The relationships between health care providers and health seekers are a topic of interest in various disciplines. Historically, the term “therapeutic relationship” derives from psychotherapy and is described as a special form of interaction between therapist and client. Beside the therapeutic method used, the therapeutic relationship is said to have an effect on its own on the outcome of the therapy [
In medical research, the doctor-patient relationship was historically doctor-centered [
Anthropological research, too, highlights the therapeutic impact of the relationship between healers and clients in ritual healing. Therein, the personality of the healer plays an important role [
Though all these disciplines put special emphasis on certain, slightly divergent aspects of the relationship, we can infer that the interaction between doctor/healer/therapist and patient/client is considered crucial for the healing/therapeutic process [
In Germany, some healing techniques (e.g., laying on of hands) have a long cultural-historical tradition [
The aim of this study was to understand the growing field of contemporary healers and their clients in Germany and to learn about their subjective experiences, biographies, concepts, and motivations. To do so, we conducted a qualitative study integrating perspectives from medicine, medical anthropology, and religious studies. For the purpose of this paper, we focused on how healers and their clients describe and discuss their relationships. This discussion allows for a conceptualization of the healer-client relationship in German healing settings.
A qualitative study based on semistructured interviews with healer and clients combined with participatory observation was conducted. To include different perspectives, the research team was interdisciplinary, composed of three physicians, two medical anthropologists, and one religious studies scholar who were all experienced qualitative researchers. The religious studies scholar had practiced healing; all the other researchers had no background in practicing spiritual healing. The whole team was involved in the development of the interview guidelines, recruitment process, data collection, and data analysis.
The interviews were designed to elicit information on biography; motives to consult a healer or to heal; expectations and explanations of the healing process; concepts of health, illness, and healing; experiences during and perceptions of the healing sessions; and the participants’ perceptions of the effects and outcomes. The interview guide was used to support the interviewers and allowed flexibility to vary and deepen particular aspects of interest. After the first interviews, the interview guide was critically reviewed by the research team and improved accordingly. This paper focuses on the statements of healers and clients about their relationships.
Because the field of healers in Germany is very heterogeneous and not in general easy to access, a snowball sampling technique was used for recruitment [
Both interviews and healing sessions were digitally recorded and then transcribed verbatim. Materials were pseudonymised. Written memos of the interviews and participatory observations by the researchers added further information on the setting, nonverbal expressions of the interviewees, and the researchers’ subjective experiences.
The data was analyzed based on a directed qualitative content analysis [
Participants provided written informed consent and the study was approved by the ethics committee of Charité University Universitätsmedizin (EA1/238/10).
In total, 15 healers and 16 clients were included in the study. The healers were 9 males and 6 females, with a mean age of 55 ± SD 7.9 years. One healer was a nurse, four healers were physicians, four were “Heilpraktiker” (nonmedical CAM practitioners), and six had no medical or CAM education. All healers worked full time or part time as spiritual healers for already many years. For example, one of the physicians had stopped practicing conventional medicine; the other three physicians practiced both, conventional medicine and spiritual healing, but never in combination and at the same time. The “Heilpraktiker” often combined spiritual healing with other CAM methods. The healing techniques mainly used by all healers were laying on of hands and/or prayer healing. The healers reported that healing talents can be inborn, developed, or acquired during life. Mostly, the experience of a powerful event or a crisis prompted their transformations into healers (all healers without CAM or medical education and half of the healers with CAM or medical background). This transformation often took many years and was often accompanied and supported by other spiritual healers and teachers. However, some of the interviewees (all with CAM or medical background) talked about becoming a healer out of sheer interest and learning to heal by attending courses in spiritual healing (for more details, see [
Of the 16 clients, 13 were female and 3 were male and they were on average
Throughout all interviews, the relationship between healer and client was characterized as a very special one, a relationship based on mutual respect and appreciation. The experienced relationship in the healing session was described by most healers and clients as a profound and “
The “ D_H2_K1, client: “ C_H2, healer: “ D_H1, healer: “ A_H3, healer: “ C_H2, healer: “ C_H2, healer: “ C_H1_H2_K3, client: “
Healers and clients described their relationship as “
Repeatedly, healers and clients talked about
Clients often seemed to be very impressed by their healers and saw them as ideals to strive for. They described their healers as powerful, knowledgeable, and wise. Due to the healers, they were reassured about what they believe in and hope for, but to which they had often lost contact in their normal lives. Thus, clients reported finding peace within themselves and a connection to a divine power during a healing session. A_H2_K1, client: “ C_H1_H2_K6, client: “ D_H1, healer: A_H3, healer: C_H1_H2_K6, client: “ D_H3_K1, client:
The healers saw themselves mostly as mediums or
Often the healing session is experienced by the clients as a dream-like or trance-like state where the healer is seen as somebody guiding them through (see also our publication on perceived outcomes of spiritual healing and explanations in [
The healer’s empathy was very important for healers and clients alike. The term empathy, in this context, means something like giving one’s full attention to the client, having an intuitive understanding of the client’s personality and health history, and being present and open without having any prior judgments or intentions. C_H4, healer: A_H3_K1, client: B_H3, healer: C_H1, healer:
Many healers reported that they have this profound empathetic understanding for their clients because of their intuitive, subtle, or clairvoyant perception.
Following this intuitive, empathic understanding, verbal communication was often not necessary for the healers.
Mostly, healers would speak with the clients during the healing session only because the clients were used to it and would become irritated if the healers remained silent. At the same time, the conversation prior to and after the healing session was seen as important by the healers. Thus, the clients would have the opportunity to share experiences or to clarify questions which arose in the wake of the healing session and which could help the client to better understand what had happened.
The healers saw themselves as A_H2, healer: A_H3, healer: A_H3_K1, client: C_H1_H2_K3, client: D_H3, healer:
Many healers and clients emphasized the meaning of individual responsibility. For the clients, it was important not to be patronized, to be able to decide freely, and not to be told what they should or needed to do. Often, clients had already demonstrated independence in their choice of healer and often enough finding the right healer for them had already taken a long time.
According to the healers, the client’s personal responsibility is an essential aspect of the healing. From the healer’s perspective, healing is possible only if the client is ready to assume the responsibility for himself. Personal responsibility, in this context, would not mean that the client was to be blamed for his problems and illnesses. Rather, personal responsibility refers to the strength and courage to overcome fears and to actively participate in the healing process. Often people would not want to assume responsibility but would prefer to be told what to do in their lives. Many healers would not encourage such an imbalance in power but emphasized reciprocal responsibilities.
The relationship between healers and clients during the encounters was described as profound and unique, wherein healer and client shared emotions and sensations and connected to a transcendent source. The personality of the healer supported the clients’ hopes for healing and helped the clients to (re)connect to their own spirituality. The healers’ empathy was emphasized by both healer and clients and was explained by the healers as a subtle, intuitive understanding of the other. The relationship was seen as partner-based. The healers were said to act as a companion to the client in his healing process. Clients had to be open for this profound connection to occur and at the same time to be willing to assume personal responsibility.
One strength of this qualitative study is the inclusion of a range of spiritual healers and their clients from different settings (rural, city), (religious) traditions, healing techniques, and professions. Another strength of this study is the interdisciplinarity in the research team, which included scholars in medicine, anthropology, and religious studies. That diversity permitted different approaches in the field. The same diversity contributed to various perspectives in the analysis. The interdisciplinary teamwork led to complex and time-consuming processes and a practicable balance had to be found between all aspects of the extensive data material and the interdisciplinary experts’ assessments.
A limitation of this study is the selection for our sample as clients were included in this study by their healers. It is likely that they have chosen clients with whom they work well. Therefore, the reported outcomes and explanations might present a picture that describes only successful healing sessions and stories of clients that improved during the healing process. This means that our results possibly reflect the more positive aspects of healing processes and preclude failed stories. Furthermore our interviews took place
The statements of healers and clients about the importance of the relationship between them correlate to studies about doctor-patient relationships and therapeutic relationships in psychotherapy as described in the Introduction [
Empathy was of high importance for the interviewees and encompassed subtle perception, awareness, presence, nonjudgment, and the company of the healer without imposing influence. Even though the term
Still these first debates about “Einfühlung”/empathy in the nineteenth century in Germany were philosophical rather than spiritual and first began in art and somewhat later infiltrated psychology. A central question was how it is possible to know what somebody else feels. It has been argued that, by reproducing or reexperiencing another’s experience, it would be possible to get a higher understanding of the other [
While there are still debates about the definition [
The importance of the personality of the healer is emphasized in this study and correlates with various anthropological studies about healers and their patients [
This partner-like approach of contemporary healers in Germany is possibly influenced by the current general discussion about paternalism versus partnership in health care [
The client had to be willing to open up to this relationship and at the same time to be willing to assume personal responsibility. Critically, it should be noted here that the close relationship between healers and their clients could contradict independence, noninfluencing, and individual responsibility. Even if not expressed in our data, we must recognize that the healer setting is not immune from fostering dependence and that abuses of power may occur [
The findings of our study also show the importance of spiritual questions related to health care. It is not only the relation to the healer that matters for the client, but also the client’s relationship to the spiritual/transcendent. In this sense, Cox proposes that the existing biopsychosocial model should be extended to a “body-mind-spirit paradigm” in individual therapies [
The results of this study stress the importance of and potential in the relationship between healer and client. In contrast to doctor-patient and therapeutic relationships, central to healer-client relationships were the shared experience in healing sessions and the triangular relation between client, healer, and the transcendent. The healers see themselves therein as a channel to the spiritual/transcendent which would allow them a subtle empathetic understanding of the client while staying personally detached. Furthermore, the personality and a partner-like attitude of the healer supported the client’s efforts to give a different meaning to his problems and his life, to (re)connect to his spirituality, and to assume personal responsibility. In further studies, the question of how spirituality may be integrated in health care and how the healer-client relationships develop over time in the healing process could be of interest.
The funding sources had no role in the design and conduct of the study, collection and management, analysis, and interpretation of the data, or preparation, review, or approval of the paper.
The authors declare that they have no competing interest.
All authors designed the study. B. M. H. Stöckigt, F. Besch, F. Jeserich, and M. Teut collected the data. B. M. H. Stöckigt, F. Besch, F. Jeserich, C. Holmberg, and M. Teut analyzed the data. B. M. H. Stöckigt prepared the paper. All authors were involved in interpreting the results of the analyses and critically reviewed the paper. The final version was approved by all authors.
The authors thank all the participants of the study. Furthermore, they thank Shelly Rafferty Withers, Ph.D., of Crossfield Writers, Troy, NY, USA, for editing the paper. The study was funded by the Goerdt-Stiftung im Stifterverband für die Deutsche Wissenschaft, Deutsches Stiftungszentrum in Essen, Germany.