Healing Relationships Research Articles

Beyond parallel play: Science befriending the art of method acting to advance healing relationships.

Research underscores the central role of factors in healing that appear to relate to the therapeutic relationship. These nonspecific or common factors and placebo effects are often overshadowed by an emphasis in the field on particular empirically supported therapies. Yet relationship variables account for a greater proportion of the variance in treatment outcomes than the technical intervention employed, representing a notable blind spot in our science and, by extension, our practice. As a consequence, clinical instruction in psychology and in the health professions more broadly generally lacks adequate specificity with respect to how to cultivate a healing relationship. Through the elaboration of several techniques derived from theatrical traditions, the authors propose that method acting and similar schools of drama provide a method for honing clinical skills in these areas that is amenable to empirical scrutiny. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Envisioning Nursing in 2050 Through the Eyes of Nurse Theorists: Leininger and Watson

Madeleine Leininger and Jean Watson envision how their theoretical ideas will be expressed in the world in 2050. Leininger explains how her theory and ethnoresearch methodology have given rise to transcultural nursing and the culture care nursing paradigm and predicts that they will continue to contribute to culturally congruent care practices that promote health, healing, quality of life, and even world peace. Watson provides a vision based on an emergent perspective that emphasizes subjective dimensions related to self-knowledge, self-control, self-caring, and self-healing potential; spirit and wholeness of being/becoming; natural healing approaches; and caring, healing relationships with self and others.

Spiritual transformation and healing: anthropological, theological, neuroscientific, and clinical perspectives

Chapter 1 Foreword Chapter 2 Preface Part 3 Part I: Finding Our Way Through New Terrain Chapter 4 Chapter 1: Exploring Spiritual Transformation and Healing: Fundamental Issues Chapter 5 Chapter 2: The Meaning of Spiritual Transformation Chapter 6 Chapter 3: The Spirit of Spiritual Healing in the United States Part 7 Part II: Traditional and Indigenous Healing Systems: Anthropological Perspectives Chapter 8 Chapter 4: Spiritual Transformation and Radical Empathy in Ritual Healing and Therapeutic Relationships Chapter 9 Chapter 5: Radical Empathy, Gender, and Shamanic Healing: Examples from Peru Chapter 10 Chapter 6: Sustainable Faith? Reconfiguring Shamanic Healing in Siberia Chapter 11 Chapter 7: The Making of a Shaman: A Comparative Study of Inuit, African, and Nepalese Shaman Initiation Part 12 Part III: Spiritual Transformation and Healing from Religious Perspectives Chapter 13 Chapter 8: Spiritual Transformation and Healing: An Encounter with the Sacred Chapter 14 Chapter 9: Spiritual Transformation and Healing in Light of an Evolutionary Theology Chapter 15 Chapter 10: Personal Tranformation: Perspectives from Psychology and Christianity Chapter 16 Chapter 11: Spiritual Growth, Cognition, and Complexity: Faith as a Dynamic Process Part 17 Part IV: Neuroscientific Perspectives on Spiritual Transformation and Healing Chapter 18 Chapter 12: The Neurobiology of Spiritual Transformation Chapter 19 Chapter 13: Narrative in Holistic Healing: Empathy, Sympathy, and Simulation Theory Chapter 20 Chapter 14: Healing of the Self-in-Context: Memory, Plasticity, and Spiritual Practice Part 21 Part V: Clinical Perspectives on Spiritual Transformation and Healing Chapter 22 Chapter 15: Spirituality, Spiritual Experiences, and Spiritual Transformations in the Face of HIV Chapter 23 Chapter 16: Spiritual Engagement and Transformation in Cancer Patients: The Experience of the Patient, the Role of the Physician

Awesome families: the promise of healing relationships in the International Churches of Christ

Awesome families: the promise of healing relationships in the International Churches of Christ

Awesome Families: The Promise of Healing Relationships in the International Churches of Christ

Awesome Families: The Promise of Healing Relationships in the International Churches of Christ

Therapeutic touch and dementia care: an ongoing journey

Touch is considered a core aspect of care provision and therapeutic relationships. Therapeutic touch allows nurses to facilitate healing and forge therapeutic relationships through touch or non-touch and maintain channels of communication often lost in dementia as the disease progresses. This article reports the findings of a research project to examine the effectiveness of therapeutic touch in dementia care.

AWESOME FAMILIES: THE PROMISE OF HEALING RELATIONSHIPS IN THE INTERNATIONAL CHURCHES OF CHRIST Edited By Kathleen E. Jenkins

AWESOME FAMILIES: THE PROMISE OF HEALING RELATIONSHIPS IN THE INTERNATIONAL CHURCHES OF CHRIST Edited By Kathleen E. Jenkins

The alienating language of health care

Language is one of the many tools of medicine. Language can educate and inform or confuse and mislead. Language can inspire or alienate, cherish or insult. It is increasingly recognized that communication between clinicians and patients is one of the most important aspects of the healthcare relationship and yet the way language is used in the health service is often opaque, alienating and disrespectful. My attention was drawn to this recently by the emergence in the media and in management speak of the term ‘frequent flyers’ to describe those frail, mainly older people who come in and out of hospital on a regular basis. The term ‘frequent flyer’ in this context is demeaning, trivializing and of course plain wrong. It implies that somehow these people want regular trips to hospital, that they are collecting points, that they enjoy the health and life threatening roundabout of continual admission, treatment and discharge. The health service uses language in this way to shift the blame. By using ‘frequent flyer’ we imply that patients are acting out of choice whereas of course people who are forced to attend hospital too frequently are a sign of our failure. ‘Bed blockers’ is another alienating term which shifts the blame from the NHS to the patient as, in its different way, is the reduction of all of us who don't turn up for appointments to ‘DNAs’. Categorizing people as DNAs allows the service to avoid looking at why its appointment system doesn't work. I confess to being a DNA. I became one because the appointment letter was sent to the wrong address. I didn't even know I was expecting an appointment letter. What is it about the NHS and appointments? It is the only organization I know where the word ‘appointment’ means an instruction to attend rather than an agreement between two parties to meet. And why does the NHS feel the need to SHOUT at me? Appointment letters are constructed unlike any other with strange uses of typefaces, capital letters and italics. ‘Dear MR CAYTON’, they bellow. ‘Your APPOINTMENT is on Monday 17th July... ’ they go on. Nor should you imagine that the appointment time is real. A colleague of mine, taking his elderly mother who has Parkinson's disease from her care home to see a consultant, was told to arrive at 9 am. This of course meant getting a frail, unsteady lady out of bed and dressed at seven in the morning. When they got to the clinic the consultant hadn't even arrived and didn't do so until well after the first appointment time was passed. No explanation or apology was given. It's not surprising some of us become DNAs. Labelling people in this way is the most common way in which the NHS dehumanizes those it is supposed to care for. As well as notorious terms such as ‘crinklies’ and ‘crumblies’ sometimes used in geriatric wards, people are also reduced to no more than their condition; ‘We have two hips and a knee in today’ in the surgical ward or the diminution of a human being with Alzheimer's disease to no more than a ‘Dement’. It is interesting to note that this language is most commonly used about older people. Older people generally use the health service most often but they are also sometimes the least able to speak up for themselves, the most vulnerable. Maybe the embedded ageism in society allows these terms to be more acceptable. So what might be done about this use of alienating and dehumanizing language and does it even matter? Is my disgust just another example of political-correctness-gonemad? I can understand in the stressful environment of health care, when you are working close to pain and disease and possibly death, you need some distance. This language establishes distance by turning people into objects. But there are other, kinder ways of achieving detachment and, yes, language does matter. Language both reflects and shapes our thinking and thus our behaviour. Discourtesy cannot be the basis on which a healing relationship is built. The reduction in sexist and racist language has not eliminated sexism and racism but it sets a context and an environment in which sexism and racism are more shocking and tolerated less. We must do the same with the language of blame and disrespect. We are a long, long way from patient-centred health care and our language betrays us.

The Gift of Therapy

An office visit for even a simple condition like hypertension may be routine to a physician, but patients, in the back of their mind, may fear the implications of the doctor's assessment for the length of their life or changes in their lifestyle. Existential concerns are never far from a physician's daily business, yet we receive little formal instruction in how to use the doctor-patient relationship to talk with patients about issues like death and life meaning in a helpful way. While Yalom's intended audience is the young psychotherapist, physicians of any specialty will find both the existential theme and his reflections on the healing relationship quite relevant to their own practices. The Gift of Therapy is a brief work written as a series of 2- to 3-page tips of the trade, with a tone somewhere between that of an informal memoir and off-the-cuff teaching on morning rounds with a seasoned psychiatrist. It is peppered with brief clinical examples invariably on point, as well as well-distilled literary references. The first 40 mini-essays address the therapeutic relationship, stressing how Yalom works by keeping the content in the moment rather than analyzing past conflicts. The next 10 sections describe how he discusses the issues of death, freedom, and life meaning with patients. Seven sections are devoted to working with dreams, and the remainder of the book is composed of miscellaneous observations and advice on the conduct of therapy with its joys and hazards. A work of this nature is brief by necessity, but it would have been helpful to include a discussion on isolation, since he lists it among the 4 existential life concerns and since it is an integral part of the experience of physical or mental illness. The Gift of Therapy is not an exposition of theory or philosophy—it is meant as a high-yield, practical guide to building healing relationships with patients. Yalom has done a service by demystifying the act of engaging with patients about their ultimate concerns in the moments of great life transition that we physicians are privileged to share with them.

Can an ethic of caring be maintained?

Can an ethic of caring be maintained?

Toward a Reconstruction of Medical Morality*

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary. * Originally published in The Journal of Medical Humanities, 8(1), Spring/Summer 1987. Reprinted with permission from Springer Science and Business Media.

A “Holistic” Model of the Healing Relationship: What Would That Require of Physicians?

Pellegrino (2006) rightfully argues that the healing relationship is at the heart of medical morality, and a philosophical understanding of the healing relationship is necessary for any reconstruct...

Some Thoughts on History and “Healing Relationships”

Some Thoughts on History and “Healing Relationships”

65: The role of healing relationships in the treatment of violence and depression among Latino male youth in a Correctional Treatment Center

65: The role of healing relationships in the treatment of violence and depression among Latino male youth in a Correctional Treatment Center

Moral Agency in Pain Medicine: Philosophy, Practice and Virtue

Although established as a field of specialization, pain medicine remains somewhat fractionated. Such lack of cohesion creates dissonance on multiple levels, and thus, impedes the provision of effective pain care. This paper asserts that there is a core philosophy of medicine that reflects the intellectual and moral quality of the healing relationship. I argue that pain medicine, in all its constituent disciplines, is bound to this philosophy. The intricate relationship between pain, the pain patient, and the pain physician creates pragmatic and moral dilemmas that may not be well served by the use of prima facie principles. It is argued that an agent-based, virtue ethics best enable the clinician to both apprehend the complexity of this relationship and appreciate other ethical approaches in the discourse arising from issues of care.

Existential-Phenomenological Psychotherapy in the Trenches: A Collaborative Approach to Serving the Underserved

AbstractThis article describes the origin and the work of a volunteer run nonprofit agency designed to provide low cost psychotherapy. The agency was developed by psychotherapists connected with the Seattle University graduate program guided by the vision of psychotherapy as a healing relationship and in response to a growing crisis in the mental health system. We address the benefits and the challenges of this collaborative effort, and especially the difficulty involved in successfully running an agency while staying true to a particular vision of therapy, collaboration, and community.

Complexity and Healing Relationships

The Institute of Medicine's first simple rule for quality health care is a long-term healing relationship; and the first aim for a quality health care system is patient-centered care.1 The Association of American Medical Colleges' Medical School Objective Project urged faculties to teach interpersonal and communication skills.2 The Accreditation Council for Graduate Medical Education accredits residency programs based, in part, on their demonstration of residents' competence in interpersonal and communication skills.3 Similarly, the American Board of Medical Specialties' member boards include communication skills in the criteria for certification and recertification.4 Yet the scientific and theoretical basis for these recommendations remains sparse.

Communication About Symptoms in Primary Care: Impact on Patient Outcomes

Good communication is an integral part of a healing relationship. Our study's purpose was to explore the relationship between patient-doctor communication about physical symptoms and patient outcomes Five hundred (500) consecutive adults presenting with physical symptoms were surveyed. Previsit surveys assessed for patient symptom characteristics, illness worry, stress, expectations, functional status (MOS SF-6), and mental disorders (PRIME-MD). Immediately postvisit, patients were asked about their satisfaction (Rand-9), the presence of unmet expectations, and what the clinicians did for them; clinicians were asked what they did for the patients and also completed a 10-item measure of how difficult the encounter was from their perspective (DDPRQ). At 2 weeks, patient surveys assessed symptom outcome, functional status (MOS SF6), and satisfaction. There was a high degree of agreement between clinician and patient reports about concrete actions during the encounter, such as prescription writing, diagnostic test ordering, or providing referrals. However, there was little agreement about whether clinicians discussed the symptom's diagnosis (k = 0.18) or prognosis (k = 0.27). Encounters in which patients' reported receiving such information were associated with greater satisfaction ( 2.1, 95% CI: 1.5-3.1; 2.0, 95% CI: 1.4-2.9), fewer unmet expectations ( 0.41, 95% CI: 0.24-0.71; 0.75, 95% CI: 0.52-0.98), less postvisit worry that their symptom( s) could be serious ( 0.41, 95% CI: 0.29-0.64; 0.53, 95% CI: 0.36-0.79), and better 2-week symptom outcomes ( 1.7, 95% CI: 1.1-2.5; 1.9, 95% CI: 1.3-3.0). Patients and clinicians disagreed about whether or not communication about symptom diagnosis and prognosis occurred during their encounter. Patient reports of receiving such information were associated with greater satisfaction, less worry, fewer unmet expectations, and better 2-week symptom outcomes.

Challenges and Opportunities in Achieving Healing

The current health care system in the United States must shift from a primary focus on acute care and cure to also emphasize maintenance of function and the relief of suffering that derives from the ailments associated with chronic disease and illness. To achieve this goal, the individual components of the health care equation must all respond and work in concert. These components include the provider, the venue, the patient, the community, our society, and the fiscal realities of paying for care. However, the barrier for change stems from the marked heterogeneity that exists in the definition of each of these individual components. Thus, the fundamental question is, can our current and future medical care system respond to the imperative of focusing on healing with a particular emphasis on chronic diseases? A solution is the provision of individualized care in a mindful practice and the purposeful cultivation of a healing relationship suffused with compassion and empathy in the therapeutic alliances between patient, provider, and advocates.

Developing Healing Relationships: Foreword from the Organizers

S-1 This 3rd American Samueli Symposium entitled “Developing Healing Relationships” was held on April 21–22, 2005, in Alexandria, Virginia. The symposium was designed to complement the two previous American Samueli Symposia, both of which explored the subject of optimal healing environments. The 1st symposium, “Definitions and Standards in Healing Research,” was held in January 2003. The content of that meeting focused on the variety of frameworks in which healing occurs and on approaches to the investigation of the internal environment of the patient and practitioner. The papers from this symposium were published as a supplement to the peer-reviewed journal Alternative Therapies in Health and Medicine in May 2003. The 25 papers of the 2nd symposium, “Toward Optimal Healing Environments in Health Care,” were published as a supplement to the peer-reviewed Journal of Alternative and Complementary Medicine in October 2004. This meeting explored the core domains of an Optimal Healing Environment (OHE) and provided recommendations for performing research in the inpatient, outpatient, and worksite venues. These papers are accessible on the Samueli Institute website, www.siib.org. The primary mission of the Samueli Institute is to support clinical and basic research in the science of healing. A primary goal of this research is to examine how relationships in health care either do or do not facilitate healing and self-recovery processes and to identify methods to extend that information to clinical and treatment settings. Accordingly, we fund collaborative research efforts that are oriented to the development, implementation, and evaluation of optimal healing environments and the relationship to these environments to the health care team members, the patients they serve, the patients’ significant others, and the community. To further define our research agenda, we invited colleagues who have been thoughtful contributors to this field to prepare papers related to OHE. As a result of their efforts, we have created the graphic on the back cover of this supplement. It highlights individual elements that combine to define an optimal healing environment. The graphic illustrates what we feel are the core domains of an optimal healing environment. They involve activities that do the following: