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.