by Miranda Castro, FSHom


It is rare that a patient knows who they are and is able (or willing) to reveal that to us.

I believe that we do need someone beyond the clinical training, to follow through, to help us ground the theory in practice.

Our difficult patients nearly always reflect unresolved issues within ourselves.

I asked him back so that I could take his case history in full. He laughed and said there wasn't anything else to take...

Many people, prior to visiting a homeopath, have never, ever had that much attention in their entire life.

Abuse is endemic across the world in every society. Actually, it always has been.

The ways in which we communicate are complex and varied. The spoken word is the most obvious, and in some ways, the most superficial of our communications-our outermost layer. We confirm our words with our non-verbal communications, and give away any real (and possibly different) feelings or thoughts through our body language, our eyes, our facial expressions etc. Homeopaths need to become keen observers because we rely on these discrepancies in order to "perceive what is to be cured". It is rare that a patient knows who they are and is able (or willing) to reveal that to us. Mostly we have to catch the shadows in between a patient's words in order to perceive their whole picture, or at the very least to see beneath the surface. This is when we do our best work. People who are highly skilled observers are sometimes described as "intuitive" because others may not be aware that what they are really doing is catching those small, and sometimes minute, non-verbal cues and making sense of them.
 
We must not forget that perceiving goes two ways: Our patients will be observing too although this is usually more unconscious. We need to make sure that our verbal and non-verbal communications are congruent so that we can create a safe enough space for people to feel they can reveal themselves.
 
This paper will discuss the patient-practitioner dynamic and the importance of respecting the process of healing in which both the patient and the practitioner are involved. While training in homeopathy, I also took a number of psychotherapy training courses because I recognized the limitations of the homeopathy teachings and because I knew instinctively that as I was going to be delving into the psyches of patients. I would need more than a working knowledge of remedy pictures, much more.
 
Supervision
 
When I set up in practice, I made sure I had regular supervision. Psychotherapists (in common with psychiatrists and social workers) automatically have supervision built into their working lives, and I built it into mine knowing that it would be essential for my health and, therefore, of benefit to my patients. I have gained so much from having supervision in my working life that I cannot imagine having worked without it.
 
Six years ago I started to develop a program of supervision for homeopaths, designed for students in their final year at college. I called it "Supervision into Practice" and I ran a number of successful groups over a two year period. It was successful because those students found that they were better prepared for the realities of practice than many of their peers, were better able to recognize and deal with their mistakes anti difficulties appropriately, and had more confidence generally. I believe that we do need someone beyond the clinical training, to follow through, to help us ground the theory in practice. Many colleges in the UK have, over the past five years, built in supervision programs for new graduates.
 
As a result of this work I gave a presentation at The Society of Homeopaths Conference in 1988 on supervision and have spoken every [1] other year since on aspects of my work. The Society is the organization that represents the professional homeopath (as we prefer to be called) in the UK. The term "lay" homeopath means, I believe, something different in this country. In the UK it is a derogatory term, implying something homespun and that is why we have promoted the term professional homeopath. The Society is at the forefront of the classical homeopathic movement and has been instrumental in setting up the European Council for Classical Homeopathy and the International Council for Classical Homeopathy. These councils are working towards a common core teaching curriculum, and eventually we hope there will be reciprocal arrangements between countries. You can subscribe to our Journal alone or take out a full subscription in which case you will also receive our incredibly lively newsletter, and discounts at our conferences and seminars!
 
In 1989, The College of Homeopathy in London, the largest homeopathic teaching establishment in the UK, asked me to develop my program further and integrate it across all years both in their full time and part time courses over a three year period. This enabled students to address a great number of personal, practical, professional and ethical issues before they take that big step out into the world.
 
The risk of burn-out in the helping professions is great. We can end up looking after others too much and lose touch with ourselves or deny our own needs. It has been through supervision that I have learnt what my own unique signs and symptoms are, and to respond to them. I believe I have a primary responsibility to look after myself, to satisfy my own needs, to be fully active in my own healing on a daily basis so that I can care for others. I want to feel good about who I am and what I do, to feel confident and satisfied in my work, to be a "good-enough" homeopath. Above all, I want to practice what I preach. Supervision gives me a place and a time to relax and touch base with myself, to stand back and reflect — an opportunity to talk about myself, about difficulties that come up with patients, about called "difficult" patients. Our difficult patients nearly always reflect unresolved issues within ourselves.
 
The value of supervision is that we can uncover these issues and work on them. Every single time we have feelings about a patient there is some element of projection (and/or counter transference) involved, whether those feelings are so-called "good" or "bad" ones. I need to be just as wary about the patients I look forward to seeing as the ones I dread seeing. I shall talk more of this later. Right now I want to share a case with you.
 
I would like to talk about a patient who came to me two years ago with arthritis — a young man, twenty-four years old, and a carpet fitter, which is a physically arduous job. He asked me at the end of his girlfriend's session whether there was anything I could do for him. He said he was very healthy apart from the arthritis, so I made some quick notes regarding his physical symptoms.
 
Arthritis: Started two years ago in his left hipand spread to his right hip a year ago. X-rays showed shallow hip joint and inflammation of tissues around the joint. Hydrotherapy (for 3 months) didn't help. He complained of pain in his left thumb joint. His pains were dull and worse flexing the legs (2); stretching the legs (2); cold weather (3) and snowy weather (3).
 
Etiology: At age 10 - 14 he took intensive karate lessons and has been told he may 'have overstretched the ligaments in his legs. From age 16 to 24 he has been carpet fitting, which involves a lot of heavy lifting and carrying, also kneeling and kicking the carpet laying tool with his right knee.
 
General information: 6 feet 3 inches tall. Weight: ten-and-a-half stone (147 pounds). He has never been able to gain weight, has been skinny all his life. He smokes 20 cigarettes a day (since the age of 14). He smokes cannabis daily. His appetite is poor; he decided to go vegetarian for moral reasons and now snacks on sandwiches: he often doesn't eat dinner. "Once I stop eating I can't start." He likes milk (2).
 
Family/Relationships : He gets on well with his parents, including being able to argue with them. He works for his father which is difficult at times: "I worry about him: I'm too involved with him. I hate getting paid by him." He is planning to leave in two months and set up his own business. His girlfriend has severe health problems which is difficult. "She leans on me; my parents lean on me. If she and my parents aren't talking, I feel stuck in the middle."
 
I gave him a lecture about eating, the importance and value of it, and how to build eating into his life. I also said that homeopathy would be limited in its effectiveness by his dope-smoking, and he agreed to consider cutting it out. Because his arthritis seemed quite severe and there wasn't a clear picture, I asked him back so that I could take his case history in full. He laughed and said there wasn't anything else to take: he was fit as a fiddle and happy with his life. But I insisted that I would need to do that to prescribe properly, and he agreed. He came back feeling better in himself; his energy had improved with eating more and eating regularly (although his weight was constant), and he had managed to cut down on cigarettes (to 10 a day).
 
I elicited a few more general symptoms: Aversion to fruit (3), salad (3). Desires: fried eggs (3), cereals (3), beer (3)—drank up to 12 pints of beer a night when younger (from 12 on), but only drinks alcohol moderately now (2 or 3 times a week). Bites nails (2) Chilly (3) Cramps of the feet (3), in bed usually or at any time; mainly as a child; only rarely now. I asked him about his childhood. He was hyperactive (3), always on the go. He was scared of school (3), of teachers (3), of anyone in authority (3), of men (3). He said he and his brother felt isolated and didn't fit in because they had more (material things) than the other kids and were resented.
 
He rebelled at an early age, which included not wearing his school uniform, and at the age of ten he was put down into a lower class to "teach him a lesson," then moved back to a desk outside his old classroom. He wore make-up to school; he said it was in order to shock. He was copying his favorite baud (Japan) which wore make-up. He played guitar in a band and was passionate about music. He still loves it, saying it makes him feel great (3). He loved sports (3). Everyone thought he was gay. He said he didn't know if he was or not. He was beaten constantly and never fit in at school although he had friends outside school. One day he was beaten up and stabbed, and so he left school and went to work for his father. He was 15 years old. He had nightmares as a child (3), that his parents weren't who they said they were, that they took their masks off after he went to bed. He never slept well, had a fear of the dark (3), of going to bed on his own (3); he hated going to bed because of having to go to school the next day.
 
Remembering our previous talk and his being the strong one that others leaned on, I asked him who he leaned on, and he said, "I don't lean on people, because I don't trust anybody." And then I was at that stage in the case where I had a lot of it, with the most important bit missing. I knew that something had happened to this young man. I didn't know what, but I had some ideas.
 
Power In the Consulting Room
 
The artificial boundary we create in the consulting room not only protects patients and practitioners, it is also designed to break down resistance and encourage patients to reveal themselves and their innermost secrets so that we can fully understand who they are and what has shaped them. Some practitioners have talked about "penetrating the case." I would like to question that. It isn't what I do. I don't feel that I'm fully active in the process of taking a case history, but neither am I passive. What I do is closer to "receiving," to trust in a process of unfolding such that ultimately I can comprehend a whole picture with the consent of that patient. It is intense. Many people, prior to visiting a homeopath, have never, ever had that much attention in their entire life.
 
I have a profound respect for the fact that someone who was a complete stranger 30 minutes previously is now revealing to me intimate details of their personal life — details they may never have revealed before to anyone. This automatically confers on us enormous power, enormous transference. Because at the point that we have built rapport and trust, at that point patients will tell us anything, will do almost anything we ask of them. We have all the power and we need to acknowledge that so that we can use it wisely and not abuse it.
 
The caring relationship is always a complex relationship full of challenge and enormous healing potential. It's as much a learning process for us to use our power wisely and fully as it is for our patients to heal themselves. Also, I have to be smart to withstand a patient's transference, to put it in perspective, to put a boundary up that protects us both.
 
Back to my patient (who I shall call R.), he had nothing else to say that he could think of. He said his parents always said he was old for his age. So I said my bit, that there was something that didn't add up. Why the make-up? Why the nightmares? It is interesting that there was a theme — the mask in the nightmare, the make-up. Was it covering up his face? What happened to him before or around the age of ten? Why the fear of men? Was there a trauma or bad experience that he may have dismissed or never talked about?
 
I spoke gently and left a space for R. to open up into if he so chose, or not to. I knew that it was a big one and that he would have to feel right about telling his story. I remember his eyes hardening as they filled with remembering and pain, and fear. He said that when he was eight years old, he'd gone on a three day trip with the Cub Scouts. The Scout leader had systematically sexually abused all the children in his camp and made all the boys have sex with each other, except for R. He said, "I can't get it out of my head. It's always there." He had never, ever talked about it. I believe the little child inside this man was relieved at that point to be heard and not judged.
 
R. was shocked when I labeled the experience a sexual abuse; he'd assumed that because he hadn't been physically abused, it didn't count. Then I knew that he had worn make-up as a massive cover-up and an unconscious plea for help. He had been singled out for a very peculiar form of sexual abuse; he'd felt the odd one out and had created this "odd-one-out" scenario in his life. His nightmares reflected his confusion about adults and who they really were, behind their masks.
 
I repertorized eccentricity, music ameliorates and hyperactivity, and then found the confirming mental in the Repertory: Hide, desire Synthetic to, on account of fear of being assaulted. Tarentulawas the only remedy. I prescribed Tarentula hispanica 200 (three doses at two hourly intervals).
 
This case isn't, in my experience, unusual. Abuse is endemic across the world in every society. Actually, it always has been. The difference now is that it is horribly, horrifically visible, on our television screens and radios and in papers and magazines, in our homes on a daily basis. In this media age we know it in graphic detail. Wars are widespread, and children are increasingly victims either directly or indirectly through witnessing atrocities.
 
According to UNICEF (The State of the World's Children 1992), in the last ten years more than ten million children have suffered psychological trauma in civil and international wars. We are living in a world where there's an increased and increasing awareness of violence. I believe we are seeing the tip of the iceberg, that we will see more and more traumatized patients over these next years and not less, and because of that I think we need to be prepared mentally, emotionally and spiritually.
 
R. returned a month later, and the pain in his hip (and the lower back and headaches that he'd forgotten to tell me about) had gone. He had put on nearly 14 pounds in one month. Three months later his hip, back and headaches were all still fine. I talked to him then of the value of some counseling or psychotherapy to do some conscious healing. He was adamant that he didn't want to do any; he said he didn't want to talk about it and that was that.
 
Looking after Myself
 
After I had seen R., I felt angry and overwhelmingly sad, because I know there are many sexually abused boys hiding inside grown men as a result of the action of this one, very damaged scoutmaster. That's where supervision comes in for me — because I find it hard at times, emotionally, dealing with those patients who have been traumatized, especially if that trauma has been sexual abuse. In supervision, I can get things off my chest and explore how their experience has touched off a wound of my own, if I need to. It is healthy for me to have somewhere to take my problems, someone to answer to, someone to lean on, a place to go where the focus is on me for once, a helping hand on a sometimes lonely path. It is, after all, support that we offer to our patients. How can we deny that for ourselves and maintain our own integrity?
 
In the case of R., I found it hard to slow myself down and respect his pace. There was a voice inside of me that wanted to leap out and say, "Can't you see how this affected you. Don't you want to talk about it and deal with it. Talking about it once isn't enough." But I have to respect my patient's boundaries and their own process of healing. I need to demonstrate my respect with attitudes and intention that is congruent with my body language and my behavior. Some patients rattle around in our brains; we think of them and worry about them. This isn't healthy for us, or them. I needed to back off, to accept that I had done the job I'd been paid to do and to let him go.
 
We are not simply case-taking automatons. How we flow or interreact with our patients is as important as our ability to make a good prescription. How we are in our practice speaks not only for each of us as individuals, as practitioners, but also speaks for our profession. Every good relationship we make supports our work and this rubs off on the larger profession or homeopathy. part 2