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From Luke’s Journal June 2024  |  Vol.29 No.2  |  Christian Hospitality

Declaring that hospitality underpins the task of healing is perhaps an anathema to modern consumerist attitudes to healthcare, and to everyday realities that clinicians face as they navigate the logistical pressures of their roles. And yet – the word ‘hospital’ has its roots in the Latin words for ‘guest’. Perhaps clinicians can reclaim some of the heart of medicine by remembering we are hosting guests each time we connect in a therapeutic relationship.

There are many forces that push the practice of medicine away from a healing-orientation and toward transactional encounters. These include financial or time limitations; patient expectations to be related to as customers; policies that value precision and efficiency over time with people who are distressed; bureaucratic healthcare rationing; siloed disciplinary fragmentation of care; misguided positioning of professional boundaries as equating to emotional distance; or clinician weariness and moral injury. These forces are a real threat to quality healthcare. They risk undermining the core task of healthcare: therapeutic relationship.

There is extensive evidence that the quality of therapeutic relationship predicts outcomes and therefore is a crucial element of all clinical care. One study of outcomes from a raft of therapy techniques concluded that 30% of therapeutic change could be attributed to the quality of the therapeutic relationship (which they described as empathy, warmth, congruence, alliance and therapist attitudes), while only 19 % of change could be attributed to the technique being used.¹ A key study of healing relationships in primary care identified important processes and competencies that build hope, trust and a sense of being known. These centre around valuing the patient, managing power and abiding with the patient over time.² These were driven by essential competencies of the clinician including a sense of confidence, emotional self-management, mindful awareness of the encounter, and clinical knowledge. A recent Australian study of deep general practitioner-patient relationships (as defined by both clinician and patient using a standardised measure) were marked by collaborative clinical rigour; genuine personal care that embraced their shared humanity; trust built over time; and strategic investment in preparation for times of trouble.³

“A key study of healing relationships in primary care identified important processes and competencies that build hope, trust and a sense of being known”.

This study, entitled ‘Where the joy comes from: a qualitative exploration of deep GP-patient relationships’ reported that clinicians reported finding both cost and joy in these types of relationships, mediated through navigating boundaries and uncertainty within their own human limitations. Other sources that remind us of the core skills in the therapeutic relationship that attend to the patient as a person include works describing the patient-centered approach,⁴ the need to attend to the selfhood of the patient,⁵ experienced clinicians who reflect on the embodied process of attending ⁶ and the writing of Nouwen about being a wounded healer⁷ and about reaching out to others.⁸ The First Nations concept of ‘dadirri’ which means “inner deep listening and quiet still awareness”⁹ (p.14) is also deeply instructional for the would be healer.

Assuming the underlying professional competence of all clinical care, while aware of the logistical limitations of practice, clinicians who seek to also be healers do need to reflect on these themes of valuing the person, managing power, deep listening, attending, and abiding. They also need to heed the themes of genuine personal care that sees the self, shared humanity, and boundary management highlighted in these writings. Perhaps the roles of host and guest implied in the concept of hospitality can guide us and can help frame and clarify our thinking.

Henri Nouwen writes beautifully about the intertwining of hospitality and healing. He states, “What does hospitality as a healing power require? It requires first of all that the host feel at home in his own house, and secondly that he creates a free and fearless place for the unexpected visitor.” (Henri Nouwen, The Wounded Healer)

This phrase holds so much wisdom and has guided my reflections on clinical practice for years. It assumes the inherent value of hospitality as a contributor to healing. It assumes the healing impact of treating a person with dignity, tuning in to them, standing by them, and welcoming their presence into our own space. Hospitality is commanded a number of times in the Christian scriptures – a needed reminder of the dignity of each guest and the intentional ways that the host needs to open their heart towards each person no matter their condition, no matter how wounded or distressed. It is a way of being with others that lends hope and knows the important transcendent experience of truth, beauty and love that Maslow named.¹⁰

“Nouwen’s phrase also reminds the healer to take care of themselves – to create a space for their work where they ‘feel at home’“.

Nouwen’s phrase also reminds the healer to take care of themselves – to create a space for their work where they ‘feel at home’. How many of us work in spaces that do not offer that kind of experience for the clinician? How many of us find it difficult to settle ourselves and feel at home anywhere? This is a call for deep healing for the healer – healing from restless striving, from perfectionist checking, from fearful insecurities, and from dutiful over-responsibilty for the suffering of the world. It is also a call for clinicians to ensure that their own working environments are safe enough and ‘like home’ enough for their bodies to have rest, refreshing, creativity, connection, clarity and curiosity as part of each day. This task of building our own sense of safety at work is also sacred – as it requires the clinician to have tasted living water that soothes and heals in order to let refreshing water overflow to others.

At a recent conference with young medical students and clinicians, I described how remembering the nature of God can help us to find rest. We reflected on snuggling up close to God – with no assessment, judgement or any need to earn that love. A place where our heart and respiratory rate settle, where our autonomic nervous system and stress response systems become regulated, where we can imagine new stories, and digest conversation and nourishment and be refreshed. A place where it is well with our souls. Clinicians of faith have a chance to reach out for this kind of healing from the God who is Love – to never walk alone – to always have a safe haven to return to when they are distressed.

Lastly, Nouwen’s phrase reminds us about the kind of space that healers create for the ‘unexpected visitor’:  a ‘free and fearless space’. This space has edges – boundaries that make it safe, that enable the clinician and the patient to keep their integrity and remain generous (not resentful) towards each other (“Boundaries. Integrity. Generosity.” as Brene Brown says). It is a space that offers both a safe haven and a secure base. These concepts are fundamental to the circle of security parenting training used to teach parents how to meet the attachment needs of their children.¹¹ In therapeutic relationships, the space we create also offers a safe haven in which to be welcomed and comforted, attended to and listened to; as well as a secure base to encourage and enable the person to step out from that relationship to ‘reconnect with ordinary life’.¹²

In my research into trauma-informed and healing-oriented approaches to the whole person in distress, I have had a revelation of the importance of sensing that we are safe.^13,14 Humans have an overarching need for safety¹⁵ that often drives behaviour and is a prerequisite for resting, learning, growing, belonging and healing.¹³ Providing a clinical space and trying to build a life space where people sense they are safe is a central aspect of healing care – relevant to both physical and psychosocial aspects of healing.  Trauma-informed goals of care name the first phase of care as ‘establishment of safety’; the second as ‘remembrance and mourning’ and the third as ‘reconnecting with ordinary life’. The sense of safety approach that I have been developing sees these processes as intertwined.  It proposes instead that healers who offer a ‘free and fearless space’ should provide a place that builds safety, grieves safely and enables growth.¹³

Figure 1: Used with permission from Lynch, J.M (2021) A whole person approach to wellbeing: Building Sense of Safety

So – hospitality, healing, attending, listening, protecting dignity, feeling at home ourselves, and creating spaces that are free and fearless. Could these be clues to help us become not just technicians or clinicians – but healers? Creating this welcoming space for each guest is a mysterious joy of the therapeutic relationship worth honing and protecting.

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