6 ways to

As therapists, we know that working with clients who are unwell or emotionally draining can take its toll. This, paired with the adjustment of returning to work following the most recent lockdown, may leave the best of us feeling drained. We share some suggestions to help you maintain and boost your energy levels throughout your workday...

Visualisation

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We know that ‘prevention is better than cure’, so start your day as you mean to go on. Before treating clients, use visualisation to protect your energy levels. Try this exercise: imagine you are putting on a new pair of overalls 6ways... to practice self-care between clients before your first client, the overalls will help to protect you from absorbing any negativity. When the day is done, you can then ‘take off’ your overalls and leave all that stress behind. Mindful handwashing Washing our hands thoroughly is a necessary practice between clients, so why not make the most of this time and carry it out mindfully? Run the water until it is at the right temperature for 2you before lathering the soap in your hands, giving yourself a soothing hand massage while you do. Dry your hands slowly, trying to take note of what your hands look and feel like. Most In this regular, we’ll be offering six top tips to support you, personally and professionally. importantly, moisturise before you head back out to the treatment room and appreciate the softness of your hands. Block out ‘me time’ In our business feature published in the International Therapist Winter 2021 (issue 135), we asked our FHT Virtual Congress speakers to tell us some of the biggest lessons learned during the pandemic. A reoccurring reflection 5 6 was recognising the importance of scheduling in ‘me time’, even just five or ten minutes can leave you feeling refreshed and ready to carry out your next treatment. Connect with the outdoors Ritualise heading outdoors to connect with nature – no matter the weather. Studies show that 29 minutes outdoors can increase productivity by up to 45% (Richmond, 2020). If for some reason you might struggle to achieve this, bring the outdoors in by adding some indoor plants to your treatment room. Pen to paper Keep a journal. You can use this for reflective practice at the end of the day – writing down what went well and what didn’t go so well, so that these thoughts don’t stay running round in your mind, stopping you from relaxing and recharging your batteries. You can also write down all the tasks you need to carry out the following day — clients you need to speak to, follow-ups, suppliers you need to ring, and so on. Then leave this journal on your desk or in your bag for the following morning, so that you learn to ‘leave work at work’. Level up your meditation Do you practice meditation or controlled breathing exercises? They can be particularly useful tools to slow the mind down and become more present. Monks in Tibet are often taught to practice meditation in a busy place to help them use the tool whenever they need it. A nice little goal to set yourself may be to improve your daily meditation practice, so that you can find your calm place no matter what is going on around you. T For references and further reading, visit fht.org.uk/IT-references

As good as its people...

We take a look at how the environment shapes our health and how we can become the architects of our own communities.

hat comes to mind when you read the phrase, ‘healthy city’? Perhaps an abundance of green space, the whirr of cyclists making their daily commute, or affordable healthy food down every shopping aisle?

As therapists, we are of course aware of the things we need to make us healthy and how our environment can impact our wellbeing. But in a world with so many options at our fingertips, where do we begin when it comes to building infrastructure, a healthcare system and a health education system that works for all? We share some eye-opening statistics about UK population health, before delving into government plans to improve this and how we can make a difference in our own communities.

z FACTS & FIGURES

THE COST OF LIFESTYLE FACTORS ON THE NHS:

1

Smoking £5.2 billion

2

Obesity £4.2 billion

3

Alcohol £3.5 billion

4

Inactivity £1.1 billion

Danny McConnell, Strategy Programme Manager for NHS England, said, ‘The evidence is very clear of the links between places and health. For example, the proliferation of hot food takeaways in areas of depravation exacerbate health inequalities and increase rates of childhood obesity.’

OTHER STATISTICS REFLECTING LIFESTYLE IN THE UK:

30%

of all car journeys in Greater Manchester are under 1km long1

(Greater Manchester Transport Strategy, 2017)

1in10

£2.5

Poor quality housing costs the NHS2

People order a takeaway

billionper year once a week3 (YouGov, 2019). (BRE, 2010)

1. On Dr Rangan Chatterjee’s podcast, Feel Better Live More, he interviewed gold medallist Olympian, Chris Boardman about his mission to encourage the public to move more. Chris said, ‘... it's an incredible statistic. A big chunk of those journeys will be the school run, for example people not wanting their kids to walk to school because of the danger of the cars.’ (Feel Better Live More, 2019). 2. In their Spatial Planning for Health document, Public Health England states,

‘It is estimated that 20% of the UK’s housing stock does not meet decent home standards [...] Living in good quality and affordable housing is associated with numerous positive health outcomes for the general population and those from vulnerable groups.’ (Public Health England, 2014). 3. According to YouGov, ‘34% of this group are men under 40. 18 to 24 year olds account for 17% of this demographic, and another 17% are between 25 and 39.

Young women are the next largest group, with 18 to 24 year olds comprising 13% of takeaway regulars and 25 to 39 year olds amounting to another 12%.’ (YouGov, 2019).

What makes a healthy city?

The World Health Organization’s (WHO) definition of a healthy city is ‘one that is continually creating and improving physical and social environments and expanding community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential’ (WHO, 2021). Countries across the world, including the UK, are designing healthy cities and towns based around this concept. The UK’s Healthy New Towns Programme is working with 10 demonstrator sites to explore how the development of new places could create healthier and better-connected communities with integrated and high-quality services (NHS, 2019). Representatives from the development and planning and health and care sectors, as well as the wider local community, sit on these planning committees. The programme has three key aims: to promote health and wellbeing,

A CLOSER LOOK: ENVIROMENTS TO INSPIRE

Manchester

Devolved powers to the Greater Manchester region involved the UK government delegating powers of the organization of health and social care to give the region greater control over funding streams. This has resulted in the Greater Manchester Health Population Plan which supports coordinated region-wide action on health. This includes a unified governance system and a tobacco reduction plan which aims to reduce smoking ‘at a pace and scale greater than any other major global city’ (The Kings Fund, 2021).

THE LINE city in Saudi Arabia

The Prince of Saudi Arabia unveiled plans for THE LINE city in early 2021, with a view for completion by 2030. The proposal is a 170km city built in straight line with only natural, walkable spaces above ground. A transport system will sit underground in the second layer and below that will be an Artificial Intelligence (AI) and freight hub to support the overall running of the city.

It is hoped that the city will be home to one million people and that it will address some of the world’s most pressing challenges such as climate change, urban sprawl, traffic congestion and social disconnection (NEOM, 2021).

Amsterdam

Renowned for its cycle lanes and encouragement of public transport, Amsterdam is considered to be one of the worlds healthiest cities (iamsterdam, 2018). Its ‘Vision for Health and Wellbeing’ also focuses on self-reliance, encouraging its citizens to lead an independent, healthy lifestyle for as long as possible. It aspires to be an ‘age-friendly city’ in which every resident can keep participating in society, even if they are no longer able to do everything on their own. It is envisioned that innovative technology such as self-monitoring devices, diagnostic software and care robots will play a part in helping to achieve this (amsterdam.nl, 2021). prevent illness and keep people living independently; to rethink the delivery of health and care services; and to spread learning and good practice to future developments and regeneration areas (Kings Fund, 2019). The Healthy New Towns Programme is currently in the second year and will run until 2023.

Dr Michael Dixon, GP and chair of the College of Medicine, is a commissioner on the Healthy Cities project at the University of Oxford. We spoke to him about what makes a healthy city and the steps needed to create one...

How much of a part does effective governance have to play in designing a healthy city? Does it make the process slower?

‘Governance is important because you’ve got to speak for the people, you’ve got to represent them and get the best value for money according to the evidence you’ve got. I think this inevitably slows things down, as getting people to agree to things takes time. For me the key thing is not only that people have a say in decision making but that they have a role to play in volunteering and in the provision of a city.

‘I think an important part of our infrastructure is joining people together where you can. For example, in a town local to where I live in Devon, there is a volunteer care coordinator in every street who knows everybody in their area and matches them to volunteers who they feel might be helpful. This brings a sense of connection and it's when you get that level of connection in a town that things begin to change.’

Where do you start when it comes to designing a healthy city?

‘Planning is crucial. Affordable housing and how this is organised, as well as employment, a good public transport system and walkways to schools are so important. Clean air is also key, and it is very easy to measure, which is a positive. In our most recent manifesto at the College of Medicine, we’ve suggested that everybody should be entitled to air monitors and to make noise if the air quality in their area is poor. 'One issue with the planning process is that it often happens the wrong way around. For example, a developer will buy some farmland and the planning committee can then have some influence.

But I think a re-write of that script is needed — it should be led by the committee. It should be that the town develops its concept of what it should look like, based on all the points listed above, and then says to the developer, ‘how are you going to make this a reality?’. It would make a lot more sense that way, but sadly it comes down to money and is very unlikely to change.’

Is it possible to work with ‘what you’ve got’?

‘You certainly can! You can make the air cleaner, you can add more green space (for example, on unused church or council property), and you can easily develop social and cultural offerings. 'So much thought goes into the way places look but you can get towns that look absolutely awful and have a huge social heart that you couldn’t replicate. I can think of a village near me that looks a bit of a dump, but it’s got the most incredible community feel. I have a little surgery there and when people come in, they’ll always give their place to someone who looks more poorly. They never mind if they have to wait an hour - in fact, they tell me off if they haven’t caught up with the local gossip! So, you can create the most wonderful city from the ground up, but it could be totally heartless. If it’s not got a soul, a culture and a history, what has it got? The buildings and infrastructure are important, but they can be changed. What matters more is the goodwill of the people to help achieve that.’

What does the future look like for healthy cities in the UK?

‘I think we are slowly moving in a good direction. The real problem is a national agenda - the income between rich and poor needs to be narrower and people need to feel less alienated. We need everyone to feel that they’re part of their town and that they want to be a part of making it better - this is where social prescribing comes in.

‘Social prescribing takes people who are most down on their luck, who are the least motivated, and gives them the opportunity to be listened to, to share their history, beliefs, hopes and challenges. They’re then supported, whether that’s joining a group, finding an allotment or helping them into employment — leading them to a better place as an individual. In doing that, you build up the voluntary offer locally and increase social capital, which leads to a community that’s beginning to create health rather than make people ill, which is what I believe many communities do at present.’

Change in our own communities

Jot down in the box below some changes that could be made to make your local town or city healthier. Sharing what you are doing to make your town or city healthier with your clients may inspire them to also make a wider change in their local community, or to make small changes that positively impact themselves or a loved one. It could be choosing to walk to the shop rather than driving, taking the time to have a conversation with a neighbour, organising a garden veg swap, or starting a ‘walking school bus’ — these things can all have a positive ripple effect on health and wellbeing.

Below we have listed some steps that you or your clients could take to make wider change in the local community:

n Local council A good first step is to contact your local councillor. Write them a letter explaining some of the changes you’d like to see and ask questions about the best way to make change happen. They’ll likely be pleased you got in touch and help you to figure out a way to help that works for you too. n Social prescribing The role of a link worker role is a paid position and involves supporting people in your community by connecting them with others. Find a role local to you by visiting

socialprescribingnetwork.com/contact-us.

n Volunteering We understand not everybody has the time to dedicate to a regular voluntary role but nowadays there are so many options to choose from. Whether it’s offering half an hour a week to call someone who is lonely as a volunteer at The Silver Line or a morning at your local food bank, start your search today. n Social groups Join a social group in your local community and do something you enjoy while connecting with others. Search via your local Facebook group, or simply ask a friend if they are part of any social groups that might interest you. T

SHARE YOUR TIPS OR STORIES WITH OTHER MEMBERS...

Maybe you are already involved in projects that aim to make your town or city a healthier place to live. We’d love to find out more and to share these stories with your fellow members. Please send a few paragraphs (and a photo, where relevant) to Leanne at lsheill@fht.org.uk

Dear little siles

Reflexology expert, Sue Ricks, MFHT, talks about her work with babies and children

Iremember always wanting to work with babies and children. As a little girl, my earliest ambition was to be a children’s nurse, so I spent a lot of my playtime caring for dolls and teddies and I enjoyed taking care of my friends’ brothers and sisters whenever I had the chance.

When I trained in reflexology many years later, I was quite disappointed to find out that it was all about treating adults and I wasn’t ‘supposed to’ treat babies and children, which just didn’t seem right. My first son was a baby at the time, so I decided to ‘secretly’ use some reflexology techniques on him, and then I moved on to treating my friends’ children, and it grew from there.

The next significant step came when

I invited the amazing Susanne Enzer to my school in Leicester, to run some training in maternity reflexology. I had all her books and sat at the back of the class with one of my Gentle Touch students and friend, Karen. We listened avidly to

Susanne, scribbling down notes all the while, and I remember turning to Karen at one point and saying, “When is she going to get to the bit about working with babies?” Karen replied, “It’s a maternity reflexology course, Sue.” I was initially puzzled but then the penny dropped – this course, while brilliant, was about treating pregnant clients and it was going to end when baby arrived into the world. Many maternity reflexology courses today now include working with babies and children, but in those days – and I’m talking a very long time ago – the focus was very much on treating the mum-to-be.

Sharing of knowledge

Our conversation continued with a few of the other students in the tea break, with Karen asking me why I wanted to learn about working with babies and children, because I’d already being doing it myself for many years. I explained that I just wanted to learn more, to which she replied, “Actually, I think people want to know what you know – would you be willing to teach us?”

I was a little reluctant at first but we eventually agreed that I would hold a small, informal class, as long as they gave me their honest feedback. Three weeks later, Karen and three others arrived at my home and I literally walked them through “this is what I do and this is why I do it this way”. Their positive comments and encouragement that I must do more prompted me to put together a training manual, and this became the foundation of my training course for parents and practitioners.

From the outset, the courses proved a real hit, however there was one reflexology student I remember vividly, who raved about the course and told me in one email how helpful it was but then in a follow-up email just a few hours later, said it hadn’t quite hit the mark. I was naturally confused and because I like to understand where people are coming from, I asked her if she’d be happy to discuss this in more detail. We chatted for a long time on the phone and I eventually realized that, strangely, after 12 years of teaching the subject, this lady was probably the first person I had taught who wasn’t a mother and didn’t work with children on a regular basis.

I immediately went off and changed all of my manuals, to include details about how to pick up and hold a baby, and so on, for anyone else who didn’t have this knowledge. I kept adding more and more detail over time, and eventually the core content of my manuals became the foundation of my book, the Gentle Touch of Reflexology for Babies and Children, which is primarily aimed at parents and carers. As a mother myself, I remember being 

a new parent and how hard it was at two or three o’clock in the morning, when your baby is crying and you just don’t know how to soothe and help them. The book takes the parent through different techniques, step by step, to help settle their baby, without having to see a reflexologist. If they still struggle or the baby has more complex issues, then of course it’s marvelous that they can go to a reflexologist who is trained in this area – and that’s what I do now, I train reflexologists how to work in all kinds of situations and with issues that affect babies and children, right up to the age of 16.

International calling

When my book came out, I was invited to give a presentation at a conference in Denver, Colorado, organized by the Reflexology Association of America (RAA). I became wonderful friends with so many from the RAA and it was this, combined with a real appetite in America for working with babies and children, that took me on to Kentucky and Ohio, where I also gave talks. This then led me to working in a number of hospitals in the area, teaching nurses, intensive care workers and complementary therapists how to use simple techniques to help soothe the babies. Over the course of 12 years, I travelled back to two hospitals in particular, where I spent a lot of time in the neonatal intensive care units, as well as teaching staff how to support babies and children in other situations – from babies with neonatal abstinence syndrome, who have a range of issues because they are exposed to drugs in the womb before they are born, to working with children who had undergone transplants, operations, were transitioning, or receiving oncology care.

Working with babies and children

Although I have worked across the world and been involved in reflexology and healing for more than 30 years, I still feel like I’m learning all the time. In fact, one of the things I love about children is that they constantly teach us, by their responses and the way that they communicate with us. I like to call babies ‘energy sponges’, because they absolutely know how we are, even when we think and say we’re ‘fine’, when actually we’re not.

In my earlier training, I would cover the different reflex points and how to approach babies and children — when to work with them, how to work with them, and when not to work with them, and so on. However, over time, I realised that the course needed to cover much more, because it’s imperative that we never go to touch a child unless our own energy is in a good place. I’ve seen many examples over the years of very caring, well intentioned people giving treatments, but the child is actually saying by their movements, sounds or facial expressions, “please get off me”. That’s why my course on gentle touch reflexology for babies and children is underpinned by teaching the parent or practitioner how to get their energy right before they even start the session, because the baby or child will respond accordingly and we want to encourage them to enjoy the benefits of reflexology for life, not put them off having the therapy ever again. It’s the most extraordinary thing when you see a parent or practitioner finally understand how the smallest thing can actually make the biggest difference – that being quiet, calm and settled, and using just the gentlest, simplest technique can have such a profound effect.

When teaching groups of parents or carers as a reflexologist, the parents are the only people who actually touch the child, while you take on the role of instructor, using a doll or dummy to demonstrate the different techniques, supported by various charts. As with most training courses, there will be variations in what you teach parents and carers but in my course, we cover the ‘five essentials’, which involve working reflexes relating to the head, bowels, solar plexus and spine, using very light but grounding techniques.

Practitioners who have the relevant training can also treat babies and children themselves. When working on babies and children, as well as the hands and feet, you can also do some facial reflexology too, if that’s one of your skills. The key thing is to be flexible, because it is the child that leads the treatment. Sometimes they’ll happily give you access to their feet but not their hands, or vice versa. Other times you may even find yourself working with one hand and then the opposite foot! Always work with what you are offered, because it’s a blessing.

Techniques and benefits

All reflexologists are familiar with techniques such as thumb walking,

hooking and pivoting, and all of these techniques are appropriate to use with children, as long as they are used extremely gently. Flowing from one technique to another and from one area to another is also important, as it helps the child to stay in their own energy and place. It’s obviously good to have some idea in your mind about the reflex points that you might want to go to, and these will be similar to an adult’s, however because the child’s anatomy is quite different and their bones and ligaments are still developing, it’s important to only apply the gentlest touch.

One of the greatest things about a parent learning reflexology for their baby or child is that helps to support the bonding process, at any age. Parents are often very busy and living inside their heads and if the child understands that reflexology can only be done when the parent is quiet, settled and truly present, it’s more likely that they will ask for reflexology.

I remember one of my students saying her 11-year-old son had never allowed her to hug or touch him. During her training, she asked her son if she could practise on him and she was really surprised when he said yes. She sat herself down and made sure that she was very calm and present and then eventually said to him, "Am I OK to treat you now?" He put his feet forward and they both cried, because it was such a unique experience they had never shared before.

Consent and cues

It’s really important when working with babies and children that you gain consent before you start. I always recommend having a consultation with the parent and in that you explain to them that you’ll also need consent from the child. If you are working with children who aren’t old enough to speak or who are non-verbal, you need to be aware of any signs and signals that would indicate they are OK or not OK, and have this agreed and recorded beforehand. Signs of not wanting to be involved could be a grimace, pulling away, or even a grunt or other sound. In babies, it could be a tiny twitch of the mouth, or they pull their foot or hand away, but bear in mind that there is a

Benefits to Babies Benefits to Children

Calming and relaxing

Aids restful sleep Calming and relaxing

Improves concentration and focus

Helps to boost the immune system Helps to boost their immune system

Improves digestive function Improves self-confidence / self-esteem

Helps to alleviate colic Helps to address headaches, tummy aches and non-specific symptoms

Improves ability to breastfeed Aids sleep

Improves bonding between parent /carer and baby Helps painful joints

difference between pulling a foot away and baby dancing around. It’s a question of becoming skilled in knowing the difference between the two.

As mentioned earlier, the key is to always follow their lead and work extremely gently. As well as following their cues, be guided by your own intuition rather than a mental plan or set routine, as what you have in mind might not tally with what the child wants and needs. You have to be flexible when working with little ones, as well as have the ability to remain still and calm, inside and out. Children are more sensitive than adults and have often learnt to adapt to what’s required of them in an adult world. The joy of using reflexology with children is that you give them the place and space to be who they are — make an inner promise to honour that by working with the child and connecting with what’s right for them as opposed to what you may have learnt on a course. T

Sue Ricks, MFHT, has more than 30 years’ experience as a therapist and runs the Sue Ricks Clinic & School of Complementary Therapies. As well as being a practitioner and training provider, she has written books, produced DVD’s, designed charts and produced other items to help people learn more about the benefits of reflexology. suericks.com