CHAPTER 10: Communication for Empowering Therapeutic Alliances

Introduction

Chapter Overview

Our patients' achievement of optimal quality of life can be greatly facilitated by supportive therapeutic alliances with their health-care practitioners. This chapter explores the application of effective communication in the context of building such partnerships, the components of which include understanding the challenges of the illness experience and applying the principles of patient-centered care.

Key Terms

• Self-efficacy

• Illness

• Therapeutic alliance

• Patient-centered care

• Person-first language

What Does It Mean to Be a Patient?

Pain and Suffering

What is a patient? The American Heritage Dictionary of the English Language¹ provides eight different definitions of the term. Five of these are adjectives, relating to the bearing of pain, annoyance, or difficulty. The most ancient use of the term, however, is as a noun, meaning “one who suffers.” Accordingly, a guiding assumption in health care relates to the concept that patients come to us because they are suffering on some level.

The concept of suffering as a subjective experience of pain derives from many sources. Accordingly, Cherney describes suffering as “a state of severe distress with events that threaten the intactness of the person.”² Cicely Saunders, who is credited with being the founder of the hospice movement, was one of the first physicians to identify (and then treat) the numerous sources of distress confronting patients at the end of life. Saunders coined the term total pain to describe the sum effect of these multidimensional contributions to patients' suffering. According to Saunders (who, in 1967, established the world's first medically based hospice in London), these sources include not only physical, emotional, and spiritual elements but also other potent stressors such as family responses, financial concerns, and coping with the increasingly obfuscating demands of the medical bureaucracy. In summarizing the patient's perspective, Saunders wrote: “The whole experience for a patient includes anxiety, depression, and fear; concern for the family … and often a need to find some meaning in the situation, some deeper reality in which to trust.”^3,4

Figure 10-1 illustrates some sources of total pain.

The degree to which each of our patients suffers depends on many factors. Not surprisingly, any loss of function is likely to be stressful; our patients are thus likely to experience one or more elements of total pain. Although the extent of this distress will vary, even patients with minor injuries are likely to face challenging consequences that affect their daily lives. To ...