The stress management process/Develop stress management programme

Structuring a stress management programme
The stress management programme should include
 * Programme goals
 * Lifestyle modification (activities to increase/decrease)
 * Massage (frequency and focus)
 * Stress management exercises
 * Expected length of the programme

Programme goals
Your over-riding programme goals should have been identified right back at the start of your assessment process. Sometimes these goals change somewhat over time as details of the client's condition emerge or as the client's condition improves.

You should identify realistic short-term and long-term goals which are tied into the baseline assessment data that you established in your assessment. It's important to have short-term goals that you can achieve in a reasonable time period (2-4 sessions). Acheivement of these short-term goals will make the long-term goal seem more achieveable, and so will motivate your client towards achievement of that goal. It's important for goals to be acheivable or motivation will be lost.

Be conservative with your goals. If you under-promise and over-deliver then your clients will be stoked whereas if you over-promise and under-deliver they will be disappointed.

When you are considering the development of your client's healthcare programme, you should revisit these goals to ensure that the programme you develop is aligned with your client's best interests.

Lifestyle modification
During your subjective assessment process, you should have identified factors which contribute to stress in your client's life, and you may also have identified activities which they participate in which act to reduce their stress levels.

Lifestyle modification in a healthcare programme is all about trying to reduce or avoid the effect of stressors while taking advantage of any stress reducing agents.

For more information, see this resource on Lifestyle modification.

Massage
The deeply acting stress relieving effects of massage are a useful addition to any stress management programme. Having a weekly massage is ideal, but this is limited by the income of many clients.

The focus of the massage will depend on the level and stage of stress present, and the resulting effects on the client's body.

Regular massages in a stress management programme provide the therapist with the opportunity to check on prograess and motivate their client towards the achievement of their stress management goals. For this reason, it's best if massage sessions are not more than two weeks apart.

Stress management exercises
Stress management exercises should be chosen for the stress management programme based on the client's goals and on your perception of their commitment to change.

Meditation will be inappropriate for a client with a low level of commitment to change, just as it would be inappropriate for a client who is after short-term stress relief.

Stress management modalities should be chosen in accordance with your client's medical condition. For example contract-relax progressive muscle relaxation methods would not be used with a client presenting with hypertension, and meditation would not be used with a client presenting with a history of schizophrenia, whereas progressive muscle relaxation would be ideal for a client presenting with Occupational Overuse Syndrome (or R.S.I. as it was once called).

It's best to minimise the number of exercises in the stress management programme. If you give your client one exercise they will be much more likely to continue with the programme than if you give them three exercises.

Expected length of the programme
Your programme should include an expected length. This is the point in time at which you expect to have achieved your goals. At this point you should reassess the client against the baseline which you established in your first session, and decide whether what you are doing is helping the client achieve their goals (see Discharge/Ongoing management)

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