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Pathways2wellbeing Ltd, 27 Bridge Street, Hitchin, SG5 2DF

We Offer Treatment Groups In the NHS  And The Community To Support People With Persistent Undiagnosed Symptoms

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Case Studies

Lyn

Lyn is a middle aged woman in full time employment visiting her GP for consultations lasting on average 36 minutes each time. Lyn visited her GP at least 13 times per year over two years.   

Lyn presented as tense, a “bundle of nerves” and complaining of muscular cramps, insomnia, headache and feeling low and tired. She often visited A&E with headaches and muscular cramps. Lyn’s symptoms began after a traumatic event in the past. Since then whenever stressful situations arose in everyday life she had panic attacks and could not function or self-manage. She was unable to sleep well, found it hard to go to work as she felt tired and could not concentrate which resulted in frequent absences from work. Lyn’s GP was unsure whether she needed investigations however sent her for two scans and for several different blood tests. It was made clear to the patient by the GP that the investigations would probably come back negative. CBT was discussed with Lyn but she was reluctant to attend as she insisted on a physical explanation for her symptoms not wanting to consider a psychological one. The frequent referrals for tests and scans increased her belief that there would be a physical, medical explanation which just had not been discovered as yet. Her reluctance to engage with psychological therapies was based on her fear that she would be given a mental health label. She explained her depression as being concerned with a reaction to the lack of medical explanation. Lyn received consistent advice within the practice GPs in the practice as they were all aware of Lyn and the fact that her symptoms were medically unexplained.   

Lyn’s GP continued to discuss the case with fellow GPs and other specialist colleagues at formal clinical meetings that supported the difficult decision of not referring for any more tests or investigations.

Lyn’s GP explained to her why referrals for investigations were no longer going to be made and discussed with her the idea of attending a supportive group treatment (The MUS Clinic) focusing on her symptoms and quality of life as being helpful in the meantime.  

Lyn’s GP used the Pathways2Wellbeing consultation document for GPs in order to give her the relevant Information and answer queries which enabled her to participate in a shared decision-making process to attend the group.

Lynn attended 10 out of the 12 MUS clinic sessions. She began to explore her breathing patterns through various exercises.  She soon realised something was different and discovered the correct way of breathing and practised it frequently. In the group Lyn looked happier, seemed more energised and reported to the facilitator and group that she was now sleeping better and enjoying work. Lyn said that the new breathing pattern had become second nature to her and she appeared to increase in confidence at every session. Through the bodywork practices Lyn found that she was well co-ordinated and gracious in her movement, had a good sense of rhythm and could dance!   

Lyn now enjoys dancing around in her kitchen pain-free! She has reported six months later that the group experience changed her life. Lyn has not needed to return to her GP or A&E again for these symptoms and enjoys a better quality of life. When Lyn’s symptoms return, which they do from time to time, the bad days are not so bad and she can self-manage them so that she feels far more in control. Lyn’s medication for depression and pain relief are reduced to almost nil.  

As a result of the reduced number of appointments and time spent discussing Lyn’s case there has been increased capacity for her GP and his colleagues. This means that they have been freed up to see other patients that they can help. The costs for tests and scans have been significantly reduced as the patient no longer requests these. Medication costs have also been reduced considerably. A&E visits have stopped altogether reducing costs to the surgery. The frustration felt by the GP in being unable to help Lyn has disappeared, improving their quality of life and job satisfaction. Lyn only visits the surgery on occasion now for different conditions with organic explanations.     

  


Gemma

Gemma came to the sessions after surgery to remove her breasts after having suffered with cancer. She was a sporty, rode horses, was married and was in employment. She came to look at why she was having such bad headaches, low mood, nausea and because she had also noticed increasing difficulties in her relationships.

Gemma was initially very sceptical. She expressed her concerns openly with the group which gave other people permission to question what we were doing. During the time with the group Gemma explored many of her feelings using imagery, movement and reflection with the group.

She explored strong feelings of rage using imagery that came through processes we did. She also started to get in touch with some of her underlying needs, namely needing support and reassurance from those around her. She found she wanted more physical nurturing (and got it) and used all sorts of visual and creative cues to help her come to this realisation.

She started also to link when her symptoms came on to when certain issues were stimulated. She also started to link the delayed messages her body was giving her about her wellbeing e.g. shock in her body post-surgery. Gemma used the support and the creative process of the group to question and explore the meaning of her symptoms in her life.

This opened new doors for Gemma. She found some reduction in her symptoms and realised her needs more clearly. With the group she was able to unpick and speak about some of the fear around her feelings of depression and fears around her own death.

Gemma became more in touch with her vulnerability but was in a better position to get her needs met. This was from friends, colleagues and most importantly for her, her husband. She was someone with whom we talked about links onto ongoing support if she felt she needed it.

Gemma was good at expressing how surprised she was at the support she felt from the group. She was also someone who pushed and questioned things as we went along, not just conforming to a structure but creating it for herself.

Jane

Jane had lived in the UK for a number of years although was originally from Continental Europe. She was a highly qualified nurse in the NHS and continued to work as she attended the group.

She presented as a very articulate independent woman who was managing her symptoms well enough although it was causing her a lot of distress. She found she would hold her breath and could not breathe out at times. She felt it was psychological but did not know how to get a handle on it.

 During the sessions Jane explored her symptoms using a lot of imagery, relaxation and group movements. What Jane found was that the images and reflections on some of the witnessing around breathing and her body, lead her to traditional stories that contained information that held keys to her past. Very subtle watching and listening to her symbolic body cues held information that helped Jane be seen, and make sense of some of her feelings.

This was particularly around the death of her mother when she was a child, and her feelings of security and safety whilst living in another country. When Jane began to become aware of some of her unresolved longings (even when they could not necessarily be fixed) her symptoms began to resolve and her understanding and compassion for herself increased.

The knock on effect of this meant that she became more aware of needing others in her life, and she became very interested in movement therapy and followed up with some more training in this area.

Eddie

Eddie was 26 years old, he is one of two brothers, living at home with parents, and he works full time.

He was referred to the symptoms group by his GP, and attended 11 of the 12 sessions. He seemed to be very committed (he missed one session because he had flu).

The most prominent symptoms that Eddie was aware of were concerned with his eyes.  In his description he saw bright white light, he had static vision and had vision blink. He suffered this for more than a year in which he had undertaken almost all of the medical tests available but nothing was found.

He was given medication to attend to his pain. Eddie was worried that he might have some incurable illness or the start of some psychological impairment. He continued to be affected by these symptoms, he went to work but his condition prevented him doing sports or to see people. He became depressed and socially isolated. He was preoccupied that his eye sight would diminish and that he might have something more serious.

Eddie seemed to have very little to say since his first individual pre-group meeting with the facilitator and in each session, his answers were concise. Everything was matter of fact.  Inquiring in to his feelings and emotion was difficult.  He seemed to have no words for feelings and he often said that he didn’t know what I meant and saying “I don’t feel anything”.

The group welcomed him warmly.  He experimented with the various activities which he called “strange things”. He listened to the others and although he didn’t seem to be able to empathise, he seemed attentive and interested. Eddie said that he was not expecting anything from this group, he had never done anything like it and he was curious. Eddie was a good listener and the group offered him an opportunity to learn from others. Eddie was taken into consideration by other group members and given attention.  

Eddie seemed to relax in the group; in one session E told the group that he had joined a fencing group and that he enjoyed it.  Eddie was invited to show the group the fencing technique, and he used it for his improvised movement. It looked like a dance. It was a great pleasure to see Eddie looking at ease and free in his body. After a little while he was teaching the group the fencing movement, he was offering something to the group for the first time. Although everyone was overjoyed he remained undemonstrative but in his own way pleased. Towards the end and after the group Eddie hardly mentioned his symptoms again and did not return to his GP with them. He appeared renewed in confidence and far less preoccupied with his eyes.

James

James was a young man who had been identified by a community pharmacist as being appropriate for the group. He was 21 years old, living at home and struggling with symptoms of increased urinary frequency and at times incontinence. He had every investigation under the sun with as yet no success. This had interfered with his ability to continue at university and had gradually meant he had stopped socialising and had become very low in confidence. He joined our small group with a few other younger participants and a few older ones. James attended very regularly and found that after his symptoms disappeared, which happened very quickly, he found he felt incredibly depressed. He was able particularly to link art work with body feelings and attitudes. He found he could talk about his difficulties with the group without ever having to actually name the symptom he had come with.

He used the sessions to access his creativity and began to become aware of levels of tension and relaxation in his body. He had a vivid imagination which he could tap into through the relaxation and playful aspects of the group. James used art work particularly to find which bits of himself and his body he liked or found difficult. He began to build a more detailed picture of the different aspects of himself, which meant he came back into relationship with parts of himself and began to feel more in control. James found the middle stages of the group difficult and would spend long periods being quiet and sometimes have to actually move away from the group. However he still stayed with it, he turned up and eventually found ways to talk about his experiences. He found in the later stages that he could share more about how he felt about himself, and through the group realised that some people could understand how he struggled with certain things. He realised that some young people and older people shared similar experiences to him. He felt the possibility of being better understood and he said this gave him hope about the future. Part of what James discovered and could share with the group was a sense of his own uniqueness. People enjoyed his quirky sense of humour, his artistic mind and alternative ways of looking at things. They would actively give him feedback when a new or different idea sprang from him. As a result of the group he felt he was able now to go back and study and felt more confident in sharing himself with those around him. By the end his mood had lifted considerably, however once again links to other support were discussed with him should he feel the need of it in the future.