A recent series published in the Asia Pacific Chiropractic Journal turned its eyes toward a lesser examined but vitally important aspect of the chiropractic experience: that of compassion. The multiple-article series spanned psychotherapeutic, chiropractic and other paradigms, and examined the power of bringing sympathy, empathy and compassion into the centre of the care experience – seeing the practice member first as a person among other powerful themes. While one can’t summarise the indepth qualitative and narrative work undertaken by the eight-authors contributing to the series, here we will tease out some of the powerful themes.
Previous literature has examined the power of the therapeutic alliance between chiropractor and practice member, with one such article finding four key aspects to be core to the patient experience [1]. These were honesty, communication, perceived competence and caring. It followed earlier work in the Netherlands which examined the strength of the chiropractor/patient therapeutic alliance and found that collaboration between the two parties was core to developing and maintaining a positive therapeutic alliance [2].
While the background is there in literature, the deep-dive into the impacts of compassion in practice is a moving and worthwhile read – one which starts with the important issue of compassion in psychotherapy. Citing meta-analytic research into psychotherapeutic outcomes, the author, Jeffrey Blum, remarks that “the social connection provided by compassion is a type of medicine needed by us all. As a healthcare practitioner, particularly in the psychotherapeutic arena, if I can have compassion for the client that comes to me for care, hopefully this can give them an experience of compassion and through that experience develop compassion for themselves.” [3] His commentary links to research on positive regard and psychotherapy outcomes, as well as the concept of seeing the person first and always as a person. [4,5]
This idea is central to chiropractic, and has been for a long time. Many of us will recall that Jim Parker emphasised that “Loving service is my first technique.” This serves as a reminder that they are not “our patients.” They are partners on a wellness journey as we serve through subluxation-based care. Perhaps compassion reflects the philosophical viewpoint that chiropractors also adjust “above the atlas”.
Compassion in the chiropractic setting
Another cab off the rank in this series is by prolific chiropractic author, Charles Blum, who reflects on his four decades in chiropractic practice by talking about compassion in the chiropractic setting [6]. Among the insights offered up in this reflective piece are reflections on the hope and helplessness with which people may approach the chiropractic experience, as well as the naivety that chiropractors may exhibit when they fail to understand the impact of careless comments. In it, he reflects on Carl Jung’s concept of the shadow – the unconscious aspect of the personality. While time may grow the practitioners self-awareness as to their shadow, often it is the patient who is impacted by it when we aren’t able to pay attention to the impact of our demeanor, commentary and general presence in the clinical encounter.
Blum remarks that “By bringing these insights into the clinical encounter with kindness, compassion and caring, then our patients can feel safe and we can focus on our patient’s optimal wellbeing and better channel our healing energy [6].” According to Blum’s conversational analysis, the key to improvement here is self-reflection.
What impact might compassion in practice have on the autonomic nervous system?
Erin Carr’s contribution to the series raises an interesting observation. She notes that “compassion and empathy may instigate the parasympathetic response which triggers the body’s own ability to heal. A central component to long term recovery.” [7] Carr is a Doctor of Physical Therapy, and not a chiropractor, which means this observation is one that comes from outside our own profession. It should ring true to chiropractors though, as we understand more than most just how the function of the Autonomic Nervous System may hinder or enable healing.
Carr reflects on how compassion might impact one particular group of people: those who are misdiagnosed or misunderstood. They may have been given inaccurate information which may have lead to a backwards step in healing. They may be coming to us for a second opinion. This observation speaks directly to the hope and helplessness Blum referred to in his paper on compassion in the chiropractic setting.
How many times have you seen a practice member come to you seeking a second opinion, or perhaps just seeking hope that something can be done? Inside this person may sit a nervous system reacting to fear – that is a nervous system in fight or flight, unable to deploy the healing mechanisms to their fullest potential.
Do we just adjust subluxations?
Chiropractors are Doctors of the Nervous System. We know this. We know we deploy our healing hands in the service of people by checking and adjusting subluxations. We know that the body does the rest – emphasising this series of articles presents the case that chiropractic is more than hands on healing. It is the adjustment. It is the demeanor, the way we communicate, the way we listen and express within the bounds of communication at the time of consultation. There is more to the interaction that has impact on a therapeutic level – and chiropractors know, understand this and express this through their consultative process.
It all leads the series’ final author, Gilbert Weiner to exhort chiropractors towards acceptance as we wade through the often-tricky waters of patient compliance [8]. To Weiner, the literature and his own self-reflection drives the case for sympathy, empathy and compassion. He also challenges the reader to deploy these three core skills not only in the chiropractic setting, as well as in educational and training settings. It is an exhortation that is reflected in the Cleveland Clinic’s HEART communication – Hear, empathise, apologise, respond, thank.
Weiner remarks that “the crux of healing is in the interpersonal relationship, one person to another. The role of the healthcare provider in healing has to depend on his/her particular personality and qualities as a person, and the interaction with the particular characteristics of the patient. It is an art, rather than a science, which best prepares the physician to be the facilitator in the healing relationship with the patient [9, 10].
Truly, this sits at the heart of chiropractic – that we facilitate healing through removing subluxation and allowing the body to self-heal. This is a timely reminder to pivot towards compassion, towards the HEART. As we recover from the challenges of the pandemic, and as we shepherd our practice members through their own wellness journeys, the reminder to be aware of our Shadow and its impact on the therapeutic experience is indeed welcome.
If you’d like further reading on this topic, the book by David Hamilton, “The Five Side Effects of Kindness: this book will make you feel better, be happier and live longer” provides a wonderful read and scientific investigation into the effects of kindness and compassion, supporting everything we’ve discussed in this article. This expands on ground-breaking working by Dr. Dean Ornish, his book “Love and Survival: Eight Pathways to Intimacy and Health” revolutionised the idea that kindness and compassion are essential in both therapeutic outcomes and a better life.
Thus, there may be a far more significant truth to Parkers words, Loving service is my first technique – and we may do well to heed this advice.
REFERENCES:
- Connell G, Bainbridge L. Understanding how chiropractors build trust with patients: a mixed-methods study. The Journal of the Canadian Chiropractic Association. 2020. 64(2):97–108.
- Lambers, N.M., Bolton, J.E. Perceptions of the quality of the therapeutic alliance in chiropractic care in The Netherlands: a cross-sectional survey.Chiropr Man Therap 24, 18 (2016). https://doi.org/10.1186/s12998-016-0100-4
- Blum JD. The value of compassion in the psychotherapeutic encounter. URL Asia-Pac Chiropr J. 2022;3.2. URLnet/Papers-Issue-3-2/#CompassionJeffreyBlum
- McKenzie EL, Brown PM. ‘Just see the person who is still a person (…) they still have feelings’: Qualitative description of the skills required to establish therapeutic alliance with patients with a diagnosis of dementia. Int J Ment Health Nurs. 2021 Feb;30(1):274-285.
- Farber BA, Suzuki JY, Lynch DA. Positive regard and psychotherapy outcome: A meta-analytic review. Psychotherapy (Chic). 2018 Dec;55(4):411-423.
- Blum C. Channeling healing energy: The value of compassion in the chiropractic clinical setting. Part one. URL Asia-Pac Chiropr J. 2022;3.2. URL net/Papers-Issue-3-2/#CompassionCharlesBlum
- Carr E. Healing effects of compassion. URL Asia-Pac Chiropr J. 2022;3.2. URL net/Papers-Issue-3-2/#CompassionCarr
- Weiner G. Compassion is the key to Patient Compliance and ‘paradigm shift acceptance’ for Chiropractic patients. Asia-Pac Chiropr J. 2022;3.2. URL net/Papers-Issue-3-2/#CompassionWeiner
- Hutchinson, T., Hutchinson, N.and Arnaert, A. (2009).Whole person care: encompassing the two faces of medicine. CMAJ. April 14, 180 (8) 845-846; DOI,: https://doi.org/10.1503/cmaj.081081.
- Communicate with H.E.A.R.T.® ,Cleveland Clinic Experience Partners, URL https://my.clevelandclinic.org/departments/patient-experience/depts/experience- partners/licensed-programs/communicate-with-heart
