«An explorative study of a complementary therapy method Rosen Method Bodywork User´s reasons for therapy utilization, experienced benefits and ...»
Department of Neurobiology, Care Sciences and Society
Division of Nursing
An explorative study of a complementary therapy method Rosen Method Bodywork
User´s reasons for therapy utilization, experienced benefits and existence
of caring in the treatment interaction
All previously published papers were reproduced with permission from the publisher.
Published by Karolinska Institutet. Printed by Arkitektkopia AB. Stockholm © Riitta Hoffren-Larsson, 2013 ISBN [ISBN] 978-91-7549-296-4 Abstract The utilization of complementary and alternative medicine (CAM) therapies is increasing and the users frequently report satisfaction and benefits from the treatments although scientific support for these self-reported experienced benefits are largely lacking. This thesis analyses users` experiences of Rosen Method Bodywork (RMB), a relatively unevaluated touch based CAM therapy method. The theory behind RMB suggests that bodily problems such as muscle tension are partly due to unresolved emotional problems or suppressed traumatic experiences. The treatment includes gentle touching on tense muscles with the purpose to detect and make the client aware of the tenseness. This project consists of two related studies and is innovative in studying a CAM therapy method from a nursing theoretical perspective. The study design is qualitative, exploratory and descriptive. The overall aim is to contribute to the understanding of possible health promoting aspects of RMB. The specific aims are; to describe why clients consult RMB, and what kind of benefits they perceive (study I), and; to explore if caring is a part of the interpersonal interaction in the treatments by analysing RMB clients experiences from a nursing theoretical framework (study II). The data was collected from a survey of 53 conveniently sampled Swedish RMB clients (study
I) and through semi-structured interviews with 11 clients with both positive and negative experiences from RMB (study II). The data were analysed by content analysis and descriptive statistics in study I and the interviews were content analysed by using a nursing theory, the SAUC Care Model, as the theoretical framework for the analysis. The results show that RMB is consulted for three main reasons; that the experienced benefits include psychological and physiological health improvements but also a new awareness about the body, personal growth, and self-initiated lifechanges. The results also indicate that treatments where participants reported satisfaction seem to include supportive caring as an integrated part in the interpersonal interaction. In contrast, the participants who were dissatisfied with the treatment described opposite experiences including lack of proper caring and failure to meet the client`s needs. This findings add to previous knowledge, in showing that caring is an integrated and essential contextual component in RMB treatments.
Based on the results a theoretical model of the components that might contribute to treatment satisfaction and experienced benefits is discussed. However, it is important to note the study limitations and that these qualitative studies were not designed to inform any conclusions about the efficacy of RMB.
Keywords: Rosen Method Bodywork; Complementary and Alternative Medicine; Benefits; Client satisfaction; Caring; Interpersonal interaction List of publications This licentiate thesis is based on following two papers.
Hoffrén-Larsson, R., Gustafsson, B., and Falkenberg, T. (2009). Rosen Method Bodywork – An Explorative Study of an Uncharted Complementary Therapy. The Journal of Alternative and Complementary Medicine. 15. 9:995-1000.
Hoffrén-Larsson, R., Löwstedt, J., Mattiasson, A-C., and Falkenberg, T. Caring as an essential component in Rosen Method Bodywork - Clients´ experiences of interpersonal interaction from a nursing theoretical perspective. European Journal of Integrative Medicine. Accepted for publication July 19, 2013.
2.1The Swedish health care
2.2 Research on CAM
2.3 The history of Rosen Method Bodywork
2.4 The principles and the treatment
2.5 RMB therapists` training
2.6 Potential treatment risks
3. The study rationale and aims
4. Material and methods
4.1 The sample and drop-out
4.2 Method – Study I
4.3 The analysis – Study I
4.4 Method – Study II
4.4.1 The theoretical perspective in study II
4.5 The analysis – Study II
4.6 The study population
4.7 Ethical considerations
4.7.1 The research sovereignty
6.1 A tentative theoretical model
6.2 Methodological considerations
6.3 Study limitations
6.4 Considerations regarding the theoretical framework
6.5 Clinical implications and further research
7. Summary in Swedish – Sammanfattning
1. Preface The existence of Complementary and Alternative medicine (CAM) is not a new phenomenon.
When I grew up in a little village on the Finnish countryside during the 1960s home-prepared herbal remedies, massage, Finnish copping (carried out in Sauna) provided by laymen were some of the health promoting activities the people in the neighbourhood often used as first option to relieve bodily, but probably even embodied mental health problems. I suppose the utilization of these traditional therapies sometimes relieved the illness, sometimes led to harm and sometimes did not work at all. Why or when the treatments worked, or did not work, were not scientifically known. The people did not bother about that. It was enough to get some relieve and they often expressed satisfaction with the treatments. If the layman provided therapy that did not work they chose in a pragmatic way to consult the provincial physician or district nurse but did not always inform them about their use of these unofficial treatments. When I became registered nurse in Sweden in the mid 1980s I again met the same utilization of these kinds of therapies among the people. I learned that the therapies had a name, Complementary and Alternative Medicine (CAM). Even now the CAM users I met were often satisfied with the treatments and in the same way as my previous experiences they seldom informed the conventional health care personnel about the use. Some years ago I got an opportunity to study Rosen Method Bodywork (RMB) which almost was a “tabula rasa” concerning scientific documentation. A natural point of departure for me was to start asking the therapy users, about their experiences with the therapy.
Because I am registered nurse and teacher in psychiatric nursing my pre-understanding is based on a nursing perspective. In addition to the data collection, I have observed and carried out informal discussion with many RMB therapists and clients in order to understand the context of RMB. During the project, I met the RMB founder, Marion Rosen and she showed me very pragmatically (“hands-on”) something about the concept of “presence” in the therapist-client interaction and how to “listen” to a client with “the hands”. These encounters and observations raised my curiosity about how the clients experience the interaction with the therapist and what it means for the experienced outcome and satisfaction with the treatment.
2. Background The interest in complementary and alternative medicine (CAM) has grown rapidly among populations in different high-income countries during the last two-three decades (Bodeker and Kronenberg, 2002; Harris, Finlay, Cook, Thomas and Hood, 2003; Hanssen, Grimsgaard, Launso, Fonnebo, Falkenberg, and Rasmussen, 2005; Barnes, Bloom and Nahin, 2008). The CAM utilization pattern can be seen in Sweden (Davidsson, Eriksson, and Östby, 1986; Eriksson, Davidsson and Davidsson, 1990; Eklöf, 1999; Nilsson, Trehn, and Asplund, 2001). But despite the increased utilization many CAM therapy methods are still relatively unevaluated.
Therefore, for the sake of patient safety, it is important to increase the knowledge about different CAM therapies. This is one of the main motives behind this licentiate thesis. The CAM therapy method, studied in this project, Rosen Method Bodywork (RMB) is a popular therapy method that lacks scientific documentation and informal reports indicate that clients are satisfied with the treatments or experience improvements. Therefore, there is a need to obtain initial information about why people turn to this therapy method, what kind of benefits they experience, and what in the treatment might contribute to the experienced treatment satisfaction.
2.1The Swedish health care The services that provide the population with health care to cure or prevent illness, to improve wellness and life-quality are offered within several different systems in Sweden. The main (formal) health care system is conventional health care (CHC). Besides CHC complementary and alternative medicine (CAM) therapy methods are available in a parallel health-promoting system (market). The present definition of the concepts “complementary” and “alternative” medicine is according to the National Center of Complementary and Alternative Medicine (NCCAM) in the
“The term “Complementary” generally refers to using a non-mainstream approach together with conventional medicine. The term “Alternative” refers to using a non-mainstream approach in place of conventional medicine” (www.nccam.nih.gov/health/whatiscam#definingcam, date: 2013-09-17).
CAM therapies are generally not integrated within the Swedish CHC service but many patients use them simultaneously to CHC service. This kind of use is similar in many other countries (Fönnebo and Launsö 2009). The Swedish CHC service is compensated by the Swedish Social Secure Health Care Insurance. This will guarantee that the health care service is available to the whole population regardless of income or social class. CAM therapies are not included in the insurance and the users must pay the entire therapy cost themselves. Some authors (Hawk, Ndetan and Evans 2012) claim that the increased use of CAM therapies is important because it plays a significant role in improving public health. Therefore, the authors state that co-operation should be essential between CHC providers and CAM therapists, and they argue that there is a need to engage CAM therapists in health promotion counseling. The role of CAM for public health is probably the same in Sweden. But the co-operation between CAM therapists and CHC personnel is still limited and the CHC personnel`s knowledge about CAM is scarce as well according to Bjerså, Victorin-Stener and Olsèn-Fagevik (2012). This is problematic for patients who want to utilize CAM therapies as a complement to CHC treatments or have a need for professional advice about the therapies. The common simultaneous use is also problematic for CHC personnel because they probably lack knowledge about adverse therapy interactions and for this reason cannot assess risks properly.
One possible obstacle to providing professional information is the formulation in the “Patient safety” Act (Socialdepartementet SFS 2010:659) which regulates the Swedish CHC personnel´s responsibilities, their professional competence and the treatments provided by CHC. The act states that treatments within CHC must be based on experiential knowledge and scientific evidence. The concept scientific evidence is defined as treatments that are supported by theoretical knowledge and/or the best available results of high-quality research. The concept experiential knowledge is intended to describe clinical treatments that are commonly accepted and practiced within CHC. Moreover, the same act defines CHC personnel who have certification and/or a protected health care occupation title (for example; physician, nurse, psychologist, and physiotherapist). This means that the specific title can be used only by persons with an educational and/or practical background approved by The Swedish Social and Health Welfare Board.
Certified personnel must uphold their responsibilities in accordance with ‘‘science and experiential knowledge’’ inside and outside of their professional work. This means that they are in general prohibited from providing CAM therapies and cannot recommend such therapies or inform patients about their advantages and disadvantages if the therapies lack extensive scientific evaluation or the therapy is not practiced within CHC. However, this is changing and there is today “grey zones” between different legislations that regulate the CHC services and patient`s rights. In case the patient initiates the request for a specific CAM therapy or when CHC service cannot provide a treatment to the patient, and there are no risks that are associated with the CAM therapy, certified CHC personnel can provide the therapy if they have adequate skills.
2.2 Research on CAM The early research on CAM has been departed in general from a bio-medical perspective, which focuses on aspects of cure, the therapy effects and bio-medical explanations of the therapy outcomes. This research has often included a paradox - studies show ambiguous or ineffective results (Carpenter and Neal, 2005; Stevinson and Ernst, 2001) whereas many anecdotal reports from the CAM therapy users that often indicate improvements and satisfaction (Stewart, Weeks and Bent, 2001; Molassiotis et al. 2006; Hök, 2009; Arman, Hammarqvist and Kullberg, 2010).
An explanation for the paradox may be that the previous research in many cases has ignored the importance of other aspects, such as, for example interpersonal interaction and social support, for the user´s satisfaction or experienced benefits. As a consequence, knowledge about other components or mechanisms that might contribute to users´ satisfaction or benefits is still relatively unevaluated. For this reason several leading authors in this field (see e.g. Fönnebo et.al 2007;
Verhoef, Vanderheyden and Fönnebo, 2008; Verhoef and Leis, 2008) have claimed that there is a need for new theoretical or methodological perspectives on CAM and to develop new research strategies to evaluate CAM therapies.