Person-to-person advocacy has overtaken all other forms of communication as the most persuasive influence on people’s attitudes and behaviour. Kinsey marketing survey 2013
Health Guides help people to find and then build on their strengths, so as to be able to engage more meaningfully with their health challenges. There are many ways to do this, some outlined below. However core to the work is the awareness that meaningful interactions between people are the most likely generators of long-term personal changes.
For many the only way to feel more in control of health is with the support of others. The evidence is that actually peer support is as powerful as professional direction in this. It is also clear that the benefits of mobilising inner resources, in terms of reducing symptoms and distress, are potentially huge. A Health Guide will seek any way to improve engagement.
Health guidance will often be in addition to the usual duty directly to reduce symptoms or correct imbalances, and any health or care professional can add the role to their core work. For example anyone can use our workbooks to support patients and clients between visits, and physicians may offer ‘social prescription‘, a referral to a non-medical or community service in the locality.
Honorary Health Guide status goes to anyone working to reduce social and health inequality through childhood education, employment and working conditions. We can only guide health if people are able to make healthy choices.
Health guidance can involve techniques of interpersonal engagement and motivation, or identifying resilience-promoting treatments, or both. The Health Guide’s core offering is facilitation rather than prescription. The starting material and best orientation is the individual’s story. A Health Guide helps individuals to greater self efficacy, and better interactions with their world.
At the bottom of this page are some initial suggestions for approaches that Health Guides can use. Before that we open the reflection with a visual meditation – a Greek resilience-building fantasy!
The best way to use this picture is to start at the bottom, with reflections on the foundations of our ‘temple’ of wellbeing. Here we have a truly eco – (in the Greek sense) perspective where home, family and community, interactions with one’s world – underpin almost everything.
We continue through proposed ‘pillars’ of self care (approaches often best tackled without prescriptions). This also introduces our core Health Guide offering: OurMedicine workbooks for ‘Learning to be Well‘. These are elaborated here.
The role of Health Guides picks up from this with a range of approaches that can further support an individual in building health, starting with facilitating their self care (eg by using the workbooks). Health Guides can also help fend off looming health threats by applying other professional skills, some of which are listed.
Beyond this, meaning reasserts itself as the abiding principle of both good living and good dying.
The following skills and techniques may build strength and resilience. Anyone using them is already guiding health and they are offered as opportunities for further training for budding Health Guides.
We offer a first Health Guide skill of facilitated self care that anyone can apply when dealing with a health or social care issue. OurMedicine workbooks, under the banner ‘Learn to be Well‘ provide a diary-based approach to tackling at home core health matters like sleeping and eating well, managing stress and back and muscle pain, and lifting spirits and energy. These are all areas where direct treatments are less effective and where therapeutic interventions may be best integrated into the subject’s daily activities. The workbooks export your practice into your patients’ or clients’ homes.
This work is further supported by our free-to-access Self Care Library of user-friendly evidence on the self care in 12 common areas.
The following is a starting list of other health guide interventions. Please send in suggestions. (Tip: one measure of whether an approach counts as health guidance is whether it becomes less necessary as it is applied!)
Principles of health guidance recur in a range of therapeutic techniques, some listed below. They all share themes of facilitation through interaction.
There are some treatment approaches that may directly build resilience. A Health Guide here will still be juggling between education and facilitation of self care on the one hand, and prescription or treatment on the other. However the treatment itself may build strengths.
Coaching is a core skill for Health Guides. The term also covers a range of recognised professional roles – ‘heath coach’, life coach’ etc. Health Guides need not call themselves ‘coaches’ though they will certainly benefit from learning coaching approaches in their usual work.
Coaching is well defined as helping people gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals [Bennett & Bodenheimer]. Coaching aims –
- to draw out a person’s potential rather than instruct
- to enable rather than prescribe
- to restore each person’s health care to its owner
A coaching session is always unique. There is no formula or fixed prescription. A coach’s job is to work with clients to help them find the answers themselves. Coaches learn to guide with a blend of asking, listening and informing, to resist correction and confrontation. Coaches understand that very few people lack motivation but may want help in harnessing their motivations to improve their wellbeing.
Coaching is supported by compelling evidence that taking a collaborative approach will dramatically increase the likelihood of healthy change. Self care is always more effective if it is facilitated by others.
Helping someone better to breathe, be more mindful, meditate, or to practise yoga, tai qi or qi gong or other mindful exercises is among the most impressive resilient-building work.
Creative and eco-therapies
Introducing arts, music and other creative and outdoor activities (like gardening or wildcrafting), usually in a group context, has been shown many positive outcomes across the whole health and care spectra. Particular benefits are noted among those with chronic ill-health, who are socially isolated or deprived, or with mental health problems
Group and family therapies
Group therapy involves engaging clients together rather than in a one-to-one relationship with the practitioner. This context is explicitly applied as a mechanism of change by developing, exploring and examining interpersonal relationships within the group. Examples include peer-support groups (such as Alcoholics Anonymous), skills training (eg mindfulness or anger management), self care groups for different health conditions, and group provision of cognitive behavioural, arts and other therapies.
Family therapy recognises that in may areas of ill-health the dynamics within a nuclear or extended family network can be critical barriers or opportunities.
Although the evidence base and some assumptions in Cognitive Behavioral Therapy have been challenged, not least in its reductionist belief in cognition as the determining principle in mental health, there are some strong resilience-building threads. One is the assumption that when individuals come to their own conclusions (as opposed to being told by someone else), the change that results is likely to be more meaningful and lasting.
One CBT process, Guided Discovery, sometimes linked to ancient practice of Socratic Questioning, envisages new revelatory insights into one’s personal condition emerging in dialogue.
An approach founded by Carl Rogers and others in the 1950s emphasizes a person’s inherent drive towards ‘self-actualization’: the process of realizing and expressing one’s own capabilities and creativity and helps change one’s usual reactions to events to more productive self-awareness and mindfulness. A variation on this is transpersonal psychology, an approach that integrates the spiritual and transcendent aspects of the human experience within a modern psychological framework. The transpersonal is defined as “experiences in which the sense of identity or self transcends the individual or personal to encompass wider aspects of humankind, life, psyche or cosmos”. Work includes spiritual self-development and other spiritual practices.
Associated with the work of Martin Seligman, this approach applies a scientific approach to personal growth and the achievement of a satisfactory life rather than treating mental illness or pathologies.
It is clear that the body will only be strong and resilient if it is provided with the right building blocks when needed. The human being is an omnivore and when healthy can make good of an extraordinary range of foodstuffs.However the demands for good food may tighten if health is poor. Nutritional expertise may be helpful in identifying the foods most likely to support health and resilience. This is likely to emphasise foods that are closer to humans’ evolutionary habits: plants (vegetables, cereals, seeds, nuts and fruit), eggs, free-range meat, fish, and ‘fermented’ (probiotic) foods like yoghurt and pickles, as well as enough water to prevent dehydration. There may also be a real need for supplementation with key food constituents like vitamins and minerals in recovery from illness and debility. However the provision of food supplements may not always be in the best interests of building resilience. It has been easy to create an unquestioning reliance on daily regimens without any indication of their value. Some supplements can be a pill-popping substitute for improving personal responsibility for a good diet, or may feed neuroses rather than health. A good nutritional guide will use them only as part of a broader education in what the Greeks called ‘dieta’: right living
Animals evolved relying on plants. Rich relationships with the plant world are built into the human genome. Plants supply as their ‘primary metabolites’ the base food-chain for all animal life, carbohydrates, fats and proteins, vitamins and minerals. These have been bred up in the varieties of vegetables, cereals, seeds, nuts and fruit we consume as foodstuffs. Any growth, repair or recuperation will call for a large quota of food plants in the diet. Health professionals may also appreciate their modulating role in cardiovascular, digestive and urinary health, and in preventing inflammatory disease and cancer. The evolving worlds of animals and humans have also been dominated by other characteristics of the plant world. Plants produce ‘secondary metabolites’ for defensive or reproductive purposes. Some of these metabolites (eg alkaloids) are poisonous or are the basis for very powerful modern medicines. Others have gentler though still interesting effects on consumption. They are the basis for most traditional medicines around the world and core to herbal medicine (or phytotherapy) to this day. It is clear that humans learnt very early on about the properties of the major groups of secondary plant metabolites, and how to extract them as more concentrated and effective ‘drugs’ (drogen is an early European word for dried plant). They are also accessible to anyone and have always been the basis for most self-care medicines. Examples of the early drug fractions are:
- ‘Acrids’ – as in the hot spices like ginger, chilli or pepper, gently stimulate pain receptors and provoke reflect vasodilation and thermogenesis.
- Bitter principles – long used to stimulate digestive and hepatobiliary functions; now thought to lead to reflex increase in cholecystokinin and other hormone levels from bitter receptors in the mouth and elsewhere.
- Flavonoids and anthocyanidins – polyphenolic plant pigments (yellow and blue respectively) long associated with fever management and now understood to have promising cardiovascular and inflammatory modulating roles thanks to gut bacteria conversion into simple phenols (see below).
- Mucilages – soothing ingredients of some plants used to provide topical comfort on wounds and inflamed tissues.
- Phenols – active, often aromatic plant constituents with inflammatory modulating properties; the classic example are the salicylates (eg aspirin).
- Resins – antiseptic and topically anti-inflammatory.
- Saponins – detergent and steroidal molecules that appear to modulate steroid hormone responses in the body and often chosen traditionally for women’s health care and to modulate adrenal responses,
- Tannins – curdle (‘astringe’) surface protein for wound healing, and can reduce excessive gastro-enteric responses like diarrhoea.
- Volatile oils – antispasmodic, ‘carminative’ (for settling digestive upsets), antiseptic when distilled.
Traditional medicine focused much more on the repair phase of illness than is now common. It was generally understood that managing the acute symptoms of disease was only the first step and that unless recovery was complete there would be relapse and conversion to a chronic condition. The English word ‘convalescence’ well describes a structured approach to recuperation found in traditional medicine, with attention to rest, exercise, and diet, and with the prescription of medicines with particular reputation for supporting recovery. These have lazily been termed ‘tonics’. Among them are many remedies that a Health Guide would find very useful. Herbal practitioners and some naturopaths are trained in using these tools. Other health professionals can search them out for referrals or may wish to learn more themselves
The Alexander technique (‘a way to feel better, and move in a more relaxed and comfortable way… the way nature intended’) and Feldenkrais therapy (‘an educational method focusing on learning and movement, which can bring about improved movement and enhanced functioning’) are two examples of approaches that aim to help re-learn awareness of being in and moving with one’s body.
Many have lost the skills to exercise safely and effectively and may also need motivation and encouragement to get back on their feet. Where this drifts into Fitness Training however it may become a less healthy focus on body-building. The Hippocratic authors were dubious about the ‘health’ of prime athletes!