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.