It might not seem rigorous to talk about tenderness as a therapeutic tool, especially in the field of care and health. Something similar can happen with compassion or with the so-called soft or personal skills: on the one hand, they are confirmed as essential to technically qualify health professionals.^1,2 And on the other hand, they are delegitimized as unscientific elements, even though they are quality differentiators.³ Even recognizing that tenderness is a human right and duty.⁴ It is somehow outside the ethical or political debate for the common good of society. We can position tenderness as one of the basis of ethical care⁵ because, as a human attitude, it is totally opposed to cruelty but the closest to giving fair and humane treatment to others.⁶ Let's start from the Boff´s⁷ “it is the affection that we offer to people and the care that we apply to existential situations, and it breaks out when the subject decenters himself, goes towards the other, feels the other as another, participates in his existence and lets himself be touched by others life stories”.

When we care for other with tenderness, we stop being the center and pay attention to what that other is and needs, regardless of whether it matches with our way of seeing life. Tenderness humanizes us, without a doubt, because it frees us up from self-referentiality and helps us pay attention to the other. This is why tenderness is therapeutic for the one who applies it and for the one who receives it, like a permanent round trip. How can we doubt that what makes us more human also makes us more professionally capable? There is multiple scientific evidence indicating that there are symptoms of the disease that are alleviated when there is tenderness: agitation, pain, breathing difficulties, anxiety... It is measurable. It is provable. It is part of our biography.⁸ A prestigious doctor and essayist, already complain about the fact that scientific studies on love and tenderness "are forgotten by the University, postponed by researchers, neglected by the large companies that protect science”.

In the field of scientific knowledge we sometimes forget that what we are looking for is to get closer to the greatest truth of the studied object and not simply to measure it. If we really believe that the object of research is to generate knowledge that transforms the world, if we believe that the object of our care is the well-being of the person who suffers, then we will not be able to rule tenderness as a way of knowledge and a therapeutic tool. Something therapeutic, by definition, what it is aimed at treating some ailment or suffering. Etymologically, it comes from the Greek verb therapeuein (heal): care, care, relieve; and from a derived noun, therapon (therapist): squire, the one who helps the warrior). Therefore, it could be assumed that the one who cares is a servant, a squire, a companion of the warrior. This is our job. The warriour is undoubtedly, the person who suffers and struggles in this vital continuum between health and illness that we all go through, from the moment we are born until we die. If this is so, the main tool of our work is ourselves, our attitude, our look, our gestures, our tone of voice, our words and silences, our decisions. When a person faces the vulnerability of the disease, drugs and medical techniques are not the only need. Above all, the main need is do not only need drugs or techniques. The main need is to be tenderly cared. There is the need to being looked in the eye, to be made felt not alone or withou control over one´s body and privacy. That is being tenderly cared for.

Tenderness and time

Tenderness, like love, implies time. Love cannot grow quickly and there is never enough time in healthcare practice; in fact in any work. Possibly because we do not value the presence above other supposedly more effective results.

It is truly impossible to care quickly tenderly. The rush speaks of something else. Tenderness requires a certain softness in treating others, going slowly and avoiding a power or authority positioning. That is the maximum expression of the desire for the other to be well and to be perceived as important, dignified.

We are not talking about amount of time. It is the way we enter a room or remove the bedding. It is the way we live that moment. Dr. Elisabeth Kübler-Ross, who accompanied thousands of people at the end of life, affirmed that the memories that most accompany us at the end have nothing to do with successes but with experiences where a profound encounter with a significant someone takes place, a moment of intimacy loaded with meaning: words of gratitude, caresses, glances, a goodbye, a reunion, a thank you, a sorry. It is those moments that remain recorded: moments of selfless love (tenderness) and mutual care.

Tenderness and tactful communication

Tenderness is essentially communication. It is not a data exchange. For this reason, it is closely linked to the body and, in a special way, to touch. Few basic clinical procedures can do without personal contact and therefore tenderness. Touching us has value because it is valuable, it brings us good. The Lancet recently published an article in which Horton⁹ wonders why doctors barely touch their patients and concluded that the mere physical examination, touching (with tenderness, I add), communicates comfort and interest in the person. Being told: “you have the right to exist as you are; as you are, it's fine; here you are safe."

How important are our hands in care! Touching another's hand balances affection and respect very well, it is intimate and not invasive. However, if it is rudely and coldly done, it can make the other feel de-personalized. Like an object and not a person. Words can be right or wrong. Physical contact reaches the brain directly, without translation. Because the well-being or discomfort it causes is immediate. A health professional can learn various techniques and tell the patient that he or she is our main concern, but if a contradiction is perceived, the person will be left with the feeling of having been treated delicately or arrogantly, if our hand was respectful or rather shaken violently.

Tenderness and self-care

Despite defending clinical practice in multidisciplinary teams, it is common to see power struggles between roles. Where there is tenderness, there is no rivalry. Tenderness never competes. Tenderness seeks to generate bonds; it does not claim anything. Competitiveness does. How have we come to convince ourselves that being aggressive and self-sufficient makes us better people and better professionals? Tenderness heals and saves us, first, from ourselves. That is why it makes us happier and more professionally competent. It reconciles us with our human frailty and opens us to the wealth of possibilities and resources that the truly human also engenders. Choosing tenderness as a way of being and exercising our knowledge is like a caress: it is impossible to give it without receiving it. The tenderness that we give becomes well received: attentive listening, a kind gesture, the demonstration of interest in the other, without compensation.

Being tender is brave and it is an act of maturity.¹⁰ Someone self-sufficient, rigid, who does not want to depend on anyone for anything, will not be able to enjoy tenderness or cause tenderness in anyone. Irony, arrogance, emotional distance scares away any gesture of tenderness and opens an abyss with the one we care for. As Ola Tokarczuck¹¹ said in her speech upon receiving the Nobel Prize for Literature in 2018, “tenderness is the most modest form of love. It appears when we look closely and carefully at another being, at something that is not our "I" but where we discover ourselves.¹¹ To recognize the other as another is to respect their dignity.

We can all be therapeutic, a hand that nourishes, cares, grows and heals. And we are all like a bird in the middle of a snowfall, needing to be recognized and respected, cared for. With the greatest technical excellence possible and with the greatest dose of tenderness that humanizes us and makes our environment a kinder place to get sick, heal and live.

None.

The authors declares that there are no conflict of interests.

1. Bermejo J, Muñoz C, Villacieros M. Conceptualization of professional competence in the field of health humanization. Delphi study. Ethics of Care. 2021;14:e13869.
2. Esquirol JM. Human, more human, an anthropology of the infinite wound. 2021.
3. Pérez FM, Molero JM, Herrera PI, et al. Proposal for a humanization model based on personal competences HUMAS model. Eur J Health Res. 2019;5(1):63–77.
4. Restrepo LC. The right to tenderness. Arango Publishers. 1997.
5. Moreno E. The tenderness is urgent. Professional practices in mental health and rights of children and adolescents. Frontiers.2022;18:94–105.
6. Ulloa F. where cruelty is born. The Nation. 1999.
7. Boff L. Ethics of the human, compassion for the Earth. Essential Care. 2002.
8. Carballo R. Man as encounter. Vobiscum Bookstore. 1973.
9. Horton R. Offline: touch–the first language. Lancet. 2019;394(10206):1310.
10. Torralba F. Tenderness. 2010.
11. Tokarczuck O. The tender narrator speech. Nobel Prize for Literature 2018. School of Athenas. 2018.