Healing Relationships Research Articles

The healing relationship

Understanding the different methods of therapeutic communication is vital for nurses, writes Lynn Jones

Role of foster family belonging in recovery from child maltreatment

Research on foster care suggests that children who have experienced abuse are susceptible to a range of negative life outcomes. Such research also suggests that children removed into foster care can recover from abuse if given opportunities to develop healing relationships with caregivers. Drawing on qualitative data from a national research project on Australian foster carers, this paper explores how foster families enact forms of belonging that potentially work to ameliorate experiences of abuse among foster children. With a specific focus on experiences of family solidarity, rituals, identity, and culture among foster carers and the children in their care, the findings highlight the role that foster carers can play in contributing to national child protection agendas aimed at addressing experiences of maltreatment among children removed into care in Australia.

The Courage to Teach Caring

The Courage to Teach Caring

Radical Remedies:

As states weaken and public health care deteriorates throughout the developing world, new spaces are opening for civil society groups to fill the gaps of declining health systems. In Mexico, popular health groups have responded to health care decline by building community clinics, establishing health promoter training programs, and opening natural medicine pharmacies. Lower- and working-class women are the primary participants in these groups that use a self-help approach to find practical solutions to local health care problems. However, little is known about participants' circumstances, motivations, or the ideals they embrace. Drawing from women's narratives, I explore the "micropolitics" of women's participation in local health groups. I examine their efforts to reclaim control over the health process as a metaphor for claiming control over their lives. Highlighting the "instrumental effects" of participants' medical encounters and healing relationships, this case illuminates some unintended consequences of health care decline.

Cultivating Healing Relationships

Cultivating Healing Relationships

A Health Care Cooperative Extension Service

RIMARY CARE IS THE ESSENTIAL FOUNDATION FOR AN effective, efficient, and equitable health care system.Callstorebuildthecrumblingprimarycareinfrastructure in the United States are reaching receptive ears, with public and private advisory groups includingtheMedicarePaymentAdvisoryCommissionand the National Business Group on Health recommending increased payments for primary care. 1 The American RecoveryandReinvestmentAct(ARRA) 2 of2009appropriated$19 billion for the purchase of health information technology (HIT), with primary care physicians’ offices slated to be among the beneficiaries. Policy makers expect that new investments will transform primary care by creating more effective and efficient patient-centered medical homes. The primary care physician community acknowledges the need for new practice models that provide accessible, comprehensive, integrated care based on healing relationships over time. 3 New investment in primary care is necessary but not sufficienttorevitalizeprimarycareunlesscombinedwithastrategy for disseminating and implementing innovations and best practices. Acquiring an electronic health record (EHR) will not create a highly functioning medical home unless it can be used to create functional patient registries. Receivingenhancedpaymentsforcarecoordinationwithoutaworkable plan for hiring and training health coaches for patient self-management leaves a gap between expectations and reality. Large, organized delivery systems such as Geisenger, Kaiser Permanente, and the Veterans Administration have theinstitutionalwherewithalandeconomiesofscaletoimplement practice redesign in a systematic and successful manner. However, two-thirds of office-based physicians work in practices of 4 or fewer physicians. 4 These clinicians oftenhavelittleornotechnicalassistancetodeployandmaintain new practice improvements like EHRs. To successfully redesign practices requires knowledge transfer, performance feedback, facilitation, and HIT support provided by individuals with whom practices have established relationships over time. The farming community learned these principles a century ago. Primary care practices are like small farms of that era, which were geographically dispersed, poorly resourced for change, and inefficient in adopting new techniques or technology but vital tothenation’swell-being.Practicingphysiciansneedsomething akin to the agricultural extension agent who was so transformativeforfarming. 5,6 AnationwidePrimaryCareCooperative Extension Service, modeled after the US Department of Agriculture’s Cooperative State Research, Education,andExtensionService(CooperativeExtension),which so successfully accelerated farm transformation, should be created.County-basedhealthextensionorganizationswould supportprimarycarecliniciansinthesamemannerthatthe agricultural model assists family farmers, providing infrastructureforlocallearningcommunitiesandpracticetransformation. ARRA establishes a Health Information Technology Extension Program 2 to “assist health care providers toadopt,implement,andeffectivelyusecertifiedEHRtechnology,” which could serve as the nidus for a broader program to revitalize primary care and community health.

Healing relationships and the existential philosophy of Martin Buber

The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core.

Is it Morally Right for Physicians to Kill Patients that Good May Come?

Robert Truog and Franklin Miller have recently argued against the dead donor rule in organ transplantation. We question their position that it is morally right for doctors to kill their patients when the patients would be allowed to die anyway and when such killing would yield benefits to others. Assuming, for the sake of argument, Truog and Millers position that both brain dead organ donors and donors by cardiac death are alive before organ removal, we argue that physicians are not morally justified in such killing. Medicines fundamental end involves a healing relationship between a vulnerable patient and a physician with both the knowledge and power to help that patient. Killing a patient violates the nature of this healing relationship and is neither justified through utilitarian considerations nor through informed consent. Thus killing patients for their organs is morally wrong and inimical to the proper practice of medicine.

A functional analytic approach to group psychotherapy.

More than two decades ago, Kohlenberg and Tsai (1987) published the first book chapter on Functional Analytic Psychotherapy (FAP), an approach to psychotherapy that is based on the functional analysis of the therapist-client relationship in the individual talk therapy setting. Over time, FAP has consolidated its place among third wave behavior therapies. Third-wave behavior therapy is a strand of treatments that builds upon many of the acquisitions of first-wave (exposure-based) classical behavior therapy and second- wave (based on modifying thoughts and beliefs) cognitive behavior therapy, but differs from them in its distrust of verbal control and its focus on contextual meaning. These differentials give the third-wave behavior therapies an experiential flavor which is strongly evident in FAP. Relying on a client case conceptualization, the FAP therapist observes clinically relevant behavior when it occurs in-session. When it does not occur, he or she evokes it. The curative process depends on the therapist's allowing natural, direct consequences to affect these clinically relevant behaviors in-session. In addition, the therapist monitors and when necessary, promotes generalization. These tasks are interwoven to produce FAP's approach to the healing potential of a relationship. While FAP was developed mainly as an approach to individual psychotherapy, there have been translations into group therapy (e.g. Gaynor & Lawrence, 2002; Hoekstra & Tsai, in press). The present paper presents one such translation. It suggests that, when properly understood, FAP necessarily leads to a type of group therapy that is pragmatically quite different from traditional behavioral group therapy. How could we describe this difference? Since its early days, behavioral group therapy has been distinguished by its teaching technology, including training activities and streamlined learning modules (e.g. Rose, 1977). Group therapies in the cognitive mainstream of behavior therapy (e.g. Free, 1999; Bieling, McCabe & Antony, 2006) tend to maintain this characteristic, through activities such as lectures and structured exercises. Even when, for example, exposure for social phobia is done in-session, the programmed teaching focus is maintained (Becker & Heimberg, 2002). When we apply FAP to the group setting, however, it comes much closer to Group Psychotherapy, which has often focused on unexpected experiences and outcomes (Yalom, 1975; Rutan & Stone, 1984). However, group FAP is not a compromise between these two traditions. The combination of a flexible focus on spontaneously evolving interactions with a functional contextual approach to the healing nature of relationships adds a new dimension to group therapy. The aim of the present article is to discuss how this dimension works. For that purpose, personal experiences in supervising FAP in group therapy will be described. These groups functioned as free-of-charge services for socially disadvantaged patients. First, some points of inspiration for conceptualizing the work in the groups will be presented. Then, it will be described in an informal way how a group can be transformed into a network of healing relationships. It will be shown how this can be done on different levels of analysis, namely that of long-term strategy, of in-session tactics and of moment-to-moment technique. Finally, the transformation of unplanned events into in-vivo learning opportunities will be illustrated with a series of short examples. The chronic pain group experience Our first group, described by Vandenberghe, Cruz and Ferro (2003) was formed at the initiative of the two latter authors with the intention of helping people referred from a nearby pain center. These were patients who did not respond to medical treatment for chronic orofacial pain. The group started in August 2001 as the first in what would become a long series of FAP groups for chronic pain (e.g. Vandenberghe, Ferro & Cruz, 2003; Vandenberghe & Ferro, 2005; Martins-Queiroz & Vandenberghe, 2006). …

The 3 H and BMSEST Models for Spirituality in Multicultural Whole-Person Medicine

The explosion of evidence in the last decade supporting the role of spirituality in whole-person patient care has prompted proposals for a move to a biopsychosocial-spiritual model for health. Making this paradigm shift in today's multicultural societies poses many challenges, however. This article presents 2 theoretical models that provide common ground for further exploration of the role of spirituality in medicine. The 3 H model (head, heart, hands) and the BMSEST models (body, mind, spirit, environment, social, transcendent) evolved from the author's 12-year experience with curricula development regarding spirituality and medicine, 16-year experience as an attending family physician and educator, lived experience with both Hinduism and Christianity since childhood, and a lifetime study of the world's great spiritual traditions. The models were developed, tested with learners, and refined. The 3 H model offers a multidimensional definition of spirituality, applicable across cultures and belief systems, that provides opportunities for a common vocabulary for spirituality. Therapeutic options, from general spiritual care (compassion, presence, and the healing relationship), to specialized spiritual care (eg, by clinical chaplains), to spiritual self-care are discussed. The BMSEST model provides a conceptual framework for the role of spirituality in the larger health care context, useful for patient care, education, and research. Interactions among the 6 BMSEST components, with references to ongoing research, are proposed. Including spirituality in whole-person care is a way of furthering our understanding of the complexities of human health and well-being. The 3 H and BMSEST models suggest a multidimensional and multidisciplinary approach based on universal concepts and a foundation in both the art and science of medicine.

Awesome Families: The Promise of Healing Relationships in the International Church of Christ, by Kathleen Jenkins. New Brunswick, N.J.: Rutgers University Press, 2005, 272 pp.; $22.95 USD (paper), $62.00 USD (cloth)

Awesome Families: The Promise of Healing Relationships in the International Church of Christ, by Kathleen Jenkins. New Brunswick, N.J.: Rutgers University Press, 2005, 272 pp.; $22.95 USD (paper), $62.00 USD (cloth)

Creating "Kantri" in Central New Guinea: Relational Ontology and the Categorical Logic of Statecraft

Creating "Kantri" in Central New Guinea: Relational Ontology and the Categorical Logic of Statecraft

Understanding Healing Relationships in Primary Care

Clinicians often have an intuitive understanding of how their relationships with patients foster healing. Yet we know little empirically about the experience of healing and how it occurs between clinicians and patients. Our purpose was to create a model that identifies how healing relationships are developed and maintained. Primary care clinicians were purposefully selected as exemplar healers. Patients were selected by these clinicians as having experienced healing relationships. In-depth interviews, designed to elicit stories of healing relationships, were conducted with patients and clinicians separately. A multidisciplinary team analyzed the interviews using an iterative process, leading to the development of case studies for each clinician-patient dyad. A comparative analysis across dyads was conducted to identify common components of healing relationships Three key processes emerged as fostering healing relationships: (1) valuing/creating a nonjudgmental emotional bond; (2) appreciating power/consciously managing clinician power in ways that would most benefit the patient; and (3) abiding/displaying a commitment to caring for patients over time. Three relational outcomes result from these processes: trust, hope, and a sense of being known. Clinician competencies that facilitate these processes are self-confidence, emotional self-management, mindfulness, and knowledge. Healing relationships have an underlying structure and lead to important patient-centered outcomes. This conceptual model of clinician-patient healing relationships may be generalizable to other kinds of healing relationships.

Awesome Families: The Promise of Healing Relationships in the International Church of Christ. By Kathleen E. Jenkins. New Brunswick, N.J.: Rutgers University Press, 2005. xii + 284 pp. $22.95 paper.

Awesome Families: The Promise of Healing Relationships in the International Church of Christ. By Kathleen E. Jenkins. New Brunswick, N.J.: Rutgers University Press, 2005. xii + 284 pp. $22.95 paper. - Volume 77 Issue 1

Asian models of excellence in psychiatric care and rehabilitation

In Asia, like other regions, the circumstances for psychiatric care and rehabilitation impose various limitations on us. However, committed professionals have been creating innovative models of excellence, which are culturally appropriate and clinically effective. In this paper, seven innovative models of psychiatric care and rehabilitation are presented.The Nitte project in India provides a comprehensive free rural psychiatric service, while transforming the ‘brain drain’ problem to ‘brain circulation’ cooperation. Through Social Enterprises in Hong Kong recovered clients are trained and employed. Senior Peer Counselling in Singapore emphasizes the relief of emotional distress by psychological methods and the primacy of communication in the healing or therapeutic relationship. Seoul Mental Health 2020, an epoch-making project in Korea, has increased the coverage rate of community mental health centres remarkably. Yuli Psychiatric Rehabilitation Model in Taiwan helps long-term inpatients to get reintegrated into the community. In Japan, models of excellence for community-based psychiatry have been developed at local government, hospital and community/NGO levels. Chinese Psychiatry Online, an excellent website, provides public education, resource searching, self-testing and consultation services for the public along with various contents for professionals.We must disseminate information about models of excellence which provide great benefit to the people who suffer from psychiatric illness without high expenses.

Regaining Our Humanity Through Story

In this issue of Innovations in Integrative Healthcare Education, we are departing from our usual format of spotlighting specific projects or programs in lieu of presenting a more extended piece by MacKenzie on relationship-centered care and narrative medicine. The importance of these topics cannot be overestimated in their role of humanizing the healthcare encounter, improving self-awareness of the practitioner, and creating a space in which the patient feels deeply listened to. A commentary by Dr Michelle Sierpina is also included in this special section to put into context the power of narrative in medicine and in patients' lives. Her recent PhD focused on the power of life stories told by seniors; that research and training enables her to provide a broad and scholarly review of the power of story in relation to MacKenzie's article. In the medical school at University of Texas Medical Branch, we send out first-year medical students in the first couple of months of the first semester to patients' homes to just get their story, not a medical history, as part of a required course on the practice of medicine. Many students find this immensely anxiety provoking, due to the lack of structure and familiar context. However, ultimately they find an opportunity to encounter a real person in a nonclinical setting. A scoring rubric based on the construction and quality of a short story allows us to grade the students objectively. However, a most interesting finding, which we expect to present at the Ottawa Conference in Australia next spring, is the process of personal transformation that such story writing has for students. This is also reported by MacKenzie in her article and in Sierpina's accompanying commentary. The importance of capturing and understanding the patient's story is also a major focus in nurse practitioner programs across the United States, where the art of listening and the importance of patient narratives have long been emphasized. In an integrative assessment of patients, we "make a history" rather than "take a history." This means that we coconstruct with the patient the reality of the medical encounter and the tone and timbre of the healing relationship. By bringing our own culture, beliefs, and values to the exam room and then allowing the patient to share theirs with us, we create a new kind of relationship-centered, patient-centered care model. This allows the strength of the linear standard medical history, chief complaint, history of present illness, past history, social/family history, review of systems, etc, to be informed and enriched by the nonlinear, perhaps circular, patient story. This story making further allows deeper exploration of the patient's life goals as well as their medical goals.(1) It creates increased personalization of the provider-patient relationship and moves from the "I-them" to Buber's "I-thou." Enjoy the article and the accompanying commentary and consider how to implement this kind of care and mindfulness into the education of health professional students and your practice.

Use of Patient-Reported Outcomes in Clinical Oncology Practice

The Institute of Medicine report, Crossing the Quality Chasm, suggested some new ways of thinking about organizing care. This article describes how practices might create continuous healing relationships using methods that are independent of patient visits to monitor and address problems that may occur during cancer care. Such a system would be based on patient report, timely and useful, sensitive to change, and low burden for patients, clinicians, and administrative staff. Furthermore, it would be built into the delivery of care and be integrated with other data systems such as patient records, decision support, and community or other resources. Using reports for patients that are presented in a format that is easily understandable, patients should be able to monitor their own progress.

Awesome Families: The Promise of Healing Relationships in the International Churches of Christ By Kathleen E. Jenkins Rutgers University Press, 2005. 283 pages. $22.95 (paper)

Journal Article Awesome Families: The Promise of Healing Relationships in the International Churches of Christ By Kathleen E. Jenkins Rutgers University Press, 2005. 283 pages. $22.95 (paper) Get access David Yamane David Yamane Wake Forest University Search for other works by this author on: Oxford Academic Google Scholar Social Forces, Volume 85, Issue 4, June 2007, Pages 1820–1822, https://doi.org/10.1353/sof.2007.0086 Published: 01 June 2007

Viewpoint: Reflections on a Well-Traveled Path: Self-Awareness, Mindful Practice, and Relationship-Centered Care as Foundations for Medical Education

Medical students enter medical school hoping to have good relationships with their patients. Along with residents, however, they are exposed to a hidden curriculum that places the acquisition of biomedical knowledge above and at times at odds with development of the awareness and relationship skills important to the patient-physician relationship. Seasoned clinicians often enjoy the capacity for rich, healing relationships that are marked by reciprocal influence between them and their patients. The author argues that it is not necessary to relegate this recapturing of the human side of medicine to a midcareer epiphany, and the author calls for educational measures to encourage development of the communication and relationship-building skills throughout the medical education process. This will require a paradigm shift to a culture where teachers and learners are willing to consciously attend to their relationships and to work on self-awareness and mindfulness while they also master the biomedical knowledge required of the profession. Medical educators can facilitate and support continuous development of these skills throughout medical school and residency. Within the curriculum, there are many opportunities to teach how to reflect and to guide those reflections in ways that enhance our students' and residents' understanding of themselves as individuals and in the relationships they form with their patients. Using examples from narratives gathered in workshops and on work rounds with students and residents at the University of Washington School of Medicine, the author explores the concepts of relationship-centered care, self-awareness, and mindfulness as proposed cornerstones of a new foundation for medical education.

Awesome Families: The Promise of Healing Relationships in the International Churches of Christ. By Kathleen E. Jenkins. New Brunswick, N.J.: Rutgers University Press, 2005. Pp. 283. $22.95.

Previous articleNext article No AccessBook ReviewAwesome Families: The Promise of Healing Relationships in the International Churches of Christ. By Kathleen E. Jenkins. New Brunswick, N.J.: Rutgers University Press, 2005. Pp. 283. $22.95.Janja LalichJanja LalichCalifornia State University, Chico Search for more articles by this author California State University, ChicoPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by American Journal of Sociology Volume 112, Number 5March 2007 Article DOIhttps://doi.org/10.1086/518071 Views: 14Total views on this site Permission to reprint a book review printed in this section may be obtained only from the author.PDF download Crossref reports no articles citing this article.