PRACTITIONER REFLECTION & MANAGEMENT

Practitioner Reflection & Management of Issues with Boundaries within Therapeutic Relationships

Practitioner Reflection & Management of Issues with Boundaries within Therapeutic Relationships

The relationship between acupuncturists and their patients is currently receiving a great deal of attention. Plays, films and books are featuring the travails of patients who seek medical care and depicting physicians as emotionally distant, abrupt, pompous, insensitive and even incompetent (Consider for example: Wit an off-Broadway hit play by Margaret Elson, Patch Adams a film starring Robin Williams, and a recent Canadian book, Operating in the Dark by Lisa Priest). Indictments of medicine and the physicians that practice it are cropping up everywhere in North America, the United Kingdom and Europe. The notion that something is seriously lacking in the acupuncturist-patient-relationship seems to have become thoroughly embedded in contemporary Western culture.

At the same time that patients are criticizing the way their physicians relate to them, we are witnessing a remarkable and widespread surge of interest in complementary and alternative medicine (CAM) and an increasing use of CAM practitioners. One of the reasons that has been cited for the current attraction to CAM practitioners is that they are more empathic and collaborative than physicians and take a greater interest in the individual psycho-social aspects of their patients' lives. Patients are said to choose CAM practitioners because they seek a more satisfying therapeutic relationship. It has also been suggested that the high degree of rapport that exists between the alternative practitioner and his/her patient has a powerful placebo effect and may indeed be the key factor in the ability of these practitioners to help their patients. However, the assumption that CAM patients have more positive and valuable relationships with their practitioners than do patients of family physicians has not yet been subjected to rigorous research. It is a notion that requires serious examination rather than stereotypical thinking. (Williams 2010 1003-1009)

A typical setting for the acupuncturist patient relationship is formal and often institutional. The physician wears a white coat and practices in a professional office with a receptionist or nurse who sees the patients first. When patients are ushered into their physician's office, the acupuncturist usually sits behind a desk and takes control of the interaction, posing a series of questions to the patient allowing little time for response . If a physical examination is required, patients move to another room, usually removing at least some of their clothing, and then return to the acupuncturist's office to learn their diagnosis and hear the recommended treatment. This kind of setting contributes to social distance and establishes the physician's authority in the healing process. (Wallston and Maides 2006 580-585)

Despite this portrayal, most of the family physicians' patients in this study reported that they had a positive relationship with their acupuncturists. Most of their relationships developed over a long period of time (mean number of years=9.7 and the median= 7.0). Close to one fifth (18%) of them had been seeing the same physician for 20 years or ...