Definitions of Holistic and Integrative Healthcare: a Practitioner’s View.

1. Definitions of Holistic and Integrative Healthcare: a Practitioner’s View. Presented by Christina Dawson

2. Introduction & Agenda • Background to the study • Research methodology & participants • Findings • Conclusion & questions for further research • Q & A

3. Background to the study1 • Origins of the research • Working in counselling and complementary therapy centres, increased knowledge of CAM therapies and how they can help clients, clients’ use of CAM. • Counselling world’s growing interest in treating the whole client and accessing the mindbody • 2003 – idea of CAM therapists and counsellors working in a team explored at one of the centres, recently suggested again. • Research seen as first step to explore if this is a viable project, do they agree on what holistic and integrative healthcare is?

4. Background to the study 2 • Aims of the study • Purpose of the study to explore what ‘holistic’ and ‘integrative’ healthcare mean in the context of counselling and CAM therapies. • No research found on CAM therapists and counsellors providing holistic and integrative healthcare through teamwork in a private setting. • Study aimed to provide insights and information for therapists and centres wanting to develop a holistic/integrative approach or teamwork in private practice and raise issues for further investigation.

5. Research Methodology1 • Qualitative research • Qualitative research methodology chosen – interpretative-descriptive - as study based on participants’ words and meanings as data for analysis.

6. Research methodology 2 • Constructing Grounded Theory – Kathy Charmaz- Sage Publications 2006 • Charmaz’s constructivist version of GT chosen because it sees ‘both data and analysis as created from shared experiences and relationships with participants.’ Meanings are co-constructed – appealed to me as a counsellor. • On a personal note I found Charmaz easy to read and accessible with interesting examples of her own research into chronic illness.

7. Research methodology 3 • Data collection • Data was collected through a semi-structured focus group of 9 participants and 11 individual semi-structured in-depth interviews. • Participants • Criteria – counsellors and CAM therapists with at least 2 years experience in private practice were chosen as purposive sample. The CAM sample based on 5 sub-categories of Crock et al (1999).

8. Research methodology 4 • Participants’ practiced therapies: • Asian: Acupuncture, Acupressure, Patent Chinese Herbs • Body: Reflexology, Massage, Shiatsu, Aromatherapy, Scio Energetic Medicine • Food/Supplements: Nutritional Therapy, Bach& Bushflower Remedies • Manipulation: Osteopathy, Bowen Technique • Psychosocial/Spiritual: Hypnotherapy, Counselling, Reiki, Feng Shui, Psychosexual Therapy, Lifecoaching, Homeopathy, NLP

9. Research Methodology 5 • Participants • Participants mean age was 49.45 years, 22%male (2) and 77% female (9) • White British 7 • Irish 2 • French 1 • Indian 1 • (This sample is fairly representative of British independent practitioners. Andrews and Hammond (2004) found of their 426 respondents that 36.4% were male, 63.1% were female and the mean age was 46.9 years).

10. Analysis • Initial coding • Initial coding raised nearly 200 codes. • Focused coding • This second coding produced 20 focused codes which raised 5 conceptual categories: ‘Mind, body and spirit?’ ‘Can I walk the holistic talk?’ ‘Helping clients heal themselves’‘Being Integrative’ and ‘Working Together’.

11. Findings 1 • Mind, body and..spirit? • There was broad agreement that holistic meant ‘mind, body spirit…environment..the whole works.’ • Although aware of the mind-body link, the counsellors were reluctant to discuss this with clients, fearing that ‘some people are very anti complementary therapies…’ • 4 participants said they ‘did not do spiritual.’ • Can I walk the holistic talk? • There was a consensus that congruent holistic practitioners ‘walk the talk’ and attend to their own spiritual well being.

12. Findings 2 • Participants’ reluctance to promote spirituality in their practice was therefore surprising. All participants wait for clients to mention it first, none used the word in their advertising, ‘as it can scare people away.’ • One participant described the population as ‘spiritually constipated’ • Only 3 of the 9 participants used the word ‘holistic’ in their advertising.

13. Findings 3 • Helping clients heal themselves • Empowering clients’ healing through informed choice and by clients taking responsibility for their own health was a tenet of holistic philosophy, also subscribed to by the non-holistic participants. • CAM therapists insist that they can ‘only facilitate your body to heal’ they do not ‘cure’.

14. Findings 4 • Being Integrative • Integrative healthcare proved difficult to define. • The consensus was that it involved more than 1 therapist and implied ‘people working together in some way’ to provide therapy and healthcare, and that ‘they are talking more to each other about that client’. • My findings were very similar to Boon et al’s (2004) systematic review of the literature defining integrative healthcare. They found 4 main elements.

15. Findings 5 • Philosophy and values: treating the whole person in their environment, focusing on health creation and healing, prefer health promotion to the treatment of disease, and creating a partnership between practitioner and client. • Structure: Participants required any team of therapists to ‘go in as equals’ and to ‘have common values and mutual respect’. • Process: ‘combining the power of our therapies’ and the necessity of a co-ordinator/manager to organise the team.

16. Findings 6 • Outcomes: more effective healthcare, synergistic care that exceeds the collective effect of the individual therapeutic practices. • Working together: • 6 participants were enthusiastic about teamworking. • 4 were interested but expressed reservations. • 1 felt unable to work in a team.

17. Findings 7 • The counsellors were unwilling to join an integrative team. One found confidentiality a serious difficulty. (She would participate if there was no note sharing or team supervision and if the client decided what to divulge to other members of the team. She uses CAM therapies.) • The other counsellor thought that her model of CBT precluded her from teamwork and she did not feel it ‘would sit comfortably with her.’ She did not use CAM therapies.

18. Findings 8 • The difficult issues to resolve were: who has overall responsibility for the client’s health, who decides how many sessions of each therapy, their sequence and compatibility, and how to organise team meetings when all can attend.

19. Conclusions 1 • Holistic and integrative are difficult words to define, but they are not synonymous. • Most holistic therapists felt unable to promote their holism and all participants felt unable to promote their spirituality in case they ‘put off’ potential clients.

20. Conclusions 2 • Integrative healthcare usually signifies the integration of conventional medicine with CAM therapies, but can include or exclude any modality/therapy. • There are different levels of integration. • There are many different models for working integratively: informal referring networks, multi-disciplinary and inter-professional teams. • It can denote one individual integrating several therapies, but only 1 participant explored this concept.

21. Questions for Further Research 1 • Should all counsellors’ training place more emphasis on mind-brain-body connections, somatisation and therapist embodiment? • Is it possible to train therapists to be spiritual and feel sufficiently grounded in their beliefs to help clients with spiritual concerns? • Does taking a full medical history and life story increase or reduce the number of client sessions needed?

22. Questions for Further Research 2 • The 2 male participants were negative towards holism. Larger scale research would discover whether their views are typical of the wider male population. • When clients organise their own integrative care, do they choose the most appropriate therapies for their health and well-being? How do they decide where to start, how many sessions, in which order? • Can research provide evidence that synergising therapies is more effective and cost effective?

23. Q & A • Please email me with any further questions: • c.dawson1@btopenworld.com