More good old days

The "therapeutic alliance" a term intially and still  most frequently applied in psychotherapy.  In my view it is applicable to all the varied paradigms involving supplicant and healer. The notion of the suffering and the healer emotionally bonded together in the search for relief has been a part of me, seemingly forever. I really have never questioned its operation at the core of the healing professions.

Though not always well defined, for several years I have felt assaults on this powerful intellectual and humanizing tool. As the assaults are escalated to fever pitch in the political issue du jour I decide to think a little more. Somewhat casually I made the comment in my Reflections.  "There was a bonding for me that was likely more through mutual suffering than my inherent character or training."

Now I am wondering how much of that dedication to the alliance is a result of having received my medical training almost exclusively in institutions of that great era of the "charity hospital." Socially conscious states and communities created taxpayer subsidized facilities with the chartered purpose of caring for the indigent. Medical staff was largely trainees and volunteers. Intern and resident salaries were tokens and there was indeed a lot of mutual suffering.

Even the private hospitals of most of my era were non-profit and there was quite a stir when for profit institutions first began to be established. My limited experience in private for profit institutions does not permit reliable interpretation. I do wonder if that bond flourishes as automatically in a paradigm of reputedly well financed consumers intending to purchase life from "providers" operating in their self interest.

In all the really disorienting chatter I believe I hear a longing for a restoration of that "therapeutic alliance" by patients and physicians alike. Nurturing these impulses can't be a bad thing.