The ASO Newsletter - 27th Edition

Helping you stay connected to research on the Alexander Technique

Introduction

(11 min read)

This post introduces two new research articles based on the same data set but which adopted quite different approaches to writing up for publication. Alongside providing an overview of the articles, we hope that revealing some of the decisions made by the research team along these different routes to publication, and how they came about, might be of interest to the ASO community.

The data in question were responses to an online survey of members the Society of Teachers of the Alexander Technique (STAT) about the experience of Alexander Technique (AT) teachers of employing the technique with people with dementia and with carers. This was circulated to UK STAT members in February 2020 and later to international affiliate societies. The survey was exploratory and aimed to get a sense of how many AT teachers had experience of working with people with dementia and with carers, and to capture something of their experiences and views on the topic.

The survey was prepared by Emma Wolverson and Lesley Glover. At the time they were both Senior Lecturers in clinical psychology in the Faculty of Health Sciences at the University of Hull, UK. Emma is a dementia specialist and AT student, and Lesley is an Alexander Studies Online (ASO) and STAT Research Group (SRG) member, with an established track record of research, doctoral supervision and publication related to the AT. Emma and Lesley had discovered that they shared an interest in the potential of the AT in supporting dementia care with ASO/SRG colleague Charlotte Woods a year or two earlier. Charlotte is an AT teacher and had taken early retirement from a Senior Lectureship in Education at the University of Manchester in part to be able to better support her mother who had been diagnosed with dementia.

Emma, Lesley, and Charlotte had had a number of conversations and exchanged draft research outputs prior to the Covid-19 pandemic, and these conversations became more regular with the advent of Zoom[1]. When the results of the survey became available, the team agreed to divide up the initial analysis and write up of the data, with Lesley handling the data pertaining to the AT and dementia, and Charlotte tackling the sub-set of questions specifically relating to the role of the AT and caring.

Background to the survey

Emma and Lesley had written and submitted a bid for research funding to the Alzheimer’s society, in 2017. This bid was unsuccessful and while the reviewers were complimentary about the proposed research, they turned it down because of a lack of any published work or research to support the AT as an intervention for people with dementia. In 2019 Emma and Lesley began preparing a further bid, this time to explore the AT for carers of people with dementia. The Poise project had done some work in this area, as had Charlotte, but at that time there were no published papers on it. We decided we needed to collect some information as part of involving people who would be our potential participants to see what they thought of the idea. This is called PPI (patient and public involvement) and is commonly done when making a research funding application. Our PPI was done via an AT group taster session for carers to get their reactions to their AT experience, and through the survey. We hoped to be able to publish the findings in the longer term to provide support for further work.

Emma and Lesley submitted the bid to the Alzheimer’s society in spring 2020. They did not have all survey responses at that time but had enough to help with the bid. Unfortunately, because of Covid, the funding round was cancelled and so they did not get the funding. However, we now have published work which supports further investigation of the AT for people with dementia and their carers. Besides the two articles discussed in this post, Charlotte’s work led to a publication in the Journal of Dementia Care (Woods, 2021) and an article on Emma and Lesley’s AT taster session for carers quickly followed (Wolverson et al., 2022).

Dementia paper

The survey had 84 responses from 11 countries, which was great. Of these 18 AT teachers responded that they had experience of teaching the AT to people with dementia. This in itself was an interesting and heartening finding. It confirmed what the team had thought, which was that there is a role for the AT working with people with dementia, and surprised us that there were so many teachers with this experience. The three of us shared the sense that the AT can be adapted and used for people across the lifespan, and with a range of abilities both physical and cognitive. The people who replied had a wide range of experience. This ranged from several years working in a care home setting, to teaching one person who might be a relative, or be someone they had been teaching for years and who had developed dementia during that time. The teachers had useful things to say and were generous with their comments on the survey. We felt we had something useful to report and wanted to do that in a peer reviewed journal so that the information could be used to support future research activities as well as be accessed by AT teachers and dementia professionals.

While all of this was interesting to us, we realised that such a small number of responses from an overall, by a lot of standards, small number of total responses was unlikely to be acceptable to a peer reviewed journal. We therefore needed to think about how to support the findings. Amazingly, two of our respondents, both from Germany, had provided references to published written accounts of their experiences, which they told us about and which we accessed and translated where necessary. In addition, two survey respondents had offered follow up interviews. Charlotte was one of the respondents who had volunteered to be interviewed. She was keen to have the opportunity to add insights and examples to the data from her direct experience of working with people with dementia and of researching, writing about and reflecting on this area.

Including the articles and interviews involved gaining further approval from the university’s ethics committee. This was a valuable extra stage as the articles and interviews together offered the chance to extend the study to include rich, personal accounts of teaching people with dementia. We now had a degree of breadth of information from the survey and depth from the four accounts. We found a great deal of overlap across all the data which encouraged us to feel that we were gaining a good picture of the work of AT teachers with people with dementia.

We initially analysed the survey responses separately to the four in depth personal accounts. We read each of the accounts and identified themes within each of them and then combined these to give a preliminary sense of the main elements and issues in the responses. We combined these with the survey data analysis and gained a strong sense of the key issues and themes in teaching. The data were rich and there were things we had to leave out but hopefully the final analysis gives a clear picture of the work that teachers were telling us about and includes the key elements.

Most striking in terms of findings was the value placed on the possibility of having a reciprocal relationship with someone with dementia through touch, through the use of inhibition and direction on the part of the teacher, and through the use of AT principles. Changes were observed and the difference the sessions made to people was wide-ranging, including a reduction in pain, reduction in stress and anxiety, and finding a voice.

We are very aware that this tells us about the teachers’ perceptions of what happened in AT lessons and that we haven’t heard from those people with dementia. However, the findings are promising that the AT can provide a helpful intervention for people with dementia across a range of issues, eg pain & mobility, agitation and memory problems. The next steps are to investigate from the person with dementia’s point of view and to look more at how AT might be used.

The final paper has the title ’I am teaching them and they are teaching me’: Experiences of teaching Alexander Technique to people with dementia and can be accessed for free at: https://doi.org/10.1016/j.eujim.2022.102200

Carer article

With increasing attention being paid to care since the start of the Covid-19 pandemic, it seemed important to try to get our message out to academics involved in developing theory and practice in the field. Emma had had a positive experience of the International Journal of Care and Caring (IJCC) when she had published a co-authored article with them. It is a new, high quality, multi-disciplinary journal in an area of rapidly growing interest. As well as carer intervention studies following the traditional test-treat-test approach, it publishes more theoretical and socially critical work in fields such as economics and social policy. With experience of working in a university education department, this latter type of article was not unfamiliar to Charlotte, and the team agreed to make the IJCC the target journal for the carer paper.

Having identified a suitable journal, deciding what to do with the survey responses related to caring proved more tricky. A strength of the data was the high level of consistency among respondents in reporting beneficial AT effects relevant to caring, especially among older adults (eg mobility and managing persistent pain), and these were also consistent with other AT research. However, compared to previously published quality AT research, the data also had significant limitations. First, though the data included responses by AT teachers reporting on their direct experience of caring, many more were from AT teachers’ merely reporting their perceptions of changes in their carer students, weakening validity.  Second, despite the generosity of respondents in giving their time, written responses are necessarily typically briefer than spoken ones, and contextual and other important details were sometimes lacking. Third, because the survey was directed at STAT members, the answers included a lot of AT-specific use of language and assumed knowledge that would not necessarily be shared by people outside the AT community.

Another significant challenge lay in the fact that the very disparate set of physical and psychological benefits of the AT for carers identified by respondents might sound rather too good to be true - too much like magic - to be credible to anybody without direct experience of the AT. Given this problem, and the limitations of the data, how on earth could the findings be presented in a way that would (a) make sense, especially to people who are unfamiliar with the AT and (b) persuade busy researchers and practitioners to read about something unfamiliar and of dubious relevance? It was clear that merely setting out AT teachers’ perceptions of likely benefits of the AT for carers, would not be sufficient.

What was needed was some kind of explanation of why or how the AT might be relevant to caring. A period of several months followed involving intermittent brief periods of reading, thinking and writing about the data. Three ideas seemed promising in putting together an explanation: (i) the concept of carer ‘self-loss’ from clinical psychology, arising from the stress of caring and engulfment in the caring role, and associated with depressive symptoms and loss of self-esteem and self-mastery (eg Skaff and Pearlin, 1992).; (ii) evidence pointing to the fact that aging and stress can interfere with interoception – awareness of our own body-based feelings (eg see Van der Kolk, 2014) (iii) the notion that care is an embodied phenomenon, ie it is something that is felt or experienced, and mainly conveyed non verbally (via touch, tone or voice, facial expressions etc), rather than by words or actions (eg see Hamington, 2004). All three are complex areas, and the relevance of the AT and the survey data to caring requires explanation for people unfamiliar with the technique. It therefore proved challenging to stay within the journal’s word limit of 8,000 words per article and to cover the territory in a way that might be convincing.

With many drafts, crises of confidence, false starts and switching back and forth between rival approaches along the way, the article gradually took shape. Quite late on in the writing process, the idea of presenting the article as solving a riddle or mystery emerged as a potential means of gaining the reader’s attention. Most articles reporting on ways of supporting carers involve some form of carer-specific intervention, with data being collected to establish impacts on study participants, strengths and limitations of the intervention etc. The AT survey was different. It was not describing a carer intervention: in almost all cases, the carers referred to in the data were not taking AT lessons because they were carers. Reported benefits of the AT specifically as a support for caring were therefore indirect and, presumably, unanticipated by the carers themselves.  The purpose of the article became trying to provide an answer to the puzzle of why the AT might indirectly be relevant to care of the self and others.   

The arguments covered in the article are too complex to cover in detail here. However, the main ideas proposed are that (i) important embodied habits relevant to caring for the self and others are acquired, or reacquired, when learning the AT, (ii) these habits are acquired both via explicit instruction by the teacher and unconsciously via the expert, embodied care modelled by the teacher. It argues that the ability to attend to the self while caring for another person is a habit that can boost interoception and act as a buffer against carer self-loss. The article highlights important practical and philosophical differences between AT lessons and other more cognitively-oriented interventions to support carers. It suggests that these differences challenge common assumptions about carer support, invite fresh thinking and indicate the potential contribution of the AT in developing embodied approaches to theory and practice in supporting care.

It seemed important to indicate in the title the contribution to theory made by the article, as this would be likely to be of interest to the intended academic audience. Charlotte was in favour of omitting the word ‘Alexander’ from the title altogether, in case it made the article unappealing to people unfamiliar with the AT. In the end, the title adopted was: Extending understanding of ‘care’ as an embodied phenomenon: Alexander Technique teacher perspectives on restoring carers to themselves.

Unfortunately, the article is behind a paywall, but a copy will be sent on request by emailing charlotteemmawoods@gmail.com

In conclusion

We hope this post has given a flavour of the sometimes rather lengthy process involved in trying to convert raw data into publishable articles. For the dementia paper participants had offered us the possibility of providing useful additional data in the form of interviews and articles. For the carer paper, both the journal requirements and the lack of available rich data indicated a more theoretical examination. Both led to published papers which we hope contribute usefully to the literature and will support future AT work in dementia and in caring.

Footnotes

[1] If you have an interest in the subject of the AT and dementia care, you can find previous blogs by the team here, and articles on the topic in the Alexander Studies Online research database here.

References

L. Glover, E. Wolverson , C. Woods (2022), ’I am teaching them and they are teaching me’: Experiences of teaching Alexander Technique to people with dementia European Journal of Integrative Medicine (2022), doi: https://doi.org/10.1016/j.eujim.2022.10220

Hamington, M. (2004) Embodied care: Jane Addams, Maurice Merleau-Ponty, and Feminist Ethics, Urbana and Chicago, IL: University of Illinois Press

Skaff, M.M. and Pearlin, L.I. (1992) Caregiving: role engulfment and the loss of self, The Gerontologist, 32(5): 656–64. doi: 10.1093/geront/32.5.656

Van der Kolk, B. (2014) The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma, London: Penguin Random House.

Wolverson, E., Glover, L. and Clappison, J. (2022) Self-care for family carers: can the Alexander Technique help?, Complementary Therapies in Clinical Practice, www. sciencedirect.com/science/article/pii/S1744388122000147?dgcid=co-author.

Woods, C.E. (2021b) The Alexander Technique: a role in dementia care?, The Journal of Dementia Care, 29(2): 15–17.

Woods, C., Wolverson, E. and Glover, L. (2022) Extending understanding of ‘care’ as an embodied phenomenon: Alexander Technique teacher perspectives on restoring carers to themselves, XX(XX): 1–17, International Journal of Care and Caring, DOI: 10.1332/239788221X16643644394404

Post Resources and Links

• The Dementia Paper:

  • See the abstract in ASO Research database here

  • Download: I am teaching them and they are teaching me’: Experiences of teaching Alexander Technique to people with dementia and can be accessed for free at: https://doi.org/10.1016/j.eujim.2022.102200

• The Carer Article:

  • See the abstract in ASO Research database here (Extending understanding of ‘care’ as an embodied phenomenon: Alexander Technique teacher perspectives on restoring carers to themselves).

  • Although the Carer article is behind a paywall, a copy will be sent on request by emailing charlotteemmawoods@gmail.com

Thank You

Thank you for being here and supporting research on the Alexander Technique and its teaching. Special thanks to Lesley Glover and Charlotte Woods for their generous contribution to this post. To all community members who have contributed so far, thank you! Your work is appreciated and making a difference.

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