some heart-warming feedback from a woman, again in her 50s, after 59 sessions over a 2-year period of receiving aquatic bodywork from me at a private spa retreat (no longer open).

The questions are modified from surveys I created for those who had received 3+ and then 15+ sessions with me. Responses like this can provide information that is valuable in ongoing work with someone and also in gaining insight into your own practice and its effectiveness.

Such anecdotal information can also be useful in devising more extensive studies of specific effects of this work, giving weight to the differences between practitioners, among clients, and in a variety of settings. I will be writing more about this in this section of the blog 'An aquatic practice'.

In future posts, I will also comment on further responses to questionnaires given to 15 people (3 men and 12 women aged 40s to 70s) who received more than 3 (some over 10) sessions of aquatic bodywork with one of two practitioners (female, male) during a 2-year period.

Samples of the forms and questionnaires I have used in my practice can be obtained from me on request for a reasonable fee. Guidance and suggestions for modifications to suit your own practice are also offered. Email me for more (see left-hand column).

What do you find to be the ideal frequency for taking sessions and why?

For me the every two week frequency is great. It's a treat, it provides deep relaxation and it's a time commitment so twice a month feels pretty great.

If you have not been able to do this, what has been the main limitation?

Illness, travel.

Is the setting/ambiance an important part of the experience? If so, say how ...

It's very important. I love the pool house; I immediately relax just walking into the space. It's a lovely place - beautifully built with natural materials and simple lines but very interesting visually.

Has anything detracted from your experience...

I seriously cannot think of anything!

Which of these is the most common effect of a session for you (relaxing, energizing, both):

Relaxing.

On which levels do you experience beneficial effects (rate 1 = none to 5 = significant):

[Physical, emotional, mental, spiritual aspects were all rated 5] But if I had to rank them [in order of importance] I'd say physical, mental, emotional, spiritual - because I need and get the beneficial effects most physically, then mentally next, etc.

Give examples of an issues in the above areas that have improved with or been positively affected by sessions?

A physical issue I have a sedentary job (desk work) and usually have a strong workout right before an aquatic bodywork session. The experience in the water helps hugely with each of these: providing stretching and movement to stiff, under-used and over-used muscles.

An emotional issue I did aquatic bodywork during and after the death of my mother. The water was a safe place for feelings to come up, be experienced and let go of. There was a lot of stress in the aftermath of Mom's death - paperwork and family communication. The space provided by the water and by Sulis helped me both stay with and move through the grieving process.

A mental issue I spend a lot of time in my head and heart - but can be out of touch with my body for days on end. The aquatic bodywork reconnects me mentally and physically - it's very integrating.

A spiritual issue Boundaries between self and ALL melt away during a session. I am floating in a creek; I am the creek; I am the light on the water; I am in the gurgling of the water; I am a cello, etc., etc.!

Has this work had an effect on any of the following general areas? Mark yes/no and say how if yes.

Health Yes - more in touch with and aware of my body, much release of my somatized stress.

Relationships Indirectly - makes me better able to meet others from a centered, calm place.

Creativity Indirectly - gets me out of linear thinking, more open.

Work Mitigates the stress of work. Makes Monday (my usual session day) a great work day!

Would you find (or have you found) either of the following helpful before your experience:

- conscious setting of intention to work with a current issue

Yes, this sounds like a good idea.

- more time to unwind physically or otherwise (e.g. walking the labyrinth or trails, doing a movement class, taking a sound journey)

Yes - I already am doing these.

Would you find any of the following helpful after your experience:

- quiet time to meditate

- quiet time to journal

- guided review with practitioner

I enjoy the conversational debriefing I do with Sulis in the pool after, but generally feel ready to move on with my day/evening after my session

Which of the following is true for you? ALL!

- each session is very different

- sessions are generally similar

- sessions seem fairly varied

Please rate the following parts of a session for effectiveness

on the scale 1 = not effective to 5 = very effective:

Stretching movements 5

Massaging actions 5

Use of pressure points 5

Periods of stillness 4

Subtle energy work 4

Underwater movements 4

What is your main reason for continuing to receive aquatic bodywork?

I love it. It makes me really happy. It's really good for me.

Comments reproduced with permission of the client.

This is just one person's response of course ... more will follow. Your feedback welcome!

What kind of evidence are we looking for in aquatic therapy?

2009-11-05T18:21:47-06:00

My main interest in this blog is alternative aquatics, which I have defined as any water-based healing modality that involves movement and/or bodywork but that is not considered suitable without significant modification for clinical settings or medical billing.

These kinds of practices may be found as part of spa-leisure and alternative health services, and are concerned with preventing ill-health and maintaining good health. Sometimes, though, people suffering from chronic problems that have not been helped by medicine do find help from alternatives.

There are many questions to be asked about this regards people made vulnerable by desperation in dealing with a health issue. Whether the alternative approaches are safe is paramount. Whether they are effective is also relevent, though the methods science uses to assess these may not be ideal.

In this post, I take a look at the evidence dilemma as it affects conventional medical practices. Contrary to what many believe, the situation is not any more certain or reliable for some clinical treatments than it is for alternative healing methods.

For people needing treatment for serious acute and chronic health issues the issues are different than for those who are seeking preventive or maintenance health care, and those who are looking for enhanced well-being.

Aquatic physical therapists and other aquatics staff working in clinic situations are concerned with the first group. In the current US social and medical climate, cost and effectiveness are inseparable for this injured or unwell population. The situation is further complicated by malpractice issues.

In the July&August 2008 issue of AARP Magazine, Shannon Brownlee asked 'Why does Health Care cost so much?' (pp. 50-57) and put forward some ideas for possible medical health care reforms and their pros and cons in the US. Brownlee noted that:

'Nearly a half-million [American] people file for bankruptcy every year because of high medical costs. Another 47 million lack health insurance altogether.'

'[T]he most significant reason Americans are drowning in health care debt may shock you: Americans are getting far too much unnecessary care ...[and] new evidence suggest that too much health care may actually be killing us.'

(Under Obama's new administration the urgent need for reform is recognized and right now is in challenging process.)

In her article, Shannon Brownlee also discussed evidence-based medicine:

The prestigious Institute of Medicine recently published a report that estimates that only about half of what doctors do today is backed up by valid, scientific evidence. The rest? Many procedures and tests are based on medical tradition or on unproven and potentially faulty assumptions about how the body works.

Evidence-based research. It is essential that we gather better scientific evidence for what works in medicine, what doesn't, and for which patients - and get the word out to doctors. Take the example of spinal fusion to treat acute back pain. We spend more than $16 billion each year on spinal fusions, even though there has never been a rigorous government-funded clinical trial showing that the surgery is superior to other methods of relieving back pain.

All this seems quite reasonable until you ask what kind of 'evidence' you need, how that 'evidence' is arrived at, and what you will use the information for. Here are some questions that arose for me:

Can enough scientific research be done?

Will that research provide the evidence that is needed to help people?

Will this have any effect on treatment success?

What can be offered to people who need help now?

It is arguable that we might get deeper and more lasting value - for some issues at least - by looking more closely at the subjective elements of health care - from an individual's life choices, to the person by whom, and context in which, they are given help.

This is something I'll be addressing as part of a discussion on the value of documenting alternative aquatics, in Chicago at ATRI's Aquatic Healthcare Conference, 19-22 Nov. 2009. I'm hoping to encourage dialog between medical and alternative aquatics practitioners regards the ways in which both could better serve those in need.

We need more critical (but not defensive) discussion. In future posts, I'll continue to write about how and why it's going to be valuable to do this. We also need to listen far more to those who are suffering and seeking help through aquatic therapies - see for example this recent post: Feedback after aquatic bodywork: pain.

See also this post on Alternative Aquatics Research
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Feedback after aquatic bodywork: pain

2009-11-02T16:02:39-06:00

How do you respond when a client has an 'adverse' reaction to an aquatic bodywork session?

Here is an example from my records of 5 years ago now. The extracts are from email correspondence with a woman I will call Nancy (not her real name) in her 50s who opted for a series of 5 weekly aquatic sessions. This feedback came after the 4th session.

In her younger years, Nancy was a professional dancer but at this time was doing computer work. I came to know her as a good friend and someone of extremely high integrity, courage, and self-awareness.

She also carried a burden of deep sorrow regards the state of the environment, especially of water. A couple of years after the sessions we shared, my friend ended her life apparently suddenly and without warning.

Reviewing this correspondence has further inspired me to commit my healing work to the inclusion of all aspects of our human experience. In my practice, I've found aquatic bodywork to be effective on all levels - physical, emotional, and spiritual.

Acknowledging this and developing skills to guide those who are dramatically affected by the work in safe and supportive ways, is important. Collaboration with complementary and compatible professionals as a team or by referral may also be a great help.

You'll read that Nancy inadvertently benefited from adjunct work (orthobionomy) and that she found land movement (yoga) - which I offered alongside the aquatic sessions - to be valuable. What works will vary from person to person, and it is important to be guided by their experience.

Orthobionomy is a land-based method that developed out of osteopathy. It uses subtle positional release, following the body rather than pushing it through a predefined routine. Similar explorations can be done effectively in water where joints are supported yet relatively unrestricted. It is especially effective in working with symptoms from chronic stress, and pains or problems associated with postural and structural imbalances.

Nancy was hyperflexible and it is possible that this led me to move her through more elaborate patterns in the water than was right for her. As a yoga teacher, I have learned to be wary of encouraging those who are naturally flexible into poses they cannot also support with strength. In the water it is tempting to overlook this, or just not notice it because of the supportive medium.

Important in any bodywork is to move slowly - giving time for both giver and receiver to feel what is happening and to sense where the body itself wants to go when a movement or position is 'suggested' to it. Allowing time to integrate these shifts in alignment is also essential.

Immersion in warm water can effectively dampen sensations of pain both by relaxing the muscles and soothing a reactive nervous system. On the surface this is a good thing but it might also mask signals that would otherwise warn of overstretching. Pain and its signals are complex and often mysterious.

As I was putting this post together I met Loolwa Khazzoom online after reading her article in AARP magazine 'Drug-free remedies for chronic pain'. Loolwa has used dance to help her recover from a head-on collision that left her hurting badly. I anticipate I'll learn a lot from her.

On her website Dancing with Pain, Loolwa writes:

While there has been a growing body of research on pain medication and management — offering both pharmaceutical and natural pain relief – few health professionals are equipped to offer comprehensive guidance through the maze of Eastern and Western resources now available to those who suffer from chronic pain. In addition, few health professionals have been trained to listen adequately and respond appropriately to the needs of those in chronic pain – leading to an unintentional exacerbation of their problems.

I don't want to be one of those helping people who fail to listen and respond.

The resting position I suggested for Nancy in recovery is one that I have written about in a previous series on working with psoas-related trauma - constructive rest position. Liz Koch recommends this for any practice of yoga, dance or other exercise form. I find it a very helpful and simple thing to share with everyone. It can be more effective and comfortable than yoga's svasana (corpse pose).

I hope this post will also show that there cannot ever be a one-size-fits-all program. I suggest that as practitioners we need to be willing and able to be truly present to the person we float in our arms, without judgment or assumption, especially regards their more challenging experiences.

It is an ongoing learning process and one that we share mutually with our 'clients'. I welcome your comment on this example. I would also be glad to hear of challenges you have faced in your own practice, and to offer support where I can.

Nancy's feedback:

Aquatic bodywork has returned me to an intense awareness of my body that I have not had for years. That awareness is continuing and changing as I discover new layers, and I adapt every day. After the last session (after, not during), I experienced a lot of physical pain in my hips, shoulders and neck. The pain was so intense that I could not sit in a chair for more than a few minutes at a time, and since my work involves sitting in a chair (unfortunately), I couldn't get much done. I don't know the "reasons" for this, other than perhaps the sessions facilitated a breakthrough to a whole new layer of body tension that I was not aware of before. This is all positive, except that I can't take being in pain...

Anyway, I went to a spring retreat for the weekend and my friend who does orthobionomy was there. I had two sessions with her and I'm now pain free. I don't know whether I would have 'worked through' the pain on my own or what, but at this point I am truly fearful about getting another aquatic bodywork session, and I'm not generally a fearful person! What do you think? I'm sure this isn't unusual and you must have had other clients who've experienced this.

Btw, I am changing the way I work, I do not sit in front of the computer for hours at a time, I get up and move around much more, and this is great! I have already changed the chair I'm using. In fact I'm going to redo my entire workspace. Looking forward to that!

Sulis responds:

I am glad you let me know about this and I am so sorry that the pain affected your work. There are two factors to consider - physical and emotional. They may both apply, and in any case the physical precautions mentioned below should be taken for any further sessions.

1. In this session we achieved a further degree of freedom of movement and relaxation of musculature (in all sessions you have show remarkable flexibility). This could have moved you on a little faster than your structure could integrate, resulting in some instability in later land movement that caused you pain. I remember you talking about strong physical pain experienced in the past - was this anything like that? In other words, we may have inadvertently revealed an 'old weak link'.

This indicates that despite your great capacity for movement, it is advisable to err on the side of caution in following this to its extremes. This can be done in future sessions and should avoid any recurrence of the pain - if this is its cause.

2. You mentioned that during this session you also experienced some sadness which you ascribed more to world issues than to your own life. Deeply hidden emotions do not often come to the surface easily or willingly. In fact, sometimes the body-mind manifests strong pain in order to avoid their surfacing. This pain/ fear combination presents the body-mind with an 'excuse' to discontinue the process that might reveal something it has chosen to suppress. It's an unconscious process and not a reflection on your courageousness or otherwise.

If this is the case, it indicates that you have a choice to make regards your willingness to work with a possible emotional issue in this way. You may consider combining ongoing sessions with some form of adjunct therapy or psychotherapy.

I have found that if a person does not wish to work with a deep issue, they and the practitioner can 'decide' to keep the session on a purely physical therapeutic level. However, I cannot guarantee this since the body-mind has its very own ways of working its ends out.

Of course, your decision regards the next session will be the right one for you. My thought is that since you are no longer in pain (yes?), you could come and we would work in a way that should not risk any destabilization of your physical structure. You can, and only if you wish, use this opportunity to examine the internal process that may have been associated with the sadness you talked of.

After the session, I recommend that you lie on a flat surface, knees bent, for at least 10 minutes in order to give your body a chance to realign and stabilize itself. And, I will also honor a decision on your part not to come, or to delay.

I hope that the above helps - please do phone or email me as soon as you have had time to think about it. Once again, I am sorry you have had this rough 'wave' in the flow of the series of aquatic bodywork sessions.

Nancy responds:

Thanks so much for your response. Very validating. I'm much less fearful now.

About that emotional stuff. I don't separate the physical, emotional and spiritual realms. That's why I don't do 'fitness workouts' and why I love yoga and dance. I wouldn't know how to keep a session on just a physical level only. I've been exploring that tremendous feeling of sadness, without trying to analyze it. I've been doing some crying, in fact I was crying when I wrote to you yesterday, as well as yelling, laughing, journaling, etc. I've come to realize that I'm very 'homesick' - that's the word that comes up. It's very personal and also connected with what's happening to the earth, it's about nurturing and the lack of, both in my own life and the body of the earth. This is important and I'm glad it's coming up. I can work with emotional stuff easier than physical pain any day. I'm just a wuss when it comes that.

I would still like to come back tomorrow. I will definitely take your advice about lying down on a flat surface afterwards for a while. I'm willing to go wherever this journey takes me, and perhaps it was just 'too much too fast'...??? Overall, I must say, the aquatic bodywork has given me back my dancer's body, my intuitive body. And for that I am so grateful!

And in a follow-up to the fifth session:

Thanks for checking in with me! All is good, a bit of soreness but nothing out of the ordinary. I'm finding I can stretch through any achy places. And I really like the lying on the floor, knees bent, exercise. It really helps! Have been doing yoga also. The whole series was really extraordinary and life-changing for me. I recommend it to anybody who is self-aware and wants to explore bodywork in another dimension.

Next month, while in Chicago to present at the ATRI conference, I shall also be attending a workshop on the importance of the Body in Sacred Activism with Andrew Harvey. I will be writing more about both these events afterwards.

Meanwhile, in memory of Nancy, I'd like to end this post with an extract from the foreword to Carolyn Baker's book Sacred Demise: Walking The Spiritual Path of Industrial Civilization's Collapse, written by Sarah Anne Edwards, since it takes water as a strong metaphor:

[F]ew of us are prepared mentally or spiritually for the onslaught of feelings, the tide of emotions, the rush of the unexpected that is engulfing us. After all, the world that anchors our daily lives now is collapsing right along with the dam upon which our current way of life in built. We don't know if we'll make it to the bottom of the spillway as the dam cracks and breaks away. Assuredly some of us won't. Even if we do, there is no guaranteed, made-to-order world awaiting us on the river once it has burst forth from the dam. For sure there will be no welcoming "comfort inns" along the shore. We're uncertain what the unleashed river of our life will look like or if we will have the knowledge, skills, and acumen to survive in it. But life, death, mystery, uncertainty, paradox, and danger are all part of the natural world we inhabit.

As practitioners of aquatic bodywork, perhaps we can restore and instill a sense of safety in the fluid process of life, while still acknowledging all the above.

See also Avoiding hot water - good practice for non-clinical practitioners of water therapy