The listening healer in the history of psychological healing

Examining the empathy levels of medical students using CHAID analysis

BACKGROUND

Empathy is a key factor in the medical field as it strengthens doctor-patient relationships, enhances communication, and leads to improved patient outcomes. This study aims to investigate the empathy levels of medical students, providing insights into the factors that influence these levels and using advanced analytical methods for accurate predictions.

METHODS

The study was conducted with 322 medical students from a public university in Turkey. A relational screening model was applied, using a "Personal Information Form" and an "Empathy Scale" to gather data. CHAID analysis was employed to identify the key predictors influencing empathy levels, whereas machine learning algorithms were utilized to classify and predict individuals' empathy levels.

RESULTS

The analysis revealed that 41.3% of students displayed high empathy, 44.7% moderate empathy, and 14.0% low empathy. Factors such as parental education, maternal occupation, and gender were significant in determining empathy levels, with gender being the most influential. The machine learning models achieved an 80.1% accuracy in predicting empathy levels.

CONCLUSIONS

The findings indicate that targeted educational and social interventions, especially those addressing gender differences, could improve empathy in medical students, potentially leading to better patient care.

TRIAL REGISTRATION

Not applicable, as this study does not report results from a health care intervention involving human participants.

Effects of emotional healing on organisational learning and radical innovation: a leadership-based approach

Purpose

The objective of this study was to provide empirical evidence of the relationship between emotional healing, analysed as a leader behaviour and radical innovation.

Design/methodology/approach

To test the hypotheses, structural equations were used, with organisational learning capability as an explanatory variable. The study was conducted in a population of 402 Spanish companies. A sample frame of 292 questionnaires was obtained from 146 different organisations. The fieldwork took place in two stages, in 2010 and again in 2015.

Findings

Results confirm the hypotheses proposed in the model. Emotional healing promotes organisational learning capability and, in turn, radical innovation.

Practical implications

Our results provide some guidelines for companies that are trying to develop radical innovations by improving the workplace conditions.

Originality/value

To our knowledge, there are no previous studies which studied the relationship between emotional healing and its effect on radical innovation. Therefore, providing empirical evidence of such a relationship is the main contribution of this paper.

Hospital Chaplains and Embodied Listening: Engaging with Stories and the Body in Healthcare Environments

This article illuminates how a largely overlooked group of healthcare professionals—hospital chaplains—engage in listening, along with what they perceive it means to listen well. The analysis of data generated reveals that engaging in listening, and doing this well, is for chaplains about inhabiting a relational body that includes: (a) being at eye level in relation to the other person; (b) making eye contact with the other; (c) understanding emotions as embodied narrative plots; (d) being still; and (e) distancing themselves from religion. The article closes with some critical reflections on listening and preparing our bodies to listen well.

Engaging religious experience in stroke rehabilitation

In this article, I respond to the problem of engaging with religious experience in health care environments. In particular, I illuminate the relational aspects of religious experience in the context of stroke rehabilitation by providing a commentary on data gathered from existing qualitative research and personal narratives in the acute and rehabilitation phases of stroke recovery. In so doing, I address the necessary balance of empathy and alterity in the art of resonant listening. I also provide some critical reflections on interdisciplinary approaches to engaging with religious experience with reference to a largely overlooked group of health care professionals-hospital chaplains.

Suffering, meaning, and healing: challenges of contemporary medicine

This essay explores the thesis that changes in contemporary society have transformed the work of doctoring and challenge doctors to be physician-healers. Medical advances in the prevention and management of acute disease have wrought a growing population of chronically ill patients whose care obliges physicians to become holistic healers. Holistic healing involves the transcendence of suffering. Suffering arises from perceptions of a threat to the integrity of person-hood, relates to the meaning patients ascribe to their illness experience, and is conveyed as an intensely personal narrative. Physician-healers use the power of the doctor-patient relationship to help patients discover or create new illness narratives with fresh meanings that reconnect them to the world and to others and thereby transcend suffering and experience healing. Physician-healers equipped with the attitudes, skills, and knowledge to assist patients to transcend suffering are indispensable if contemporary medicine is to maintain its tradition as a healing profession. In the process, physicians may discover meaningful connections with patients that bring new and refreshing perspectives to their work.

Preparing medical students to become attentive listeners

BACKGROUND

The ability to listen is critically important to many human endeavors and is the object of scholarly inquiry by a large variety of disciplines. While the characteristics of active listening skills in clinical practice have been elucidated previously, a cohesive set of principles to frame the teaching of these skills at the undergraduate medical level has not been described.

AIMS

The purpose of this study was to identify the principles that underlie the teaching of listening to medical students. We term this capacity, attentive listening.

METHODS

The authors relied extensively on prior work that clarified how language works in encounters between patients and physicians. They also conducted a review of the applicable medical literature and consulted with experts in applied linguistics and narrative theory.

RESULTS

They developed a set of eight core principles of attentive listening. These were then used to design specific teaching modules in the context of curriculum renewal at the Faculty of Medicine, McGill University.

CONCLUSIONS

Principles that are pragmatic in nature and applicable to medical education have been developed and successfully deployed in an undergraduate medical curriculum.

The salutogenesis-oriented session: creating space and time for healing in primary care

Primary care in America is in need of a rescue. Clinicians are asked to see more patients in a day that only allows time to focus on a physical symptom or disease process. They do not have time or space to use their humanism to develop insight toward what the patient needs for the symptom to resolve, and they are often forced to suppress it with technology. This results in a very expensive medical system that leads to frustration for a clinician who realizes that this is not the way toward facilitating health. This clinically focused paper proposes the incorporation of a healing-oriented session into the delivery of primary care to bring focus toward the creation of health (salutogenesis). A salutogenesis-oriented session (SOS) honors relationship-centered care and will provide a unit that can then be studied to see if it has a positive influence on cost, quality of care, and provider satisfaction.

Active listening in medical consultations: development of the Active Listening Observation Scale (ALOS-global)

OBJECTIVE

Active listening is a prerequisite for a successful healthcare encounter, bearing potential therapeutic value especially in clinical situations that require no specific medical intervention. Although generally acknowledged as such, active listening has not been studied in depth. This paper describes the development of the Active Listening Observation Scale (ALOS-global), an observation instrument measuring active listening and its validation in a sample of general practice consultations for minor ailments.

METHODS

Five hundred and twenty-four videotaped general practice consultations involving minor ailments were observed with the ALOS-global. Hypotheses were tested to determine validity, incorporating patients' perception of GPs' affective performance, GPs' verbal attention, patients' self-reported anxiety level and gender differences.

RESULTS

The final 7-item ALOS-global had acceptable inter- and intra-observer agreement. Factor analysis revealed one homogeneous dimension. The scalescore was positively related to verbal attention measured by RIAS, to patients' perception of GPs' performance and to their pre-visit anxiety level. Female GPs received higher active listening scores.

CONCLUSION

The results of this study are promising concerning the psychometric properties of the ALOS-global. More research is needed to confirm these preliminary findings.

PRACTICE IMPLICATIONS

After establishing how active listening differentiates between health professionals, the ALOS-global may become a valuable tool in feedback and training aimed at increasing listening skills.

Relationships between scores of the Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI)

This study was designed to examine the relationships between scores of two measures of empathy. One was specifically developed for measuring empathy in patient care situations; the other was developed for the general population. It was hypothesized that the overlap between scores of the two measures would be greater for their constructs that are more relevant to patient care. Study participants were 93 first-year internal medicine residents at Thomas Jefferson University Hospital in Philadelphia. The Jefferson Scale of Physician Empathy (JSPE, specifically developed for administration to health professionals), and the Interpersonal Reactivity Index (IRI, developed for the general population) were administered. A statistically significant correlation of a moderate magnitude between the total scores of the JSPE and IRI (r = 0.45, p < 0.01) was found. The research hypothesis was confirmed by observing higher correlations between those scales of the IRI that were relevant to patient care (e.g. empathic concern, perspective taking) and related factors of the JSPE (compassionate care, perspective taking) than other scales of the IRI that seemed less relevant to patient care (e.g. personal distress and fantasy). These findings provide further support for the validity of the JSPE. It is concluded that physician empathy as measured by the JSPE and its underlying factors are distinct personal attributes that have a limited overlap with fantasy and no overlap with personal distress defined as dimensions of an empathy measure that was developed for the general population.

Comparisons of nurses and physicians on an operational measure of empathy

In view of many changes taking place in today's health care marketplace, the theme of empathy in health provider-patient relations needs to be revisited. It has been proposed that patients benefit when all members of the health care team provide empathic care. Despite the role of empathy in patient outcomes, empirical research on empathy among health professionals is scarce partly because of a lack of a psychometrically sound tool to measure it. In this study, we briefly describe the development and validation of the Jefferson Scale of Physician Empathy (JSPE), an instrument that was specifically developed to measure empathy among health professionals (20 Likert-type items). The purpose of this study was to compare nurses and physicians on their responses to the JSPE. Study participants were 56 female registered nurses and 42 female physicians in the Internal Medicine postgraduate medical education program at Thomas Jefferson University Hospital. The reliability coefficients (Chronbach's coefficient alpha) were 0.87 for the nurses and 0.89 for physicians. Results of t test showed no significant difference between nurses and physicians on total scores of the JSPE; however, multivariate analyses of variance indicated statistically significant differences between the two groups on 5 of 20 items of the JSPE. Findings suggest that the JSPE is a reliable research tool that can be used to assess empathy among health professionals including nurses.

Anguish and Despair in Adolescents with Eating Disorders

Summary: Adolescents struggling against anorexia nervosa or bulimia nervosa often experience self-punishing thoughts and behaviors, including self-mutilation, and suicidal ideation and attempts. These arise out of the profound anguish and despair frequently experienced by these young people. This paper outlines four particularly salient clinical themes underlying this despair that have significant implications for treatment. A practice perspective is discussed which emphasizes empathic listening and the development of a strong therapeutic alliance with the adolescent. Treatment recommendations draw from narrative theory and practice, and from feminist perspectives. The paper also draws on cognitive therapy and on recent developments in the areas of spirituality and motivational enhancement. Involving the distressed adolescent's family is also addressed.

Expressive metaphors in cancer narratives

This article presents and interprets illness narratives, told by patients treated for cancer. The aim is to discuss the meaning of cancer metaphors. The interpretation focuses on the relationships of metaphors to bodily experience and to social and cultural levels. The experience of cancer and cancer therapy obviously involve the patient's body. To comprehend what is happening is a process full of uncertainty and obscurity. Metaphors, such as cancer "eating," are widespread and persistent while the meaning of that metaphor today mirrors new scientific and lay explanations of cancer and cancer treatment. Personal newly created metaphors express threatening experiences in which fear of losing oneself and fear of death are involved. Ambivalent hope in relation to treatment and caregivers is expressed. Creating new metaphors involves imaginatively using the available concepts and metaphors. Narrative communication gives access to patients' experiences of an unwanted and painful physiologic process leading to forced embodiment of sickness. Patients want consolation and must overcome solitude by articulating experience, being listened to, and, in this way, recreating and strengthening identity.

The economic consequences of social phobia

Background. Social phobia has been under-recognised and under-treated in many countries. Little is known about its economic impact. This study aimed to identify the economic consequences of social phobia for individuals, health services and wider society. Methods. Secondary analysis of 1993-1994 Psychiatric Morbidity Survey data compared 63 people with social phobia and 8501 people without psychiatric morbidity. Results. People with social phobia were less likely to be in the highest socio-economic group and had lower employment rates and household income compared to those with no psychiatric morbidity. They also had higher levels of drug dependency and use of prescribed oral medications. Although there were no differences in total health care costs, costs of GP contacts were significantly higher. Individuals with a comorbid psychiatric disorder made higher use of some health services than those without a comorbidity. Limitations. Analyses were performed post hoc on data collected for other purposes. The defining questions for social phobia have not been studied much before. The number of identified subjects is small and thus raises the possibility of type II errors. Larger numbers may have revealed even more differences from the psychiatrically well population. Data on treatment patterns of the psychiatrically well population were limited because the surveys focused on subjects with psychiatric morbidity. Conclusions. The burden of social phobia on individuals, health services and the wider society could be reduced through improved rates of detection and appropriate treatment.

Placebos, placebo effect, and the response to the healing situation: the evolution of a concept

In spite of its impressive progress, medicine has been strongly criticized for relying on its modern biomedical tradition to the neglect of the psychosocial aspects of health. This neglect may account for patients' dissatisfaction and eventual use of alternative health approaches. The concept of placebo has sustained dramatic "protean" metamorphoses through the ages. For centuries, placebos have been regarded as powerful deceptive therapies. From the middle of the twentieth century, however, conventional medicine has used placebos as methodologic tools to distinguish the specific from the nonspecific ingredients in treatments. In modern medical research, the double-blind, placebo-controlled, randomized clinical trial has been established as the gold standard for the assessment of any new treatment. Recently a new trend regarding placebos seems to have emerged. The placebo and other nonspecific effects elicited by the "healing situation" have been independently subjected to scientific study. Progress in this area may promote useful clinical applications, enabling physicians to broaden their perspectives on the healing process. We present the historical changes of the concept of placebo and the ethical issues raised by their use.

On analytic listening

Multiple dimensions of the listening process as implemented in the analytic process are discussed. Listening is not the same as hearing; it is done with the mind rather than just the ears. Listening seeks meaning, specifically the meaning in the mind of the patient. The meaning of words is often obscure, ambiguous, and uncertain, and their deeper implications can only be approached over time through uncovering associative linkages. Listening takes place in multiple perspectives--subjective/objective, active/passive, dynamic/genetic, etc. Listening is also contextually related to dimensions of the analytic relation, including transference, alliance, and real relation. Modalities of listening related to each are explored for both analyst and analysand, and aspects of listening empathically and listening to silence are discussed.

Psychiatrists' views of managed care and the future of psychiatry

Managed care aims to insure the health of a population rather than that of an individual. This paper compiles opinions of psychiatrists and others on managed care and lists ways managed care potentially affects psychiatry. Managed care reverses the economic incentives indemnity insurance gave doctors to prolong treatment. It encourages psychiatrists to spend less time on empathic discussion and to use more standardized, less costly treatments. Many psychiatrists feel distressed about how managed care has changed their practices. Capitation care will change it further. Current trends suggest the U. S. will use and train fewer psychiatrists. Psychiatrists will spend less time with individual patients and more time planning and guiding the treatment of severely impaired patients. Many more psychiatrists will likely have unprecedented changes imposed on their careers.

Depression after childbirth: the views of medical students and women compared

BACKGROUND

Little research has been conducted on the views of health professionals about women's experiences of depression after childbirth. This study compared the views held by undergraduate medical students about postnatal depression with those of women who had themselves experienced it.

METHODS

Fourth- and sixth-year medical students at one Australian university were surveyed (n = 134). Their views about prevalence, duration, contributing factors, and advice for dealing with postnatal depression were compared with the findings from 60 women in a population-based study of mothers who gave birth in Victoria in 1989, in which women scoring as depressed 8 to 9 months after birth on the Edinburgh Postnatal Depression Scale were interviewed 12 to 18 months later about their experiences of depression and their advice to other mothers.

RESULTS

Women's and students' views differed markedly, with students much more likely to view hormonal and biologic factors and a "tendency to depression" as playing an important role than women who identified a wide range of social, physical health, and life event factors as contributing to their experience of depression. Fourth-year students tended to overestimate the prevalence of depression and sixth-year students to underestimate it. Both groups underestimated the duration of depression compared with women's actual experiences.

CONCLUSION

Medical students need to develop a broader understanding of maternal depression after the birth of a baby, and women's own views of the experience can and should make an important contribution to medical teaching on this topic.

Applying what burn survivors have to say to future therapeutic interventions

Statements by caregivers can be beneficial to paediatric burn patients, facilitating their psychological adaptation. However, the concerns of the burned child are not always obvious, and caregivers may flounder, not knowing how to elicit the concerns of the patient. The purpose of this paper is to examine whether universal concerns of the postburn survivor can be detected through one type of psychological assessment tool, a sentence completion task. Sixty paediatric burn survivors, ages 6-19, were administered a 30-item Incomplete Sentences measure. Five major aspects of postburn life were identified and proscribed the following descriptive labels: (1) preoccupation with health; (2) the struggle for internal acceptance; (3) reconstruction of one's life map; (4) changing relationships; and (5) redefining the world. These five dimensions of postburn life are discussed, as well as applications for each.

In search of clinical excellence

This article was presented as a lecture at the 1995 Combined Sections Meeting by Joseph P. Farrell, MS, PT, who received the Orthopaedic Section's Paris Distinguished Service Award. He was recognized for service to the Orthopaedic Section in the area of manual therapy and for the formation of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Clinical excellence is a journey that every clinician should commence early in his/her career. The purpose of this paper is to discuss clinical excellence and its importance to the physical therapy profession. To address this topic, the following items will be discussed: 1) clinical competency and clinical expertise; 2) communication and patient management in the current era of health care reform; 3) politics relating to manual therapy; 4) the role of manual therapy in our profession; 5) clinical residency educational programs; and 6) the academic and clinician role in education. The author concludes that if physical therapy is a profession of excellent clinicians, then the physical therapy profession can survive evolving changes in the health care system.

Emergency Psychiatric Assessment: The Nurse, Psychiatrist, and Counselor Roles During the Process

1. Psychiatric nurses, psychiatrists, and counselors value their previous clinical experiences and appear empathetic with patients. 2. Clinical experience facilitates the development of expertise in clinical skills, more willingness to include clients in the decision-making process, and increase self-confidence when making less restrictive treatment recommendations. 3. Psychiatric nurses differ from psychiatrists and counselors in their perceptions of teamwork, responsibility, role expectation, and in connecting with clients.