Transformational changes in health status: a qualitative exploration of healing moments

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Background and aims: Dramatic self-change is a familiar concept within religious experience and is recognised within psychotherapy and some fields of nursing. However, it has been given limited consideration in wider health research, including
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  1 Transformational changes in health status: a qualitative exploration of healing moments   Dr Emmylou Rahtz, University of Exeter. Corresponding author, e.rahtz@exeter.ac.uk, European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom Dr Sian Bonnell, Manchester Metropolitan University Dr Sarah Goldingay, University of Exeter Prof Emerita Sara Warber, University of Michigan Prof Emeritus Paul Dieppe, University of Exeter Word count: 4,913 plus references Keywords: healing; transformational change; connectivity Abstract Background and aims: Dramatic self-change is a familiar concept within religious experience and is recognised within psychotherapy and some fields of nursing. However, it has been given limited consideration in wider health research, including healing research. We sought to explore the phenomenon of 'healing moments'. Methods: Alternative medicine practitioners attending a continuing professional development ouse fo heales ithi the UKs Holisti Health “ho ee sho a te iute ideo lip shoig two of the authors discussing healing moments. Sixty-nine (69) of the practitioners then provided shot stoies outliig thei o epeiees of suh oets . Both the video and the short stories were analysed qualitatively using a thematic approach. We sought to evaluate holistic practitioners' perceptions of the concept of healing moments. Main Results: The concept of healing moments was widely accepted by the 69 participants. An overarching theme of transformational change described personal shifts that ranged from the sudden and quasi-miraculous to transient but much-needed improvements in health and wellbeing.  2 Three subordinate themes of connectivity, quiescence and control were identified. Connectivity described intense connections, experienced through touch, empathy and love, which could provide reciprocal benefits for healers as well as clients. Quiescence captured the quiet, calm atmosphere that pervaded many healing episodes. The contrasting aspects of control encompassed healers relinquishing control in order to channel healing, and clients seizing control to become empowered in their own healing process. Discussion: Healing moments are a recognised and distinct concept within healing, although they remain under-explored in the literature. Our findings suggest that such experiences are common among alternative medicine practitioners. The concepts we uncovered can inform future research. Introduction Dramatic self-change is a familiar concept within religious experience, and is recognised within psychotherapy and some fields of nursing. 1  However, it is rarely discussed within biomedicine and has been given limited consideration in wider health research, including healing research. In religious terms, dramatic change may take the form of religious conversion, described by William James as a transformation from unhappiness and conflict to a unified, energised self, which can be gradual or sudden; a journey or a moment. 2   I pshotheap, uatu hage des ibes sudden transformations in soeoes perception of themselves and their environment, 3,4  transformations which have substantial beneficial effects on mental and physical health. Holistic nursing recognises unique connecting moments; caring-healing moments in which a healthcare practitioner is intensely present in a healing interaction with a patient. 5,6  However, although dramatic change is part of the discourse in healing and complementary and alternative medicine (CAM), it has been little explored in other healthcare literature. These experiences may be overlooked because they are viewed as anomalous, but the evidence suggests they are not uncommon. 7,8  Healing can be defined in contrast to curing: Frank quotes physician Rachel Naomi Remen: We thought we could cure everything, but it turns out we can only cure a small amount of human suffeig. The est of it eeds to e healed   ad otes that healig atteds to the est . 9  In CAM and certain branches of nursing healing has a holistic meaning: the sense of enabling people to reach a state from which they can flourish, despite whatever physical or psychological constraints may still affect them. 5,10,11  Elsewhere, healing can refer to the physical process of wound healing, as in biomedicine, or psychological wellbeing and recovery from emotional trauma, as in psychotherapy.  3 A small number of theory-driven papers in humanistic and holistic nursing use the terms healig oet  or  caring-healing moment  . Healing here is often synonymous with aig  and can be otaied i a sigle aig oet. 6(p179)  These accounts emphasise the interconnection between those giving and receiving healing, 10  which could benefit both parties, 12  and both in turn could be connected to a higher source of power. 6  Healing is more often understood as a journey than a moment in these accounts, 11  although the journey often included an first intense moment 12  or period of hours or days 10  preceding the journey. Recent work by our group highlighted the idea of a distinct moment of healing that resulted in significant, transformative changes in health status. These moments were brief and transitory, but highly charged. For example, a pilgi isitig Loudes desied he healig oet: I just felt this warmth go over me... wash over me, and it just felt like I was being enveloped... being held. And it took over my body and I felt just complete calm and peace and the pain just disappeared into isigifiae . 13(p315)  In a re-enactment of a medical consultation, a doctor commented on the oet he the oo disappeas: a oet he tesio is eleased ad the patiet is transformed. 14  The concept crystallised during a workshop among the authors of this paper, when SW and PD discussed their emergent thoughts on healing moments. Their unscripted conversation was digitally recorded, and formed a proposition for further research in which we sought to explore how healers conceived of healing moments. Our aim was to illuminate a little-explored phenomenon, with a longer term aim of informing healing research and healthcare practice. Our research question was to evaluate holistic practitioners' perceptions of the concept of healing moments. Methods Two sources of qualitative data contributed to the analysis: a video and a set of short stories. The video was produced during a three day workshop about healing in March 2015 among the authors of the paper. The film records an unscripted conversation during the workshop between PD and SW. Both are academic medical doctors with an interest in healing who have conducted extensive research on healing 15  – 20 . SW is an academic holistic family physician and mixed methods researcher of complex interventions who has trained in Native North and South American healing techniques. PD is an academic rheumatologist and health services researcher. The conversation was facilitated by SG and videoed by SB. Field notes collected by ER added further context. The conversation was edited to create a ten minute video,  Approaching the Healing Moment  .  4 The stories were written in response to this video by people attending a continuing professional development course for healers ithi the UKs Holisti Health “ho  in May 2015. The healing movement in the UK comprises energy, spiritual and Reiki healing. Participants watched the video and were invited to respond on a postcard. The postcard read:  We are trying to learn more about the epeiees that suoud healig oets  and would appreciate your help. Please tell us a shot sto aout ou epeiees of a healig oet . Participants were asked their age, sex, and whether they were best described as: Healer / Complementary therapist / Other health care professional / Someone who has received healing / None of these. Postcards were returned to the authors by the meeting organisers. The videoed conversation was transcribed and the healing stories were typed up. Each participant was identified by a unique number (P1, P2, etc.), with personal details stored separately and securely. ER carried out the first stage of analysis using thematic analysis 21  on each data set. In each case, the analysis began with repeated close reading of the transcripts of the video and the brief case histories provided on the postcards, and highlighting of salient words, phrases and sections. Codes were generated inductively from this close reading, and the transcripts were then coded. The resultant codes were visually mapped and annotated on an OSOP (One Sheet Of Paper 22 ) to explore interconnections. This included the frequency of each code, and resulted in the formation of one overarching theme with three subordinate themes. These codes and themes were discussed and refined with reference to the srcinal transcripts. Initial discussions were between ER and PD, and later discussions included SB, SG and SW. Results The video can be viewed online https://www.youtube.com/watch?v=J29PrL3XUOk. In it, SW and PD talk about their own experiences of healing within the biomedical contexts of their work. They compare scientific biomedical approaches with those of healers, who are described as having presence, relying on instinct and good intention, and who might channel energy or an intangible force. SW and PD discuss the potential for reciprocal benefit for healer and client. Seventy two (72) useable postcards were returned from 69 people (one participant returned four postcards). Organisers estimated that about 100 people attended the session. Five unusable postcards were received: four which did not provide a story, and one negative comment on the video quality. The useable stories averaged 41 words, equivalent to three or four sentences. Three quarters of the responses were provided by women (Table 1). Ages ranged from aged 25 to 79, with a mean age of 55.  5 Table 1: Demographic profile of participants N % Total 69 100% Gender Male 17 25% Female 52 75% Age 25-34 6 9% 35-44 5 7% 45-54 23 33% 55-64 18 26% 65-74 16 23% 75+ 1 1% The majority of participants saw themselves as complementary therapists (Table 2); participants could tick multiple options. Table 2: Participants' healthcare work / experience (multiple choice question) N % Total 69 100% Healer 25 36% Complementary therapist 51 74% Other healthcare professional 15 22% Someone who has received healing 22 32% Participants included lay healers, practitioners of energy healing, Reiki, acupuncture, reflexology, homeopathy, osteopathy, chiropractic, kinesiology, Chinese massage and others including a doctor and a nurse. Over half had received healing in addition to providing it: it was common to have experienced both sides of the exchange, and both were brought to bear in accounts. Less than half of the stories specified a complaint; the most common complaint was pain followed by psychological distress. Overall observations in the data None of the participants rejected the idea of a healing moment. However, we discerned three different interpretations of the idea: instantaneous healing moments, turning points, and healing  journeys. Over a third clearly described a precise, charged moment when change was instantaneous and tangible. Healing occurred in that moment, and symptoms abated immediately afterwards. Just under a third described healing as a turning point in the illness experience; a first step on a healing  journey; these turning points typically lasted longer but were still contained within a single interaction or consultation. Finally, one in ten described gradual healing journeys without an evident
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