This article presents my journey as a therapist working on the fringes of healthcare in the field of Craniosacral Therapy a mind-body approach that has its origins in the field of Osteopathy. To an academic researcher of wellbeing measurement, complementary and integrative approaches to healthcare and the developer of the Warwick Holistic Health Questionnaire (WHHQ) and Director of Measure Well Ltd.
Imagine what is possible for sound therapy…an opportunity for you to evaluate your practice and capture the positive outcomes your clients experience as a result of receiving sound therapy.
Please tell us about your career, what led you to Craniosacral Therapy, when you qualified and describe your practice today.
I first used complementary and integrative medicine over 20 years ago to support my own ill health at the time. It was reflexology that awoke me to my innate healing ability. I was fascinated by the body-mind results I felt, I responded so well that I decided I wanted to train and spread the word. I qualified in reflexology, aromatherapy, massage and Bowen Therapy, obtaining an Integrative Massage Therapy Certificate at the Southern School of Natural Therapies in Melbourne, Australia in 2003. I also completed my Reiki Master Teacher training at that time.
Back in the UK I’d had direct guidance from spirit that I had an enormous skill as a Craniosacral Therapist ((CST) never having heard of it and thought I would take a look) so attending an introductory training at the Karuna Institute in 2004 and by lunchtime on the first day I knew with every fibre of my being that I was in the right place. I joined in that year’s training and qualified in 2006 with Franklyn Sills.
Today, I work mostly with CST with a variety of people from babies, young people and adults. Usually by personal recommendation – tinnitus, unexplained pain, chronic fatigue, acute stress, and complex cases that are not going far with standard health care are common reasons people come to see me. I work 3 days and see 15 clients per week. I am also a Craniosacral Therapy clinical supervisor.
At this time, did you have contact with mainstream healthcare services and was there anything that frustrated you about how CST was perceived by conventional healthcare?
I was getting in through the backdoor so to speak with colleagues who were allied health professionals in NHS mental health services, using Reiki or reflexology to support carers of patients. Few professionals had heard of or knew about CST at that time.
My personal frustration within practice was that I didn’t have a way of capturing the sometimes-transformative changes my clients reported and I saw unfolding during our work together. This was also in the context of the Advertising Standards Agency (ASA) enforcing new guidelines about what you could claim or write on your website. For me I’ve always been cautionary around asking for a testimonial from clients due to the ethical implications this might have.
All the therapies I was offering at that time were side-lined as ‘not having enough evidence’ the narrative hasn’t changed so much despite there being much more evidence across the field of complementary and alternative medicine available. Although there are research papers now available in some areas, CST still has a long way to go to build an evidence base.
Why did you feel it was important to undertake a research project that focused on Patient Reported Outcome Measure (PROM) as a measure of the efficacy of CST? Had you experience of them before? If not, what brought them to your attention?
Earlier in my career, I had worked for a leadership and management company undertaking psychometric testing for training and recruitment purposes. It just made sense to me that benchmarking was a good thing to do. Using tools to measure the ‘inner world’ intrigued me. Although I had not come across PROMs at that point.
In 2009 the CSTA were looking for a volunteer to do a study of effectiveness for CST using the Measure Yourself Medical Outcomes Profile (MYMOP) – this was undertaking a Masters by Research project with the University of Warwick, Medical School under the supervision of then Chair of Public Health – Professor Sarah Stewart-Brown. This was set in motion, as part of the study I had to do a literature review of potential measures – I didn’t believe the MYMOP to be the best tool for the job and nobody had explored clients’ experiences of CST to find out what outcomes were important to them. After much negotiation with the CSTA it was agreed that I would do that work first so that when selecting PROMs practitioners would know what was a good fit, and what wasn’t.
I undertook 29 qualitative interviews with CSTA members clients to identify what outcomes they believed they experienced as a result of having CST and what importance they had in their lives. I then undertook some thematic analysis to find the themes and created a Conceptual Framework of CST outcomes. This seminal paper on CST outcomes was published in 2015 in the European Journal of Integrative Medicine.
I was awarded an MPhil for outstanding work – something no one else had achieved at that point at Warwick Medical School. This paved the way for a Chancellors scholarship and PhD.
Can you briefly explain how you defined the possible effects of having CST and how this supported the development of the Warwick Holistic Health Questionnaire (WHHQ).
The conceptual Framework of CST outcomes was validated with CST practitioners and more CST clients who took part in focus groups. Using the feedback to refine, the conceptual framework was validated.
The conceptual framework of CST outcomes (Brough, N., 2017) identified important domains of health, not explicitly expressed as statements or items in other measures including the ‘development of self-awareness’ and ‘individuals taking responsibility for themselves’.
I set about using verbatim statements from client interviews to address all areas of the conceptual framework with statements for a questionnaire. 72 statements were the starting point of the WHHQ.
As PROMs are subjective measures, are they considered clinically validated or evidence based by healthcare professionals?
The development and validation of the WHHQ followed gold standard protocols for PROM validation (like those used in clinical trials). Both CST clients and practitioners were involved in all stages of the development and validation process. As a result, the WHHQ is a psychometrically robust measure that is sensitive to change at individual level (client level) and group level (for a service evaluation in a clinic). To date WHHQ is the only measure for CST. It is also that only PROM measure that is applicable across other Complementary and Alternative Medicine modalities that has been subject to this rigor.
The WHHQ (Brough, N. et al, 2021) is a measure of wellbeing (18/25-items) that covers mental wellbeing, physical wellbeing, spiritual wellbeing, social/relational wellbeing. The WHHQ widens the meaning of health and wellbeing because it taps the concept of self-awareness and individuals taking responsibility for themselves with items such as:
‘My awareness about my health has helped me manage my life’
‘I’m learning about myself and my body’
‘I’ve felt in control of my health and wellbeing’
‘I’ve been able to take care of myself’
How was the WHHQ project received by the health and wellness community and organisations, I.e., NHS and CHNC?
I was awarded the Best complementary therapy research award sponsored by the Federation of Holistic Therapists (FHT) in 2018 for my work on the WHHQ. The CHNC are aware of the WHHQ but as of yet, have had no direct conversations with them about its use.
During the development and after the PhD, I had promoted the WHHQ internationally within the CST field I can honestly say that I have had nothing but positive feedback.
Why did you set up the Measure Well platform and what does it aim to provide?
Challenges arose but have since been overcome around ownership of IP and licensing arrangements for the WHHQ. Measure Well Ltd was set up as a means of making the WHHQ accessible beyond the University. Professor Stewart-Brown since retired and I was never employed by the University beyond the Early Career Innovation Fellowship which enabled me to further develop the WHHQ as a tool that practitioners can use.
The pandemic sobered me into thinking that digitalisation was the way to go, the Measure Well hub enables exclusive access to the digital WHHQ, it collects, stores, analysis and reports on client/patient outcomes. It’s very easy to use and provides practitioners with a quick snapshot of where their client perceives their wellbeing to be.
How established is it in the complementary and mainstream healthcare communities? Is it international?
We only launched the Measure Well Hub and started to give access to the WHHQ during winter 2023 – so it is early days. I feel optimistic and see so much potential for its use across the wellness sector.
Who is currently using it and what has the response been so far?
The WHHQ has been used in complementary therapy services within NHS Harrogate & District Foundation Trust - Sir Robert Ogden Macmillan Centre (SROMC), Harrogate Hospital and there are discussions underway to roll this out to the wider multi-disciplinary teams. The implementation paper has been published. The positive outcomes for the department included:
Simple to use, easy to interpret
Fewer mistakes made due to digitalisation
Provides a broad perspective of patient wellbeing concerns
Fewer personnel hours consumed inputting and collating data.
The WHHQ is currently being trialled in Staffordshire Combined Mental Health Trust within the Clinical Health Psychology department, the psychologists within the department really like the WHHQ content as it gets patients reflecting on what’s working in their lives instead of what’s not.
How do you use it in your day-to-day CST clinic?
I use the WHHQ every time I have a new adult client come to see me. A link is sent out via email along with my online case history form. We discuss the scores at the initial consultation, and I use the statements that have been highlighted as problematic areas to guide discussions along with what the client is bringing in the moment. Clients are asked to complete a follow-up WHHQ at a future session depending on our treatment plan. I find it helps to focus the sessions. The WHHQ is scored 0 – 100 (the higher the score the greater the wellbeing) and it enables me to get a handle on where someone perceives themselves to be and/or if they are masking on arrival.
I can monitor progress of my 1-2-1 clients quickly online and I can benchmark across all my clients. I use the WHHQ results to write reports when clients need to make Personal Independent Payment (PIP) claims, for those that get funding for sessions, or GP letters. I certainly feel it adds an extra dimension of professionalism to what I am doing.
What do you hope it will do for Sound Therapy practitioners? How do you envisage it will benefit Sound Therapy in the longer term?
The benefits of evaluating wellbeing outcomes can vary at organisational, practitioner and client levels.
Improves the credibility of a profession
Increases the public profile of an intervention
Enhances funding applications
Demonstrates the value and shows visible progress of therapies
Improves client communication and understanding of progress made
Provides tangible reporting
I wish for sound therapy practitioners to have the confidence within themselves:
a) to give evaluating their practise ago and
b) to see the bigger picture and the opportunity we have as a profession to work together to gather some meaningful outcomes (data) on the modality that is sound therapy.
How do you see WHHQ developing or evolving and what are your hopes for the Measure Well platform in the holistic space?
Over time I would like for Measure Well to be in a position where we can report back out to the different areas of the wellness sector about the outcomes we have collated. I am keen to increase awareness of the benefits of outcomes evaluation and excited to see how the WHHQ might be used in the wellness sector.
Are there other areas that you think could be suitable for research projects?
Outcomes studies using sound therapy for Headaches, lower back pain, and chronic pain might be good areas for future research.
Do you have advice for anyone considering a research project?
Find good links within universities and don’t try to do too much. Things always take much longer than you think they will. Don’t give up, look at what I have achieved!
Is there anything else you would like to share about your work and Measure Well that we haven’t touched on?
Measure well runs CPD online trainings for practitioners
How to undertake a successful service evaluation
How to use the WHHQ.
Podcast series – The ‘Connection heals, the elements to the art of listening’ is a suite of short podcasts designed to support practitioners in building a successful therapeutic relationship with your clients/patients and help you think about the elements that contribute to a successful professional working relationship. Hosted by myself and Judy Hemmons. Licences to use the Measure Well hub that provides exclusive access to the WHHQ can be purchased directly by individual practitioners, clinics with multiple associates and training schools. Our online courses can be purchased from our website www.measurewell.co.uk
