PSYCHOLOGY OF REHABILITATION

Rapport can be developed verbally through good communication skills including: ■ active listening - not simply nodding and agreeing at the right points

■ paraphrasing and summarising - to check understanding ■ empathising ■ by taking a genuine interest in the person and their situation - perhaps the most important and effective way of developing good rapport

■ additionally rapport can be developed verbally by matching the person’s speech in terms of voice tone, tempo, volume, speed, or intonation.

Rapport can also be physiological and can be gained by matching: ■ breathing patterns ■ posture ■ head gestures ■ facial expression ■ body movement through space ■ muscle tension.

It is important to stress that with all ‘matching’ strategies the aim is not to directly imitate or copy the person but to select key aspects to match. When done with respect and subtlety they are very powerful ways to build unconscious rapport. Good examples of advanced matching would be making a physical repetitive gesture eg. tapping a finger lightly in time with a person’s breathing, or folding arms to match crossed legs.

Naturally these skills take time to develop, but will prove very useful. BOX 1: BUILDING RAPPORT

■ Take an interest in your client’s situation - use basic coun- selling/coaching skills such as paraphrasing, summarising, empathising.

■ Build unconscious rapport through verbal and non-verbal matching.

INNER MOTIVATION Poor adherence and lack of motivation can be problems for sports injury practitioners, as can over-motivation or over-compliance. It is important to try and gain an understanding of the athletes’ inner motivational strategy, as this will allow you to work with them more effectively.

There are basically two forms of motivation: negative motivation moves away from negative experience; positive motivation moves towards a positive experience eg. a client may move away from the pain of injury or towards the feeling of wellness or recovery; they move away from the feelings of being inactive and unable to train, or towards the images of being fit again and participating fully.

To enhance recovery and rehabilitation both forms can be useful for motivation, for example, by vividly imagining specific undesir- able consequences worth avoiding and then imagining the very desirable and worthwhile goals that draw them forward. By doing this you get the maximum motivation.

www.sportex.net BOX 2: WORKING OUT A CLIENT’S MOTIVATIONAL STRATEGY

To find out how someone is motivating themselves just listen to them. If they are using words such as ‘have to’, ‘must’, ‘should’, ‘need’, then that is indicative of negative motivation. If they use words such as ‘want to’, ‘will’, ‘looking forward to’, then they are using the language of positive motivation.

When a client comes in and says that they want to get rid of the pain, that is indicative of negative motivation. The client who wants to get fit to compete again is indicating positive motiva- tion.

ENCOURAGING NEGATIVE AND POSITIVE MOTIVATION

To get this motivation, or leverage on your clients it is useful to ask them what are the costs if they do not get better/do their rehabilitation programme and what are the benefits if they do.

GOAL ACHIEVEMENT Goals are important to the rehabilitation process, particularly because when they are specific, achievable

and celebrated, the

satisfaction of achieving each one helps to maintain positive motivation.

There are two types of goals that you want to be aware of: outcome goals and process goals. Outcome goals are the end result eg. being healed, feeling fitter. Process goals are the specific actions, behav- iours, moods and mental processes required to achieve the desired outcome eg. doing the required exercises, staying positive. Both types of goals are important to success: you want to have a desired outcome and you also want to have a means by which you’re going to get your outcome - and these are your process goals.

For rehabilitation, goals should primarily “What

patients believe, think and feel has profound effects on the body.”

Herbert Benson, Associate

Professor of Medicine at Harvard Medical School

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