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what is securebasing?

 

Securebasing describes how a person can create a safe emotional environment for another person. 

Our term 'securebasing' is based on Dr. John Bowlby's concept of the 'secure base', which he used to describe an available, caring and responsive parent. 

Secure base has also been used to refer to the characteristics of a compassionate, caring healthcare provider (Gerretson and Myers, 2008). A health professional creates a secure base by being emotionally available and assuring his or her patients that they will not be alone in their suffering. This concept has also been applied to hospital staff who also can create a secure emotional environment for their patients (Adshead, 1998).

With securebasing, patients feel more comfortable to share their concerns with their healthcare providers.


 

Attachment theory [more]

Attachment theory

  • Attachment theory is model about human development from which the terms secure base and securebasing come.
  • Attachment theory suggests that all persons lay down memories, even ones that are not easy to remember all the details about, based on earlier experiences - good or bad.
  • These memories can last into adulthood and may influence how people act around others later in life, particularly at times of high stress, such as when an illness is acting up.  

The path to securebasing [more]

The path to securebasing

  • People who are paying attention to securebasing consider not only what is said but how things are said, i.e. saying things in way that increases trust.
  • Also, in healthcare settings, aspects of 'bedside manner' are taken into consideration and used whenever possible. Examples include:
    • making greater eye contact, e.g. ensuring that time looking at a computer screen does not compete with time looking at a patient
    • when running behind, apologizing for being late
    • considering appropriate body posture during an interaction
    • asking about and addressing a patient’s preferences
  • Such measures taken by healthcare providers can make it easier for patients to trust others and to share with healthcare providers and teams.
  • Helping patients overcome difficulties and barriers in the healthcare system can also be a form of securebasing. Such 'customer service' oriented measures can help to build trust and reduce the stress or impact of the following:
    • difficult payment structures
    • difficult eligibility criteria for receiving care
    • long lines and wait times
    • over-reliance on voice mail responses
    • decreased clinical face-to-face time between patient and provider
    • rashly delivered health information
    • unavailability of support between healthcare visits 

Examples of securebasing [more]

Examples of securebasing


The following quotes are from "The interpersonal experience of healthcare through the eyes of patients with diabetes" (Ciechanowski and Katon, Social Sciences and Medicine, 2006).

Of course, when she is sitting on the step that pulls out on the bottom of the examination table, you can’t help to think of her as a person… ‘Cause she’s kind of sitting down there. And that’s important. You know, body language is really important. She pulled that thing out, sat down. This is two times in a row! 
 
And I feel comfortable saying I don’t have good coverage for a specific treatment…. “Can we consider something else?”…Whereas with the other doctor, I never would have thought about it, because he would be, “This is what I ordered and that’s what you’re going to be on.”
 
She finds something good no matter what. There’s not much when you get a bad report. She always finds some good in there. She works on the positive and I like that instead of always the negative, you know, like a lot of doctors do.
 
But somehow the way she approaches her practice of working with diabetic [patients]…at least for me, she has been able to communicate a sense of “I am bigger than this disease” and that together as a team this can be managed. And it’s not something that is so big and so powerful.
 
Uh, Doctor Z, I don’t know too well yet. But I feel comfortable in the fact that if I come with a question, no matter what it might be, I can ask. 
 
He doesn’t just come in, do your treatment and leave. He kind of talks, you know, “How things going? Tell me about yourself”, and he has a fabulous memory. He remembers about those things that you tell him….I don’t know if it’s just a really good memory, or he puts notes in the chart, or whatever, but it’s just……he makes you feel comfortable coming in…. With my doctor who I have now, I feel like I can be my weird, twisted self and my doctor understands that.

References [more]

References

  • Adshead G.
Psychiatric staff as attachment figures. Understanding management problems in psychiatric services in the light of attachment theory.
Br J Psychiatry 1998;172:64–9.
  • Bowlby J.
Separation: Anxiety and Anger. 
New York, NY, USA: Basic Books, 1973. 
  • Gerretsen P, Myers J.
The physician: A secure base.
J Clinical Oncology 2008; 26(32): 5294-5296.
  • Ciechanowski P.
Hidden exchanges: Working with relationship styles to improve patient-provider relationships.
Current Medical Literature: Diabetes. 2007;24(2):35-42.
Click for pdf (available with permission from Remedica)
  • Ciechanowski P.
As fundamental as nouns and verbs? Towards an integration of attachment theory in medical training
Medical Education. 2010;44:122-124.
Click for pdf (available with permission from Medical Education)
  • Ciechanowski P, Katon WJ, Russo JE, Walker EA. 
  • Ciechanowski P, Walker EA, Katon WJ, Russo J.
  • Ciechanowski P, Katon W, Russo J, Dwight-Johnson MM.
  • Ciechanowski PS, Hirsch IB, Katon WJ.
  • Ciechanowski P.
Working with interpersonal styles in the patient-provider relationship.
In: Practical Psychology for Diabetes Clinicians, Anderson BJ, Rubin RR (Eds.), American Diabetes Association, Second Edition, 2002.
  • Thompson D, Ciechanowski PS.
Attaching a new understanding to the patient-physician relationship in family practice.
J Am Board Fam Pract. 2003;16(3):219-26.
  • Ciechanowski P, Sullivan M, Jensen M, Romano J, Summers H.
The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain.
Pain. 2003;104(3):627-37.
  • Ciechanowski P, Russo JE, Katon WJ, Walker EA.
Attachment theory in health care: The influence of relationship style on medical students’ specialty choice. 
Med Educ. 2004;38(3):262-70.
  • Ciechanowski P, Katon W, Russo J, Von Korff M, Ludman E, Lin E, Simon G, Bush T.
  • Ciechanowski P, Katon W, Russo J.
The association of depression and perceptions of interpersonal relationships in patients with diabetes.
J Psychosomatic Med. 2005;58(2):139-44.
  • Ciechanowski PS, Russo JE, Katon W, Von Korff M, Simon GE, Lin EHB, Ludman EJ, Young BA.
Association of patient relationship style and outcomes in collaborative care treatment for depression in patients with diabetes.
Med Care. 2006;44:283-291.
  • Ciechanowski P, Katon W, Russo J, et al. 
Where is the patient?  The association of psychosocial factors with missed primary care appointments in patients with diabetes. 
Gen Hosp Psychiatry. 2006;28(1):9-17.
  • Ciechanowski PS, Worley LM, Russo JE, Katon WJ.
  • Ciechanowski PS, Katon WJ.
The interpersonal experience of health care through the eyes of patients with diabetes.
Soc Sci Med. 2006;63(12):3067-79.
  • Sullivan MD, Ciechanowski PS, Russo JE, Soine LA, Jordan-Keith K, Ting HH, Caldwell JH.
Understanding why patients delay seeking care for acute coronary syndromes.
Circ Cardiovasc Qual Outcomes. 2009;2(3):148-54. 
  • Ciechanowski P, Russo J, Katon WJ, Lin EH, Ludman E, Heckbert S, Von Korff M, Williams LH, Young BA.
Relationship styles and mortality in patients with diabetes. 
Diabetes Care. 2010;33(3):539-44.
  • Maunder RG, Hunter JJ.
Assessing patterns of adult attachment in medical patients.
Gen Hosp Psychiatry. 2009;31(2):123-30.

And the non-verbal communication: The sound of his voice, the pitch of his body, the way he tries to maintain his schedule, what he has to say and how he says it when he can’t – just being human... 

Someone that is just open – if you meet them, they’ll shake your hand and say hello and look at you, you know, and take a little bit of time to see what you’re about before they just look at your chart and say – and judge, and just put you in this block – “Okay, you’re this” and not talk to you or get your point of view about it.
- A patient describing securebasing.
From Ciechanowski & Katon, 2006.
 

 

  
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