Relaxation and Creative Therapy: An Interview with Christel Fröse
Today, I am in conversation with Christel Fröse, delving into topics such as autogenic training, relaxation, and creative therapy. Christel, who is personally navigating life with endometriosis, brings her expertise to her current role as a clinical art therapist.
Dr. Nadine Rohloff: Today, we are exploring the realms of autogenic training, relaxation, and creative therapy. We are fortunate to have Christel as our expert on these subjects, and I am thrilled to have you with us. Would you mind giving us a brief introduction?
Christel Fröse: Certainly. I am Christel, a member of the Endo-App team and living with endometriosis. Through my own experiences, I have become acquainted with the myriad challenges faced by those with this condition—not just the physical symptoms like pain but also the profound impacts on social, professional, private, and family life. With a background as a physiotherapist spanning 30 years, I eventually had to step away from the profession due to endometriosis. However, my interest in the psychological aspects of patient care persisted. Even during my time as a physiotherapist, I pursued additional training as a relaxation therapist and menopause counselor. When my physical therapy career became untenable, I was fortunate enough to be allowed to retrain as a clinical art therapist. Now, I work in psychiatry, psychosomatics, and addiction therapy, addressing various clinical cases and working with diverse patient profiles. I’ve also undergone training in stress management. In addition to my therapeutic work, I co-lead the self-help group “Aufgefangen” (caught up) in Münster with Vanessa and served as a consultant for the Endometriosis Association for several years.
Dr. Nadine Rohloff: That is an incredibly diverse wealth of experiences. Let us delve into the broader topic. What does relaxation therapy typically entail for individuals with endometriosis?
Christel Fröse: In essence, any activity promoting relaxation is beneficial for individuals with endometriosis. The symptoms, especially pain, create a heightened level of tension in their bodies, exacerbated by associated worries and fears. Managing these stressors is crucial. Some find solace in reading or listening to music, while others engage in activities to clear their minds, such as exercise or sports. From a therapeutic standpoint, various relaxation methods can be effective, catering to individual preferences. Autogenic training, which involves visualization and positive ideation, is one approach. Progressive Muscle Relaxation (PMR), according to Jacobsen, focuses on systematically tensing and relaxing muscles, starting from smaller groups to larger ones. Mindfulness, pleasure training, yoga, Tai-Chi, Qigong, breath relaxation, singing bowl massages, body journeys, and fantasy journeys are among the diverse array of methods available. It is a matter of exploration to find what resonates best and promotes relaxation for each individual.
Christel, personally impacted by endometriosis, had a long career as a physiotherapist. However, her condition led her to transition to a clinical art therapist and undergo training in stress management. Currently, she works in psychiatry, psychosomatics, and addiction therapy, catering to diverse clinical cases and patients. Christel also spearheads the “Aufgefangen” self-help group in Münster, served as a counselor at the Endometriosis Association for years, and is an integral part of the Endo-App team.
Dr. Nadine Rohloff: I find your emphasis on individuality quite crucial. Let us delve into autogenic training, your specialized area. Could you provide more insights into what autogenic training is, and who might find it beneficial?
Christel Fröse: Autogenic training was developed by Johannes Heinrich Schulz and has its roots in hypnosis. Historically, hypnotists aimed to eliminate symptoms by hypnotizing patients. Nowadays, it is a method where individuals learn to direct their focus inward, exploring their imagination, thoughts, or feelings. Schulz, a psychiatrist and neurologist, conducted further research, aiming to harness the positive effects reported by patients under hypnosis but without the need for external influence. He devised specific formulas, including those for inducing feelings of heaviness, warmth, regulating heart activity and breathing, and promoting sensations in the solar plexus and forehead coolness. The choice of forehead coolness is intriguing—it stems from the cultural association of a cool forehead with health and clarity of mind, in contrast to the warmth associated with illness or stress.
Dr. Nadine Rohloff: So, these pleasant and relaxing feelings are generated by focusing on them?
Christel Fröse: Precisely. There are numerous CDs available for passive listening, but many find it more beneficial to attend an actual course. In a course, usually spanning six to ten sessions, participants learn a new formula each week. The course delves into why autogenic training is important and how it operates. Autogenic training affects muscles, induces relaxation, and promotes blood circulation by relaxing and regulating muscle vessels. Consequently, it influences the autonomic nervous system, responsible for numerous regulatory functions in the body and internal organs. Excessive tension hampers rest, causing the body to be down-regulated. By gradually practicing these formulas, participants within a group, develop personal associations with each formula. For instance, they might associate the word “warmth” with specific ideas, thoughts, or images.
Dr. Nadine Rohloff: Sunshine.
Christel Fröse: That is a common response. One can envision basking in the sun, feeling embraced, kissed, caressed, and warmed. However, for those with endometriosis, the imagery can also include a hot water bottle, a bathtub, a sauna, or a fireplace. The possibilities are diverse, and the key is that it should always be fitting. Various ideas are explored, and individuals choose what resonates best with them. For the heaviness formula, many express, “Heavy is associated with darkness.” Why darkness? Some link lightness with a brighter tone, while heaviness is likened to a darker tone. When lying in bed, in a state of sleep or fatigue, the surroundings are often perceived as dark.
Dr. Nadine Rohloff: There is something intriguing about that.
Christel Fröse: Remarkable outcomes emerge from that. I always emphasize that everything exists within oneself. Everyone must make their own decisions, and then it is a matter of practice. The more consistently you practice and persist, the quicker your body adapts. Initially, you might need a specific phrase like, “My right arm is getting heavier, and heavier.” Later on, you can simply say, “Both arms are quite heavy.” Or, if you are quite adept, just hearing or thinking the word “heaviness” induces relaxation in your body. It is also a matter of training.
Dr. Nadine Rohloff: It is not just about listening; it is about fully engaging, and visualizing. Another crucial point is regular practice to make it effective. So, you can utilize it when needed, like in stressful situations, right?
Christel Fröse: Absolutely. Sometimes it takes a while. Many people mention struggling to attend classes or maintain their practice. However, the more consistently you engage in it, the quicker your body adapts. Eventually, a single word like “heaviness,” “warmth,” “rest,” or “solar plexus” becomes sufficient. Mastering it well is advantageous because you can apply it in various situations. The beauty of it is, you do not need the CD or any audio files. When you are at a chilly bus stop, having mastered this technique, thinking of warmth can make you feel less cold. Mastering an exercise on your own is incredibly rewarding. It can become a part of your routine, like brushing your teeth daily—essential for psychohygiene.
Dr. Nadine Rohloff: Shifting from relaxation exercises to creative therapy, what does creative therapy entail? What is done, and what is its purpose?
Christel Fröse: Creative therapies are psychotherapeutic methods that can be both calming and emotionally intense. One form of creative therapy is art therapy, which includes music therapy, dance and movement therapy, and drama therapy. The aim is to find expression for one’s emotions and current state of being, offering not only relaxation but also clarity. It can uncover new solutions and reawaken inner resources. Sometimes, individuals discover latent qualities or networks they were unaware of through creativity and creative therapies.
In art therapy, the uniqueness lies in the tangible outcome—a creative work that persists. While music, dance, and theater are ephemeral, an art therapy work endures, be it a painting, sculpture, collage, or even masks made from natural materials. Although many associate art therapy solely with painting, it encompasses various forms of expression, with individuals often using colors and diverse materials to convey their emotions.
Dr. Nadine Rohloff: Could you provide an example of art therapy, allowing people to visualize it? What might be a task, for instance?
Christel Fröse: In art therapy, there is a dynamic between the individual affected by endometriosis and the therapist. Both engage in a conversation on a psychological level, involving careful listening to the emotions, thoughts, and expressions of the person. In the context of endometriosis, where pain is often challenging to describe, an exercise could involve locating the pain in the body—upper or lower abdomen—and assigning it a color. Participants may then draw, paint, or sculpt the pain, exploring its shape and characteristics. For instance, if pain were a shape, would it be angular, round, jagged, or sharp-edged? This process allows individuals to make their pain visible to themselves, facilitating a more profound understanding. The focus in creative therapies is not on the final product but on the judgment-free process. Participants are encouraged to express their feelings without concern for artistic talent. Creative therapy, in essence, emphasizes the journey—the exploration of emotions, thoughts, and sensations during the process. All feelings are welcome, and the approach is tailored to the individual’s goals, whether it is relaxation, emotional release, or gaining new insights. Engaging in creative therapy provides an opportunity for self-expression, allowing individuals to channel their emotions outward in a supportive environment. It is a process-driven approach, encouraging participants to observe and reflect on their feelings throughout the creative journey. Whether the outcome is a painted canvas, a sculpture, or any other form of expression, the therapeutic value lies in the personal experience and exploration.
Dr. Nadine Rohloff: It is important to recognize that therapy is highly individual, catering to specific needs at any given time—whether it is about strengthening resources, exploring emotions, or addressing pain and other sensations. The beauty of therapy lies in the dialogue that helps determine and select the most fitting approach.
Christel Fröse: In the realm of creative therapy, especially when you are uncertain about where to begin or what to do, there are fantastic mandala books designed for relaxation to provide a starting point. Creating one’s mandala can be a gradual process. Collage-making is another accessible entry point, particularly for newcomers to art therapy, to prevent overwhelming them. I often use collage materials like magazines, foam letters, or small items to initiate the creative process. The goal is not predetermined; instead, it is about exploring what catches the eye, what sparks interest, and allowing something to evolve naturally. Nature itself can serve as a wellspring of materials, offering insights into the cycles of change and letting go—akin to the seasonal transformations observed in trees. Incorporating these natural elements into art therapy can be both calming and illuminating.
Dr. Nadine Rohloff: That is the beauty of it. Creative therapy has no limits. I still have one general question: Where are these forms of therapy offered? Are they also covered by health insurance?
Christel Fröse: It depends. Let us revisit relaxation. Neither relaxation nor creative therapies are prescribed. However, in the realm of relaxation, there are preventive courses—learning techniques before falling ill. Relaxation educators or therapists may submit their concepts for review through the central prevention testing agency. Although this process involves significant effort, some mistakenly associate the effectiveness of therapies with health insurance subsidies. This is not necessarily true. In the case of preventive classes, you can inquire with your health insurance company about available courses, such as autogenic training, yoga, and progressive muscle relaxation (PMR). The costs may be fully covered or up to a certain percentage. This is the initial step in utilizing health insurance for these therapies.
Dr. Nadine Rohloff: Things vary greatly depending on the health insurance company. Where is the best place to get information?
Christel Fröse: The best place to gather information is on the website. You can check if there is an autogenic training course available in your town. The website provides numerous options, and you can contact the providers to inquire about the course details, fees, and whether it is covered by health insurance. In some cases, you may find this therapy available in acute clinics, although it is less common. Many therapists, including occupational therapists or physiotherapists, have additional training in these methods and may incorporate them into their treatments. Rehabilitation clinics that are certified often offer autogenic training and PMR for endometriosis, recognizing the individual nature of these therapies. Creative therapies, unfortunately, are generally not covered by health insurance in Germany. Unlike in some other countries where creative therapy is considered a psychotherapeutic procedure, here, patients often have to choose from available methods in acute hospitals, mainly in psychiatric, psychosomatic, addiction therapy, or oncology clinics. Occupational therapists and physical therapists in hospitals may also have additional training in art and design therapy. Private options exist, and one can explore dance therapy, music therapy, or theater groups in the area. Contacting therapists privately might involve checking their websites, and some therapists, working as alternative practitioners for psychotherapy, may partially bill through Heilpraktiker psychotherapy. This applies, especially to conversational areas within creative therapy. While the path may be challenging, there is often a way to access these therapies with persistence.
Dr. Nadine Rohloff: In gynecology, it seems that there are still avenues for payment, though not as straightforward as one might expect. Unfortunately, with endometriosis, this is often not the case.
Christel Fröse: Indeed, it is regrettable. In pain clinics, creative therapies, along with relaxation therapies, are employed because tackling chronic pain requires addressing both physical and psychological aspects. Finding a balance and identifying effective approaches is key. Medical professionals, including those at health insurance companies, acknowledge the efficacy and benefits of these therapies, though always in moderation. Engaging in creative therapy or educational exercises will not miraculously cure endometriosis; if it could, there would be ample financial gain. Instead, it is about managing the condition and alleviating stress. The potential benefits are significant, offering various ways to support individuals dealing with chronic conditions such as endometriosis, promoting mental well-being. Unfortunately, health insurance does not cover these beneficial therapies.
Dr. Nadine Rohloff: We have brainstormed various ideas to enhance the situation for those dealing with these challenges. Now, let us address a community question about finding a starting point. Christel, would you like to share some insights on that?
Christel Fröse: Absolutely. My suggestion is to take that first step. It involves overcoming hesitations and stepping out of your comfort zone. Perhaps, find a companion who is willing to explore with you. Gather materials of any kind, and, like a child unburdened by constraints or rules, let your instincts guide you. For instance, in visual arts, just open a paint bottle, let the colors flow, dip your finger, and see what emerges. In dance therapy, the choice of music is not relevant; move freely within your space. While you are free to do this outdoors, it might look amusing to others, but why should that stop you? If you feel like crossing the street and doing a little bounce, why not? It is a pity that we often hold back when a spontaneous impulse arises. I often say, embrace that childlike freedom—maintain an open mind and dare to follow your instincts.
Dr. Nadine Rohloff: Another question that has come up is whether there are creative therapies that do not involve painting. How can one explore these alternative creative therapies?
Christel Fröse: Absolutely. In dance therapy, as I mentioned earlier, it is as simple as moving to music. In the realm of visual arts, you can go to a museum, collect postcards, or interesting cards. In music, there is often a misconception that everything needs to sound pleasant or follow a specific rhythm, but that’is not the case. Just as we do not walk in a set rhythm, you can experiment with various materials, whether it is a bucket, a pot, or different metals or woods, and listen to the sounds they produce. Explore how you can modulate your voice—our voices have highs and lows. What does it feel like when you hum? Your voice may vary when you are happy compared to when you are sad. With theater or drama therapy, it can be a bit challenging as it involves more imagination. For example, if you are sitting between two chairs, mentally question whether you are doing something or not. Then, physically place two chairs, sit on one, express your thoughts, and switch to the other chair, allowing them to communicate with each other. Another approach is to gather your favorite objects, place them on a table, and see what you can create with them. There are endless possibilities, and our minds and bodies appreciate the freedom to let imagination run wild.
Dr. Nadine Rohloff: Yes, I think that’s wonderful. These are all ways to creatively express your emotions and thoughts. It is a delightful way to initiate the process.
Christel Fröse: Absolutely. Creativity is essentially a problem-solving process. When faced with a problem, it undergoes stages. The initial step is to recognize its existence and perhaps contemplate potential solutions. If progress is not made, setting the problem aside temporarily is an option. In the second phase, the subconscious seeks solutions in past experiences or, according to C.G. Jung, in the collective consciousness—a fascinating aspect. The third phase involves simply experimenting with different approaches. Eventually, the “aha” moment arrives. Many people say, “Let me sleep on it overnight,” or ideas may unexpectedly surface during activities like showering. You suddenly think, “I have got it; this might work for me.” You give it a try, and if it succeeds, that is great. If not, you may wait a bit and continue the creative process. Brainstorming in business is a familiar concept, where everyone shares thoughts or potential solutions without judgment. It is a non-evaluative process to explore possibilities before refining ideas. While external limits may exist, we essentially shape them. The freer our thinking, the more possibilities we unlock.
Dr. Nadine Rohloff: We have one last question here. Where can I find free online exercises?
Christel Fröse: It can be challenging to find free online exercises. There are various platforms where you can actively participate in relaxation procedures immediately. These are typically designed for you to lie down or sit and simply listen. Our Endo-App is a valuable option as it offers a range of relaxation methods, including dream journeys, fantasy journeys, body journeys, breath relaxation, and yoga. While you can find some content related to relaxation on the internet, free resources for creative therapies are scarcer. Searching for creative therapies online often yields explanations or paid courses, which I avoided exploring extensively. However, there are resources such as mandala books and a book titled “Painting against Stress” that provide various exercises you can try.
Dr. Nadine Rohloff: Absolutely. YouTube can be a useful resource, although exercises found there are often lacking instructions. Therefore, it might be beneficial to start with a course or experiment with online resources. In our app, we offer various options for you to try out. Once you find something that resonates with you, consider enrolling in a course or delving into more specific aspects. This approach could be helpful for creative therapy, providing a starting point that makes it easier to evaluate online exercises.
Christel Fröse: When it comes to online resources, it is crucial to consider whether the content aligns with your preferences. In our app, we have autogenic training with explanations and instructions, which may not be available with other online providers. Factors such as voice, pace, and the ability to connect with the pauses are essential for a successful experience. Participating in courses with interpersonal interactions allows the course leader to gauge participants’ reactions and make necessary adjustments in real-time. During relaxation, various phenomena, like restlessness or physical sensations, may arise, and it is important to recognize them as normal and welcome. Discharge phenomena signify the release of tension, and experiencing them alone may lead to anxiety. Therapists can guide individuals through these moments, explaining and reassuring them. Similarly, creative exercises may stir up emotions, turning a seemingly relaxing activity into a psychotherapeutic process. If emotions emerge, it is beneficial to discuss them with others or seek professional help to explore and address any underlying issues. Ignoring dormant emotions can potentially manifest as physical symptoms, underscoring the importance of seeking support and illuminating the soul’s depths.
Dr. Nadine Rohloff: Returning to the topic of free online exercises, there are indeed various options available. It is essential to consider your specific needs: are you seeking a casual online exercise to try out, or are you looking for something more structured, perhaps in the form of a course? Assessing your preferences will guide your choices, allowing you to decide what aligns with your goals. Additionally, exploring whether certain courses or exercises are covered by health insurance or if you are willing to invest personally is another aspect to consider. If you have any further questions on this matter, feel free to reach out, and we will gladly provide additional information. Now, I want to express my gratitude to Christel for joining us. I appreciate your insights, and we look forward to our next session!
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