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2.9 The failure of CAM therapeutic relationships: creating dependency to satisfy practitioners' emot

Although a failed therapeutic relationship is often assumed to involve a patient not returning, the case of a patient who attends repeatedly can also be highly problematic. This phenomenon can be seen as a breach of boundaries in that an inappropriately extended therapeutic relationship changes from being a healing encounter into a dependency relationship or friendship. Unlike the timescale contracts that may be negotiated in counselling and psychotherapy, there are no fixed timescales for mo
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2.8 The failure of CAM therapeutic relationships: wounded healers

Sometimes, practitioners allow their personal life and personal issues to become central to the therapeutic relationship. In a range of therapies, the practitioner is assumed to bring not only their skills but also their experiences to the therapeutic relationship. This has led to the concept of the ‘wounded healer’ (Nouwen, 1977): that is, a practitioner who, in experiencing physical, psychological or emotional pain, develops a greater understanding and empathy with other people's pain.
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2.7 The failure of CAM therapeutic relationships: breach of boundaries

In this section, failures caused by breach of boundaries are discussed under the following headings:

  • ‘wounded healers’

  • creating dependency to satisfy practitioners’ emotional and financial needs

  • sexual abuse and exploitation.

To reiterate a point made earlier, breaches of the therapeutic relationship cover a spectrum. Some breaches invariably thwart a successful therapeutic outcome (for example,
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2.6 The failure of CAM therapeutic relationships

Although therapeutic relationships have the capacity to heal, they can also harm. In reality, the outcome of most therapeutic encounters and relationships lies somewhere on a continuum between good and harm. Few therapeutic relationships are a complete success but, judging by the number of complaints, even fewer are a complete disaster. Studies of therapeutic encounters invariably show high levels of patient satisfaction (see, for example, Sharma, 1992; Kelner et al., 2000). None the less, it
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2.5 The therapeutic relationship as a placebo

Mitchell and Cormack propose that the relationship aspect of a therapeutic encounter can be as important as the technical dimensions of healing (Mitchell and Cormack, 1998). CAM practitioners argue that the therapeutic relationship itself may be an important tool in healing. Critics of CAM turn this argument on its head, suggesting that CAM is, in fact, no more than a powerful form of placebo. What they generally mean is that it is not the specific treatments used that evoke a healing respons
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2.4.3 How CAM therapists impose their views on users

As most people do not have a wide knowledge of complementary perspectives and philosophies, the therapeutic relationship can break down because of a mismatch between what the practitioner offers and what the user of the service wants. The practitioner's ideas about health, illness, mind and body may be at odds with the user's, which can lead the user to find another therapist who offers therapy that is more congruent with their beliefs.

The scholar Ursula Sharma argues that users of CAM
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2.4.2 Holism and ideas about the body

Reductionist medical approaches have been criticised for providing a fixed, mechanistic view of the body, which fails to capture the patient's experience. The power associated with biomedical diagnoses and expertise means that patients’ explanations for their illnesses are often overlooked or dismissed. Does holism, which seeks to treat the mind, body and spirit, fare any better in giving patients a sense of control or ownership of what their illness means? This question is often reframed i
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2.4.1 Reductionism and ‘ownership’ of the body

Social scientists interested in changing relationships between workers and users of health care often draw attention to what is termed the loss of ownership or loss of governance of the body. These terms mean that a person's body is treated in some health situations as more important than the person themselves. It is almost as if they are purely a case, an example of a type of disease, or a set of symptoms. Traditionally, such criticisms were levelled against biomedical approach
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2.3.1 Patients and therapeutic responsibility

Activity 6: Therapeutic responsibility

0 hours 15 minutes

Based on your own experience, and using the evidence you have read about and heard, answer the following questions.


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1.13 Extract 1 References

Antonovsky, A. (1979) Health, Stress and Coping: New Perspectives on Mental and Physical Well-Being, San Francisco, CA, Jossey-Bass.

Antonovsky, A. (1987) Unraveling the Mystery of Health: How People Manage Stress and Stay Well, San Francisco, CA, Jossey-Bass.

Blaxter, M. (1983) ‘The causes of disease: women talking’, Social Science and Medicine, Vol. 17, No. 2, pp. 59–69.

Bowling, A. (1991) Measuring Health, Buckingham, Open University Pres
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1.11 Researching health beliefs and CAM users' expectations

People's beliefs about health and illness play an important role in determining whether and when they seek medical care and the extent to which they follow advice and treatment regimes. Beliefs can influence the outcome of treatments (Zola, 1973; Stainton-Rogers, 1991). Therefore, it is important to explore whether users of CAM have different beliefs about and different expectations of health care than non-users.

Adrian Furnham and his colleagues conducted several psychological studies
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1.5 Models of health care delivery

In the quest to understand health and illness behaviour, social and medical researchers have developed various models to explain the different forms of health care delivery. These models emerged because, in the mid-20th century, social researchers began to question not only the position of professions in western countries but also the relationship between professionals and users. Early explorations of the patient's role in health care suggested that it was fairly prescribed (Parsons, 1951), a
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1.4 Influences on health and illness behaviour

Activity 2: Experiencing health and illness

0 hours 30 minutes

Drawing on your own experiences of health and illness, answer the following questions.


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1.3 Components and origins of health beliefs

Health beliefs, like other personal beliefs, are learned. Knowledge about health and illness is built up from childhood onwards, from diverse sources including family, social networks, community and religion, and through ‘official’ government health messages. Individual health beliefs, while rarely ‘scientific’ in themselves, none the less are grounded in experience, modified over time in the light of that experience, and rational in the light of people's wider belief systems and worl
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1.6.6 Professional bodies and societies

Consider joining a learned society or professional organisation. They can be very useful for conference bulletins as well as in-house publications, often included in the subscription. Don't forget to ask about student rates. Try looking for the websites of learned societies associated with your subject area (e.g. The Royal Society , the Author(s): The Open University

1.6.4 Blogs

The founder ofTechnorati claims that the number of ‘blogs’doubles every five months and that the creation rate is approaching two per second. One estimate I read in July 2010 put the number at 400 million ‘blogs’. Because these online diaries offer instant publishing opportunities, you potentially have access to a wealth of knowledge from commentators and experts (if they blog)
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1.6.3 Mailing lists and newsgroups

Mailing or discussion lists are email-based discussion groups. When you send an email to a mailing list address, it is sent automatically to all the other members of the list.

The majority of academic-related mailing lists in the UK are maintained by JISCMail. You will find details of joining these mailing lists on the Author(s): The Open University

1.6.1 Introduction

The process of keeping up-to-date in your chosen subject area is useful for your studies and afterwards, for your own personal satisfaction, or perhaps in your career as part of your continuing professional development.

There are a great many tools available that make it quite easy to keep yourself up to date. You can set them up so that the information comes to you, rather than you having to go out on the web looking for it. Over the next few pages, you will be experimenting with some
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1.5.8 Bibliographic software

If you are considering taking your studies further you might like to consider using bibliographic software. Bibliographic software can be used to sort references, annotate them, manage quotations or create reading lists.

There are several software packages on the market. Some are listed below.

1.5.3 Desktop search tools

Finding your paperwork or electronic files can be a problem. You may find that even if you do have some sort of filing system, your structure soon gets quite large with files in multiple locations, which can be hard to navigate. You may find yourself making arbitrary decisions about which folder to place a document in. It may make sense now but in the future, when you look where you think it should be, it’s not there.

At times like this you may resort to the search command from the Wi
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