steve graybar phd

I have been immersed in both health psychology and medical family therapy since my fellowship at the University of Rochester School of Medicine in the early 1990’s. Both health psychology and medical family therapy are grounded in a bio-psycho-social model of health and illness. This model views health and illness as a combination of biological, psychological (thoughts, feelings, behaviors) and social factors. Health psychology attempts to draw on psychological principles to promote health and intervene in illness. It does not blame people for their illnesses or disabilities or find psychological causes or cures for their diseases. In my work, I seek to help client efforts to cope with chronic illness, recover from acute and serious illness and find comfort and meaning in the wake of terminal illness. Medical family therapy focuses on the role illness plays in the lives of patients and families. This approach attempts to foster collaboration between and among patients, their families and their medical team in order to facilitate the most effective treatment outcomes possible. Ultimately, medical family therapy seeks to draw from and utilize the love, support and wisdom of family and friends to help patients cope with and recover from disease and disability.

While the bio-psycho-social model provides a theoretical framework for health psychology and medical family therapy, applied research has provided the foundation for my interventions. Studies from across the field have been synthesized and integrated into three oddly named but very useful concepts-agency, communion and meaning. We know that if patients can access the experience and emotions connected with agency, communion and meaning they frequently enjoy better short and long-term outcomes whether they have an acute, chronic or terminal illness.


Agency involves feeling empowered and effective about your health, health care and medical situation. When we feel agency we feel we have choices and can take steps that influence the quality of our health and treatment. Agency is a sense of personal activism in the face of all that is unclear and uncertain about our illness and its’ treatment. Being an active agent in our illness and health care means learning all that one can about the disease, its cause, expected course and treatment. Being an active agent means collaborating and sharing decision-making with your health care team. It is the opposite of being passive, helpless or simply going along with the program. Having a sense of agency means participating in your health care actively, honestly, respectfully and collaboratively. Ultimately, it means being calm, clear and confident about what you want and need.


Communion is a peculiar name for social support. But the phrase “social support” doesn’t really do justice to what is meant by communion. Serious, chronic and terminal illness can precipitate a personal crisis that can isolate people and create additional health consequences for them. Communion refers to the strengthening of the emotional and spiritual bonds that can be frayed, damaged, even destroyed by illness. Moving through an illness and the health care system can be a very frightening, confusing and lonely experience. To minimize the isolating effects of illness it is important to develop and accept support from multiple sources- family, friends, clergy, fellow patients and available health care providers. Developing these relationships provides us with greater access to information, personal options, compassion and wisdom- all of which can buffer us against a debilitating illness, an imperfect health care system, misinformation and fear.


Meaning is not something one can offer, provide or even suggest to another person. Yet, we know from research, people who find meaning in their pain or meaning in their suffering some how lighten the load of illness, it’s treatment and their combined impact. Finding meaning in pain and discomfort is not another form of denial. It is a way of softening the painful and often unanswerable questions of why me, why now or why this disease? Finding meaning in such suffering often involves answering the question, has anything good come of this experience? Not, do you like it? Not, could things have been worse? But has anything positive come from this pain, this discomfort or this fate? I have heard many profound answers to this question and they have come from sick children, teens and adults.

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