“One cannot not communicate”

‘Hard science with soft skills’ is the tagline for Clinical Psychoneuroimmunology (cPNI). And after the first block of lectures in October, with Associate Prof Leo Pruimboom, which introduced us to some juicy hard science, this time it was the turn of the soft skills. This part of our study revolves around psychology and communication. Soft skills is the perfect description for the communication aspect of our training in cPNI. Not only because soft skills refers to our personal attributes and the practicalities of how we relate to our patients, but also the gentle nature of our lecturer, Peter van Zalm, in contrast to Leo’s great dynamism (see blog #1).


The lecturer in communication
Peter is an experienced Psychotherapist and is one of those rare educators who are able to effortlessly intertwine their valuable practical clinical experiences amongst the theoretical aspects of the subject, thus enhancing the quality of the learning. He is also one of those rare educators who, although well skilled in his own discipline, appreciates the value of other valid health care practices. Indeed Peter acknowledged that “if you use the mind as your only tool then everything will appear a psychological problem”. And one of those rare educators who will not only give you the electronic copy of their slides but also allow you to raid their laptop for any interesting research papers the group could use. Needless to say, a lot of copying and pasting onto ones memory stick and subsequent sharing occurred! Our group has bonded very well. It’s a pity we’re not with each other more often to discuss things together, but I guess that’s the nature of post-grad education. We have a great sharing community set up in cyberspace.


What is special about communication in Clinical PNI?
Communication in cPNI is used more as a therapeutic tool than what I am used to from my own training in Nutritional Therapy. I was trained to appreciate and understand unconscious processes, somatisation, Berne’s ego states in transactional analysis etc. And although it is important that we are able to effectively communicate with our patients, communication is perhaps emphasised as a method by which we pass on our knowledge about nutrition and lifestyle factors in an effort that this knowledge will bring about the desired changes for the patient. Clinical PNI encompasses all the above, but also importantly seeks to manipulate the enormous arena of the unconscious mind. What does this mean? It means that while it is good to educate our patients about how their diet and behaviour affect their health, there is an elephant in the room when it comes to motivating behavioural change.


Education addresses the conscious mind and asks the patient to remain aware of the guidance the therapist is offering. But it is the unconscious mind that is the ultimate source of our daily behaviours. It is the unconscious mind that needs to be addressed and appeased, from a clinical point of view. And what clinical tools have shown to be effective at reaching the unconscious mind? One of them is the use of relevant story-telling and appropriate metaphor. Storytelling appeals to the unconscious mind and allows the listener/patient to be liberated from the pressings of their conscious awareness. Do you need to learn a lot of stories to address the different situations your patients find themselves? Yes. But that’s part of the enjoyment! Imagine learning how to tell therapeutic stories as part of your clinical training. It is a novel yet effective method.


Real communication
In writing this blog I reviewed the slides used in the lectures. Like all the best lecturers Peter ventured widely around his slides to elaborate on the concepts and, looking at the additional notes I made, I think that it was the additional discussion that held the most valuable secrets and clinical pearls. I’m not going to tell you them here (you’ll have to join us on the course for those!) but we defined and discussed real communication. In real communication we can imagine that two people are in one energy field enveloping them, so transferring the message is easier. And one energy field enables the understanding of one truth. If there is only one truth then misunderstanding would be impossible so the closer you can get to a deeper understanding the better. Of course, in science there are many truths and we arrive at our understanding of the truths in healthcare from many life experiences.
I got to thinking about how our (the therapist’s) understanding of the science and skills of cPNI relates to our clients and patients. But we also need to understand how the patient relates to cPNI. The skill of the therapist is to communicate this knowledge in an easy-to-understand way, especially as it is so new and unfamiliar to the lay-public. How would you most effectively explain physiological pathways in the context of the illness the patient presents, incorporate the psychological aspects and, if the consultation required it, incorporate a metaphorical story? Needless to say, this makes for an illumining consultation! As with Nutritional Therapy, cPNI focuses heavily on the necessity to truly educate the patient.


How to understand health and illness
But I wondered whether one of the potential problems of communicating cPNI with the lay-patient is that the model of cPNI is almost too up-to-date with the science! The paradox is that the health sciences require us to typically use the most recent evidence yet our understanding of health and disease has evolved so fast in recent years it is not easy for the average joe to keep up, and the paradigm in which the public understanding of health lies can often appear very dated. This thought was reinforced by the way the ‘non-initiated’ are told how to understand health and illness. Two recent examples come to mind. Firstly, I visited my GP recently and, knowing my profession, he got talking about nutritional interventions for chronic diseases. He said in all sincerity “I tell my patients about the five-mile rule. If you live within five miles of a Tesco then your nutrition is fine”. Two health professionals coming from two different paradigms! Second, on the website of a popular UK newspaper we see that ‘Medical research’ comes under the distinguished heading of ‘Science’. Yet the first subheading of Medical research is ‘Infectious disease’. Infectious disease? When 80% of the Western world’s disease burden is from non-communicable diseases which the World Health Organisation says are related to diet and lifestyle. Interestingly, the newspaper’s section on ‘health’ is buried somewhere in the ‘Life & Style’ pages. Such a yawning gulf between health and medicine! What are the messages this sends out to the lay-public and how does the cPNI practitioner educate their patients? Right now I will not venture the answers on this blog as I am still learning, but I have already witnessed in our classroom activities some of the answers.


Whatever the patient’s background or current understanding of health or medicine, the most important quality to develop for educating and communication is trust. As Peter said, “trust is the key for maintaining communication. You must have the belief you are safe with the other person”. Clinical PNI is not only about educating the patient but also empowering them. One of the most significant clinically relevant points made by Peter was that before you can really heal the patient, they must take the locus of control back again – “I will help you to heal yourself, but the responsibility is yours”. Surely, this message is key in all chronic illness.
I was fortunate to receive an e-mail from a fellow cPNI student/therapist. She said "I personally in my practice and life, cannot understand how I managed without the impact of the information impacted over two days. I certainly left a very different person than the one who arrived! My client on Saturday certainly left wiser than he otherwise would have. I have some new communication tools for a difficult meeting in a couple of weeks, I would not otherwise have had. Tools which help in our shared aims of helping each other, face the lessons and challenges the journey through life, brings us all."


Clinical PNI – Next course beginning 2012
The next course will start in October 2012, if you are interested in knowing more registering please contact Justin Sheehan on 0845 862 8862 or j.sheehan@bonusan.co.uk. If you would like to contact Adam about being a post-graduate student of Clinical PNI then please e-mail him at info@adamnt.com.