The Therapeutic Covenant
Richard Irons, MD, FASAM

The quality of the healing relationship rather than the technique may be the hidden foundation for healing. This special bond, created from compassion, trust, and the courage to move forward together, transforms the therapeutic process from curing to healing. From the joining of hearts and minds comes the realization that we are indeed one in our suffering. In the presence of this covenant, both healer and patient explore the depth of their experiences and resources. It is through this unity that both parties can indeed be healed.
-Shakti Gawain

Many who seek recovery from an addiction hope or dream of being cured. They believe that curing their addiction would make them a "former addict" that is able to regard their substance of choice as equivalent to any other substance in the world. Gone would be the core belief system that ascribes magical, mystical, romantic and pleasurable qualities to the substance. Gone also would be the anxiety associated with using the substance again, or having the strong cravings and unmerciful desire associated with a behavioral relapse. And absent would be the fears of using or the discomfort some experience when they encounter triggers to use or catalytic events and environments that have been associated with use in the past. To be cured would be to experience release from the chains, the craving, the stigma, and the burden of guilt associated with identification as an addict.

Yet, centuries of experience have amply demonstrated that cure is virtually never seen in those who have become addicted. Addictions are chronic diseases, often characterized by episodic relapses in thinking, or sometimes return to use of our substance of choice. Even if that can be avoided, a transition into some other addictive substance or behavior can be just as devastating. If addiction cannot be cured, but only put into remission, is it any wonder that many patients grow weary of the struggle and see little hope? They fall into relapse or despair. A significant cause of this loss of hope is the confusion that many have between curing and healing an addictive disorder.

Cure requires a return to the physiologic and mental state a person was in prior to acquiring a disorder. Some infectious diseases are cured. Many bacterial infections are cured as a result of both the administration of antibiotics and the ability of the immune system to complete the process. As a result, one is restored to a state of health without residual wounds or lasting effects of the disorder. Many chronic illnesses are incurable, that is they cannot be fully arrested or leave one with a legacy that results in a state of health that remains permanently lower than that experienced prior to the malady's onset. Even though many disorders cannot be cured, healing can and does occur.

For genuine healing is a journey, facilitated by a healer, into a broken and hurt self, the purpose of which is to encounter a depth of humanity deeper than the tragedy of any illness. The result is growth along spiritual lines, a spiritual awakening that transcends the body/mind into a new level of perception and being. Health is experienced from a new perspective, and effective human functioning is enhanced, often to levels beyond that which was experienced prior to the onset of the malady.

The self-conscious professional is not interested in cure of addiction but rather in healing. The wise counselor knows the true path into the core of the disorder. At the core, the patient must come to terms with certain tightly held toxic beliefs Genuine healing is a journey, facilitated by a healer, into a broken and hurt self, the purpose of which is to encounter a depth of humanity deeper than the tragedy of any illness.

The healing potential in the professional?patient relationship is facilitated by the inherent powers differential between the professional and patient that come together to engage in the treatment process. This treatment, commonly referred to in the addiction nomenclature as rehabilitation, includes not only the relief of pain and suffering, but also the restoration of hope and promotion of healing for the patient. Each patient attempts to muster enough courage and faith to trust in the professional, and implement the instructions and counsel given. The relationship between "healer" and "patient" is created from compassion, vulnerability and trust. This defines an effective treatment process. The therapeutic relationship becomes a container, a crucible in which we encounter the source of desires, fears, weaknesses, destruction, shortcomings, defects of character and violence.

The role of the healer is to guide those who have fallen out of balance while living to re-establish harmony and wellness in their lives. Healers attune themselves to their own innate healing capacity, and use knowledge gained in training to lead those they serve to honesty and self-discovery. Each disorder, every defect encountered can be regarded as a teacher that can demonstrate how we have deviated from our true path, our effective human functioning, our wellness, our family, and from our spiritual growth. Healing can go beyond the self to heal family relationships and community imbalances, for when one person completes an effective shift in their perception and state of being, every other person in their family and social network will be affected. The paradox of healing is often that one must "die" to old ways of perceiving existence in order to lovingly embrace this body and mind which inhabits the world to live not on the terms established by our ego, but on the terms that life itself offers. In reaching to embrace the world, to become one with our Higher Self and others, with Life in a larger sense, we are able to experience genuine healing. This involves:

- Non-judgmental moment to moment awareness of the world
- Living in the present rather than the past or possible future
- A commitment to be intimately involved with the lives of others around us in a healthy and non-dependent manner
- The willingness to love ourselves and others with fewer conditions and requirements

The joining of hearts and minds for healing in this manner leads to the realization that all professionals and the patients they serve are indeed one in their suffering. In the protected container of the therapeutic relationship, both healer and patient may plumb the depth of their experiences and resources. It is through this kind of unity that both parties can discern a path to genuine healing. Such miracles are experiences of spiritual growth, but they may not have directly observable signs or immediate effects. Ted Kaptchuk, describes the healing professional as "one who takes their patient into the disorder and brokenness, whether it is curable or incurable, to find an intactness and reconciliation that profoundly reflects and manifests the genuine self." Hugh Prather tells us a healing professional "merely offers a vision and path for healing but does not watch over the patient to say in what form this gift is to be received." This approach frees the healer to engage in the process wholeheartedly, unhampered by assuming responsibility for the results experienced by the patient.

Since the origin of the healing professions, standards of conduct and ethical codes have been established by and for those who practice healthcare vocations. Sometimes it is difficult to remember that healers are human and subject to the same maladies, desires and shortcomings as those they serve. Despite being held to high moral and ethical standards, some may fail to remain godlike and perfect in the discharge of duties. The temptation to abuse power and privilege for personal gain and gratification may be too enticing. Whenever a healer's mind begins to attack, to separate itself from another to use them and the situation to advance the ego's own agenda, then true healing becomes impossible, and there is danger of additional pain and suffering for the healer and the patient. Healers can and do become wounded in service, and encounter their own vulnerabilities in the process of helping others. However, leading another to honesty and self-discovery promotes healing of the true Self, and promotes not only meaningful recovery but also spiritual growth for both parties. The healing process involves finding, touching, and loving the deepest sense and darkest recesses of another, while remaining honest and respectful of their spirit, needs and best interests. The healer serves as a reflective mirror of what is discovered while simultaneously serving as a role model to inspire the patient to trust the process of discovery. With time and effort a patient may come to discover who they really are, including an honest appreciation of the beauty, talent, aptitude and strength endowed to them in this life yet never fully utilized. The healer has the privilege of witnessing this transformation; and documenting, celebrating this healing...the very healing that we all have all taken birth for.

The quality of the healing relationship rather than any particular skill or technique may well be the hidden foundation for true healing. The therapeutic covenant is a special bond created from compassion, trust, and courage to move forward together, which catalyzes and energizes the therapeutic process, facilitating healing. The professional must at all times maintain safe and healthy boundaries that protect while empowering, and that assure fiduciary responsibility while promoting the free expression of feelings and concerns by the patient. A fiduciary is considered to be a person who stands in a special relation of trust, confidence, or responsibility in his obligations to others. Changes in technology, conflicting expectations of confidentiality, and disparity in sensitivity to the needs, feelings, and vulnerabilities of patients will continue to make the definition and maintenance of these covenants challenging. However, the importance of maintaining the therapeutic covenants will remain crucial for any professional that endeavors to facilitate genuine healing in their patients.

A positive, life-affirming attitude is crucial to promoting the healing process. Effective healing is manifested not only by changes in our body and physical health, but also from a shift in perception of ourselves in the world we encounter. Healing involves letting go of fear in all of its forms and taking responsibility for the present. Yet such simplicity is difficult for an ego-intoxicated mind to understand. We are often healed into truth very gradually. A person who seeks to continue refining the ability to listen and truly hear within and without their body/mind will continue to heal. To hear the words of others and, as the Quakers often put it, our own "still small voice within" at the same time and on more subtle levels remains a challenge for each of us whether we are in the role of helping professional or patient. .

The reason we have taken birth is to rediscover the deeper, wiser, numinous parts of ourselves. The problems, losses, and maladies we encounter along the way are opportunities as well as threats, and grist for the mill. Love is the common denominator that is the foundation of all successful healing. Healing as defined here is more than a body free of disease, disorder, victimization or injury, but also a capacity for genuine forgiveness of self and others. Healing in this sense is a process of personal transformation, of merging with our higher Self, and our Higher Power.