2.8 The failure of CAM therapeutic relationships: wounded healers
Sometimes, practitioners allow their personal life and personal issues to become central to the therapeutic relationship. In a range of therapies, the practitioner is assumed to bring not only their skills but also their experiences to the therapeutic relationship. This has led to the concept of the ‘wounded healer’ (Nouwen, 1977): that is, a practitioner who, in experiencing physical, psychological or emotional pain, develops a greater understanding and empathy with other people's pain. The debates about whether practitioners can draw positively on their own negative past experience and their ways of getting over negative life events in their work are in the literature on pastoral care, counselling and psychoanalysis. The Catholic spiritual writer Henri Nouwen first developed the idea of the wounded healer and argued the need for all ‘people workers’ to recognise how their own experiences of abuse and pain can contribute towards a greater awareness of the needs of other people (Nouwen, 1977). The CAM movement took up this term, and in many therapies the idea of understanding one's own pain and personal coping mechanisms is central to being a practitioner.
Although there is no reason why personal experience may not provide a useful reservoir of insight into some users' experiences for a reflective practitioner, it can lead to therapeutic failure if practitioners cannot manage their own feelings adequately. If not properly understood, the notion of the ‘wounded healer’ could appear to excuse or support some of the following unhelpful assumptions.
‘Wounded healers’ are the most able practitioners to help users (having experienced pain themselves).
Inevitably there are ongoing issues with pain or personal distress.
It is appropriate to divulge this to users who have attended for treatment in an attempt to cope with their own pain and symptoms.
The concept also seems to imply that healers who are not ‘wounded’ are less able to be good, competent and caring practitioners. Clearly this is false. A practitioner need not have experienced the same pain as the user to be able to empathise. It would be like saying that only people who have experienced house fires can comfort others whose houses have burned down, or that only people who have explored their own capacity for deviance should become forensic psychotherapists. Many experiences can give an insight into another person's wish for healing or change. Also, people's ability to learn and use skills such as rapport, empathy and listening means that practitioners do not necessarily have to experience a difficult life to understand another person's difficult life.
The main problem with the wounded healer concept is that it can be used as an excuse for practitioners not to establish and maintain clear boundaries between themselves and the users. In the extreme case, the practitioner may feel it is all right to emotionally ‘open up’ to clients or users about their life experiences at inappropriate times or in inappropriate ways. For instance, a shiatsu practitioner who spends much of the initial interview before treatment regaling their clients with details of their failed marriage is unlikely to add to the client's sense of wellbeing or to inspire the sort of confidence in the practitioner that forges a good therapeutic relationship. Indeed, the relationship may change so that the client almost becomes the practitioner's counsellor or supporter. The alternative course of action is for the client to leave either immediately or at the end of the treatment and not return. Either way, it is difficult to see the interaction between such practitioners and their clients as being particularly therapeutic. Using the therapeutic relationship to fulfil the practitioner's own psychological or emotional needs can be seen as a form of abuse.