Relaxation as a Treatment Tool

Relaxation techniques are invaluable in the treatment of a variety of DSM-IV diagnosis but especially with trauma, depressive, and anxiety disorders. When treating children or adolescents with these disorders it is important to provide them with tools that they can use to not only “sooth” themselves but also to help them develop healing positive self-talk statements.

First it is important to lay some ground work to enlist their cooperation and belief in the techniques you will be using to help them heal. Within the first sessions I introduce some of the basic tenants of cognitive behavioral therapy (CBT). I always use two specific demonstrations to help demonstrate the power of thoughts. The first requires a small metal washer (about one inch in diameter) tied to the end of a string about 18 to 24 inches long. Instruct the child or teen to hold the end of the string between his/her pointer finger and thumb (emphasize squeezing hard) and holding in front of their body with their lower arm parallel to the ground. Then give the following instructions: “Keep your hand and arm perfectly still and simply think about your washer moving left to right across the front of your body. That’s right; just think the thought of the moving the washer and picture in your mind the washer moving on its own”. With this instruction the washer will begin to move in the direction requested. Next use the same instructions and ask that the washer move forward and backward or toward their body and away from their body. Finally ask the child to look at you and not to think anything and then give them these instructions. “Now I want you to clear your mind of all thoughts and just listen to my words. Without your even thinking about it your washer will begin to move in a circle, round and round, in a nice circle”. Then ask them to look down at the washer and it will be moving in a circle. I follow this activity with the arm strength demonstration. Simply ask the child to raise one arm or the other straight out from their shoulder (arm parallel to the floor) to the side of their body. Then say, “I want to test your arm strength so I’m going to push down on the middle of your arm and want you to resist. (pause) Now I want you to think the word strong and I will again push down on your arm. (pause) Now I want you to try and keep your arm up but I want you to think of the word weak and say weak to yourself.” With this suggestion the child finds either an inability to keep the arm up or a noticeable diminishing of strength. Both of these demonstrations can then be used to explain the power of our thoughts and words. The next step is to generate a list of positive self-statements enlisting suggestions from the child and the parent. I also suggest using statements that are goal behaviors that the child may not yet be experiencing or believing (eg. I feel happy, I am worthwhile and important, I always try my best, I listen to my parents, etc.) For good examples of positive self statements check the table of contents in the book, “Ready, Set, R.E.L.A.X.” part of the child’s homework assignment is to read this list out loud every day. I then begin to teach them progressive muscle relaxation (PMR) and send them home with the “Ready, Set, Release” CD so they can listen to the script I used during the session. I’ve used these techniques successfully with hundreds of clients over the past twenty-five years. What I like most about these techniques is the generalization effect. I’ve had numerous children stay in touch with me by e-mail and continue to report using their relaxation and positive self-talk list years after therapy ended. They feel empowered and have been able to apply the techniques learned in therapy years earlier to new problems and stress in their lives.

Case Example: Emily was 8 years old when I first saw her in my private practice. She was fearful of sleeping in her room and awakened her parents nightly wanting to sleep with them. Bedwetting was also a major problem. Adding to her stress was difficulty in school due to a learning disability. Emily came from a intact, caring family. There was a history of depression on the maternal side of the family but there was no presenting pathology in Emily’s family. My normal screening using the Parent and Teacher BASC inventories, the RCMAS and Reynolds Child Depression Inventory supported a diagnosis of anxiety disorder. After spending two sessions with Emily establishing rapport and teaching her the basic principals of CBT I led her through a relaxation exercise using one of the RSR scripts. She took home a “Ready, Set, Release” CD and practiced relaxation daily. She was instructed to first listen to the CD before she left her room to go to her parent’s bedroom. After two weeks of practice she was able to calm herself and was no longer leaving her room. We next addressed the enuresis. A through physical exam by her pediatrician was contraindicative of any physical problem causing bedwetting. I showed Emily a picture of a bladder connected to the urethra. I next had her draw her bladder and urethra. I then asked her to draw a line across the bottom of her bladder separating it from the urethra. I told her to imagine that this line was a gate. I then led her through a progressive relaxation exercise and asked her to imagine her bladder and urethra and then to imagine a gate closing off the urethra. She was then asked to keep a chart of her dry nights so we could track her progress. She continued practicing relaxation daily and each night before bed did a relaxation exercise and in her “mind’s eye” imagined a gate closing off her bladder. The frequency of her dry nights increased immediately and within a month she stayed dry nightly.

About the Author: Roger Kein has worked with children and parents since entering the field of education in 1971. His back-ground includes classroom teaching, coaching and school psychology. He is currently working part time as a school psychologist in Watertown, Wisconsin and the remaining time as a private practice clinical psychologist. Roger has presented the concepts of using music, relaxation and active imagination at the national, state and local levels. He has a masters of arts degree in counseling and an educational Northern Colorado. He completed his doctorate degree in clinical psychology, with special emphasis in children and adolescents, at the Wisconsin School of Professional Psychology. “Ready, Set, R.E.L.A.X” exercises are also used in the PTSD Projects Curricula for the Residential Treatment Curriculum and Stress In Adolescence. If you are interested in learning more about using these techniques in your setting visit the website or send Roger an e-mail .