Sunday, March 31, 2019

12. Some early mistakes in my practice

Looking back at the early years of my practice, I sometimes cringe with shame at some of the mistakes I made.  These were not, as some people might assume, to do with my very basic understanding of the elements, or my choice of treatments, although they, too, were with hindsight often rather naïve or even somewhat inappropriate.  Instead they were nearly all to do with my relationship to my patients.  Based on something which JR Worsley had impressed upon us, I somehow thought that I had to make myself available to my patients at all times, even interpreting what he said as meaning that a patient should be able to contact me at any time they wanted to.  Those were the days well before emails and mobile phones when patient-practitioner contact was nearly 100% by good old-fashioned telephone.  Since I worked from home, I soon realised that I needed to install a dedicated practice line so as not to confuse my private with my professional phone calls.  This meant also having two answering machines, making quite an impressive array of phone equipment lining my kitchen shelf.

I still remember the excitement of coming back home and seeing the “message received” light blinking on my practice phone.  I would always hope that this meant that a new patient was making contact, for each new patient was then a highly exciting event.  There was, however, one definite advantage of patients having to get in touch with me by phone, and not, as usually happens nowadays, by email or text message.  This meant that when I answered them our first contact was always person-to-person, and not the much more impersonal contact of the written word through emails.  It is now often overlooked how important this initial contact can be, not only because it offers both patient and practitioner a bridge to that key aspect of five element treatment, which is the setting up of a good relationship with our patients, but it also gives us the luxury of a first attempt at trying to diagnose two key components of an element’s presence, the tone of voice and the emotion the patient is showing.  On the patient’s side, it helps get them past the often challenging situation of a first meeting in the practice room.  I felt that this first phone call shaped the nature of my future relationship to my patients.

But the flipside of these personal phone calls was that it gave my patients the impression that they could phone me whenever they wanted to, and this was where I started to make things difficult for myself.  I didn’t then have enough confidence to lay down careful guidelines as to when they could phone and what they could phone me about.  And I soon found this led to a further mistake.  Patients got used to phoning me at odd hours of the day, either early in the morning or, most often, rather late in the evening.  And I would find myself engaged in long conversations with them, all of which, I should have told them, were best suited to being continued at their next treatment.  It took me quite some time, and many interrupted evenings of phone calls, before I realised that what the patients and I were talking about belonged much more appropriately to the practice room, where it would help me determine the kind of treatment the patient needed.  As five element acupuncturists it is the treatment we offer our patient which helps solve their problems, and although five element acupuncture is partly a talking therapy, because of course our patients need to talk to us and we to them, it is good to remember that it is the needle, not our words, which eventually helps them.

This open-door, or rather open-telephone, policy of mine also opened the door to the thorny question of discussing the element I was treating them on.  I learnt to my cost that it is never a good idea to talk this through with a patient, because often one of the reasons for doing this can be our unconscious desire for reassurance from the patient that we are on the right track, and it is surely not their task to help us.  We are often hoping that they will confirm that we have made the right choice.  I have come to realise that nobody, even the most experienced five element practitioner, is good at diagnosing their own element, though practitioners often like to feel that they are the best judge of this.  Unfortunately this is rarely the case, since we all tend to be rather blind to our own faults and like to think we have a special relationship to an element whose qualities we admire.  If you mistakenly start to discuss a patient’s element with them, what do you do when you change your mind and change element, or change it several times?    Do you tell your patient this, or leave them with the mistaken idea that they are of the Earth element when you have perhaps moved through Fire before finally landing on Wood?   We all know how often we find ourselves trawling through the elements before finally finding the correct one.  Thankfully, though, this happens less and less for me now.  So take heart all you novice five element acupuncturists out there.

I always advise practitioners to lay down firm guidelines for their patients on when and how to get in touch with them between treatments, particularly now in the age of social media.   If we don’t do this, we are laying ourselves open to the possibility of patients controlling treatment.   

Finally, it is not a good idea to tell patients what points you are using apart from very occasionally.  It is difficult enough for us to put into words why we are choosing a particular point or set of points, let alone explain this to a lay person.  If they ask, I have learnt to say, “I am not here to teach you to be an acupuncturist.  If you are interested in learning more, I suggest you read my Simple Guide which explains my approach to treating you”.  The following are some of the few exceptions to this rule:  telling patients about horary and seasonal treatments (because we have to book our patients in at specific times for these), and correcting an Akabane imbalance, because patients are often fascinated to find that the readings change after treatment.  I have found that this is a very good way of convincing rather sceptical patients, particularly hard-headed businessmen, at the very start of treatment that there is something in what I do.

It is also useful to explain to patients that some of their symptoms may be the result of an entry/exit block, and obviously we need to explain in a little detail why we think a CV/GV (Ren Mai/Du Mai) block needs to be cleared.  In the case of this block I always first ask if the patient feels very exhausted all the time, a very good sign of a CV/GV block, and tell them that this is because the main pathways of energy running up and down the body are blocked, draining them of energy.  Sometimes I add the fact that JR Worsley told us that if only these points were on the wrist we would do them on every patient!

On the other hand for obvious reasons I never tell a patient that I am about to clear a Husband/Wife block or do Possession treatment, because the last thing you want to do is worry the patient by giving them the idea that there is something seriously wrong with them.  With Possession, however, I tell the patient that I am doing some lovely connecting treatment, and that I need their help to make sure that they feel each of the seven points properly.  I have noticed that patients needing this treatment really understand what I mean when I say this, as though I am reassuring them that I know that they feel disconnected.  This is also a good way of describing Possession, which is in effect a level of disconnection of the spirit.

I am passing on some of my tips for what to tell patients because I wish I had been told much of what I learnt by hit and miss through my own practice.  It would have avoided some of the problems I created for myself.

Sunday, March 24, 2019

11. Learning to build up good relationships with patients of different elements

Like all skills, we have to practise how to create a good relationship with our patients.  A successful relationship is one where we are able to match what we have to offer with what our patients need as smoothly as possible.  Here, of course, our knowledge of the elements will act as our guide, for what one person needs will differ very markedly from what somebody of a different element will need. Some people are lucky, and either by their nature or by the circumstance of their lives have an ability to empathize with other people that a fellow practitioner has first to learn, and all of us will find it easier dealing with some elements than with others.  Perhaps to some people’s surprise we are not necessarily most at our ease with those of our own element, because seeing our own needs reflected in a patient may make it difficult for us to maintain an appropriate distance.  The secret here is to recognise that we may always find certain relationships with patients of certain elements more complex and difficult than others, and remain aware of this as we engage with these patients.

I will describe some of my own reactions and difficulties with patients of certain elements. These are personal to me, and every other practitioner must study their own responses and learn from them.  But learn they must, otherwise they will not understand their patients’ needs.  More importantly their patients will not feel understood, and then their elements will take to hiding themselves away. How can a five element acupuncturist treat if we don’t know which element is crying out for help?

Nobody should think that this comes easily to any of us.  When I look back at my own practice, I can see many instances where I did not understand what a patient needed, and I offered my help in a way which was not wanted.  Inevitably it was these patients who decided quite quickly that I was not the practitioner for them.  And they were right!  How could I help somebody if I was misreading what they were asking of me?  It was as though I was talking in an emotional language foreign to these patients, or rather assuming that both of us were talking in the same language when we very obviously were not.  One way of looking at relationships with our patients is thus to see them as though they require us to learn to speak in an emotional language with which only our patient is familiar and at ease in.  We therefore need to learn to speak in a different emotional language for each patient.  And like learning any new language, this takes time and a good deal of practise.  

We all know the warm feeling we have when we have got it right with a patient.  It is those times when we know that we have not which we should accept as teaching us the most.  JR always said that it was far better if students observing him with patients did not get the elements he diagnosed right, because the only true learning is through our mistakes.

If I look at my relationship with the Wood element, as my first example, I realise that it has taken me a long time to work out a way of dealing with its strong needs.  I tend to go through almost the same pattern of behaviour each time I encounter a Wood patient.  I pass through an initial period of wanting to step away, as though shrinking from the push I feel coming towards me, then I experience a flicker of irritation, or more than a flicker, at feeling that I am being outmanoeuvred in some way, before I finally reach a more balanced stage of understanding, where I know that to help my Wood patient I have to stand firm and, as it were, counter-punch, however gently.

With all Fire patients, on the other hand, I experience first a slight feeling of relief, since I am moving on to the familiar territory of my own element, accompanied by an initial sense of relaxation.  Fire is the most articulate of all elements, enjoying speech as its way of communicating.  Since I, too, like communicating through speech, it is easy for the patient and me to fall into the habit of indulging in a kind of idle chatter with which we both feel at ease.  Experience has taught me, though, that I must issue a warning to myself to take care and not let the ease of this interaction divert from the reason why the patient is here.  I have to be aware, too, that in its need to make other people happy, Fire may also feel it should make light of its problems, and I have to be on the look-out in case I buy into the cheerful mask and ignore what lies beneath it. 

One way I have devised of helping me here is through the simple expedient of employing silence, a tool we too seldom use in the practice room.  I try consciously to quieten the emotional tone by reminding myself to fall silent.  Silence on my part gives my patient permission to stop any superficial chatter, and offers them the space to think out what they really need to tell me.   I have often found falling silent is the most difficult thing for me to do, and I have had to train myself to be on the alert against encouraging a babble of words to flood the practice room. 

Although it is easy for me to develop a very warm relationship with all my Fire patients, this ironically makes it harder to set the correct emotional tone which is helpful for my patients.  Familiarity does not breed contempt, far from it in this case, but it certainly breeds a false sense of relaxation.

The difficulties I experience with Earth patients are of a different kind from those with Wood or Fire.  I have found that the need to be nurtured which all Earth people have awakes an echo of the same need in me, because at some deep level within me I would like some of the same kind of nurturing I am being asked to offer Earth.  A few days ago, interestingly, an Earth practitioner told me that he finds his first interaction with his patients disturbing because he feels their differing needs tugging at his Earth element which is reluctant to offer what is being demanded of it.  

Once I am aware of this reaction in myself, I remind myself firmly that I am here for the patient and not for my own needs.  What Earth needs is not a blanket response of sympathy of the “Oh, you poor dear” kind, but instead it needs to be understood.  It wants to be heard, and wants to be heard to the end if possible without interruption.  Its thinking is a circular process, ending where it began and then beginning again.  If it is out of balance, it begins again with the same words and goes over the same ground, like an oxen tied to a circular grindstone, going round and round.  When it is in balance, this need to churn over the same thoughts is lessened, but never disappears completely.  Since its function is to process all things, thoughts as well as food, it has to perform this task endlessly as the other elements pass their energies to it for processing. 

If I remain clear that my Earth patients need to be allowed time to circle round a subject, even though I may have heard the same thing in the same words before, I am able to stand back and allow this circular movement to continue without getting irritated.  But being a quick thinker and talker myself, the slow chewing-of-the-cud which is Earth’s way of thinking can tend to irritate me and make me want to interrupt it if I am not careful.  So a warning sign goes off in my head with every Earth patient I treat:  Let the patient speak, Nora, and only interrupt or add your own comments when you have given your patient time to process his/her thoughts and express them fully in the way they want.

With Metal I seem to have a far less difficult relationship than with the other elements, perhaps because it demands space to be itself and allows me time to catch my breath, as it were.  No immediate reaction is demanded of me, except an acceptance that it wants to be the judge of how our relationship should develop in a way satisfactory to itself.  It is happy with space and is the most comfortable of all the elements with silence, for it needs silence in which to work out its own solutions to life’s problems.  This need for space and silence presents a great challenge to my Fire element, if I do not recognise it in time, and find myself starting to gabble to fill the silence.  With all Metal patients I have learnt, too, that I must hold back my own impulse to share my thoughts, for this can easily lead to a kind of role reversal since I find that I can often learn from Metal’s detached wisdom.

Metal patients are not, however, there to teach me, nor for me to teach them, but to find the support for their Metal energies which treatment will offer them.  With Metal I need say almost nothing and let the treatment do its work silently.  The practice of silence which Metal needs is that which respects its need to solve its own problems.  The silence which I have to encourage myself to offer Fire is different;  it is aimed at preventing it from talking so much that it forgets why it is coming for treatment.

Finally I come to the problems I may experience in dealing appropriately with my Water patients.  I do not find the demands Water makes upon me difficult to meet, although others may.  The need for a reassuring approach to still the panic which lies deep within the heart of all Water people is not something alien to me, but something I feel at ease with and able to offer without feeling in any way diminished.

My main difficulty comes from my inability to recognise the Water element in my patients quickly enough in the first place.  We all know how Water likes to disguise itself and hide, and it has taken me longer to detect its presence than that of the other elements.  Even now I have a tendency to see Water’s uneasy laughter as coming from Fire.  Its elusive nature will often make me question whether I am really in the presence of Water or not.  Once recognised, though, I feel able to offer what I think it needs, provided that I stay focused on the profound fears which lie beneath its often apparently confident surface.  This most ambitious of all elements, and the one most likely to get to the top of whatever profession it chooses, harbours a terrified underbelly.  I must never overlook its need for these hidden fears to be acknowledged by me, and for me to offer them the correct level of reassurance.








Sunday, March 17, 2019

10. The risks involved in trying to diagnose famous people

Since all five element acupuncturists know that diagnosing a patient’s element takes a great deal of time and patience, it is obvious that trying to do this by looking at the necessarily brief glimpses of politicians and other famous people on television or social media can at best be a rather hit and miss affair, and at worst may lead us to making completely erroneous conclusions.  I remember well that I was convinced that the film actress, Julia Roberts, was Fire, because this is how I interpreted her endless smiling.  I told all my students this until one day, a good few years later, when my understanding of the different qualities of the elements had obviously deepened, I noticed a different reaction in me to this smile.  It certainly did not warm me, but, instead, irritated me with what I now thought was its artificiality.  I realised suddenly that, rather than giving me something, as Fire always tries to do, it was demanding something of me.  Once I had noticed this, I changed my diagnosis from Fire to Earth, and have stuck with that ever since.  This was a good warning to me always to hedge my conclusions about elements around with a few question-marks.

I always emphasize how difficult it is to pinpoint a person’s element, particularly that of a famous person whom I only know from the TV.  Perhaps, indeed, it is a bit risky of me to make the selections that I do, because I can so obviously only too easily get things wrong.  But somebody has to have the courage to stick their neck out, otherwise novice practitioners would have few examples of the elements to base their understanding on.  I therefore do the best I can, however inadequately I may sometimes be doing this.  My justification here is that I now have many years’ experience to draw upon, whilst students have none at all, and as I always tell everybody, we owe those coming after us to hand on whatever knowledge we have acquired.

I hope that most of the examples I give, such as those of David Beckham and Elvis Presley in my Keepers of the Soul, are still valid, but if those reading what I write disagree with me, that is all to the good, because it forces them to study the elements deeply and develop their own understanding.  And in any case, until I treat a person, I am never sure that I have found the right element.  I think, therefore, that I need to continue giving my take on the elements of famous people, otherwise there would be so few examples to offer those who are unfamiliar with the elements.  It is also good that I offer myself as a living example of somebody who doesn’t mind getting things wrong and admitting to it.  As I have said on many occasions, we all need to be humble enough in whatever field we work to accept that we will get things wrong, and to have the courage to admit that we have. 

If we are treating a “wrong” element, we may assume that we are doing something wrong.  But that is not what I believe.  No treatment we give should be considered the wrong treatment provided that we follow some basic rules of five element practice.  And these consist in ensuring that we are not going against nature by taking more energy away from an already depleted element, or adding energy to an element which already has an excess of energy.  This is gauged from our pulse-taking.  If our fingers are sensitive enough to assess the relative levels of energy in the different pulses we are taking, any treatment we give on whatever element we choose can not only not harm, but must be beneficial, because it will bring greater balance to the different levels of energy in the five elements.  And anything which brings greater balance is to be recommended.

Of course, if we can add to our assessment of the energies in the different elements that additional component of concentrating our attention on helping the dominant, guardian element to greater health by trying to balance the level of its energy in relation to that of the other four elements, then any treatment we offer will be more successful because it will be focussing itself exactly where it is most needed.



Sunday, March 10, 2019

9. Why it helps to know about the elements

Knowing something about the elements can help explain our own behaviour, the behaviour of other people and in particular our behaviour in relation to other people.  We do not exist in isolation.  Everything we do impinges on those around us, as they impinge upon us.  The well-worn cliché about raising a finger here on earth and thereby altering the movement of the most distant star is just as valid in the purely human sphere of our relationships to one another.  Nothing I do can leave another close to me untouched, just as they in turn cannot fail to influence me.  Often these influences may be too subtle for us to notice, but they are nonetheless there.  Sometimes, of course, they are so obviously powerful that some encounters knock us off-balance.  We may like to think that we live our lives cocooned in a bubble of self-sufficiency, but we all have growing out from us soft antennae, like tendrils, which touch those passing by us, and these touches shift something in us and change our shape in small or large ways.

If we are to smooth the path to better understanding and greater tolerance, we must not forget how different we are from one another, despite all our many similarities, and, I would say, that we are necessarily different, for this creates the amazing variety of human thought and behaviour.  It is surprisingly difficult to understand how others view the world.  And to those who differ from us we often react with irritation or perhaps even downright dislike, since our inability to understand their way of thinking makes us judge them harshly.  We tend to criticize what is unfamiliar to us, and herein lies the root of so many of our prejudices.  If, then, our understanding of the elements helps us to see where these differences are coming from, then we are well on the way to engaging in more harmonious interactions with those around us.   And, however basic may initially be our understanding of the elements, even the tiniest bit of knowledge will contribute to greater tolerance, a quality sadly much lacking in the world around us, and therefore all the more to be cherished.

Often without our being aware of this, we gradually build up our own list of the characteristics by which we have learnt to recognise each element.  These are like our own aide-mémoires, our short-cuts which lead us to an element.  It is worth our while to think a little more about this, as we often follow along what to us is a well-trodden route towards an element without being aware we are doing it, and, more importantly, without checking at intervals to see whether our responses have become stereotyped and no longer reflect the great diversity with which the elements manifest themselves.  We should always at intervals do a kind of a stock-take, and discard worn-out clichés about what an element represents for us which have gone past their sell-by date.

None of the descriptions by which I attempt to define the elements can be absolutely clear-cut, any more than the distinctions between one element and another can ever be clearly defined.  Like the colours of the rainbow, the elements meld into one another at their edges, so that they will share, faintly, some of each other’s characteristics.   Though slight, these similarities can nonetheless confuse us, some more than others, and explain the difficulties we all have in distinguishing between the characteristics of different elements.  My own greatest confusion has always come from the differences between Earth and Fire, and my least from those between Metal and Water, with the similarities I perceive between other pairings falling somewhere between these two.  Other people will find it difficult to distinguish between other elements.

Each of us should remain aware of where our own particular difficulties in differentiating between the elements lie, and use them as warning signals along the path to a diagnosis.  In particular we need to ask ourselves at intervals whether unconscious bias for or against an element has crept into our practice, so that without our realising it the number of patients we diagnose as being of one element seems to be surprisingly high, whilst that of another element surprisingly low.  Are we perhaps tempted to avoid recognizing the characteristics of elements we find too difficult to deal with in the practice room, or in life in general?

Sunday, March 3, 2019

8. The importance of remaining in control in the practice room

JR Worsley taught me another very important lesson early on in my practice, and one that concerns something that we often don’t deal with in our attempts to make the practice room a welcoming place.  He always emphasized the importance of ensuring that a practitioner must never allow a patient to take control of what goes on in the practice room.  For once we have lost control, he said, it is very difficult to regain it.  Control can relate to many areas of our practice.  It can cover such areas as how often and how frequently patients need to come for treatment, whether we allow a patient to tell us which points they want us to needle, or whether we should involve patients in decisions about the element we are treating.  If we allow the patient to decide how the treatment will proceed, each of these situations is potentially one where we are assuming that they are the ones who know what needs to be done.  This is of course never the case, and is particularly true in the always tricky case of treating a fellow practitioner or somebody with some knowledge of acupuncture, which I will discuss further on.

The following are some examples of times when I have lost control of the practice room in some way, showing how I at first failed to deal with the situation satisfactorily before finally, after hearing JR’s voice, regaining the control I was in danger of losing.

One of these changed totally the way in which I learnt to deal with patients I found difficult.  Of course we should never call a patient simply “a difficult patient”.  Instead, we should always add the words, “a patient I find difficult”, because our perceptions of people always colour our relationships to them.  A patient whom one practitioner finds difficult may be easy for another practitioner to relate to.  So it is always important to chart for ourselves what kind of situation we find difficult to deal with because often, when looked at closely, this will usually tell us more about ourselves and our own prejudices and inadequacies than about the patients themselves who we feel are making things difficult for us.

Analysed in this way, I realised that what particularly irritated me in a patient’s behaviour was often something as apparently insignificant as arriving a little late for treatment or always phoning to check the time of their next appointment, even though I had seen them enter this into their diary.  In such cases JR taught us a very simple procedure.  “Tell the patient what you find difficult”, but we must always make sure to include the words “I find” in what we say: “I find it difficult when….”   This is acknowledging that our feelings are filtered through our own perceptions.  It is then up to the patient to correct these perceptions or to agree that they are true.  This ensures that you avoid pointing an accusatory finger at them, and are instead asking them whether what you feel tallies with what they feel.

At the same time JR’s advice also taught me how important it was to confront any problem you are having with your patient as soon as possible, rather than trying to ignore it, because it is these sorts of problems, however trivial you may feel they are (does it after all matter if a patient is a few minutes late for a treatment?) which can take on a surprising level of importance out of proportion to their actual significance.  They can then cast disturbing shadows over our time with our patient.  For example, before I adopted JR’s advice, I would often be thinking during the treatment itself about how I should be dealing with the situation of the patient arriving persistently late rather than concentrating on the treatment.  Instead I might be cross at myself for being a bit too cowardly to dare say anything, perhaps fearing that I might offend them or that I was endangering the good patient/practitioner relationship I was trying to set up.  In fact the reverse would be true.  I was risking harming this relationship by the very fact that I was delaying dealing with a troubling issue which was getting between me and my patient.  And this was taking up precious time in the practice room which should instead have been spent concentrating upon the treatment.

Another layer was added to the incident of the patient arriving late.   After I had told her that I found this difficult, I noticed a slight change in our relationship which I had not anticipated.  She apologized and promised to make sure that she arrived on time, but actually started to arrive much too early with a rather defiant look on her face, as though challenging me in some way, which I found both puzzling and disturbing.  Something in the situation had obviously unsettled her.  It took me some time to realise that, instead of just accepting the simple fact that she needed to arrive on time, she had interpreted what I said to her as a sign that somehow she had lost face with me, and saw my comment as a reprimand which she was annoyed by.  She was telling me this not in words but in the rather defiant and slightly triumphant look on her face as she persistently arrived much too early for the next few treatments, as though saying, “See, I’m being a good girl now and doing what you told me to do, but I’m not happy with your ticking me off in this way.”  In effect, I felt she was acting like a sulky little child, and showing me an unexpected side to her character.  She was a high-flying business woman, and I had no doubt she was the sort of person who would always make sure that she arrived well on time for any of her important business meetings.  So why not with me?  Did I represent somebody who evoked a relationship where the roles of who was in charge were blurred or difficult for her to deal with, the obvious person being, of course, her mother, since I am quite a bit older than she is?

I may seem to be making rather heavy weather of this slight, but clear change in our relationship, but it made me uneasy enough to view her name in the diary with some trepidation, as though I knew there was yet another issue here that I was not dealing with properly.  It really felt that there was a hidden struggle for control going on between us in the practice room.  We have talked this through now, and she agrees that the situation of me being her therapist and she the patient somehow made her feel as though I had taken on the superior role, and she has always found that difficult, in whatever therapeutic situation she had been in.  And it turned out that it did indeed remind her of resenting her rather controlling mother.  I think we have now talked this through sufficiently to move on, but it has left a slight feeling of discomfort in the air between us, which I hope will be dispelled in time.

Often it is just this feeling I have that something is not quite right between the patient and me which leads me to understanding my patient better.  Sometimes, of course, the opposite can happen.  If a patient feels that we are moving on to emotional ground which they find too uncomfortable to deal with and wish to avoid, these become the times when a patient may suddenly stop treatment rather than confront what is causing the unease.  And I, as practitioner, may not be adept enough to work out a way of helping me get round this particular obstacle to treatment.

Another issue which can often cause us problems is the extent to which we allow a patient to become involved in treatment situations.  This becomes a particularly difficult area in five element acupuncture if we start discussing with our patients which particular element we have decided to treat them on.  I know that different practitioners have different opinions about the wisdom of doing this.  Some do not mind at all going through with their patient the reasons why they have chosen a particular element.  I am not convinced, though, about some of the practitioners’ motives for doing this.  Hidden deep within this decision may be the practitioner’s often unconscious need to get some reassurance from the patient about the treatment we are offering them.  We may feel we are on the right track if the patient appears to agree with our choice, or our confidence in our diagnosis may be undermined if the patient shows disbelief at our choice.  In both cases, we are in effect allowing the patient to influence the diagnosis, a bad idea when we consider that they are not trained to recognize the elements as we have been, and also because they may have a predilection for one or other element from their rather superficial knowledge of them.  Letting our patients influence our choice of element may well be because we may unconsciously be revealing our lack of confidence in our own diagnosis by drawing the patient in to help us.

I remember clearly the day during my training at Leamington when a group of students went up to be diagnosed by JR, and arrived back depressed in the classroom, because he had diagnosed quite a few of them as Earth, when they were convinced they were Fire, Fire apparently having a better press for them than what they regarded as the neediness of Earth.  This brings me to the always tricky problem which rears its head once we approach treating a fellow five element acupuncturist.  Here there is not just the compulsion we all seem to feel to support our treatment choices by drawing an acupuncturist/patient into discussing what treatment is needed, but there is the additional problem that a practitioner often has their own fixed idea about their element, assuming that somehow their own personal understanding of themselves makes them better qualified to diagnose themselves than their practitioner.  The opposite is true.  We often like to flatter ourselves that we possess emotional qualities which we admire, whilst ignoring those aspects of ourselves which have a less attractive side.  So we are not good judges of which is our dominant element, or even of the elements of our nearest and dearest.  I remember very vividly completely misdiagnosing one of my children, choosing to interpret his behaviour in a selective way which fitted my somewhat erroneous perception of him, much coloured, and I realise therefore distorted, by my love for him. 

We have to accept that all of us have a tendency to regard one or other element in a more favourable light than the others, however hard we try not to, because events in our personal lives have shaped our approach to the elements.  All this has proved an excellent lesson for me not to treat those to whom we are too close, although this can sometimes not be avoided, particularly if there is no other five element practitioner geographically close enough.  The important thing is to be aware of the drawbacks, of which there are many.