2. Extract 2 Critical issues in the therapeutic relationship
This extract examines the main areas of criticism of the therapeutic relationship in complementary and alternative medicine (CAM). Both social scientists and media commentators have extensively critiqued what some people call a ‘therapy culture’. Many critics have questioned the dependency that some users develop in their use of CAM and voice concerns about the ways in which the therapeutic relationship can be abused. In challenging some of the assertions made on behalf of CAM practitioners, you will be able to reflect once more on your own experiences and expectations of therapeutic relationships, and consider the strength of these arguments.
The extract begins by introducing a range of users' experiences of the therapeutic encounter in CAM. It illustrates how these experiences can be very diverse, with both positive and negative effects for users.
Then there is a more critical analysis of CAM therapeutic relationships by looking at how therapeutic relationships have changed, and re-evaluating possible therapeutic responsibilities held by users and practitioners of CAM. The work of Rosalind Coward (1990) is used to illustrate the views of a growing group of social commentators who believe social factors that contribute to ill health are often rejected by CAM in favour of emphasising the individual's responsibility for their own health and illness.
The next section explores how CAM practitioners, as well as doctors, may try to impose on the user an understanding of illness that robs them of their own views, making them feel disempowered. Even though CAM can occasionally give the user helpful ways of reconceptualising their body and their illness, both ‘reductionism’ and ‘holism’ can reduce them to a mere pawn in the practitioner's paradigm, minimising rather than facilitating the user's sense of control.
Next the controversial debate is raised about whether the success of the CAM therapeutic relationship is a powerful form of placebo. Critics using biomedical approaches to health often argue that the placebo effect is both the reason for CAM working and its weak point. They say that healing in CAM is often a result of the powerful effects of the therapeutic encounter and users' and practitioners' belief that the therapy will work.
The next section discusses what happens when the therapeutic encounter fails. It looks at four ways in which therapeutic relationships can be said to fail: clinically, interactionally, through a mismatch of expectations or as a breach of boundaries. This section also considers how far users can challenge practitioners when they believe the therapeutic relationship has been unsuccessful.
Finally, this extract briefly examines some factors that may alter the nature of therapeutic relationships in CAM in the future, including a greater integration of CAM into orthodox care, a growing litigation culture, and future advances in science.
Aims of Extract 2
To explain how therapeutic relationships have changed in recent decades.
To discuss and debate reasons for the diversity of patients' experiences within the CAM therapeutic relationship.
To identify how the philosophy and principles of CAM therapeutic relationships have been critiqued by social scientists.