1st Edition

Relationship Power in Health Care Science of Behavior Change, Decision Making, and Clinician Self-Care

    272 Pages 14 B/W Illustrations
    by Routledge

    The personal interface between clinician and patient is a misunderstood subject which can impact all areas of health care. Without adequate training in relationship science clinicians inadvertently contribute to empathic failure, poor medical decision process, difficulty changing health-related behavior, costly variation and derailment of care, extra litigation, and clinician burnout.

    Relationship Power in Health Care presents new knowledge and skills that empower health care and wellness professionals to become competent facilitators of behavior and lifestyle change, information transfer, and medical decision making in collaboration with their patients.

    The new approaches are supported by a wide variety of research and clinical evidence, derived from modern psychotherapy, brain biology, and the latest advances in health coaching and nursing science. Putting them to work to improve health care makes good sense both scientifically and ethically.

    This comprehensive text integrates past health psychology models starting from the 1950s with recent advances made since the 1990s in relationship psychology and interpersonal neurobiology. It also includes videos of brief medical interviews along with analysis of the strategies and tactics used.

    The tactics outlined and the interview demonstrations, conducted by a highly experienced clinical social worker and nurse Joanne Gaffney, offer a unique opportunity for all clinicians to acquire valuable skills in both clinician self-care and patient care.


    Introductory Discussion and Overview
    Why This Project
    Looking for Pathways to Improve: Interpersonal Relationships
    Theory, Strategy, Tactics
    Maintaining Relationships While Also Diagnosing and Treating
    Fitting into the Larger Context of Health Care

    Getting Started: Patients’ Opening Statements
    Viewing of Preliminary Video Clips


    Past Health Psychology and Neuroscience (Prior to the Early 1990s)
    Health-Related Models in Use
    Going Deeper into Each

    Present Advances in Relationship Psychology (After Early 1990s):
    A Relational Context for Diagnosis and Treatment
    List of Seven Advances in Relationship Psychology
    Going Deeper into Each Advance
    Advances in Nursing
    Conclusions about Advances in Relationship Psychology

    Present Advances in Neuroscience (Starting with the Early 1990s):
    Possible Neural Substrates of Mind Functions
    Nine Advances in Neuroscience
    Going Deeper into Each Advance
    Basics of Updated Functional Neuroscience
    Enabling Advances in Technology
    Closing Comments


    Integration of Past with Present Advances (Selections of Elements to Include in a New Model)
    Selection of Elements for Inclusion in a New Model

    Formulations of Theoretical Hypotheses and Strategies of Relational Patient Care
    Formulation of Updated Theoretical Hypotheses
    Formulation of Updated Strategies
    A Summary of Updated Strategies in Shared Medical Decision Making

    Tactical Competencies and Frameworks
    Two Frameworks to Visualize
    Core Tactics in Interviewing: Common Tactical Components that Implement All the Strategies


    Three Interviewing Demonstrations: Behavior Change, Information Interweave™, Medical Decision Making
    Behavior Change (Smoking)
    Information Interweave (Diabetes) (LD TC9)
    Medical Decision Making (Breast Cancer Treatment Decision)

    A Learning Tool to Sequence Strategies and Tactics: Self-Aware Informational Nonjudgmental Interviewing in Health Care SINHC™ ("Synch")
    Preliminary Comments

    Referring to Behavioral Health
    Why Refer?
    To Whom to Refer?


    Pathways in Education and Training
    Medical School and Residency Training
    Nursing Education
    Take-Aways from the Earlier Nurse Training Programs
    A Generic Framework for Curriculum Design

    Health Coaching: What Is It? Who Does It? Where Is It Going?

    Future Research




    John B. Livingstone, MD, FRSH (UK), former assistant professor, Harvard Medical School, founding Director, Children’s Outpatient Services, McLean Hospital; and medical director, Gaffney and Livingstone Consultants, Provincetown, Massachusetts, USA

    Joanne Gaffney, RN, LICSW, principal partner, Gaffney Livingstone Consultants, and Registered Nurse and Psychotherapist in private practice, Provincetown, Massachusetts, USA

    "When people are sick they are also highly vulnerable and impressionable. Interactions with health care professionals take on tremendous import and can strongly affect: the course of their illnesses; how well they follow clinical advice; and how they feel about and care for themselves. Livingstone and Gaffney not only elucidate this widespread problem, providing compelling research, but offer a clear and practical training to ameliorate it. This training is not only conveyed in Livingstone's highly readable prose but also well illustrated by Gaffney's video examples. Changing the way health care professionals relate to patients is a hugely ambitious task. This book is a leap forward in that endeavor." – Richard C. Schwartz, PhD, developer of the Internal Family Systems model of psychotherapy

    "This long-awaited book provides an evidence-based and highly practical approach to health communication. Clinical instructors and trainees who utilize this unique resource will have the tools at hand to develop increasingly satisfying and effective therapeutic interactions over time." – Jennifer E. Potter, MD, Associate Professor, Harvard Medical School and Beth Israel Deaconess Medical Center and Children’s Hospital

    "This book is an exploration into teaching and learning; interpersonal psychology and neurobiology, medical decision making and clinician self-care. It is for the faculty as teacher and the faculty as learner. It dares to bring the expert healer into the power of being healed in order to heal others. It challenges those who know the science of learning to know themselves. Turning these pages provides the opportunity to become an inter-professional educator building a bridge between nurses and doctors for the well-being of patients while providing a wealth of indispensable knowledge. This is where health care must go…." – Beverly Malone, PhD, RN, FAAN, CEO, National League for Nursing; Former President of the American Nurses Association; and Former General Secretary of the Royal College of Nursing (UK)

    "What the authors show us is their process of combining the best elements of the past and the present advances in science for the formation of a new model. But the book is far from a theoretical textbook. It offers very practical approaches, tools, and methodologies that can be immediately implemented by any health professional…I truly hope that the health care profession will pay attention to this brilliant work and many recommendations for a new paradigm in relational power. As a patient, I want my physician to read this book." – Magdalena N. Mook, Executive Director/CEO, International Coach Federation, USA

    "This is a valuable resource for all clinicians who want to develop a better way to communicate with their patients, so that both clinician and patient feel that there is an important exchange of information that supports a common goal of improved health outcomes. It is also an exceptionally useful tool for faculty who want to instill a behavioral change that students will use as a lifelong strategy for effective therapeutic interactions." – Cheryl Leiningen, DNP, RN, APN-C(Monmouth University School of Nursing and Health Studies), Doody Enterprises

    "Congratulations to the authors and my respect for what they have achieved. Their voice is needed. It brings attention to effective communication toward giving and receiving trust and care. I believe the practice of their integrated model is valuable for all our communications, professionally being a salient example of an application of Interpersonal Science." – Silvio J. Onesti, Jr, MD, Associate Professor and former Chief of Child and Adolescent Psychiatry, Harvard Medical School at McLean Hospital.

    "It’s no secret that traditional methods of patient education are hopelessly ineffective." – Susan Edgman Levitan, Executive Director, John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital; and Associate in Health Policy at Harvard Medical School

    "The book is organized more as a teaching tool than as a read-it-in-one-sitting narrative. It is designed to be used as a workbook of specific lessons to guide the reader-clinician in learning to be more attuned to what’s going on beneath the surface in medical encounters. It is a must for faculty…The authors include links to a number of videos that analyze, almost sentence by sentence, interviews between a clinician and patient. The videos, and accompanying annotations in the book’s text, show when the patient begin to struggle with emotional reactions to his or her medical problem and, just as important, when the clinician does – and doesn’t – 'get' what’s going on with his or her own feelings. In the detailed annotations, the authors dissect these interactions, showing how, with training, an emotionally-attuned clinician can help patients process medical information in deeper, more honest ways that ultimately facilitate behavior change and clarify important medical choices." – Judy Foreman, health columnist and author of A Nation in Pain

    "Wonderful!!! I think it’s absolutely outstanding! It’s going to be required reading for my graduate students at CIIS…They’ve done this incredible job of organizing all these historical models and theories into a conceptual framework that finally makes sense for me…I not only want to thank the authors for the countless hours of research and writing and testing and analyzing that went into this book, but I’m grateful for the spirit of generosity in which they bring their readers along, step by step, sharing how they arrived at the SINHC model." – Professor Meg Jordan, California Institute of Integral Studies

    "This comprehensive, practical and theory-based guide to enhancing patient care and outcomes through effective communication is a must read for any practitioner training in the important field of health coaching today." – Dr Nancy Shadick, Brigham and Women's Hospital

    "In short, this book provides a compelling theory and model for engaging in clinical interactions, which has the promise not only to improve patient care but also to improve clinician self-care and perhaps to decrease burnout." – Dr Danella M. Hafeman, University of Pittsburgh, USA

    "Livingstone and Gaffney are engaged in important work, involving psychiatry in the broader conversation about health behavior change and decision making. They have written a comprehensive review of the field with practical applications. Particularly powerful, even to those in child psychiatry, is their message that we are focusing too much on behaviors and cognitions and not enough on emotions. Their emphasis on the importance of clinician self-care and self-awareness is forward thinking. I am hopeful that their efforts will become a standard part of medical education." – Dr Dorothy Chyung, New York University, USA

    An important addition to the literature on health care. Within the 272 pages revealing this vital information are included: Viewing of patients' opening statements; Healthrelated models in use; Conclusions about advances in relationship psychology; Basics of updated functional neuroscience; A summary of updated strategies in shared medical decision making; Integration of past with present advances (selections of elements to include a new model) Introduction; and much morel. This is an important book that will help and encourage a better understanding between the professional healer and the patient.
    - M. G. Pareglan, Publisher