One factor which is already influencing the nature of the therapeutic relationship is the move towards greater integration with orthodox medicine. Whether or not CAM practitioners welcome this development, it is inevitable. The impetus for this is partly about providing health care that gives patient satisfaction, and also stemming the tide of the spiralling costs of hi-tech, orthodox medicine and medical litigation. Stacey (1988) points out that, when the state funds parts of the nation's health care, it has interests in the accountability of the practitioners in terms of costs as well as outcomes of treatment. Therefore, the structural and organisational changes within the NHS will impact much more directly on CAM, including:
the introduction of auditing and risk management procedures
the development of more effective complaints mechanisms
improvements in accreditation
moves to enhance the public protection functions of self-regulatory bodies
a commitment to evidence-based practice.
How will this affect the therapeutic relationship? There could be a far greater emphasis on the safety and effectiveness of CAM than is currently the case. Integration is already prompting more funding for research into CAM. This will, in turn, influence training and practice, so that those aspects of practice which enhance good therapeutic outcomes are maximised, and those aspects which place patients in jeopardy are minimised.