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Commentary on focusing awareness: the process of extraordinary healing from a Rogerian perspective.

Patricia Schneider"s "Focusing Awareness: the Process of Extraordinary Healing from a Rogerian Perspective" published in Visions in 1995 was chosen, and rightly so, for this commemorative 20th anniversary issue. Exploring #what is healing" in a unitary/Rogerian paradigm enriches our theory based practice for nurse educators, researchers and clinicians. The traditional view of healing has been linear and causal. Parts knit back together, as in wound healing; a person recovers and heals from loss or trauma. But in the last at least 20 years we have become more aware of the unitary nature of healing. As we face numerous national and worldwide crises as well as try to understand and participate with individuals as they survive and thrive, we will need to understand the full meaning of healing. This appreciation includes not only the knitting of broken bones but the restoration of broken spirits. While the mantra in unitary-transformative paradigm is that we are all whole and thus "parts" of the person do not knit back together, I contend that the sense people have in trauma and loss is that they are not whole but rather feel fragmented. Intentionally participating in helping people and ourselves to reestablish a sense of wholeness is the process of healing. Healing is sometimes a surprise to both the healee and those who work to promote recovery or cure.

Schnieder completed an early study that she believes derives from, and supports, Rogerian Science. Her theoretical backdrop reflects her time in history (the late 90"s) when Candace Pert (1993) developed her revolutionary psycho-physiologial conceptual framework. Pert demonstrated with biological evidence that neurotransmitters are not not isolated in the brain but are evident everywhere in our bodies. Body and mind were now accepted as connected and as one.

Schnieder used grounded theory to tease out the recursive phases of 'exceptional" healing in three women who used alternative approaches to severe medical diagnoses. Exceptional" healing is remission of symptoms or unexpected disappearance of disease. She frames this phenomenon through the psychoneuroimmunologic lens which assumes an "undiscovered enlivening" energy" described by Pert (1993). This energy accounts for the spontaneous communications and changes within the body that are related to healing. Schnieder describes this in Rogerian terms as the person's energy field pattern manifestation in the whole system rather than one response at a time. This seems to be her basic framework as she embarks on the study. One could critique her having a theoretical basis before doing grounded theory, but from my view one cannot do any research without acknowledging a basic philosophical and theoretical base and potential bias. Our beliefs color the kinds of questions we ask, how we asked them and then how we analyze and interpret the data and finally abstract this into a new theory, or conceptual framework. Since traditional grounded theory methodology fragments a phenomenon and examines its parts", this approach could be criticized by those espousing a unitary paradigm. However, the methodology offers the opportunity to reconstruct the parts" back into a unified whole that is greater than and different from the sum of the parts and this enhances theory and understanding of phenomena such as healing.

Schnieder derived a four-stage process to describe her participants" experience of exceptional healing. Focusing awareness was central to this process. This focus helped the person develop awareness sufficiently so that they participated more fully in their decision-making and in the healing process. The four stages in Schnieder's model include: 1) Rejecting the medical approach which was mediated by anger, 2) Deciding to find an alternative, 3) Choosing the right therapy, and 4) Active involved participation. While she admits that describing phases of healing may appear to be linear, she explains that the phases do not necessarily occur in a prescribed linear way. One phase does not cause the other but certain characteristics may be associated with how participants felt they were progressing toward a healing changes. Her theory is based on a person's reawakening (body, mind spirit) by focusing awareness on the true nature of being". Healing begins with bodily awareness of discomfort and progresses to awareness of emotional and interpersonal issues and finally manifests in behavioral change as well as a spiritual intuitive sense that something paranormal has happened.

While this can be viewed as a linear one, two, three process, any process of transformation and change has a quality of movement which can be interpreted as linear. Such linearity need not be a causal progression, or progress in a predictable manner. In reality most change progresses in a Rogerian manner: unpredictably spiraling forward in increasing diversity. While Schnieder does not explicitly describe the changes in exceptional healing as a recursive spiral, I would wonder if this more unitary Rogerian metaphor is appropriate to apply. Could the process she describes be reversed or seen in a different order? For example, might healing begin with spiritual distress or emotional pain and evolve to a manifestation of a painful physical disorder? Could emotional distress promote such significant behavioral change that the person"s focused awareness is enhanced to the extent that the person feels 'healed"? Schnieder does not ask these questions and, therefore, we must ask if her theory really does have a linear and potentially cause and effect flavor. Here we often have difficulty looking at change and describing how changes occur as a unitary and recursive phenomenon. Rogerian theory is helpful in portraying change as unidirectional, innovative and unpredictable. This is similar to other theoretical frameworks that attempt to delineate change. (Zahourek, 2005; Pilkinton, 2000)

Schnieder"s theory may be useful in both the reciprocal-interactionist as well as the unitary Rogerian paradigm. Her paper is an example of describing a phenomenon in two languages- the language of interactive process toward change (phases of healing) and the unitary framework--change is innovative and a manifestation of "ever increasing frequency patterning". Schnieder uses Rogers to frame her results by applying Barrett"s theory of power as knowing participation in change. As her participants healed they became more aware of their own power which was experienced as a #manifestation of a higher frequency pattern". Their spiritual awareness, and their choosing to actively participate in change, increased as their process evolved. Change, exemplified in exceptional healing, was manifest as innovative and unexpected which was not the same as straight forward joining of parts, as in wound healing.

Nurses have conceptually written about healing from various perspectives including a "transpersonal" perspective (Hover-Kramer, 1989) and as "integrated awareness" (Phillips& Bramlett , 1994). Healing has been linked to relationship (Quinn et al, 2003), to consciousness (Newman 1997), to spirituality (Perkins, 2003) and to environments. Consistently scholars link healing in one way or another with expanding awareness, consciousness, intention(ality), therapeutic relationship, enhanced spirituality, and whole, or unitary, change. "Healing" whether #spontaneous" and unexpected, or more protracted and subtle, is viewed ultimately as a positive multifaceted event (intervention, process and outcome). It is impossible to discuss this concept without grappling with concepts of change and transformation. Pilkington (2000) reviewed numerous philosophical and nursing theories regarding change. She concluded that in the unitary-transfomative paradigm change is associated with persistence and intentionality.

Since the 1990's when Schnieder did her study, few nurses have formally studied healing in order to build data based theoretical frameworks about the characteristics and process of healing. Zahourek (2002, 2005) and Cowling (2006, 2009) have been using qualitative data to build healing theory in a unitary-transformative paradigm. In her unitary theory of intentionality as the matrix for healing, Zahourek (2002), contends that healing is "a dynamic, transformational and ongoing process in which individuals" experience a shift in their being and feel they have significantly changed" (p. 351) . Healing is the restored or reawakened awareness of one's inherent wholeness following a period of actual, or perceived, fragmentation. The awareness, and recognition and utilization of those shifts occur in concert with, and as a result of, intentionality. Just as healers are healees and healees become healers, the characteristics of both healing and intentionality overlap in an evolutionary spiraling process of change. Both healing and expanded intentionality are manifest as sensations of connection with others, oneness with the universe, a shift in a sense of self, and a new awareness of meaning, wholeness and completeness. This awareness is both transcendent and transformational; intentionality enables the person to be fully aware and participate in the change.

Cowling is developing a unitary transformative theory of healing derived from his work on despair with women who have been abused as children (Cowling, 2006; Cowling & Repede, in press 2009). He identifies six focal and process aspects from the conceptual and theoretical structure of unitary healing that may be used as the grounds for a unitary healing practice. These include: wholeness, appreciation, participation, knowledge, emancipation, and change/transformation. Cowling's qualitative research methodology, Unitary Appreciative Inquiry, fits well with a Rogerian framework with its emphasis on identifying pattern. Like Schnieder, Cowling draws on Barrett's theory in viewing the healing process as having the freedom to intentionally participate in change. "Change and transformation are expressed in manifestations that emerge from the appreciative and participatory processes used in unitary healing. They are closely associated with innovative and creative consciousness and knowing that suggest possibilities to fulfill dreams and visions of those engaged in these processes--both the nurse and client benefit from this engagement ... Through using an appreciative stance toward the wholeness of life, encouraging knowing participation in change, and using awareness and action aimed at emancipation, change and transformation are shaped by the individuals who seek the assistance of nursing".

In summary, Schnieder's work on studying exceptional healing using a Rogerian framework is an important work for those interested in pursuing a theoretical and practice base for healing. More research is needed and from various perspectives. Research methods developed particularly using a Rogerian framework as well as other frameworks developed with a unitary transformative perspective should be strongly considered and tested.


Cowling, W. R. (2006). Unitary healing praxis model for women in despair. Nursing Science Quarterly19 2 123-132.

Cowling, W. R. & Repede, E. (in press). Consciousness and knowing: The patterning of the whole. In R. C. Locsin, & M. J. Purnell (Eds.), A contemporary process of nursing: The (Un)bearable weight of knowing persons. New York: Springer.

Hover-Kramer, D. (1989) Creating a context for self healing: The transpersonal perspective. Holistic Nursing Practice 3, 3 , 27-34.

Newman, M. (1997). Experiencing the whole. Advances in Nursing Science, 20, 1, 34-39.

Perkins, J.B. (2003) Healing through spirit: The experience of the eternal in the everyday. Visions: The Journal of Rogerian Science 11, 1, 29-42.

Pert, C. (1993) The chemical communicators. In Bill Moyers Healing and the Mind. New York: Doubleday, 177-193.

Phillips, B.B., & Bramlett, M.H. (1994) Integrated awareness: A key to the pattern of mutual process. Visions: The Journal of Rogerian Science 2, 1, 19-34.

Pilkington, B.F. (2000). A Unitary view of persistence-change. Nursing Science Quarterly 13 1, 5-11.

Quinn, J.F., Smith, M., Rittenbaugh, C., Swanson, K, Watson, J.M. (2003)Research guidelines for assessing the impact of the healing relationship in clinical nursing. Definitions and standards in healing research supplement to Alternative Therapies in Health and Medicine 9 3 A65-A79.

Zahourek, R.P. (2002) Intentionality: The matrix for healing. Doctoral dissertation. NYU Division of Nursing, School of Education.

Zahourek, R.P. (2005). Intentionality: Evolutionary development in healing. Journal of Holistic Nursing 23 1, 89-109.

Rothlyn Zahourek. PhD, PMHCNS-BC, AHN-BC
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Author:Zahourek, Rothlyn
Publication:Visions: The Journal of Rogerian Nursing Science
Geographic Code:1USA
Date:Jul 1, 2008
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