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Steering in a Different Steering in a Different DirectionDirection

Norma Scobie

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Brain storm Brain storm

Relaxation– Breathing / Massage

Distraction– Bubbles– Toys / books

Visualization /Guided Imagery– Pain Switch

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RELAXATIONRELAXATION

massageBreathing

– Exercises– Bubbles (add guided imagery)

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DistractionDistraction

Pop-up booksInteractive story tellingBubblesToys especially interactive

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ImageryImagery

“Engaging the child’s imagination & concentrating on a specific event to modify a particular response” (Doody et al., 1991)

“The internal experience of an event without the external stimuli” (Zahourek, 1988)

Flow of thoughts –see, feel, smell, taste, hear (Murphy, 2001)

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ImageryImagery

Visualize, imagine, fantasize, day-dream, pretend

GI provides relaxation & distraction technique & allows child to maintain some control (Jonas et al., 1998)

Cost-effective, child-controlledMost common form – worry

(Rossman, 2000)

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8

ImageryImagery

Preparation- realistic goals, practice

Environment – quiet, undisturbed, comfort –support limbs, blanket

Implementation – relaxationEvaluation – image, emphasis,

timing, effect

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IMAGERYIMAGERY

Some limitationsRequires the child to have

attained cognitive dev. to engage

Need to have reached pre-operational level (2-7yrs) (Whitaker & McArthur, 1998)

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Precautions and Precautions and potential problemspotential problems

Providing superficial relief of mental health problems

Causing tension by using images that promote fear

Withholding other treatment modalities

Caution with delusional or hallucinating subject

Contact lenses

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Response indicatorsResponse indicators

Eyes closed (not always at first)Eye movements (under closed

eyes)Slowing of respsRelaxed & absence of muscle

tensionSpeech: normal to calm with no

sign of apprehension

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Response indicatorsResponse indicators

Easy flowing description of imagery

Appropriateness of affect and imagery

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TechniqueTechnique

Rapport and trust

“I know a way that we can make this easier – Would you like to try it?”

Identify interest focus – FUN

Deep breaths and progressive muscle relaxation

Child describes imagery

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TECHNIQUETECHNIQUE

Inform the child as to what is happening whilst s/he is “in imagery”

Reinforce and / or reframe imagery where necessary

Round off imageryCount backwards 4,3,2,1Eyes open – look at the floor

then up

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Important to realiseImportant to realise

THIS IS NOT A REPLACEMENT FOR GOOD PHARMACOLOGICAL THERAPY

It is complementary

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Imagery & massageImagery & massage

Achieve enhanced state of health when touched in a caring way (Montagu,1986)

Effect of touch provides pleasure & relaxation of mind, body & relieves stress (Rouse, 1993)

Inc circulation blood & lymph, slows pulse, lowers B/P, releases muscle tension, tones & strengthens, relieves cramp(Price & Price, 1995)

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