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.








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