The stress management process/Stress assessment

Establishing the baseline
When your aim is treatment of a condition which is affecting your client, it's important that you are able to measure the severity of their condition. If you can do this, you can compare their current level of stress (in this case) against their original level of stress to see if the approach that you have chosen is having a postive effect.

Measuring their current level is stress is also called establishing a baseline assessment measure.

It's best if baseline assessment measures can be objective (e.g. joint range of movement) rather than subjective (“rate pain on a scale of 1-10”). You don't really want the measure to change depending on the mood of your client on the day of assessment. It's fairly difficult to develop an objective measure of stress for use in clinical practice. Stress-related research often uses blood sampling of hormones such as cortisol which are related to the stress response as an objective assessment measure, however this is not an approach that you can commonly take in your practice. Another way to attempt to measure someone's stress levels is to take a multi-factor approach.

Here are a couple of stress assessment instruments


 * Stress monitor - developed by students in the Otago Polytechnic massage therapy programm, 2008
 * Assess your stress – developed by the Cleveland health clinic

Identifying stressors
Once you've gone through the medical screening process and have taken an objective measure of your client's stress, the next stage in the assessment process is to identify the main stressors that affect your client. The stress monitor form will give you some information about how stress is affecting your client which will give you some pointers about the kinds of stressors which could be involved, but you will need to also question your client about the kinds of factors which could be involved.

This module will help you to develop an understanding of the approaches which are commonly used to assess stress, and common stressors and indicators of stress.


 * Approaches to stress assessment

Because of the psychological and often personal nature of many contemporary stressors, you should take care with the approach which you use.

How can you enquire without seeming pushy? One way is to ask a fairly general question

"so what's causing you stress in your life?"

An open-ended question like this allows the client to tell you the things which they're comfortable sharing with you. Take notes & after they've finished talking follow some of the tracks they've opened up to ask more questions. You might not get the whole picture, but hopefully you'll get most of it.

When you're questioning them in this way watch their body language. Are they comfortable with your line of questioning? If not, then they're probably not telling you everything. That's OK, it's best to leave it. Chances are they'll spill the beans to you after a few sessions once their trust in you develops.

Often after a time on the table clients can also open up to you and expand on what they told you in the initial consultation.

Professional boundaries
Given the relationship stress has to emotions & psychology, you need to be very careful with your professional boundaries when discussing situations which have caused stress in the client's life.

Often when we've had some kind of personal experience, we feel that we are able to give advice to our friends on matters similar to our experiential learning. This is not appropriate in a clinical space where the client is paying for a professional service. We are not qualified to provide advice on emotional/psychological matters, and should therefore be careful to avoid doing so & refer to others when this is required.

Record Keeping
Because the information which is discussed in a stress assessment process may be very personal in nature, you need to be careful when recording the details in your records. Bear in mind that your client, and other people they authorise (most likely another healthcare practitioner), may read your records at some point in the future. Try to avoid names, and any details which are likely to identify the parties involved.

Further considerations
Once you've gathered your assessment information, there are three questions which you need to determine the answers to


 * Do you need to refer your client to another healthcare professional?
 * What level of training would be ideal for your client?
 * What is your client's commitment to change?

Referral
If your assessment has identified signs of depression, psychological illness, or if interpersonal issues are significant stressors in your client's life, then you should consider whether the inclusion of a psychological healthcare professional such as a counsellor or a psychologist would be beneficial.

Level of training and commitment
When considering the development of a healthcare programme, you should first consider which elements of the programme would ideally suit your client.

The programme that you develop however should be realistic given your client's commitment to change. Some clients are able to motivate themselves to attend a massage regularly, but this is the upper level of their commitment to change. Learning diaphragmatic breathing requires a little more effort, progressive muscle relaxation still more, and meditation requires consistent effort over a long period of time for the client to experience significant benefits.

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