Transforming Clinical Practice Using the MindBody Approach

A Radical Integration

Brian Broom

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429923241
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book assumes that it is no longer tenable to work in healthcare without considering the person as a whole being constituted by a rich weaving of mind, body, culture, family, spirit and ecology. The MindBody approach embraces this 'whole.' But how does it transform clinical practice and training for the clinician and treatment for the patient/client? The book collects together the experiences from a diverse range of clinical practitioners (including psychotherapy, specialist medicine, general practice, physiotherapy, occupational therapy, dietetics, , nursing, and complementary and alternative medicine practitioners) who have deliberately chosen to integrate a MindBody philosophy and skill set in their clinical practices. All reflect deeply on their unique journeys in transforming their clinical encounters. Most have been trained in the dominant Western framework and have inherited the classical dualistic approach which typically keeps mind and body apart.

CHAPTER ONE

Introduction: transforming clinical practice using the MindBody approach

Brian Broom

The extraordinary stories that appear in this book provide unique, multi-faceted, and rich perspectives on what happens when ordinary clinicians become MindBody clinicians; committed to non-dualistic, whole person healthcare. The result is transformation; and this process begins in the clinician. Personal hurdles and blockages are faced and surmounted, particularly those concerning emotion, self-belief, and styles of intimate relating. The clinician’s attitudes and ways of functioning with patients are both subtly and radically transformed, nervously at first, but then confidently and often thrillingly in the end. Patients, previously stuck and chronically ill with various conditions, frequently get better; the patient is transformed. In many cases, this transformation flows through the clinicians’ workplace, as colleagues, often initially sceptical and resistant, see the clinical results for themselves. This book is therefore about a kind of transformation that ripples through established systems, a person-to-person grass-roots movement potentially involving all players and all structures.

The origins of MindBody Healthcare

Some background is needed to explain how MindBody Healthcare arose in New Zealand. Back in 1980, I was a young consultant physician at the Christchurch School of Medicine. I had previously trained as a clinical immunologist in Birmingham, London and Montreal under the generous auspices of the (then) New Zealand Medical Research Council. In 1976, I returned to Christchurch to set up a clinical and research immunology group. Five years into this burgeoning career process, I was questioning whether I could survive another thirty years or so of increasingly laboratory-oriented medicine. I was very frustrated with my occupational drift away from people towards mechanism, and desired more engagement with the psychological, philosophical, and spiritual aspects of healthcare; or more broadly, the role of human subjectivity in disease.

So, in a classic midlife crisis, I resigned my career in academic clinical immunology and started training in psychiatry. I really had only vague ideas as to where this might lead me, and the ensuing long periods of confusion and uncertainty were difficult to manage emotionally. I had a young family, felt isolated and alienated from my erstwhile internal medicine colleagues and peers, and did not feel particularly comfortable with merely shifting from internal medicine to psychiatry. My interest and general orientation had always been towards integration and synthesis, with a focus on people and their lives especially in relation to illness and disease. Simply moving from a mind-neglecting specialty to a body-neglecting specialty was ultimately not going to warrant the enormous upheaval I was visiting upon myself.

Behind all this was the propulsive idea that somehow mind, body, and spirit were not separate compartments, but day-to-day living dimensions of the person that needed to be viewed as a whole for the best care of that person’s suffering and trajectory towards healing. I certainly had a body orientation from my internal medicine background, and though in reality I did not know a lot about healthy bodies I had a reasonable grip on bodily disease as seen through the dualistic and reductive lens of orthodox biomedicine. As time went by, whilst getting experience in psychiatry, I became increasingly fascinated with the psyche. Eventually, I became a psychotherapist trained in the psychodynamic tradition, with a particular emphasis upon interpersonal, relational, self psychological, and object relations approaches. Last, but not least, there was my upbringing in an intense form of conservative Protestantism which drove a search to make sense of spirituality in the modern world. Given my integrative and synthesizing proclivities, I found it impossible to take the usual reductive options, to either deny spirituality altogether, or simply settle for a spirituality kept neatly separate from the stimulating and challenging data emerging from the natural and social sciences; and separate from any serious grappling with the meaning of illness and suffering.

In 1987, I returned to immunology practice, combining it with psychotherapy practice, within the Arahura Centre in Christchurch, New Zealand, as one of a group of people intent on integrating all elements of personhood into healthcare practice. This story has been alluded to elsewhere (Broom, 1997; Broom, 2007), but there is one aspect that needs emphasizing. As I began combining clinical immunology and psychotherapy practices, I was shaken by the constant appearance in patients of very physical disorders with life stories to match. These stories seemed to explain why these patients were ill, and working with them in the clinical setting seemed to be very relevant to why they got better. I started to see that many diseases were full of meaning (Broom, 2007), even reaching the intensity of somatic metaphor (Broom, 2002), where the physical representation of disease in the body seems to communicate the same meanings that are being expressed by the patient in words. For instance, the patient who presented with a severe facial rash and who repeatedly declared she is “keeping a brave face” on her husband’s depression.

These phenomena began to affect the way I practised. They stimulated a different kind of clinical approach to patients, whereby the stories and meaningful elements were attended to as an extension of orthodox healthcare practice. Initially, my focus was the patient’s “other” story (Broom, 1997) and particularly personal meaning and its relations to illness (Broom, 2002; Broom, 2007). Inevitably, this led to a much larger journey of exploration of the paradigmatic assumptions underpinning medical practice and notions of healing, as well as to the development of clinical skills (Broom, 1997; Broom, 2000) necessary for clinicians if they were going to be able to attend to both the physicality and the subjectivity of their patients, which I was now seeing as crucial to optimum healing outcomes.

Gradually, people became interested in what I was doing, and over the next two decades I supervised many clinicians, and actively taught the story and meanings approach to illness in many seminars, workshops, and lectures both in New Zealand and internationally. It became clear that unless such clinicians were accompanied, supervised, educated, supported, and held over a sustained period, it was very difficult for them to enact the changes needed in their clinical workplaces. As we will see in the chapters that follow, changing from a limited reductionist biomedical or dualistic approach is very difficult for many clinicians, especially initially. The challenges faced are configured by many things, including each individual’s emotional makeup, and by the inertia and constraints (some of them imagined rather than real) of the healthcare system they work in.

A training programme was needed. Initial attempts to get this established at the Christchurch School of Medicine, supported by the Dean of the School at that time, failed because academic departments in the School would not support the venture. The reported reasons were diverse. In the case of Internal Medicine the problem seemed to be mystification as to what we were trying to do. In the case of General Practice the reason appeared to be a fear of being viewed as scientifically lightweight. In the case of Psychiatry the problem seemed to be a rather rigid and unimaginative construction of what psychiatry should allow, or be involved in.

The project lost momentum for several years, but revived again when Dr Peter Greener (Head of the School of Public Health and Psychosocial Studies, at the AUT University in Auckland) and I started discussions regarding the establishment of a training programme within the Department of Psychotherapy. The University needed to be convinced. Four years later, in 2006, we enrolled nineteen MindBody Healthcare students into a part-time multidisciplinary post-graduate Certificate, Diploma and Masters programme; the MindBody papers of which are conducted over two years. The other side of this story is that in the clinical professions there are many clinicians who want to transform their practices to become more whole person-oriented.

The clinical and theoretical substance of the MindBody Healthcare approach to clinical work has been systematically detailed elsewhere (Broom, 1991; Broom, 1997; Broom, 2000; Broom, 2002; Broom, 2007; Broom, 2010; Broom, Booth and Schubert, 2012), and will be further explicated, coloured and nuanced by all the authors that follow, as they speak from their own personal experiences of transformation. To orientate readers from the outset, I will provide a short summary of the scope and methodology of the MindBody approach.

The MindBody approach: some general comments

The context is that of an ordinary clinician in an ordinary clinical setting, whether that be in medicine, nursing, physiotherapy, occupational therapy, dietetics, psychotherapy or any other discipline. Most of these disciplines have developed out of a dualistic model of the person, and more recently have become hostage to a narrow scientific, evidence-based medicine; almost entirely based on the treatment of groups of patients rather than individual persons (Broom, 1997).

Let us briefly touch on the place of biomedicine in the MindBody approach. The latter encompasses modern biomedical evidence-based practice, but broadens a clinician’s view of disease and patient care well beyond normative biomedical perspectives. It values much of biomedicine, and assumes that diagnosis and useful orthodox biomedical interventions will be utilized where appropriate (Broom, 1997). Nevertheless, in many cases, deploying the MindBody approach may actually mean that biomedical interventions are not needed.

What makes the MindBody approach so different to biomedicine is the emphasis it places on subjectivity (of both the clinician and the patient), on relationships (especially between the clinician and the patient), and on the intimate relations between life experience and the development and perpetuation of illness. The patient’s story, and the meanings heard and held in the clinical space, are seen as crucial to the healing process. Thus, from this perspective, the group data approach of evidence-based medicine is deeply flawed because of the way it makes individual patient stories invisible. Critically, the Mind-Body clinician can hold both the ordinary biomedical approach and the MindBody approach together as part of a greater therapeutic whole.

The meaning of illness is important to the MindBody approach, and for me arose from what I was seeing clinically in my work with patients, as both a physician and a psychotherapist. When my (then) new colleague and friend Michael Harlow pointed me to Georg Groddeck’s early twentieth century volume, The Meaning of Illness (Groddeck, 1928), very late in the writing of my first book, I was both delighted and deeply reassured to find that Groddeck had seen the same relations between disease and life meanings; the same kind of stories. Then, later again, I was to chance upon Luis Chiozza’s writings (Chiozza, 1998a; Chiozza, 1998b), finally translated from Spanish and supporting the reality of symbolic illness, albeit from a rather forced psychoanalytic perspective. Of course the discourse of symbolic illness has many more roots and sources (Broom, Booth and Schubert, 2012) than can be addressed in this introductory chapter.

There are many other aspects to the MindBody approach, and over its evolution there have been both general and very specific contributions from many sources, much of it by accretion or osmosis. It is difficult to honour all of these adequately. My psychotherapy interests are eclectic. Brought up to see in what way other people were wrong, I have learned that just about every school of thought, clinical framework, or theory has some value and some contribution to whole person medicine, mainly because they all reflect amplification of some aspect of personhood that the originator of the idea or theory was particularly drawn to. I have been drawn to aspects of many traditions, but feel no need to find safe harbour within any one of them.

Yet again, some aspects of the MindBody approach were crystallised in eureka moments, notably when confronted in a clinical setting with an extraordinary conjunction between disease phenomenology and the patient’s personal meanings that could not be explained using biomedical reductive theory. I can remember very distinctive clinical moments of hearing such stories, which stimulated goose bumps and tingling up my spine, and which pushed me over yet another threshold into new territory regarding mind and body relationships.

In my earlier books the meaning of illness and the patient’s story were, together, my portals of entry to a whole person approach, and the organizing concepts for my explorations and practice with patients. They are easily presented in time-constrained consultations, and intuitively comprehended by patients. From the beginning, these focussing concepts arose not only from the language of patients as they talked spontaneously about their lives and their illnesses, but also germinated within a field of ideas, theories, and certain schools of clinical practice and philosophical thought. Thus the MindBody approach represents many sources, and honours the rich multidimensionality of persons, existence, relationships, and the world; just about everything is a potential source. There are both general sources and very specific sources and I will now summarize these.

The nature of the MindBody approach

The mindbody clinician fosters a relational clinical space or “clearing” (Heidegger, 1935; Heidegger, 1962) where that which needs to emerge for healing can do so. In this clinical space both protagonists are primarily human beings-in-the-world, albeit with the secondary and contextual roles of clinician and patient. The clinician respectfully invites the patient to be fully present, creating a setting that both allows for it and insists on it (Broom, 1991). Crucially, this presence includes not just the patient’s symptoms (with a view to diagnosis and biomedical treatment) but also their story (Broom, 1991), feelings, and potentially any or all of the relational elements usually rendered invisible (Merleau-Ponty, 1969) by normative clinical processes. The clinician, in turn, is fully present for the patient, drawing on their own feelings and embodied awareness to make sense of the patient’s needs. This sounds immense, even impossible, but in reality the story is in the minor (sic) elements that are “always already symbolically mediated” (Ricoeur, 1984); if we use our senses to see what is present on the margins of our awareness. The two people are certainly separate but the relational dynamic is intimate, trusting, and determinedly authentic (Levenson, 1974).

The process of story-sharing by the patient, heard and responded to by the clinician, is based on warm, active listening, and a determination to hear the patient’s usually invisible subjective experience. The clinical attitudes and skills deployed in this process are derived from Carl Roger’s client-centred therapy, psychodynamic and psychoanalytical therapies, and the phenomenological philosophies. In accordance with modern affect and attachment theory, and all schools of psychotherapy, the clinician accepts that affect, emotion, and feelings, have a major role in the process (Broom, Booth and Schubert, 2012). These happen as part of the consultation and must be noticed, responded to, named, amplified, contained, and warmly accompanied. Many clinicians need practice to develop these skills, because biomedical training tends to constrain or stifle emotion.

As this process is enacted, the body-only, biomedical history (with which the patient usually presents) must be integrated with the other story (Broom, 1997) which emerges (Broom, Booth and Schubert, 2012) between the clinician and the patient. Often this other story is simply captured in a pattern of meaning(s) (Broom, 2007), and opens out into the therapeutic clearing in a way that is easy for both parties to grasp, and then use in the forward movement of the treatment. Sometimes the disease turns out to be so clearly and obviously full of meaning that we can call it a somatic metaphor or symbolic disorder (Groddeck, 1928; Chiozza, 1998a; Chiozza, 1998b; Broom, 2002; Broom, 2007).

The fundamental premise in all of this is that meanings, relational dynamics, and other dimensions of subjectivity do play a role in the development and perpetuation of disease. Attending to these can play a powerful role in the healing process.

A bigger story, integrating the biomedical narrative and the other story, is allowed to develop by both parties. This is enabled by various means, including clinical tentativeness and sensitivity, the clinician’s ability to explain non-dual ways of seeing illness, and of course helped by the patient’s desperation (Broom, 1997). In reality many patients know that they and their diseases encompass much more than that which is usually allowed or is visible in the orthodox clinical consultation. If the MindBody approach is enacted skilfully and compassionately, many patients will allow an integration of their physical manifestations and their life experience, and agree to a tentative or determined exploration, to help resolve pathogenic story elements.

Informed by object relations theory, this exploration involves a high quality, empathic and committed accompanying of the patient by the clinician. There is a clear intention to call the patient forth (Levinas, 1996), and, according to self psychology concepts, to evoke the patient’s agency and emotional mobility. There is a clear valuing of the patient’s strengths, as well as gentle handling of vulnerabilities, along with attention to family and cultural elements and the relationships between social networks and illness (Antonovsky, 1979; Antonovsky, 1987; Antonovsky, 1996).

The general intent is for the patient to have an experience of warmth, empathy, and understanding; as well as having their disorder viewed through multi-factorial and multi-dimensional perspectives (in which physical, subjective, and systems elements are seamlessly interwoven). The therapist is person-centred, not theory-centred. Whilst all the theories and perspectives mentioned in the above paragraphs have informed the development of ideas of personhood underpinning the MindBody approach, when it comes to the clinical encounter the clinician meets each pati...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• ACKNOWLEDGEMENTS
• CONTRIBUTORS
• CHAPTER ONE Introduction: transforming clinical practice using the MindBody approach
• CHAPTER TWO The Kafka beetle goes off his food
• CHAPTER THREE An intimate field
• CHAPTER FOUR Bodies in conversation
• CHAPTER FIVE The proof is in the pudding
• CHAPTER SIX The gift of illness: inviting physical symptoms to guide personal growth
• CHAPTER SEVEN Professional earthquake and aftershocks
• CHAPTER EIGHT From fearing to caring: finding heart in nursing
• CHAPTER NINE Touching the hurt Susan Lugton
• CHAPTER TEN Issues in the tissues
• CHAPTER ELEVEN There is always “something else”: phenomenological physiotherapy
• CHAPTER TWELVE Whakawhanaungatanga: establishing relationships
• CHAPTER THIRTEEN Making a difference: a narrative MindBody approach to school guidance counselling
• CHAPTER FOURTEEN Becoming an intimate lecturer
• CHAPTER FIFTEEN Healing through talk and touch
• CHAPTER SIXTEEN Holding it all together: integrating the MindBody approach as a breast cancer patient
• CHAPTER SEVENTEEN Transforming a pain clinic: using patient stories to integrate medical practice
• CHAPTER EIGHTEEN Training “troops” for a MindBody revolution
• INDEX