In the past medical practitioners were accepted as authorities within a social system that expected certain people to give orders and others to obey them. Certain roles such as: doctor, lawyer, teacher, allowed those persons to give advice and to receive unquestioned obedience. Since this social structure has broken down, it becomes crucial to build a relationship that allows patients to accept professional judgments and to collaborate in their own recovery. Thus, relationships can no longer be based on social role, uncontested authority or even scientific validity. If we are to succeed most fully, then we must establish trust, warmth, and an empathic response to our clients.
The connection between mind and body has been only partially established. That is, we are aware of the effects that the body has on the mind. We are clear that we can influence the functioning of our thoughts and emotions through physical interventions such as surgery, and pharmaceuticals. However, we are often unaware that the mind can influence what goes on in the body. Grief may be caused by stressors, feeling states, emotional strain or intensity, and the way we perceive things or the way we think. It is essential to establish the mind-body connection by having the client actually experience it.
Physical illness creates emotional stress and then stress causes physical illness. This is a circular process in which symptom becomes cause and the circle becomes self-reinforcing. In order to break that downward spiral, we need to intervene with stress management techniques. Additionally, when people are under stress, they lose their openness to new ideas, their coping skills, their sense of self-esteem, and actually become less competent. So, if we want clients to have the discipline to exercise regularly, make lifestyle changes, come to appointments on time, then clients need to feel competent and open. Moderating stress levels is one of the single most important ways of re-establishing the sense of being a competent, powerful adult.
Conquering Fear and Doubt
Fear and doubt are two of the most negative elements in the human psyche. The end result of these two elements is freezing or paralysis. We cannot take a step either physically or mentally. Both the mind and body can be gripped with fear and doubt. Whatever we do to help people surmount their pain, we must deal with these negativities. We cannot expect clients to be hopeful, or to have faith in our work together, or to progress, when fear and doubt are not handled. We are aware of the placebo effect or of the increased speed of healing when optimism and hope are present. Thus, when clients believe that the treatment is effective, there is a much better probability that it will, in fact, be successful.
Grief is not just a physical phenomenon, it is also a result of how we feel about what happens to us. For example, the soldier who is seriously wounded may actually be joyful and feel little pain, because s/he knows s/he will be going home and be out of danger. However, the civilian accident victim may suffer the same or lesser wounds and be devastated because this was neither an expected nor a welcome outcome. There are many changes of perspective that would help the pain victim.
In order for the client to stay healthy or continue to get healthier, there must be lifestyle changes. Giving up smoking, street drugs, alcohol, or other harmful habits may be crucial. Eating more healthily, exercising regularly, becoming productive in a career or other major lifestyle changes may be important. Letting go of negative emotions, changing self-defeating behaviors, improving interpersonal relationships, and accepting professional help more regularly may be essential skills for keeping progress from washing out.
Therapeutic Grief Work
The actual application of therapeutic grief work can only be effective when we have attended to all of the above issues. The most skilled technician in the world will not be listened to, if s/he does not:
– embed the treatment in the midst of an empathic relationship
– build on awareness of the mind’s power to influence the body
– work to conquer fear and doubt
– help shift perspectives
– moderate stress
– encourage sustainable lifestyle changes
by David Fireman, LCSW