Tuesday, May 27, 2014

The spacing of treatments: an art in itself

I have just spent a happy few days in Berlin with two very dedicated German five element acupuncturists, Christian and Thomas.  This was very stimulating, both culturally, because I saw more of Berlin on this, my second visit, and from an acupuncture point of view, as it always is. 

It was during a day spent looking at patients together that I was made aware once more of the importance of the question of the spacing of treatments as representing an essential, but often overlooked, aspect of how we help our patients.

I don’t think that we pay enough attention to this in the normal course of events.  At the start of a patient’s treatment I expect we all tend to give them a number of weekly treatments, normally something like six or so, and then we tend to space treatments more widely from once every 2-3 weeks to monthly and eventually to once a season and less.  It is what happens as we move further on in treatment that problems can arise.  I was made aware of this again by one of the questions I was asked.  How was the practitioner to deal with a patient who, he said, “insisted” on weekly treatments whilst also maintaining that treatment was not helping him in any way. 

We have various ways of assessing the effect of treatment.  There are our own observations as to whether we notice any changes or not, and then there are the patient’s own assessments of how treatment is going.  Usually these two sets of observations will coincide.  Problems only start when the two differ, as for example if the practitioner notices how much better the patient looks, or the changes he/she is making to their life, and yet the patient him/herself says that there has been no change at all.  We cannot try to persuade the patient by saying things like, “but you seem to be walking better” or, “you have not been talking about your family problems as much”, because that is denying the patient the right to make their own assessment of what they consider constitutes improvement.  On the other hand, we may be concerned that the patient is choosing not to acknowledge that there have been changes for other reasons.  These may include such things as a fear that we are “giving up” on them, or, more subtly, as part of some kind of a hidden power struggle between the patient and us.  Some people can be unconsciously reluctant to accept the help of others.

How do we as acupuncturists get over this difficulty?  If the relationship between our patient and us has been well-grounded from the start, there should be no problem, as the patient’s strengthened energies give them sufficient support gradually to do without our help.  But if something in this relationship has tilted it towards over-dependence on us or otherwise distorted it, it may become more difficult to hand control back to the patient.  We may, for example, allow our patients to contact us too often between treatments by phone or now increasingly by email, something I was guilty of in the early days of my practice, because I felt I always had to be there to help my patients whenever they needed me.   This can make it all too easy to blur the necessary lines of separation between patient and practitioner which make a healthy relationship possible.   

We must never forget that our aim must always be to reach a point where we step back and treatment is no longer needed, the point where patients are now able to maintain balance by themselves.  If we are having difficulties with working out how gradually to space out treatments for patients we can see require less treatment, we should examine our relationship with them to see if we have encouraged on over-reliance on us, and, if so, start gently to take steps to encourage the patient to greater independence.   Of course, as with everything relating to our patients, our approach to each one will be different, and must be adapted to their individual needs.  With one patient treatments may remain weekly for much longer than with another.  At each stage we have to assess whether our relationship to our patient is adapting flexibly to that patient’s needs, and not depend upon a fixed formula for the spacing of appointments.


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