Do patients need to believe?

Posted by John Dalton on September 29, 2008

+ Do patients need to believe? - December 05

This used to happen to me a lot at the sort of
functions we all attend at this time of year.  The
get-together, the dinner party, the bar-be-que,
the partner’s office party.

I’d meet new people, we’d get chatting and the
conversation would inevitably swing around to
occupations.  When it was my turn I’d stumble
through my latest explanation of CST and leave
everyone suitably confused.

Just when I’d think I was off the hook and the
conversation was going to move on, that person
would pipe up.

You know that person, the one who’s in every
fifth or sixth group of new people you meet.  The
one who feels obliged to ask the questions they
think other people are to stupid to think of, let
alone ask.  The one who takes every opportunity to
flex their intellectual muscles at anyone within
earshot.
They’re not really interested!
They’ve no intention of coming to see you!
They’ve no intention of telling anyone else
about what you do!

They’d preface their question by doing
something with their head, either a conceited
wiggle or a questioning head tilt. I don’t know
why they all do this but they do.

‘So, does the person coming for treatment have
to believe in what you do?’

They’d follow this with more head stuff,
usually the slow knowing head nod.

I’d trot out my standard answer. ‘No the person
doesn’t have to believe in it, at all.  It helps
but it’s not required.’  I liked to deliver this
answer almost like a challenge.  I could never
match the head wiggling/nodding/tilting thing
though.

This question used to annoy me, oh you noticed,
and I would get a bit defensive, oh you noticed
that too.

In hindsight I understand why I ended up with
so many difficult patients back then, what with
the challenge and all.

Fast forward to a couple of years ago.

Stay with me here.

I’m talking with one of the therapists I’ve
trained.  They’re telling me about a prospective
patient.

‘This person asked me if I can help them with
their chronic fatigue.’

‘Good.’ They don’t look like it’s good. ‘No?’

‘No.’

‘What’s the problem?’

‘Well I’ve never treated someone with chronic
fatigue before.’

‘So?’

‘So they want to know if I can help them, they
say they’re a bit sceptical and they want me to
reassure them and . . well . .  I don’t know.’

‘Don’t worry about it.  I’ve treated loads of
people for chronic fatigue.  You’ll be fine.’

‘It’s not me I’m worried about, it’s them. It’s
alright for you, I’m sure you’d get results, I
just don’t know if I can.’

‘Oh I see.’

I pondered momentarily and then I had a sort of
epiphany.  All the years of answering the, ‘Does
the patient have to believe?’ question coalesced
into a profound insight.

‘Believe, they may not, believe YOU must.’

‘Pardon?’

‘I said it’s more important that you believe
you can help them than if they believe you can.’

They looked at me dumbstruck as the import of
what I had just said sunk in.

‘Did you just put on a Yoda voice?’

‘No, I just had something in my throat.’

‘You don’t get out much do you?’

‘Look it doesn’t matter how I said it.  It’s
what I said that counts.  If you don’t believe
they can get better with you then they won’t.’

‘That’s what I was afraid of.’

‘Look salesmen have known about his stuff for
years.’

‘Do they use the Yoda voice too?’

‘I’m talking about dominant realities here.’

‘Dominant realities?’

‘Yeah, it’s a well known fact among salesmen
and psychologists that if you get a group of
people together, whomever believes in their
reality the most will dominate the others.’

‘Whomever?’

‘That’s how sales are made.  The salesman
believes his vacuum cleaner is a fantastic product
and these people’s lives will be vastly improved
if they buy it.  He believes it so strongly that
the people start to believe it too and buy the
vacuum cleaner.’

‘Oh I see, you’re talking about kidding
yourself.  If I kid myself into thinking that I
can help this person I stand a much better chance
of kidding them.‘

‘No, I’m not saying you kid yourself.  I’m
saying you need to believe it.’

‘If you tell me to, ‘Feel the force.’ I’m
leaving.’

‘Actually, I don’t really think of it as
believing, I just sort of expect it.  When someone
comes to see me I just expect that they will get
better.  I’m not kidding myself, I just think,
‘They’ve got a body. They’re breathing.  Their
body is designed to fix itself.  All I have to do
is feel what its trying to do and then help it
where its getting stuck.  There’s no good reason
why they shouldn’t get better.’’

‘Fine, but how do I believe, if I don’t really
believe?’

‘Good question.  What you need to do is, you
need to let the spirit of Elvis enter you heart. .
. . No come back . . I’m kidding . . Look, I hear
what you’re saying. . ‘

‘Really?’

‘See, it’s easy for me.’

‘Well finally you admit it.’

‘No, that’s not what I mean.  I have lots of
frames of reference for people getting better.
That’s one of the benefits of experience.  All
those frames of reference support my expectation
that the person will get better.

You, on the other hand don’t have enough frames
of reference yet.  Which leaves you with just one
thing determining the outcome.’

‘What’s that?’

‘The way you think about it.’

‘The way I think about it.’

‘The way you think about it.’

‘Stop saying that and tell me what you mean.’

‘You don’t KNOW what the result is going to be
when you treat this person.  It’s in the future.
The only thing you can do with the future is think
about it, which leaves you two options.
You can think the person is NOT going to get
better or you can think they ARE going to get
better.’

‘and that’s going to make a difference?’

‘Yes and no.’

‘Always the yes and no answers with you.’

‘What would you say if I told you that we are
making up our reality as we go and the main thing
that influences it is the way we think.  Things
are the way they are because we expect them to be
that way.’

‘I’d say you’d lost the plot and were a couple
of steps away from the funny farm.’

‘In that case I won’t tell you that and by the
way calling a psychiatric institution the funny
farm is not very politically correct, you know.. ‘

‘Me not politically correct? You’re one of the
least politically correct people I know.  You take
pleasure in being politically incorrect.  I’ve
seen you at parties, remember?’

‘Fair point.
Look, what have you got to loose by being open
to the possibility that the person is going to get
better?’

‘I’ve just never been into that whole positive
thinking thing.’

‘It’s not really positive thinking, it’s more
like . . selfish thinking.  You’re thinking about
the future in the way you’d like it to be.’

‘Does it really make a difference?’

‘It makes a huge difference if you do it in the
right way.’

‘Which is?’

‘The first thing to do is get a very clear
picture of the future you want.  In your case it
would be you supporting this person to move
through chronic fatigue successfully. The clearer
the image the better.
As you think about this outcome you’ll notice
you get an uncomfortable feeling in your gut.
That uncomfortable feeling is what has kept your
current expectations in place.’

I could see I was making progress.

‘You’ve lost me.’

‘Okay, ever thought about winning the lottery?’

‘No . . Yes.’

‘Okay, did you think about all the things you
could do with the money?’

‘Yes.’

‘That’s usually where most people stop.  A sort
of fantasy, up there with being able to fly or
having X-ray vision.  If they thought they were
REALLY going to win the lottery it would be
disturbing for them in ways that they never
suspected.
It would literally rock their world.

The statistics on lottery winners show that a
high percentage of them end up back where they
were financially within a couple of years of
winning.  Which I see as a desperate struggle to
get back to their old version of reality as fast
as possible.’

‘So it’s more than just positive thinking?’

‘If all we had to do was think positively, we’d
have things appearing in their lives all over the
place at a ferocious rate.
It would be like living in a nightmare where
everything you thought about would appear in front
of you as soon as you thought about it.  Things
you wanted and things you didn’t want but couldn’t
stop thinking about.’

‘or the one where you go to a party and
everyone keeps running away from you screaming and
then you catch your reflection in the mirror and
you’ve got the head of a shark. . ‘

‘Focus.’

‘Right.’

‘There are reason’s why we expect things to be
the way they are.  With the lottery winner they
could have a deep belief that money is bad and if
they have lots of it, they’ll be bad too.  Without
them knowing about that belief they will try and
find unconscious ways to get rid of the prize
money as fast as possible.’

‘So that’s what you meant about struggling to
get back to their old version of reality as fast
as possible.’

‘Precisely.’

We were making great progress.

‘Yeah well that’s the thing about unconscious
stuff, it’s unconscious. How do you know about
stuff . . you don’t know about, huh?’

Okay, we were making progress.

‘It’s true, you’ll do your head in thinking
about it like that.  There IS a way of starting to
become aware of it though.  It begins with getting
a clear picture of what you want and then asking
yourself how you would feel about it if it REALLY
happened.
If you can get into how you would feel in that
situation and as you’re doing that you also scan
your body, you’ll find it will be making you
disturbed some where.
When you look into that disturbance you will
get more of an idea of what has been stopping you
having the result you want.’

‘How so?’

‘Like the lottery winner believing that money
was bad.  As soon as they had lots of money that
belief was challenged.  The money made them very
uncomfortable.

If, prior to winning, they had got a clear
picture of how their lives would be with the extra
money and how they would feel in that life, they
would have discovered that it made them
uncomfortable.

If they had looked into what that uncomfortable
feeling was about they would have discovered the
belief about money being bad.  They could then
have started to work through the belief and when
they finally did win, it would have made the
process of coming into money much more enjoyable.’

‘So you reckon I have some unconscious belief
about treating this person with the chronic
fatigue?’

‘I dunno.  I think you’ll find out if you get
clear about the outcome you want and then listen
carefully to how it makes you feel.’

‘Okay I’ll give it a try.’

‘Try you must not, do you must.’

‘Cute.’

Having this chat made me verbalise what had
been brewing in me for a couple of years.  The
question of whether the patient believes in what
we are doing is secondary to what we, as
therapists, believe is possible.

If there is a difference between the results we
would like to be getting and the results we are
getting then the onus is on us to sift through
ourselves and discover why we are getting the
results we are.

It reminds me of a cartoon I saw recently.
Santa Claus is lying on the psychoanalyst’s couch
looking perturbed.  The analyst is saying to him.

‘It doesn’t matter what other people think – the
important thing is that you believe in yourself.’

.

‘Why are people so dumb?’

Posted by John Dalton on July 2, 2008

+ Emotional issues - Why are people so dumb? - September 05

Ok Maestro. Read your blurb on your website.

You don’t seem like your standard “Be still
and know that I KNOW,’ sort of cranio person.
Is there a factory somewhere I don’t know about
that churns these folk out?

Anyways, I’ve got a question for ye.
I’ve been seeing people for 4 years now, using
a combination of acupuncture and cranio.

As time goes on I’m seeing the cause of many
physical problems are emotional.

They tell you their life stories when they come
in and you can see how they keep repeating
the same self destructive patterns over and OVER again!
You point it out to them and they just keep doing it?

What gives?
Why don’t they get it?
Believe me I’ve tried everything!

So let’s hear your answer on that one Kemosabe.

K. Orlando. Fl.

>>>MY COMMENTS:

Why DON’T people get it?
Is it because they are dumb?

Well let’s explore that. If the reason people don’t
get stuff is because they are dumb then that would
include you and me.

Wouldn’t it?

Or do you think we are special?

That you and I get stuff quicker than other people?
Maybe it’s just you and the rest of us are dumb?
Okay, so maybe there is something else going on.

It’s called subjectivity.

Let me explain.

This situation happens to about once every couple of
weeks in my practie. I will be talking with a patient
about their condition. I will be in the middle of
saying something that I hadn’t verbalised before and
what I am saying is COOL!

Part of me will be listening and thinking ‘This is
really good, profound, insightful stuff I’m saying.’

Within a few minutes the patient will be looking
at me in an awed sort of way. I can see them
rummaging around internally for the makings of
a nice pedestal to put me on. That’s when my
ALARM BELLS GO OFF.

For me and for them.

While I acknowledge that every now and again
I do say something original, I know it’s not
good for me to get too self admiring about it.

I also, know that the patient is about to disempower
themselves if I don’t do something fast.

At this stage they will usually be in the middle
of telling me how they feel like a screw up of
one kind or another.

The inference being that there are people in the
world who are normal, they are in the majority
and the patient is an anomaly.

I stop them and explain the objective/subjective dynamic.
I make a point of explaining that I can have insight
about their lives because I AM NOT IN THEIR BODY.
I’M NOT LIVING IN THEIR LIFE.

I further the point by telling them that if we
swapped seats and I started telling them about
my life, they could have some very useful insights
about my life. Particularly the things I am not seeing.

Bottom line Tonto, is you have been sitting in the
therapist’s chair too long. You have forgotten what
it is like to be a patient. You have started to
believe your own press and feel like you should
be up there on that pedestal your patients have
been eager to put you on.

WARNING! WARNING! YOU ARE IN DANGER OF
FALLING INTO THE THERAPIST TRAP.

I know because I fell in it a few times myself
in different ways. It is one of those things
you need to be very proactive in not allowing to happen.

You have to nip it in the bud with yourself first
and then with your patients.

No pedestal building allowed.
No special powers implied.
No act together imagined.

So be of good cheer, K of Orlando, it’s not hopeless
but you will need to do something NOW.

I suggest going to a therapist, a cranio sacral
therapist even. Put yourself in the other chair
for a bit.

Take a class. Learn something new.

Do whatever you can to break up the cocoon of
smug superiority you have woven around yourself.

Try and energetically stand beside the patient
as you look at their problem, rather on opposite
sides of it.

Be with them, two people doing the best they can,
sometimes with ignorance and fear
sometimes with grace and beauty.

Dude, somebody hug me.

‘What did you do to me?’

Posted by John Dalton on July 2, 2008

+ How to handle the, “What did you do to me?” question. - September 05

+ Comment from Mij Ferrett, craniosacral therapist
and editor of ‘The Fulcrum’, journal of The
Craniosacral Therapy Association of the UK. - September 05

Dear John,

I have been practicing for two years and am
enjoying the work immensely. By an large my
practice is going well.

Every now and then a particular kind of patient
will come back for their second visit and accuse
me of doing something to them.

Sometimes it is subtle, sometimes not so subtle.

They will say things like, ‘My neck was fine
before I came to see you for back pain.

Now it is really painful.’

I find it very hard to know what to say to them.

Any suggestions would be greatly appreciated.

NC

Eire(Ireland) but you knew that anyway.

>>>MY COMMENTS:

Yeah, I may live in Oz but I still know where
Ireland is.

Your question highlights one of the most
difficult aspects of natural medicine.

That people have been conditioned to be
irresponsible about their health.

‘Fix me Doc.’

When someone asks you ‘What have you done to me?’
they are relating to you like a doctor.
I don’t know whether you have thought about
this or not but, like it or not, you are a pioneer.

You are at the cutting edge of a fringe.

So one of your tasks must be education.

If you are able to tell you are dealing with
‘that kind of patient’, then you would be wise
to take some pre-emptive measures to avoid them
asking you the question in ADVANCE.

The best way to solve a problem being to
never have it in the first place.

Don’t know where I heard that but I love using it.

When you identify the person as being irresponsible
at the first session, you need to start explaining
to them right away how it all works. Focusing
particularly on how you are supporting their
body to fix itself.

That you are not trying to direct how that
process will go, because you know from experience
that peoples bodies know best how to fix themselves.

How sometimes things can get worse before they get
better.

Help them to discover how remarkable their body is.

Worst comes to worst and they come back the following
week and ask you what you did to them?

You can reframe it for them by reminding them
what you actually did. You laid you hands gently on
different parts of their body for varying amounts
of time.

You didn’t click them or manipulate them or adjust
them. In light of all that isn’t it an indication
of how powerful this way of working is, that it can
reach such depths in the persons body with such a
light touch. And how their body can respond in such
powerful ways to this kind of support.

Lastly, if you are getting that kind of feedback
a lot, you might need to look at yourself. Your
intention may be too strong. You may be trying
too hard. You may be too attached to what you
think is the right outcome.

Generally speaking any repeating pattern in your
Patient’s is worth looking at in this way.

‘Is this me?’

‘Is this my issues/patterns playing out?’

***COMMENT FROM MIJ FERRETT***

Hi John,

I love your answers and have enjoyed reading them and,
for the most part, agree with them.  There is one minor
point though … when you say ‘Lastly, if you are
getting that kind of feedback  ['My neck was fine
before I came to see you for back pain. Now it is
really painful.'] a lot, you might need to look at
yourself.  Your intention may be too strong.  You may be
trying too hard.  You may be too attached to what you
think is the right outcome.’

I think what you said is relevant and true but there is
more to say. If you get this kind of comment often then
it is almost certain that there is something that needs
looking at but whether or not you get this kind of
feedback it is inevitable that from time to time all of
us will get drawn into being over-focused and doing too
much and that as a result we will tend to initiate some
kind of protective reaction from the client in response
to our inappropriate interaction. There is a natural
tendency for therapists to deny this so the process of
denial needs attention paying to it as well. In
situations like this it’s useful to spend a little time
reflecting on what has happened and notice any pull
towards being defensive. One of the most beneficial
ways of progressing therapeutically with someone is
admitting when we make a mistake and apologising for
it.
Interestingly this principle has paid dividends in, of
all places, american hospitals*. Any authentic
acknowledgement and apology will tend to help the
therapeutic relationship.

Of course there is the classic healing crisis response
as well and the classic response of the client not
taking responsibility for their own process but that
this can be used as a cover up for therapeutic error.

More power to your keyboard.

Mij

*Due to the litigious nature of the culture and the
large sums of money awarded by damages suits many
hospitals and doctors have tended to cover up and deny
mistakes.  However a pilot scheme in Lexington VA
Kentucky introduced after some multimillion dollar
lawsuits, encourages doctors to acknowledge their
mistakes and apologise for them. When patients have
doctors apologise to them and offer fair compensation
feelings are much improved and court awards are much
lower; there has also been a reduction in unjustified
malpractice suits. Subsequently many other US hospitals
have introduced the policy with similar results and
medical students are now being encouraged by Harvard
Medical School to do the same when qualified.

>>>MY COMMENTS:

I agree with everything up to the part about
apologising to the patient when we make a mistake.
For some reason this set my alarm bells off.

‘Apologise to a patient? Really?’

It troubled me.

I wrestled with it.

I pondered, even.

And then it hit me . . . a few times.

Not all apologies are therapeutically beneficial for
both parties.

When I get on an aeroplane I’m not really thinking
about the pilot. I’m thinking of where I want to go.
My destination.

If I did think about the pilot I would have to
acknowledge that he will probably make AT LEAST one
mistake on the flight.  I know it but I don’t really
want to think about it.

If we are flying along at 60,000 feet and the plane
lurches suddenly but then rights itself, I want to
think that we probably hit an unexpected pocket of
turbulence.  The ‘fasten you seatbelts’ sign didn’t
come on so everything is probably ok.

The last thing I want to hear is the pilot coming
over the intercom saying,

‘Hi Everyone, this is the captain speaking.
Look, the head cabin attendant Nancy, was just
giving me my dinner and when I reached for the tray
I accidentally hit the throttle with my knee.
That’s why the plane lurched a minute ago.  So I
just wanted to let you know and I wanted to
apologise to you all.’

The captain would probably turn off the intercom,
look at his co-pilot and say, ‘Man, that felt good.
Therapeutic almost.’

Back in my seat, I would probably have a glazed sort
of look in my eye.  My knuckles would definitely be
whiter and while rationally I might appreciate the
pilot’s honesty, most of me would be wanting to get off
at the next stop. Which stop? Who cares?

JUST GET ME OFF THIS PLANE!!!

I would still want to reach my destination, just not
with that pilot.  He is probably perfectly competent to
get me there but he just made the process of getting
there too scary for me.

Also . .

The sort of ‘mistakes’ we make are a lot more
complicated and difficult to explain than Doctor’s
mistakes.

‘I’m sorry I left my wristwatch inside you, when I
sewed you up Mr Smith.’ would be understood by most
patients.  They wouldn’t be too pleased about it, maybe
they wouldn’t sue the doctor for so much but they would
understand the error.

Whereas if we say something like. . .
‘I’m sorry you had that reaction last week. It was
my fault because I wanted you to get better too much.’

Most patients could understandably reply, ‘That’s
what I’m paying you for.  You’re supposed to want me to
get better, ya big freak!’

Equally . .

There is the possibility that we could end up
apologising for responses that are not actually
mistakes but are part of the therapeutic process.

Saying. . ‘I want to apologise for your neck hurting
this week. It was because my intention was too much
last week.’

Is apologising for what is actually part of the
process of finding the best level to work at for that
person’s system.  There is no way of knowing it in
advance.  You can only find the right level to work at
by going as lightly as possible, while remaining
physically in the room, the first time you treat the
person and then going deeper with each subsequent
treatment.

Assuredly . .

I’m all for apologising to patients if you’re
running late or you haven’t got the right change or you
fall asleep on their stomach!
No kidding, it hasn’t happened to me personally but did
happen REPEATEDLY to one of my students.

Eeeeewwwwww!

Finally . .

Be ruthlessly honest with yourself and appropriately
honest with your patients.