Originally Posted By NWI, Monday, May 8, 2017
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Dr. Halima Goss, PhD
Doctor and wellness advocate
As a small town medical doctor (with a Wellness framework in mind), I am challenged daily to balance treatment models and wellness goals. In the crafting of patient care, my intention is to patiently combine modern medicine and Wellness based ideals with compassion and kindness. I work with nurses, physiotherapists, podiatrists, optometrists and a host of other allied health professionals. It is unfortunate in Australia that our public medical funds purse has yet to embrace Wellness coaches as allied health professionals. The upshot is that we are unable to include Wellness coaches as part of “team care plans” for eligible patients. If a person wishes to use a Wellness coach, they must fund 100% of the fees. This is in contrast to other professional groups like for example psychologists, exercise physiologists, and dietitians whose fees are recoverable through our Medicare system. With time, and greater attention to refining effective paradigms and practices in both medicine and other professions, Wellness constructs as guiding principles may flow more freely. For now, those who adopt and practice Wellness in treating and helping patients with Illness are those individuals who strive to empathize and educate in transformative ways.
In authoring this article, I hope to share some ideas that are inspiring and helping me develop in my role. Whilst these ideas may not come from the Wellness literature, I am convinced that they should be essential reading for those wanting to pursue Wellness based practice.
Recently, I learned about a concept called “presence” from the field of existential analysis in psychiatry. Author, Kirk Schneider (2015) offers this definition: “a complex mix of appreciative openness, concerted engagement, support, and expressiveness, and it both holds and illuminates that which is palpably significant within the client and between client and therapist.”
Schneider (2015) further notes that presence “ embraces a much fuller and richer range of elements that may include a degree of discord and discomfort with another person.”
In contrast to mindfulness, presence is a mutual currency which we spend freely to grow honest and respectful curiosity within relationships. Schneider (2015) states that “unlike conventional mindfulness, presence does not concertedly aim to dissolve the identity of self (if that is even achievable), but to expand, deepen, and redefine the identity of self. Finally, unlike conventional conceptions of mindfulness, presence aims to coexist with and integrate not necessarily detach from suffering”.
I began to reflect on how this idea fitted with those from Wellness coaching paradigms. Wolever et al (2013) defined Health and Wellness coaching as:
A patient-centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach. The coach is a health care professional trained in behavior change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well-being.
This definition is heavily technocentric and is perhaps more closely aligned to traditional medical approaches than humanistic approaches. Transformative learning is the hoped for outcome, but without a shared journey of transformation, is the process likely to be effective?
Schneider strongly encourages that psychotherapy training must incorporate humanistic and relational qualities to help trainees become well-rounded (engaging-empathic) people, not just competent technicians. He (2015) concludes:
” the optimization of presence is neither “performed” nor “enacted.” It is lived.
Wellness based practice must also consider these urging. Perhaps a good starting point may be found in the work of Geller and Green berg (2012) who describe four dimensions that are key to therapeutic presence—
-the sense of being grounded, which includes feeling centered, steady, and integrated inside one’s own body and self;”
-the sense of being immersed “in the moment with the client;”
-the sense of “spaciousness or an expansion of awareness and sensation while being tuned into the many nuances that exist at any given moment with the client;” and
-the sense of “intention for presence to be with and for the client’s healing process” (p.109).
Knowing oneself first would seem to be the aim. Could the spiritual dimension hold a key to unlocking personal qualities that blend to help one practice presence? Unfortunately, the spiritual dimension of wellness whilst recognized by many pioneers of wellness and certainly celebrated as integral by ancient scholars of wellness seems too often to be confused with orthodox belief systems, rituals and structures. It behooves us to consider re- elevating this dimension in the ranks of our training, work, research and promotion efforts. Within it, alongside “encouragement” and “imagination” sit so many values which hold the essence of human endeavour in the quest for optimum social, environmental and physical harmony. Perhaps it holds a key to humanistic, relational transformative education for Wellness coaching training. Could it be a pivot point as Eberst (1984) suggested many decades ago?
In my doctoral thesis, I had a unique opportunity to offer a synthesized description of the Wellness paradigm. In writing this article, I decided to revisit that description (copied below for your reference)
The Wellness paradigm is concerned with the optimum functioning of individuals in society. A Well person’s awareness, understanding and active decision-making capacity align with their values and aspirations. A Wellness lifestyle is the commitment and approach adopted by an individual aiming to reach their highest potential for purposes greater than themselves. The outcome of a Wellness lifestyle is a capacity to contribute in positive and meaningful ways to one’s community, society and the welfare of the earth. An individual who adopts a Wellness lifestyle aims to seek and use knowledge to live with balance across the multiple dimensions of their health and wellbeing in concert with others and their environment. On a continuum between low-level Wellness and high-level Wellness, individuals continually move between various states of physical, psychological and spiritual harmony and vary in their capacity to reach aspirations and goals. Appropriate learning strategies, tools and techniques are necessary for one to achieve higher levels of Wellness. (Goss, 2015)
On reflection, I would probably add one more sentence which I recently heard uttered by a respected Australian (our former Governor General Ms Quentin Bryce): The greatest journey we must make is the journey to the center of our self.
I have realized that often times the seemingly simple act of being present with my patients is the key to open the door to the healing process for them. Whilst many of my colleagues in medicine may feel a little uncomfortable with quotations from complementary and alternative medicine or therapy, I believe the collective wisdom is far too valuable to ignore. I share the following quote as an acknowledgment and a reminder to those who wish to be transformed by their practice and to support others in their journeys to Wellness and Health.
Samuel Hahnemann, the founder of homeopathy, gave a magnificent description of health, when he wrote, ‘In the healthy condition of man, the spiritual vital force, the dynamics that animates the material body, rules with unbounded sway, and retains all the parts of the organism in admirable, harmonious, vital operation … so that our indwelling, reason-gifted mind can freely employ this living, healthy instrument for the higher purpose of our existence.’ [Aphorism 9, The Organon].
As an international wellness community, we have a unique opportunity to encourage the scholars of the future from all over the world to continue to seek integrative paradigms, methods and practices that serve to unlock the secrets to curing every disease that exists. May your journeys be fruitful.
Eberst, R. (1984). Defining Health: A Multidimensional Model. Journal of School Health,54. 99-104.
Geller, S.M. & Greenberg, L.S. (2012). Therapeutic presence: A mindful approach to effective psychotherapy. Washington, DC: APA Press.
Goss, H.B. (2011). Wellness education: An integrated theoretical framework for fostering Transformative Learning. PhD Dissertation, School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland University of Technology.
Schneider, K. (2015). Presence: the core contextual factor of effective psychotherapy. Existential Analysis, 26(2), 304-313.
Wolever RQ, Simmons LA, Sforzo GA, Dill D, Kaye M, Bechard EM, Southard ME, Kennedy M, Vosloo J, Yang N. A systematic review of the literature on health and wellness coaching: Defining a key behavioral intervention in healthcare. Global Adv Health Med. 2013;2(4):34–53.
Dr Halima Goss (PhD, MBBS, B App Sci, Grad Cert Mgt, Dip Teach) is a medical doctor and wellness advocate in Far North Queensland, Australia. Her career has spanned a number of fields including science, education, technology, health and wellness, psychiatry and family medicine.
A founding member of the National Wellness Institute of Australia (NWIA) she has presented Wellness topics to wide and varied professional groups from the corporate, government, industrial, medical and education sectors. She retains a heartfelt hope and enthusiasm for the coalescence of ideas and ideals born of cultural values which seek a kinder, more caring world with love as the most valued commodity. She can be contacted via email at firstname.lastname@example.org.