Relationship Power in Health Care: Science of Behavior Change, Decision Making, and Clinician Self-Care

Book Title: Relationship Power in Health Care: Science of Behavior Change, Decision Making, and Clinician Self-Care
Book Authors: John Livingstone and Joanne Gaffney
Publication Information: Boca Raton, FL, Taylor & Francis, 2016, 272 pp., $44.05, paperback

Producing long-lasting behavioral and lifestyle changes for patients is a challenging goal for many in health care. As a result, providers may not only use unwarranted variations of treatment for complex problems, but also experience rates of burnout and compassion fatigue from high-utilizing patients. Relationship Power in Health Care helps address these training and competency gaps, providing concrete information on theoretical orientations, decision-making skills and interviewing techniques to address complex patient visits and problems. John Livingstone and Joanne Gaffney, two skilled providers with extensive psychotherapy experience, offer a wealth of knowledge from their clinical and educator roles in medical schools and training programs. Throughout this text, it was impressive to read the authors’ mission to improve the science of relationships in medicine, both between providers and patients, and the psychological state of providers themselves.

The book is divided into five distinct parts, with web-based case studies that are effectively woven into different sections. The first part is a nice refresher for providers to acknowledge the importance of interpersonal relationships and patient-centered skills when improving patient encounters. The second part presents certain behavior change models (eg, transtheoretical model, health belief model) and decision-making models (eg, shared medical decision-making, clinical intuition) that can be applied in practice with patients and families. The authors expand on the principles of relationship psychology and the advances in neuroscience with a dense but thorough review of evidenced-based treatment models. Part three introduces how clinicians can integrate past and present models of care, while formulating new hypotheses of decision-making that impact the wellness areas of providers. The fourth part transitions into specific interviewing skills that are important for providers to acquire in routine practice, following up more in-depth on the clinical case vignettes from part one. In the fifth section, specific tips and suggestions are offered for educators of health care trainees, along with information on health coaching and future research in this area. It was a little surprising how briefly this last section was covered, given the authors’ backgrounds as advocates for student and resident education.

Overall, the book is well written and educates multiple providers on improving the relationships between both health care teams and patients. Several chapters (specifically chapters 9, 10, and 11 on interviewing skills) could be used as instructional material for residents, behavioral health providers, nurses, and administrators. The online modules are also a novel way to apply the skills and techniques highlighted in the text, illustrating the thoughts that both authors had of each health scenario. These scenarios illustrate effective interviewing skills applied by Gaffney to a number of clinical issues, such as smoking cessation, management of diabetes, and decision-making processes around breast cancer. While the book does not offer as many hands-on skills as other books on health behavior change, motivational interviewing or provider burnout, the authors do provide a thorough theoretical context to traditional psychotherapy and neuroscience practices.

There were only a few disappointments. While the authors cover a variety of clinical topics around theory, health decision-making, and interviewing skills in practice, it almost felt that there were three separate books compressed into one. The book would have been better served by focusing strictly on behavioral interventions and approaches to use with patients in a variety of health care settings. Attempting to address clinician burnout and fatigue in practice would have warranted a deeper explanation of this phenomenon, where recent texts highlight health consequences and wellness strategies in full depth. Additionally, most of the theoretical models and interviewing skills did not have a strong family or caregiver focus. Because many medical disciplines do not receive adequate systems training or family interviewing techniques, one of the case vignettes could have included a family case that demonstrates social and relational issues tied into the presenting medical problem.

Relationship Power in Health Care shows strong application of the teamwork and collaboration needed in primary care and other collaborative settings. As a behavioral health provider and educator for residents, I have seen first-hand the importance of developing strong interpersonal relationships with other providers in practice. Livingston and Gaffney offer valuable ways for clinicians to not only deepen their patient-centered skills, but also to emphasize a team-based approach to help patients and families make better-informed decisions around their health. As our health care system is placing increased pressures on medical providers regarding outcomes and performance, this book gives a thorough framework for providers needing tangible skills to improve both patient change and relational wellness in practice.