2 - The Wounded Healer

“What is to give light must endure burning.”

Viktor Frankl

A. Introduction
As healers, we always bring our own experience and pain to the healing partnership. The more present that we are in our own vulnerability, the deeper the connection that we can participate in. Mentally, we can move into sympathy; emotionally, we can create empathy; and spiritually, we can experience compassion. All of these states begin to pull us a bit beyond our self and into a deeper resonance with the other. In its fullest expression, this transcendence is a spiritual, sacred experience, which heals both parties. In ancient Greece, “therapy” meant service to the gods. Transcendence strengthens and calms those whom it connects. We sample this in our finest moments in relationship. This stands out as perhaps the deepest, true reward of the therapist.
In pursuit of this ideal, we therapists must constantly exercise our ability to provide more compassion, acceptance, and love to those we encounter. The path of a healer is a spiritual path. If we are actively exploring our own spiritual path, we are more open to those with whom we work and to our own learning. Each encounter becomes a valued opportunity for growth, not merely a one-way exchange of information or remedy. In a holistic perspective, the healer’s path of growth cannot be ignored. It is a major factor in positive outcome.
Some who explore this concept fear that it holds practitioners to a saintly standard. “I must be pure, selfless, and unconditionally loving. How could I ever achieve that goal?” Rather, this concept allows us to be human, real with inevitable failings. The greatest challenge lies in the demand that we hold our actions, thoughts and feelings to the light of regular self-examination.
For most, the true exploration of self-growth blends imperceptibly into a spiritual path. This is because mind/spirit resists separation just as much as body/mind does. The path of the wounded healer makes each encounter a spiritual gift. By opening in gratitude and surrender to each moment, we continue to grow. Beyond that, the active process of self-growth allows us to connect more deeply in every encounter in which we engage in, professional or not. If we choose not to pursue a path of personal growth, our capacity as healers becomes more limited. After spending decades examining these issues in therapy, T. B. Karasu states,
However, traditional approaches eventually reach an impasse, a place
where the therapist himself resides and in which he and his patients can become irretrievably trapped. This invariably occurs when the confident clinicians, regardless of their respective schools, present themselves as prototypes of health and salvation for their recipients to emulate. Alas, they are limited by an inherent constraint: they can take their patients only as far as they themselves have come. Then the question—and the quest—remain: How does the therapist get beyond this barrier; more aptly, how does he venture toward, and eventually attain, a soulful and spiritual experience? (p. 145)
The more we acknowledge our humanity, our wounds and our intrinsic spirituality, the more that we can heal others and our self. We must step out from behind the desk and the credentials and connect human being to human being. Rolo May (1958) said, “The therapist is assumedly an expert; but if he isn’t first of all a human being, his expertness will be irrelevant and quite possibly harmful” (p. 82). By honoring our spirituality and addressing our wounds, we become fully available in relationship and thus more empowered as healers.

B. Boundaries
Boundaries become more critical as we strive for deeper connection. Psychotherapy has much to offer practitioners in other modalities regarding the concepts of appropriate and therapeutic boundaries. I frequently observe CAM practitioners who strive for this ideal of connection but get lost in distorted boundaries with people in need. Issues like dependency surface frequently. I am reminded of one caring holistic physician who would over extend herself to care for her patients, go to their homes. In her desire to please, to heal, she would often lose sight of the individual’s need to equally participate, over compensate and over treat. In the end she was drained and often irritable with her office staff. This is an issue of boundaries. Her actions ended up addressing more of her own needs to please than her patient’s true needs. In this relationship, her patients became more dependent on her, a reflection of her own unmet dependency needs.
I can think of another practitioner who passionately cared about his clients. They became like good friends. Unfortunately, he spent more time than they did sharing his distress and issues. Gradually, they felt more and more burdened. Although he was not a psychotherapist, he was a talented practitioner of his approach. Sadly, he used his patients emotionally to comfort himself. Some understanding of boundaries and perhaps even some personal therapy would have helped this person become more of a true healer.
Appropriate and even therapeutic boundaries are important to creating a healing relationship. As we know in psychotherapy, even withholding at times can be helpful in certain circumstances. However, in mental health and especially in psychiatry, I observe a variant of this withholding more often. The practitioner hides behind boundaries in a defense of arrogance, distance, and detachment. Fending off connection and vulnerability, they remain safe and “professional.” More than that, these practitioners resist opening to their own deeper experience and needs. The challenge for us then becomes how we can connect on the deepest level but maintain appropriate boundaries. What limits our tolerance of deeper connection? Then [Only then] can we push this threshold even further through awareness learning and risk taking?

C. Surrender
The terms involved in this, the healing relationship, are somewhat misleading. The dialect of healer and healed makes one sound active and one sound passive. Rather, we should view this bond more as a partnership of two people seeking together.

Both parties actively participate and benefit. The healer derives deep satisfaction, positive self-esteem, external appreciation, and, most importantly, personal healing. For this to occur, both must let go in a type of surrender.
In moments of true healing, we reach down and touch the pain in which the other lives. They bring this powerful experience to us for connection and understanding. Their distress is mainly characterized by pain and isolation. We can meet their courage and vulnerability with our own empathy and compassion. In this union healing may occur.
The other needs to bring an expectation/desire for change and a willingness to surrender. Trust must be established. Surrender and trust form the indescribable core of all confiding relationships. Confiding literally means “with trust.” We open up with trust when we confide. This becomes a type of complete surrender which allows us to release our self, as we are, to the possibility of who we might become. The desire for change and the emotionally charged confiding relationship make up two of the central criteria that Jerome Frank (1971) outlined in his study of the therapeutic factors in psychotherapy.
Many of the therapies outlined in this text do not follow the traditional psychotherapy model. Some employ techniques that can be wordless (EMDR, Meridian Psychotherapies, Spiritual Healing, etc.), instrumental (Acupuncture, Herbal Medicine, Nutritional Supplements), or autonomous (Meditation, Creative Arts). Regardless, all these approaches create the same opportunity for healing that psychotherapy does. The individual experiences a moment of surrender in their vulnerability. Whether we are meditating on the nature of Buddha, talking with a compassionate/empathetic therapist, ingesting a homeopathic remedy, or having someone lay hands on us, we open to something beyond us. This transcendence forms the essence of healing. It is an extension outside our being that can strengthen, correct, and bring higher order.
If the approach addresses mainly the physical body (nutrition, manipulation, herbs, acupuncture, etc.), it can rebalance the biological even if the mental and spiritual sides are not involved. In this way these approaches can also help animals where there is no mental set or mind-body factor.
These same modalities can bring deeper body-mind-spirit healing when there is complete involvement of the individual and a surrender to something beyond themselves (friend, healer, enlarged belief, community, greater power, God, etc.).
Physical healing modalities can prepare the individual for deeper healing but ultimately possess less intrinsic power than mental or spiritual approaches (at least in humans), because they don’t necessarily involve a healing relationship and surrender. For example, acupuncture can create a pervasive body-mind-spirit impact when performed in the context of a relationship in which this expectation or allowance exists. On the other hand, it can also just be a physical technique with no deeper transformation.
Surrender involves the release of the internal attachments that may limit us or hold us back. Also, surrender acts as a key step in the process of spiritual development to move us from self to other. We need to emancipate from our selfish preoccupation to create a more sustaining spiritual perspective. Surrender moves us more to an ego-less state, where the healing power of both spirit and relationship exist. It allows us to enhance our connection to the universal order that guides both life and spirit.
The therapeutic relationship acts as a vehicle to move us to this place. We can completely surrender to a remedy or to a belief, but most humans find it easier to surrender to another human being or to their spiritual higher power. It is all about trust. Can we confide (literally trust in a person or thing) in this agent or style of healing? In my experience, trust is created through a relationship which builds belief and confidence. In service of this end, all healers become spiritual therapists whose
...relatedness is primarily a redemptive one and superordinates all other forms of relationship, that is, two persons mutually confirming each other’s underlying sense of common destiny without blame or debt. Such redemption is not geared to common sin and guilt, but to a more benevolent restitution and liberation. There is no finding of fault, no punishment, and in effect, no need for forgiveness. It is the rescue of self and others, an emancipation from the confinement of ordinary human attachments and entanglements, and deliverance from the imprisonment of mind and body without soul. It is a peaceful and restorative union (Karasu, 1999, p. 158).

D. The Partner
As we turn to the other side of the healing relationship, a few things become apparent. First, we need to know and understand the person in greater depth and breadth. In the holistic perspective, a multitude of connections/relationships has the potential to impact our well being either positively or negatively. So, we must attend the whole person. Partly, this is for information; partly, this is for our connection; and partly, this is for the needs of the partner to be heard.

E. The Holistic Evaluation
All of the different modalities contained in this text individualize the evaluation process to fit the theory and practice of their technique. While each of them differ, they share many common elements grounded in holism. For example, the homeopathic evaluation questions the person in great detail about all of their unique peculiarities, physical and mental. Patients often comment after the evaluation that they have never felt so heard and acknowledged. “If someone is that curious about me, they must care.” Many homeopathic practitioners feel that the interview is also quite therapeutic, aside from the use of any remedy. So it is in the holistic perspective.
I will now list some of the general principles involved in a holistic evaluation.
1. Evaluate the whole person. Explore the different realms of their life: environmental, physical, emotional, mental, social, and spiritual.
2. Look for patterns in these areas: imbalance/balance, excess, deficiency, stress, avoidance, conflict, etc.
3. Uncover strengths, passions, talents, hopes, goals, etc. What will help them heal?
4. Sort out external connections, intimate relationships, and the quality of their support network.
5. Assess their belief system about illness and healing. Why are they sick? What has led them to this point? Does this person believe that medications, psychotherapy, herbs, acupuncture, prayer, etc., will help them? Why?
6. Explore their spiritual health. Our current system tends to assess either physical or mental/emotional health. Both systematically ignore our spiritual self.
7. Address what keeps them from healing. What blocks them from finding more balance or harmony in their life.
in some more depth. The first principle says to evaluate the whole person. The Six Realms [Insert Chart 1 as sidebar.] give us a simple template that can guide us. These are arbitrary and artificial divisions, but they can us structure so that we address each area.
Second is the principal of balance or harmony. This echoes the philosophy of Traditional Chinese Medicine. Which areas are strong and balanced; which are weak or depleted? Is there a pattern of excess? For example, someone may be very successful in their work, but that is all they do. They may have no social or recreational life. This is imbalance. A young athlete may be strong and vital but have no inner life, no spiritual awareness. A middle-aged professor may be intellectually vital but have a sagging, neglected body. Obviously, each of us has our own, individual pattern, but is it excessive? Imbalanced?
With our unique strengths and weaknesses, we can tolerate some imbalances better than others before it creates deeper impact. For example, someone with no family history of depression may tolerate inactivity better mentally/emotionally than someone who carries a huge genetic burden. The latter may need to exercise quite regularly to avoid the onset of depressive mood.
This principle speaks of the interconnectedness of body-mind-spirit. Imbalance on any level can impair health and well being. Most people intuitively know what their imbalances are if this area is explored in a caring manner.
The third principle reflects the preference to focus on strengths and innate drives/attractions. These pull us toward wholeness and health. Talents and interests lead us to greater expression of who we are. We suffer when these are inhibited, blocked, or in conflict. Maslow (1971) saw much of mental illness as the failure of human growth and saw most of the constraints as internal, not external. As we understand and explore larger goals, we set the stage for continued elaboration and growth. The bias here also reflects negatively on pathological labels and the psychological damage they can cause. A diagnosis may be accurate and descriptive, but does it narrow our view of potential and healing? Every diagnosis may carry a quality of medical hexing that can poison hope. Use them very lightly.
The fourth principle underscores the value of social health, which is also basically ignored in our current biomedical paradigm. Most mental health practitioners intuitively understand the importance of this issue. We can either be buoyed or sunk by our relationships. Dean Ornish, MD, beautifully documents the importance of social factors to physical health in his book, Love and Survival (1998). In this book he makes a bold but well supported statement concerning the healing power of love, intimacy, and relationship:
I am not aware of any other factor in medicine—not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery—that has a greater impact on our quality of life, incidence of illness, and premature death from all causes. [Needs page number]
Our support network can impact the survival from cancer (Spiegel, 1989) or the risk of death from a heart attack (Science, 1988). Interestingly, emotions that distance us from others such as hostility and cynicism increase our risk of heart disease (Psychosomatic Medicine, 1991). Even artificially created support groups work. This is the amazing power of human relationships to heal and sustain us. The opposite of connection, isolation, has been found as a consistent predictor of premature death. (Epidemiology, 1994; Science, 1998).
We should explore the person’s relationships in some depth. A recent study confirms that the greater the number and variety of friendships that we have, the better we resist communicable disease (Cohen, 1997). In this study, people with the least diverse social networks were 4.2 times more likely to become ill. This is counter intuitive to typical thinking on infectious disease (more friends=more disease contacts). However, psychoneuroimmuniology has clearly told us that the vibrancy of our emotional health drives the effectiveness of our immune system. A simple social map (Insert Chart 2 sidebar) can plot our friendships by type and level of intimacy. This provides a visual guide about balance and depth.
The fifth principle echoes one of the underlying premises of Jerome Frank, MD, and most mind/body practitioners. Our beliefs are powerful and can alter health. In cross-culture psychiatry, this premise is a given. Does not each individual create an internalized micro-culture of personalized beliefs which must be addressed and validated? Astin of Stanford documented that people seek out CAM approaches because it better fits their worldview and philosophy of health (1998). This broad and popular belief system represents the emerging paradigm within our current culture. Either way, we must honor the individual’s beliefs. The only way to really do this is to find out what they are. Most often, practitioners assume (incorrectly) that everyone holds the same belief system that they do. A shared belief system stands as a central factor in all healing (Frank 1961).
Simply, the sixth principle highlights the power and importance of spiritual health. This can be such a wide-ranging and intensely personal structure that assumptions will always fail us. Conversely, we cannot ignore or deny this facet of health any longer. Often, the spiritual health is ignored or developmentally delayed in a culture which worships money and materialism. One way to deal with this is by taking a spiritual inventory [Insert Chart 3-sidebar] which asks provocative questions and brings the light of attention to the individual’s spirituality.
A few of the people that I talk with seem intimidated or uncomfortable with this topic. On closer questioning, they may feel negative about their early experiences of religion as a child. Or they may believe that they are not spiritual or good enough to have a personal spirituality. In either circumstance, I find it helpful to explain that we are all spiritual beings, and this can be totally separate from religion. Spirituality is an innate personal characteristic of all humans helping us move toward wholeness.
Finally, the seventh principle explores the roadblocks to healing. The questioning here may encounter a negative and limiting belief system. It can also function as a way to engage the individual’s intuition about their current state. Either way, it is often very useful to ask why people are not well, what keeps them that way, and what could help. Not everyone can give you this information. But if they can, it can be quite powerful. If done in a specific way, it can create an Eriksonian type of indirect suggestion (Rosen, 1982; Bandler and Grinder, 1975).. Milton Erickson was a master of suggestion and persuasion [reference]. Just by how you phrase a question, you can create the implication of healing: “And how will you know when you are no longer depressed?” If the power of the mind can create 45%-70% of the healing power of any pharmaceutical, why not use it?

E. The Homeopathic Evaluation
The homeopathic evaluation questions the person in great detail about all of their unique peculiarities, physical and mental. Patients often comment after the evaluation that they have never felt so heard and acknowledged. “If someone is that curious about me, they must care.” Many homeopathic practitioners feel that the interview is also quite therapeutic, aside from the use of any remedy. So it is in the holistic perspective. Let’s take a closer look at the general principles involved in a holistic evaluation.

1. Evaluate the whole person. Explore the different realms of his or her life: environmental, physical, emotional, mental, social, and spiritual. The Six Realms [Insert Chart 1 as sidebar.] template gives us a simple format to help guide us. These are arbitrary and artificial divisions that can give structure so that we address each area.

2. Look for patterns of imbalance/balance, excess, deficiency, stress, avoidance, conflict, etc. This is the principal of balance or harmony. This echoes the philosophy of Traditional Chinese Medicine. Which areas are strong and balanced? Which are weak or depleted? Is there a pattern of excess? For example, someone may be very successful in his or her work, but that is all he or she does. This person may not have a social or recreational life. This is imbalance. A young athlete may be strong and vital but have no inner life, no spiritual awareness. A middle-aged professor may be intellectually vital but have a sagging, neglected body. Obviously, each of us has our own, individual pattern, but is it excessive? Imbalanced?
With our unique strengths and weaknesses, we can tolerate some imbalances better than others before it creates deeper impact. For example, someone with no family history of depression may tolerate inactivity better mentally/emotionally than someone who carries a huge genetic burden. The latter may need to exercise quite regularly to avoid the onset of a depressive mood.
This principle speaks of the interconnectedness of body-mind-spirit. Imbalance on any level can impair health and well being. Most people intuitively know what their imbalances are if this area is explored in a caring manner.

3. Uncover strengths, passions, talents, hopes, goals, etc. What will help them heal? This third principle reflects the preference to focus on strengths and innate drives/attractions. These pull us toward wholeness and health. Talents and interests lead us to greater expression of who we are. We suffer when these are inhibited, blocked, or in conflict. Maslow (1971) saw much of mental illness as the failure of human growth and saw most of the constraints as internal, not external. As we understand and explore larger goals, we set the stage for continued elaboration and growth. The bias here also reflects negatively on pathological labels and the psychological damage they can cause. A diagnosis may be accurate and descriptive, but does it narrow our view of potential and healing? Every diagnosis may carry a quality of medical hexing that can poison hope. Use them very lightly.

4. Sort out external connections, intimate relationships, and the quality of their support network.
This fourth principle underscores the value of social health, which is also basically ignored in our current biomedical paradigm. Most mental health practitioners intuitively understand the importance of this issue. We can either be buoyed or sunk by our relationships. Dean Ornish, MD, beautifully documents the importance of social factors to physical health in his book, Love and Survival (1998). In this book he makes a bold but well supported statement concerning the healing power of love, intimacy, and relationship:
Our support network can impact the survival from cancer (Spiegel, 1989) or the risk of death from a heart attack (Science, 1988). Interestingly, emotions that distance us from others such as hostility and cynicism increase our risk of heart disease (Psychosomatic Medicine, 1991). Even artificially created support groups work. This is the amazing power of human relationships to heal and sustain us. The opposite of connection, isolation, has been found as a consistent predictor of premature death. (Epidemiology, 1994; Science, 1998).
We should explore the person’s relationships in some depth. A recent study confirms that the greater the number and variety of friendships that we have, the better we resist communicable disease (Cohen, 1997). In this study, people with the least diverse social networks were 4-2 times more likely to become ill. This is counter intuitive to typical thinking on infectious disease (more friends more disease contacts). However, psychoneuroimmuniology has clearly told us that the vibrancy of our emotional health drives the effectiveness of our immune system. A simple social map (Insert Chart 2 sidebar) can plot our friendships by type and level of intimacy. This provides a visual guide about balance and depth.

5. Assess their belief system about illness and healing.
Why do they think they are sick? What do they think can help them become well? Does this person believe that medications, psychotherapy, herbs, acupuncture, prayer, etc., will help them? Why?
This principle echoes one of the underlying premises of Jerome Frank, MD, and most mind/body practitioners. Our beliefs are powerful and can alter health. In cross-culture psychiatry, this premise is a given. Does not each individual create an internalized micro-culture of personalized beliefs which must be addressed and validated? Astin of Stanford documented that people seek out CAM approaches because it better fits their worldview and philosophy of health (1998). This broad and popular belief system represents the emerging paradigm within our current culture. Either way, we must honor the individual’s beliefs. The only way to really do this is to find out what they are. Most often, practitioners assume (incorrectly) that everyone holds the same belief system that they do. A shared belief system stands as a central factor in all healing (Frank 1961).

6. Explore their spiritual health. Our current system tends to assess either physical or mental/emotional health. Both systematically ignore our spiritual self.
Simply put, this sixth principle highlights the power and importance of spiritual health. This can be such a wide-ranging and intensely personal structure that assumptions will always fail us. Conversely, we cannot ignore or deny this facet of health any longer. Often, the spiritual health is ignored or developmentally delayed in a culture which worships money and materialism. One way to deal with this is by taking a spiritual inventory [Insert Chart 3-sidebar] which asks provocative questions and brings the light of attention to the individual’s spirituality.
Many people whom I talk with seem intimidated or uncomfortable with this topic. On closer questioning, they may feel negative about their early experiences of religion as a child. Or they may believe that they are not spiritual or good enough to have a personal spirituality. In either circumstance, I find it helpful to explain that we are all spiritual beings, and this can be totally separate from religion. Spirituality is an innate personal characteristic of all humans helping us move toward wholeness.

7. Address what keeps them from healing. What blocks them from finding more balance or harmony in their life.
Finally, this seventh principle explores the roadblocks to healing. The questioning here may encounter a negative and limiting belief system. It can also function as a way to engage the individual’s intuition about their current state. Either way, it is often very useful to ask why people are not well, what keeps them that way, and what could help. Not everyone can give you this information. But if they can, it can be quite powerful. If done in a specific way, it can create an Eriksonian type of indirect suggestion (Rosen, 1982; Bandler and Grinder, 1975).. Milton Erickson was a master of suggestion and persuasion [reference]. Just by how you phrase a question, you can create the implication of healing: “And how will you know when you are no longer depressed?” If the power of the mind can create 45%-70% of the healing power of any pharmaceutical, why not use it?


F. Summary
The healing relationship connects us and heals us. Both the healer and the partner in healing experience the deep benefits. Surrender is one powerful trigger for the transformation in the healing relationship. The healer who is on a path of personal healing and spiritual growth offers their partner in healing a deeper connection which contains more surrender. Boundaries become more critical as connection and surrender intensifies.
If we address and evaluate the whole person, we enhance our ability to connect and to heal. We function in six realms or areas which can reflect a balance or disharmony in our life. The seven principles of holistic evaluation can guide us in this task of deeper understanding. Assessment and sensitivity form critical skills for any holistic practitioner.
Modalities, remedies, and techniques may help, but relationships (interpersonal or spiritual) heal. A central principle of he American Holistic Medical Association can sand as he summary of this chapter: “Unconditional love is life’s most powerful medicine.”

References
Astin, J. A. (1998). Why patients use alternative medicine: Results of a national study. Journal of the American Medical Association, 279:1548-1553.
Bandler, R. and Grinder, Jr. (1975). Patterns of Hypnotic Techniques of Milton Ericson (Vol. 1). Meta Publications: CA.
Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S., Gwaltney, J. M. (1997, June 25).Social ties and the susceptibility to the common cold. Journal of the American Medical Association, 1940-1944.
Frank, J: (1971). Therapeutic Factors in Psychotherapy. American Journal of Psychotherapy, 25, 350-361.
Greenwood, D. C., Muir, K. R., Packham, C. J., et al. (1996). Coronary Heart Disease: A review of the role of psychosocial stress and social supports. Journal of Public Health Medicine, 18:221-231.
Karasu, T. B. (1999). Spiritual Psychotherapy. American Journal of Psychotherapy, 53(2) (Spring 1999), 145.
Ornish, D. (1998). Love and Survival. New York: Harper Collins.
Rosen, S. (1982). My voice will go with you. W. W. Norton, NY.
Seeman, T. E. and Syme, S. L. (1987). Social networks and coronary artery disease: A comparison of the structure and function of social relations as predictors of disease. Psychosomatic Medicine, 49(4): 344-354.
Spiegel, D., Bloom, J. R., Kraemar, H. C., and Gottheil, E. (1989). Effect of psychosocial treatment on the survival of patients with metastatic breast cancer. The Lancet, ii, 888-891.

Citations Without Author or Article Title:
Epidemiology. (1994, September). 5(5):495-500.
Psychosomatic Medicine. (1991, July/August). 53(4):407-419.
Science. (1988, July 29). 241(4865):540-545.