"The Helping Relationship"

Doctors of chiropractic are helpers on several levels. Firstly, they are practitioners who care for specific problems such as low back pain, headaches, neuromuscular rehabilitation, and even dysfunctional problems such as high blood pressure or perhaps specialize in certain areas such as radiology, sports chiropractic, orthopedics, neurology, mental health or even office management. Secondly, they are helpers who are confronted with patients who expect help for the social and emotional aspects of problem situations. For example, most chiropractic physicians care for the patients' spine or structural/functional problems, but they can also help their patients overcome their fear of being treated or resistance to spinal hygiene programs. Patients are people who struggle with physical, intellectual, social and emotional problems, and crises, and turn to their chiropractor in such

This helping relationship was beautifully highlighted in the movie, "Jacob's Ladder." I am certain all of us enjoyed the therapeutic relationship between the main character and his chiropractor. For many of us, the chiropractor was the main character -- and what a character he was. Didn't you enjoy the interpersonal action between the chiropractor and his patient as much as the manual care being rendered to him? Here was a chiropractor not just mechanically adjusting a spine but living a dynamic helping relationship, offering counsel and direction. And in the end wasn't it the counseling and emotional support offered by the chiropractor that was the central theme of the interaction? Of course the adjustment was central from the perspective of that given moment, but in the end the movie concluded on the chiropractor's counsel to his patient. And it was that counsel that gave meaning to the film; and that's my point. Chiropractic care such as the adjustment is given within the context of a relationship which often includes counseling from the doctor. If the adjustment is seen as the direct therapeutic action upon the patient's problem, the counseling comprises indirect action on it and is the cement that holds the helping relationship together.

It matters not that the experience in the chiropractic office took place in the soldier's mind in Vietnam. It matters even less that the entire story was just that -- a story. What matters is the view portrayed of a chiropractic event and a chiropractic helping relationship. There is no question that the portrayed presentation was a helping relationship on all levels. It is the kind of relationship we are addressing in this column.

Doctors of chiropractic often listen carefully to their patients, provide support and advice, and generally in addition to providing physical care, help them cope with problems of greater or lesser severity. Traditionally, chiropractors have taken pride in such help. I believe it was because of this rich helping history that final recognition was given chiropractic in "Jacob's Ladder." This contrast allowed chiropractic to be used as a model in the movie for an alternative to drugs and using people as guinea pigs for drug research. Chiropractic was portrayed as humane. It was also an honest portrayal of a common enough event in many offices: adjustments and counseling. It should not surprise us that some doctors of chiropractic specialize in both chiropractic adjustments and counseling, just as others specialize in orthopedics or radiology. Certainly radiology, like counseling, is not the central focus of what most chiropractors do in their offices.

The chief problem with the relationships of chiropractors as helpers is the fact that they tend to be analyzers by nature. Chiropractic as human biology stresses logical and rational solutions. Therefore, chiropractic doctors are more prone to give solutions to their relationships, extrinsic to their own personalities and wants.

A helper who must do something for another may not be satisfied unless they are, in fact, doing something. It is quite natural that doctors who repeatedly do something for their patients physically, when confronted with a non-physical problem on the part of the patient, is strongly inclined to want to do something. But this makes the relationship lopsided and places a tremendous responsibility on the helper to perform.

The heart of a good helping relationship embodies the principle of sharing as well as doing something. The chiropractic helper doesn't assume responsibility for the lives of patients but insists that the patients keep such responsibility to themselves. The helper offers presence and understanding, not control. The helper does not offer solutions but assists patients to find their own solutions, as did the chiropractor in "Jacob's Ladder."

To help another with a problem is to understand the problem. Understanding does not judge or speak with authority. It does not condemn nor does it condone. Understanding does not deny the problem nor does it push it aside lightheartedly. Through understanding, the helper is able to see the viewpoint of another.

It is important for the helper to appreciate his limitations. While chiropractors don't guarantee cures, they may place unreasonable expectations on themselves as helpers. No one helper can be effective with every patient or even every type of problem.

A helper can't be a success all of the time. Chiropractors are preoccupied with the quest for success. While success means different things to different people, for many, chiropractic success means wealth and a large number of patients or office calls. Generally speaking, such success means "more" rather than "better." Success in chiropractic should mean better patient care and self-improvement on the part of the chiropractor personally and professionally. Clearly, success is a matter of quality, not quantity.

In order to have such success the helper must help oneself. This means the doctor of chiropractic must apply the principle to "know thyself." Every chiropractor as a helper and as a human being has certain wants, some of which are unrecognized. Helpers who are not in touch with such wants or feelings will be limited in their effectiveness as helpers and are less likely to be successful, as well as being vulnerable emotionally.

A chiropractor who sees success as wealth and a large number of patient visits is imposing a self-centered agenda on the patient population. This agenda is at odds to the helping relationship. Ultimately, it is self-defeating since at an unconscious level the chiropractor is at odds with conscious wants or actions. The mental apparatus of the moral personality will be at odds with itself and ultimately stress and failure or breakdown are highly likely. Freud often wrote of the conscience inflicting punishment upon the self for such violations of conduct. Such punishment need not take the form of guilt but could include burnout, emotional disturbance, and even physical illness.

There is a significant difference between the self-centered agenda and having self-respect or esteem for oneself. Each person has their own unique moral code given to them by their parents and significant others. Departure from this code carries serious psychological risk. Most of us are aware of what is required of us or not required in any given situation. If we refuse to follow our conscience, we compromise our self-respect.

If we diminish our self-respect for engaging in unprincipled behavior, how do we see our colleagues (consciously or unconsciously) who behave as us? Soon our view of the profession becomes seriously tarnished. In order to bolster the profession in our eyes, we may attempt to change it by attacking it, or perhaps we will attack those who promote large practices, or those who have such practices. Perhaps we will begin to believe all chiropractors are greedy or not trustworthy. It should not surprise us that some doctors of chiropractic who have attacked the profession vigorously have engaged in unethical behavior previously.

All humans are fallible and as helpers we need to understand ourselves and to forgive our past mistakes. We cannot be effective or really successful until we are satisfied with our own motives and actions. When we are happy and content, we will be able to appreciate what we can and cannot do in the helping relationship. Moreover, unlike ideologues who are impassioned in their dogmatic demands, we will be able to make a rational contribution to the problems of society, our profession, and the public it serves.

If you are an ACA member and would like more information on the American Council on Mental Health of the ACA, or would like to join the council, please write to: Dr. Martin J. Brown, Secretary/Treasurer, ACA Council on Mental Health, 11474 East 15 Mile Road, Sterling Heights, Michigan 48312

Edward Sullivan, M.A., D.C.
Mt. Vernon, Washington