Friday, June 25, 2021

76. Some of the reasons why it takes courage to be a five element acupuncturist

 It is only recently that I have realised how much courage it requires of any therapist to enter the emotional and, as acupuncturists, also the physical space of another human being.  This is all the more so if the conditions under which we practise make the kind of close relationship of patient and practitioner almost impossible.  Here in the West at least we live in a world very familiar with the one-to-one relationships which form part of all psychotherapeutic encounters, amongst which I count five element acupuncture.  I found that this was not the pattern yet in China, where it is rarely practicable to find the space or have the time to treat individual patients to foster the close relationships necessary for a good five element practice 

  I only became aware of some of the difficulties those training to become five element acupuncturists encountered in China after a few visits there, and I therefore did not realise how much Chinese practice conditions differed from what I was used to in this country.  This meant that what I was recommending for my budding five element practitioners was simply something they could not do.  Patients and practitioners alike were then accustomed to view acupuncture as a kind of adjunct to orthodox Western medicine, regarding it as just another form of physically-based therapy, concerned only with helping to treat physical symptoms.  The concept of dealing with patients' deeper emotional levels was a totally alien one, so much so that I remember one Chinese practitioner saying sadly, "I really don't know how to start talking to my patients about their problems as you do."


There was the additional problem, still experienced even now by most Chinese five element acupuncturists, and one touched upon by my French acupuncturist friend, Pierre, (see my recent blog of 18 June 2021).  This relates to the thorny question of who is paying for treatment, and what such payments cover.  Where the state or medical insurance includes some cover for acupuncture treatment, how many treatments does that include, and perhaps also for what conditions?  This is an area of practice with which I am unfamiliar, since most of my years of practice have been at a time when patients could not yet take out any medical insurance to cover acupuncture treatment, and therefore took it for granted that they would be paying for treatment themselves.  This had the effect of keeping fees as low as possible to be affordable to as many people as possible, with most acupuncturists having a sliding scale of fees, which could be adapted to help the less well-off.  


In his email to me, Pierre writes:   

"In France, we have " la sécurité sociale", that allows people to consult a physician for free. We pay but afterwards we are reimbursed by the social security. So French people are really not accustomed to pay for their health without reimbursement.  And when they come to acupuncture (they know that this practice is out of the reimbursements of the social security) then they want the treatment to be as short as possible because they don't want to pay too much for that. 

I realize that is may be a very different thing between France and England. 

This is a very bad thing, that the government here in France has accustomed people to a false free health care. Acupuncture for them is a short treatment. Totally different from psychotherapy for which they agree in relation to long-term treatment." 


Pierre is therefore treating patients with a clock ticking away over his head, not an easy situation to deal with.  To some extent, though, the same can be said of every practice situation which I have had to deal with during my years of practice.  Even though my patients were not relying on outside help to pay for their treatments, they and I were always very conscious of the cost of the kind of long-term treatment a good five element practice demands.  Because I was very aware of this, I gradually worked out how to counter patients' natural concern about the cost of treatment by addressing the issue right at the start of treatment. I found that by doing this I avoided the kind of problem Pierre has to deal with.


What I did was make sure during my first interaction with a new patient that they understood what I hoped five element acupuncture could do for them, emphasizing that it dealt with the whole person (hence the use of holistic (from the Greek work meaning "whole") to describe it, as compared with orthodox Western medicine which tended to deal only with physical problems.  I would make sure that a new patient was aware of the reach of five element acupuncture from the start of their treatment, by saying things like, "I'm interested in hearing about any physical problems you have, but these may be related to other issues.  For instance, a stiff neck may be caused by somebody you know being literally a pain in the neck, or a sore knee because you may feel like kicking somebody."  These comments may sound a bit flippant, and often made the patient laugh, but I could immediately detect the change in tone as patients were quick to acknowledge the relevance of what I was saying.


I would also tell them that the initial stage of treatment would require 5 - 6 weekly treatments before they might feel any benefit.  Any longstanding problems might take longer than that to be helped, but treatment would be spaced out gradually from weekly to monthly and longer as soon as they felt any improvement.  I emphasized that, unlike psychotherapy, where patients often have to commit in advance to as long as a year's weekly treatments, they would be free to stop treatment at any point if they felt it was not helping them.  Interestingly no patients I addressed like this ever did stop treatment, and many were content to continue as my patients over many years at ever longer intervals.



Friday, June 18, 2021

75. We should never assume that we know what our patients want from treatment

A French five element acupuncturist, Pierre, comes regularly to our seminars and uses the time between them to send me interesting questions about his practice.  He is tucked away in Brittany, far from any regular five element support network, and has been brave enough to study on his own.  His latest email to me deals with one of the uncertainties therapists of all kinds have to learn to face.  What do we do if we are not sure that we are helping our patients?  What if the patient's symptoms persist?  It is interesting that his email also contains part of the answer to his question without his realising it.  


With his permission, I will quote what he was written (and he asked me to forgive any faults in his English!):


"The more I treat patients with Five Element Acupuncture only, the more I feel I miss something like a deep knowledge of the spirit of the points.  The treatments I give to somebody, focused on the CF (guardian element), is often good to improve their well-being.  But too often they continue to suffer at a level that I seem not to be able to achieve. After a number of treatments, I feel like I'm going around in circles with the points I use to help them and the treatment seems to be on a plateau.  Examples : The pain (a patient) feels on the wrist doesn't really change, the weight (a patient) wants to lose doesn't really move,  the fear (a patient) has concerning his future retirement doesn't really reduce,  but they all feel better inside them with some improvements in their well-being and even in their other symptoms. 


How to improve a treatment with somebody beyond the treatment of the CF (guardian element) when we feel that we are on a plateau?" 


I can see that there may be some mismatch here between what his patients expect of their treatment and what he does.   This brings me to an important aspect of our practice.  By what criterion do we judge the success of treatment?  In a purely physically-based medical system, such as that of most orthodox Western medicine, a successful outcome is usually measured by how far one or more physical symptoms have disappeared, or at least been alleviated.  That assumes that as five element acupuncturists we are there simply to treat the physical, whilst ignoring the other, deeper levels of our being, our minds and spirits, or in general terms our emotional well-being.  We all know that a holistic therapy like five element acupuncture does not or should not confine itself to treating just the physical level, indeed often viewing this as in some senses the most superficial level.  And my French acupuncturist's patients appear to recognize what five element acupuncture has done for them at this deeper level by telling him that "they all feel better inside them with some improvements in their well-being and even in their other symptoms".


It seems, though, that it is the practitioner who is more concerned with assessing the effect of his treatment on his patients' physical symptoms than they are.  Perhaps to some extent we all live in a medical environment concentrating so much on treating purely physical complaints that we may overlook what to our patients may well be the most important effect of their treatment, which is the fact that they "feel better".  My advice to my French friend will be to be glad that his treatment has increased his patients' general well-being, to continue with the kinds of treatment that have already produced such good results, and, most importantly, to give himself more time for treatment to work.  He may be in too much of a hurry to judge the success of treatment simply because he is overlooking how much his treatment is already helping his patients.


When I was a student we had a rule of thumb which stated that it takes one month of treatment for each year that a condition has persisted.  For most patients their imbalance has lasted for many years, and a practitioner must therefore assume that things will not improve quickly (although they may!).  Often it is the practitioner who is in more of a hurry to get things moving than patients are.   




Sunday, June 13, 2021

74. What recording my videos has taught me about myself

My preferred way of teaching is not to draft what I want to say in advance, as many people feel they need to do, but to gain inspiration from those listening to me.  I may have a topic in mind, perhaps a title for my talk, just as the title for this blog is prompting what I want to write about here, but I rarely have any idea what words are going to come from my pen (if I am writing something) or from my mouth (if I am lecturing or recording myself on video). In fact, past experience has taught me not to attempt to fit my teaching into what is, for me, the straitjacket of a prepared text.  I've tried to do this in the past, feeling that I should rein in my very impromptu lecturing style, but with no success.  Quite the opposite.  I was asked by my translator tin China to give her an outline of what I intended to say to help her prepare.  And at times I have tried to do this, only to realise how far I was diverging from what I had intended to say in order to elucidate some additional point I felt needed saying.  This acted as an inhibiting factor on me from the start, confusing my thoughts and almost bringing me to a halt.   

I always like to relate people's behaviour, here my way of teaching, back to a person's element, and I have therefore thought a great deal over the years about where this, to some people, rather odd way of delivering my lectures comes from.  I now recognize this as being an understandable product of my Fire element, and specifically, of my Inner Fire official, my Small Intestine.  It will be useful here to summarize the Small Intestine's task as part of the family of the 12 officials, for this does much to explain the way I like to teach.

The Small Intestine is known as the sorter, the official in charge of sorting the pure from the impure, and disposing of the impure through the Large Intestine, as its physical counterpart does in our body.  It is the closest official to the Heart, being the yang official tied for all eternity to the yin of the Heart, and this close relationship gives it its most important function, that of ensuring that it gets things right for the Heart.  It is there to help this Emperor of the kingdom of body, mind and soul rule with justice and fairness.  If the Small Intestine is weak and gets things wrong, it will allow impurities through which will pollute the Heart.  The need to sort things out therefore influences all that I do, including what I say and write, and how I do both.  I have to be sure that what I say at every point represents the truth of what I wish to convey.  


Whilst I am talking, therefore, I am at the same time checking to see that the words I am using accurately reflect what I wish to say.  If I am lecturing to a group of people, I also watch my audience carefully all the time to check whether they follow what I am saying or are puzzled by it. If they are, I then adjust what I intended to say to take account of my audience's reaction.  From the listener's viewpoint I may then appear to qualify one statement I make with other statements which I think will add to what I am saying until I am happy that I have covered all I want to talk about.  Hence my poor Chinese translators' bewilderment, as they try to follow some unexpected detours before arriving back at where they expected to be.


I have observed how other people approach their teaching, none more so than my fellow acupuncturist, Guy Caplan, who accompanies me to China.  He, I clearly see, prepares his talks very carefully, sticks to what he has planned in advance to say, and certainly doesn't confuse his Chinese translators, as I tend to do.  But then this is his Metal element working within him to determine his actions, so different from my Fire element, with its Small Intestine working so busily to get things right.

Sunday, June 6, 2021

73. Continuing teaching during lockdown

Being unable to give any person-to-person seminars during this year of COVID has meant that I have had to come up with other ideas for continuing to help my many hundreds of Chinese five element practitioners and students from a distance.  Like many of us, I have been driven to think of ways of using social media to do this, and it was while watching one of the many online programmes which helped me while away some of the lockdown time that I realised that here was another excellent way of passing on my knowledge.  So for many months now, but only after many hours of tuition from a media-savvy son, I would sit down each day in front of my iPad and record myself for up to 10 minutes talking about whatever five element topic came into my mind as being of interest to my students.  


These recordings started off without much of a plan, but I soon realised that they had developed into an excellent accompaniment to my Handbook of Five Element Practice, the text which all Chinese five element students base their studies upon.  I was very pleased to hear recently that over 50,000 copies have been sold worldwide over the past 10 years, making it the most successful book on acupuncture my Chinese publisher has sold.  I thought it that was very likely, therefore, that there would be many aspiring five element practitioners who would welcome the kind of personal teaching my video recordings offer in my absence.  I arranged these video recordings around the different topics covered in the Handbook so that the complete set of more than 30 videos adds something to the text.  I sent each video over to China as I recorded it; they were then edited, Mandarin subtitles added and put online to be downloaded on subscription.  These subscriptions have proved very popular, with more than 1500 people so far enrolled.  And Guy Caplan has now added a further series of videos on ways of helping students with their CSOE (colour, sound, odour and emotion) sensory skills.


After completing the Handbook videos, I moved on to recording a more advanced set for practising five element acupuncturists, and followed that with a kind of online autobiography, describing my journey from my first encounter with five element acupuncture as a patient more than 30 years ago to my arrival in China.  Finally I am also now working with Guy Caplan on a series of videos about treating long-term patients, which will list the kinds of treatment we give patients who have been coming to us for many years.  


Novice practitioners often find the move from the well-defined early stages of treatment to the more spaced-out treatments at later stages difficult to deal with.  For these long-standing patients there is no longer any need to worry ourselves about finding the right element, since the fact that they are still coming to us after so many years of treatment is proof that they are doing well and just need some top-up treatment.  Practitioners, though, often feel that they have to ring the changes and each time should be searching around for different points to use.  This is not what is needed, and we list for each element the kind of simple treatments we continue to give our long-term patients, showing that, apart from interspersing basic element treatment with the occasional clearing of a block, the points we choose are often much the same year in year out, with the simple aim of reinforcing the patient's element.  


In fact, long-term treatment is in a way the easiest treatment of all.  By this time, we know all about our patients' lives, and have developed very easy, warm relationships with them.  Patients' eagerness to continue coming for treatment year after year is satisfying proof of how effective five element treatment can be.  This can provide a welcome relief from the much more complex work involved in attempting to manoeuvre a path through the undergrowth of the different elements until we find our way to the right element at the start of a patient's treatment.  So we have asked long-standing patients of each element if they are happy for us to record them talking about themselves, and tell us how their treatment has helped them in the past and is continuing to help them now.  We also list the one or two years' treatments they have recently received as further encouragement for our fellow practitioners.