A Whole Person Approach to Wellbeing

Building Sense of Safety

Johanna Lynch

• Editorial: Routledge
• Año: 2020
• ISBN:
  9781000343557
• Edición: 1
• Categoría: Medicina
• Categoría: Medicina de familia y práctica general

This book builds on the person-centred medicine movement to promote a shift in the philosophy of care of distress. It discusses the vital importance of whole person health, healing and growth. Developing a new transdisciplinary concept of sense of safety, this book argues that the whole person needs to be understood within their context and relationships and explores the appraisal and coping systems that are part of health.

Using clinical vignettes to illustrate her argument, Lynch draws on an understanding of attachment, and trauma-informed approaches to life story and counsels against an over-reliance on symptom-based fragmentation of body and mind.

Integrating literature from social determinants of health, psychology, psychotherapy, education and the social sciences with new research from the fields of immunology, endocrinology and neurology, this broad-ranging book is relevant to all those with an interest in person-centred healthcare, including academics and practitioners from medicine, nursing, mental health and public health.

Section Two

Building the concept of sense of safety

Insights from consultation

Building on the first section, Section Two takes the reader on a journey through the findings from stakeholder consultations, academic critique and analysis of transdisciplinary literature that were part of my doctoral research (Lynch 2019). This doctoral research, undertaken in Australia, used a transdisciplinary generalist methodology (Lynch et al. 2020).

Stakeholder consultation was conducted in three stages: initial question (to be discussed in this Chapter Six), follow up questions (included in following chapters) and reflection on iterations of the research findings (included in Chapter Ten). As outlined in the Introduction, stakeholders included people with lived experience of being patients (le), rural and urban general practitioners (gp), indigenous Australian Aboriginal academics (ia) and multidisciplinary mental health clinicians (mhc). The ideas were also submitted for formal academic review to a ten-member international multidisciplinary academic panel (denoted as mhc-a, and gp-a), which will be discussed in Chapter Ten.

In this section you will be introduced to the analysis of this research. Analysis of the data included iterative and reflexive (Tobin and Begley 2004) coding and the development of theoretical or pattern codes through inductive, deductive and abductive reasoning, the use of Inclusive Logic and discernment (Crabtree and Miller 1999, Nicolescu 2014).

The concept of sense of safety will be discussed in Section Two as an active appraisal process that includes a broad scope of attention (whole person domains) and concurrent processes (sense of safety dynamics) that build, protect and reveal wellbeing. Learning to attend to the broad scope and dynamics of sense of safety is something that both the practitioner and Humpty can do to restore their own and other’s wellbeing.

References

1. Crabtree, Benjamin F., and William L. Miller . 1999. Doing qualitative research. Thousand Oaks, CA: Sage publications.
2. Lynch, J.M. 2019. Sense of safety: A whole person approach to distress. PhD, Primary Care Clinical Unit, University of Queensland.
3. Lynch, J.M., C.F. Dowrick, Pamela Meredith, S.L.T. McGregor, and Mieke Van Driel . 2020. ‘Transdisciplinary generalism: Naming the epistemology and philosophy of the generalist.’ Journal of Evaluation in Clinical Practice, 1–10.
4. Nicolescu, Basarab. 2014. ‘Methodology of transdisciplinarity.’ World Futures 70 (3–4):186–199.
5. Tobin, Gerard A., and Cecily M. Begley . 2004. ‘Methodological rigour within a qualitative framework.’ Journal of Advanced Nursing 48 (4):388–396.

6 The integrative gift of an ordinary phrase – Humpty’s native tongue

• The ordinary English phrase ‘sense of safety’ offers a genuine shared language for communication about wellbeing
• The phrase ‘sense of safety’ implies a broad concurrent awareness of self, other and context
• Appraising a ‘sense of safety’ is an active process of knowing

‘Sense of safety’ is an ordinary English phrase, but does it communicate clearly and have a communal shared understanding? Is it an adequate trade language that unites the different knowledge cultures? Does the phrase ‘sense of safety’ enable understanding of the complex whole person? When people use the English phrase ‘sense of safety’, what do they mean?

As an initial stage of focus groups and interviews, before we had done more than introduce ourselves, I asked stakeholders to write down their answer to this key question:

What does the phrase ‘sense of safety’ mean to you?

Fundamentally, this question sought to see whether the ordinary English phrase ‘sense of safety’ was a widely understood phrase and whether the meaning across descriptions was coherent and shared enough to be useful: was ‘sense of safety’ a natural, understandable part of Humpty’s native tongue? What emerged from the written responses did more than establish the joint understanding of the term. It also revealed a concurrent breadth of perception and an active appraisal process that underpinned sensing safety.

Breadth of perception: what contributes to sense of safety?

When stakeholders described the meaning of ‘sense of safety’, their descriptions included multiple layers of awareness – across self, other and context. Often all three were mentioned at once. They also described dynamic awareness of experiences of self-in-relation to other (named ‘connect’); self-in-relation to context (named ‘engage’) and others-in-relation to their context (named ‘culture’). These key elements are mapped in Figure 6.1. This broad awareness of the ‘whole’ of what was going on at that moment was a consistent finding across descriptions. It revealed not only the breadth of information appraised to determine a ‘sense of safety’, but also the concurrent awareness of many aspects of safety at once.

Figure 6.1 Broad concurrent awareness: mapping responses to ‘What does the phrase “sense of safety” mean to you?’

Perception of self included an appraisal of capacity to face (or ‘engage’) threat, experience in relationships (safety to ‘connect’) and sense of freedom to be and own themselves. They described sensory and cognitive experiences of threat, and used words such as ‘anxiety’, ‘fear’, ‘vulnerability’, ‘intimidation’, being ‘threatened’, ‘harmed’ or ‘compromised’.

Perception of others included awareness of other people’s availability, and presence – assessing ‘connection’. They also assessed character (e.g., ‘trustworthy’), and subjective observations, interpretations and perceptions of behaviour. They frequently mentioned awareness of themselves in relationship to or in the presence of another person. This relational assessment included many descriptions of feelings of belonging, trust, respect and acceptance with others. They also described their sense of freedom to express themselves and be themselves in the presence of the other, as well as feeling safe in culture.

Perception of context included awareness of place or situation over time (including future ‘demands’, ‘expectations’, ‘consequences’ or ‘impact’). They mentioned safety being affected by work and living environments, culture, time, information, opportunity and needs being met. When noticing themselves in relation to context, they noted their own confidence to ‘engage’ with their context, aware of their own capacity to face threat, including a sense of relational support.

As well as awareness of self, other and context, there were descriptions of an integrative appraisal process – allowing concurrent real-time active attention to the whole. Somehow information from self, other and context is ‘known’ all at once, giving a ‘sense of safety’ in that moment – depicted as ‘integrate’ where these aspects intersect in Figure 6.1. Stakeholder descriptions repeatedly revealed concurrent awareness: broad integrative attention to time, connections, context, relationships, identity, agency, culture and moment-by-moment emotional and bodily experiences.

Active appraisal process: how is safety sensed?

Active appraisal process: sense of safety – broad concurrent awareness

Appraisal of ‘sense of safety’ is an active process. Stakeholder descriptions repeatedly used verbs to describe a process of appraisal that included feeling, sensing, owning and being when they described ‘sense of safety’. Appraisal of sense of safety emerged as an active process, stakeholders were aware of dynamics between self, other and context and of the degree of threat and their own sense of capacity.

Those who write about the appraisal process involved in clinical assessment describe ‘diagnosis’ as a verb or procedure, not a denotation (Sadler 2005). Similarly, those who study professional knowledge see ‘knowing’ as a verb, not a noun (Carlsen, Von Krogh, and Klev 2004) – an active reflective process, rather than a static piece of evidence. Seeing clinical appraisal (or diagnosis) as an active process counters the narrow interpretation of diagnosis as classification (Langeland et al. 2007). As an active relational process that includes awareness of the self, other and context, diagnosis becomes more personal. It becomes less a societal contract (Blazer 2005) that endorses ‘abdication of responsibility’ (Carey and Pilgrim 2010, 449) or the individualisation of health responsibility (Yoder 2002). Instead, it aligns with Sadler’s journey-like description of diagnosis as a ‘consistent way to forge clinical understanding and moral purpose into therapeutic action’ (Sadler 2005, 419). Appraisal of one’s own safety aligns with clinical appraisal – they are a moment-by-moment active dynamic kind of ‘knowing’. Sensing safety is a kind of self-diagnosis.

Active appraisal process: sense of safety – sensory embodied experience

Stakeholder responses revealed an active moment-by-moment bodily and sensory appraisal of ‘sense of safety’. Occasionally responses used cognitive processes (e.g., ‘without negative consequences’ (mhc)), but, overwhelmingly, descriptions used emotional and sensory verbs to describe the process of appraisal. One participant described it as a ‘state of feeling’ (mhc). Although the word ‘sense’ was only used four times in the...