Open Source Cranio

Tag: Practitionership

  • Question – Tips for starting a craniosacral therapy practice?

    Hi John,

    I am a qualified Reflexologist and in September 2005 I did a 4 day course in Cranio-Sacral Reflexology in Mullingar Co. Westmeath with Martine Faure-Alderson. I was so impressedby the Cranio-Sacral element of the course the I wanted to learn more and more about it all as it seemed so fascinating. I researched courses in Cranio-Sacral therapy on completing this course in Cranio-Sacral Reflexology. I was directed to the College of Cranio-Sacral Therapy in London. I began the one year course there in September 2006 and completed the course in July 2007. Since then I have been busy with my two young children. I want to start up my own practice in the very near future and keep up learning Cranio-Sacral therapy.

    Have you any tips for starting up as a therapist?

    Regards,
    Catriona
    Ireland

    MY COMMENTS:

    Hello Catriona,
    The main thing that will help you grow a strong practice may sound obvious – be very good. Get remarkable results consistently.

    If people have a positive experience with you they will tell 5 other people.  If they have a negative experience with you they will tell 20 other people. So nurture your word of mouth carefully.

    One of the most unacknowledged ingredients in building a successful practice is time.  There are many things you can do to kick start the process and I will go into them below but it is my experience that it takes about 2 years to build a strong practice from scratch.

    Now on to the marketing stuff.

    FINDING YOUR IDEAL PATIENT
    Before you launch yourself into any marketing activities the first thing you need to  do is think about what sort of people you want to treat.
    What kind of a practice you want to have.
    Getting that clear in your head will make a big difference to your marketing efforts.

    Write down what your ideal patient would be like.
    Include in as much detail as possible.  Once you get really clear about the sort of person you want to treat then you can start to ask yourself the following questions about them.

    – Where do they shop?
    – How do they get their information about things?
    – How do they learn about new services?
    – What do they do in their recreation time?
    – What sort of clubs they are attached to (Tennis, hiking, bike riding?)
    – What sort of clubs do they go to?
    – Where do they live?

    As an aside, the answer to that last question should determine where your practice is located. There is no point locating your practice on the other side of town from the people you want to be treating no matter how convenient it is for you or what a great deal you are getting on the treatment room.

    You have to be pretty ruthless with yourself about this point.  I have seen many a therapist move into a room they really liked that had ‘great energy’ and was a real bargain only to find that no one would make the journey to it.  That is also why treating people from your home will only work if your home is in the area where your ideal patients live.

    GET WRITING.
    So once you get clear about who you want to treat and where you want to be located then the next thing is to start writing.   Don’t write for any particular thing like a website or brochure or talk just write for clarity.

    If the thoughts of writing are too much you can hire someone to do it for you.  You can do it through elance.com.  I will explain more about elance below. The important thing is that what is written expresses your perspective on your work.

    A common mistake I see in cranio sacral websites and literature is trying explain what cranio sacral therapy is and how it works.  If you ever watch someone reading these kinds of explanations you will see their eyes start to glaze over before they get to the end of the second paragraph and the fourth reference to the craniosacral rhythm.

    Keep your ideal patient in mind and write for them. Don’t worry about everyone else.  Try and get into the head of your ideal patient and what THEIR head would be like when they are looking for a solution to THEIR problem.  Try and speak to them there.

    The first thing you should write is a description of where THEY are at.  Outline their problem in detail.

    Here is an example from my website of the sort of thing I am talking about.

    “Is your faith in the medical system shattered?
    Has your wallet been emptied by over confident
    therapists? Have you been on the emotional roller
    coaster, rising with hope that each new approach
    is going to work, then crushed when it doesn’t?
    Have you tried everything and still not got the
    results you wanted?”

    You get the idea – use your own words.

    Next write about yourself and how you are qualified to talk about helping them.

    Next write about how what you do can help solve their problem.  Keep it simple with not too much jargon.

    Next write what the benefits of coming to you for treatment are from THEIR perspective are.

    Here is an example from my website of the sort of thing I am talking about.

    Visit the last resort first . . .and save money.
    It became a joke among my students and
    graduates that we were actually in the resort
    business because for most of the people who
    came to see us, we were the last resort.
    It doesn’t need to be like that. Most people are
    floored when they add up how much they’ve spent
    so far trying to get better.
    Don’t waste any more of your money.

    Benefit from no returns.
    When you understand that cranio sacral therapy
    helps trauma release from your body, then it makes
    sense that once restrictions are released in this way,
    they are gone for good.
    So when you’re done, you’re done.
    It’s as simple as getting a big piece of cellophane
    and scrunching it into a ball and then assisting it
    to unravel itself.
    Once it has unraveled itself, there’s no need to
    ‘maintain’ its state of unraveled-ness.
    So you don’t need any ‘maintenance’ treatments
    to keep your health. What you spend having
    treatment is finite and has a very definite end.

    Gentle on you.
    Cranio sacral therapy is a very gentle approach.
    There is no pushing, adjusting or manipulating your
    body into a set or ‘correct’ position. There is no
    intrusive probing into your past. The contact is very
    gentle and people often fall asleep during treatment.
    Because of this gentleness it is good for children
    and people in a lot of pain.
    You will feel the benefits within 4 weeks.
    Most people feel the benefits immediately. If it
    takes longer you will generally see enough
    improvement after 4 weeks to know that it’s going
    to work.

    Gets to the root of the problem.
    There are many approaches that will give you
    complete reduction of your symptoms. The trouble
    is the reduction only lasts for a short period of time
    and then you have to return from more treatment.
    Eventually this kind of approach makes your body
    dependent on the treatment.
    Cranio sacral therapy works with the root cause
    of the problems. This has the effect of causing
    lasting relief of symptoms.
    In 15 years I have never had anyone return for
    treatment for the original problem they came to
    me with.
    Not one.

    These are all great benefits from the patients perspective.

    Next write about what you charge and why it is good value.  You may find this hard but if you can’t explain why it is good value you may be charging too much. This is a time for taking the bull by the horns. If you feel what you charge is good value and you can explain why then your ideal patient will be grateful.  It’s your job to explain it to them not their job to try and intuit the reasons why it is good
    value.

    Once you are happy with what you have written try it out on some family or friends who are the type of people you would like to treat.

    Ask them to read it and give you feedback about it.  You don’t have to take the feedback but you will find it illuminating.

    What you have written forms the backbone for your marketing.  You can adapt and edit it for the different types of marketing activities you might engage in. What type of activities you engage in will be determined by the sorts of people you want to reach.  Reread everything you have written every six months or so.  You will be surprised at what you want to change and edit.

    TESTIMONIALS
    It is important to get testimonials from people you have treated.  Most people will come to see you because of a word of mouth referral. If they can’t get a referral then all they have to go on is what you have written.  People who don’t know you will generally be suspicious of what you say about yourself.  It’s not personal, we are all jaundiced by sales claims.

    Having testimonials go a long way towards easing that suspicion.

    The good news is that getting testimonials is relatively easy.  When a patient is finished their treatment program you can explain to them that there are other people who have the same condition who would be helped if the patient wrote something about their experience of
    treatment.

    Give your patient the option of remaining anonymous in the testimonial. Obviously the full name and location with a photograph is ideal.

    Here are some of the ways you can use your written material, including your testimonials.

    WEBSITE
    I can’t over emphasize the importance of getting yourself on the internet. If you don’t know anything about computers and the thoughts of organising a website for yourself seem overwhelming, fear not. There are plenty of ways around it.

    With websites there are a few simple things you need to know and the complicated stuff you can get someone else to do for you.  I will explain where you can find those people in a minute.

    One of the most important, and often overlooked, things with websites is the domain name. The domain name is what comes after the www For example with my Irish website the domain name is www.cranio.ie

    I will come back to the name part in a minute because I want to talk about the other really important part which is the suffix. That’s what comes at the end of the domain name, the .com end.

    It is important to get a domain name for the country you are working in.  So for Ireland that would be .ie for the United Kingdom that would be .co.uk for South Africa it would be .co.za for Poland it would be .pl and so on.

    Each country has their own suffix.  Having the right suffix for the country you live in will make it easier for google to find you when people in your country look for you. (Technically speaking the suffix for America is .us but it is rarely used so if I lived in America I would get a .com suffix.)

    If you are not sure what the suffix is for your country you can look here

    Double check it by looking at local businesses and see what suffix most business are using.

    One last thing on suffix’s, .net  .org and so on don’t generally work as people will forget the subtle difference and look for .com or the suffix of your country.

    For example if I couldn’t get
    www.johndalton.ie
    but I saw that
    www.johndalton.net
    was available it would be tempting to get it.

    Let’s check this against what I like to call the Party Rule.  The party pule states that your domain name has to have a more than 50% chance of being remembered by a mildly inebriated person you tell it to at a party.

    So if I told this person my domain name was
    www.johndalton.net
    there is a good chance that the next morning they would look for
    www.johndalton.com
    then
    www.johndalton.ie
    and when that didn’t work they would give up.
    So no .org .nets etc. please.

    Now back to the name bit. The bit between the www. and the .com

    You could try for craniosacraltherapy but it will probably be already taken.  There are some countries where it hasn’t been taken but it will be gone in most.

    What I suggest you use is your name. So in my case the domain name would be
    www.johndalton.ie
    Short, simple, memorable and relevant
    – and it passes the Party Rule.

    If your name is unavailable I suggest you use your name plus cranio so in my case it would be
    www.johndaltoncranio.ie
    I don’t suggest you use craniosacral or craniosacral therapy as most people won’t remember it.  I have found that cranio is the only part of cranio sacral therapy that people remember on first hearing the name.

    It is important to buy your domain name yourself and it is relatively easy to do.  Just type ‘domain registration’ into google and you will find  lots of companies offering to sell you domain names.

    Lastly, bear in mind that domain names are a commodity like anything else and different companies will have different prices. Shop around for the best price.

    Next find yourself a hosting company. A hosting company is the company where your website lives.
    If your website was a horse, the hosting company would be the stables where you keep it. Don’t be tempted by free hosting. There is usually a catch. The most common one being the inclusion of the hosting companies name in your domain name.

    So for example if I opted for free hosting with a company called Bluebird Hosting there is a good chance my domain name would end up being
    www.bluebird.johndalton.ie

    Shop around.  I have found this company very good. powweb.com

    Next thing to do is find yourself someone to set your website up for you. I suggest you go to elance.com and register.

    Then place the following ad.
    _______________________________________________________

    Job Title – WordPress Instalation and Setup.

    Category – Web & Programming

    Job Description – Set up wordpress site.
    Install and activate the following plugins –
    – All in One SEO Pack
    – Akismetincluding
    – cforms ( Including configuration of basic contact form)
    – Google XML Sitemaps

    Suggest WordPress theme for natural therapies website
    – minimum of 3 suggestions – plus minor modification
    of theme to suit site.

    Inclusion of staff training in wordpress usage.

    Hosting company and domain name already in place.

    Desired Skills – WordPress

    Job Type – Fixed price
    – Approximate Budget – Between $50 and $500
    _______________________________________________________

    Then sit back and wait.
    Before long you will have bids from all around the world from experienced professionals offering to set up your website. They can all see each others bids so they will try to get your work for the lowest price.

    Have a read through elance’s guidelines before you start so can set miles stones and generally make sure that you pay on results. You can explore elance here.

    Once the site is set up you should be able to update the site yourself, adding all text you have written. You will know how to do this because the professional will have given your staff, you, training.

    Give your web site about 6 weeks to begin to show up for in google searches.  Adding to your website on a regular basis helps keep it up in the rankings.

    PRINTED MEDIA
    Over the years I have tried it all, flyers of all shapes and sizes, brochures, adds in magazines and newspapers. Nowadays I mainly just use business cards and postcards. Both of which are geared toward sending people to my web site where they can get all the information they need to make an informed decision about whether they want to come and see me. I use Vistaprint for these.

    I suggest you get good quality card for your business cards.  This is not a place to skimp.

    BROCHURES
    Whether or not you do a brochure will depend on who your ideal patient is.  They may like to have something to hold and review. For me, the disadvantages of brochures far out way their usefulness plus I don’t need them for my ideal patients.

    The main disadvantage of brochures is that to produce one that looks professional costs a lot of money.
    It is also very hard to get everything that you want to say into a brochure no matter how small you make the print.

    Letter box drops, tiny advertisements in the local paper, flyers up at the your local health food shop and notices stuck on community boards are probably NOT going to get your practice where you want it to be.
    Here is a little scenario to explain why I say that.

    Mum and Dad are walking past the local health
    food shop with their 4 year old Autistic child.
    They see a photocopied flyer for Cranio Sacral
    Therapy on the notice board, behind the Dream
    catcher making workshop and beside the ‘Learn
    to Channel’ weekend.  It is highly unlikely that
    Dad will turn to Mum and say ‘Hey, Betty this
    cranio thing just might be worth trying for
    Timmy.’

    A word of caution: When you first start marketing yourself you can invest a lot of energy doing things that are comfortable for you to do.  They even allow you to feel like you are really doing something to build your practice, letter box drops are particularly good for this, but they may not be very effective and can leave you feeling somewhat of a failure when no one responds.

    Always come back to your ideal patient and ask yourself if they would respond to what you are doing.

    WORKING WITH LOCAL BUSINESS
    One way to create word of mouth referrals in your local area is to work with suitable local businesses so that they will refer to you.

    Firstly you need to discern which businesses are suitable by their product / service to helping you. Look at the local businesses and see which ones spend time talking to their customers.  What do their customers talk to them about?  Is it feasible that in the course of conducting their own business that these people may have reason to mention you?

    For example, hairdressers, podiatrists, beauty therapists and barbers spend a lot of time talking to their customers.  Their customers talk to them about a whole range of things from work to holidays to their children and partners, including their health.

    It is feasible that a hairdresser, if they knew about cranio sacral therapy, would mention it during a conversation about their client’s skiing accident or chronic back pain etc.  This business represents a good opportunity for you to receive word of mouth referrals.

    Be mindful of the appropriateness of the business you approach.  Is their product or service in alignment with the work you do.  Bartenders spend a lot of time talking to their customers but probably wouldn’t be a suitable business for you to work with. Again it comes back to who your ideal patient is.

    When you have identified 3-4 suitable businesses in your locality you will need to introduce the owners and/or staff to what you do.  In order for them to be able to reasonably refer someone to you they need to know a bit about what you do.  What is it good for? Is it gentle?  Who does it help? etc.  This can be done on an individual basis or as a group.

    When talking about cranio sacral tell stories about patients you have treated to highlight how cranio works rather than dry and boring explanations.

    If you are working with 3 or 4 businesses you may find it easier to talk to them all as a group.  A good start is to write an introductory letter to each of them. Outline what you have in mind and invite them to your clinic to hear a bit more about cranio sacral
    therapy.

    I suggest you make this meeting a generous affair.

    Most business people are always looking for new ways to boost their profile.  Provide tea and biscuits or wine and nibbles etc.  Try to create an arena for discussion and interest.  They will be coming to hear about cranio sacral therapy but also to take advantage of having other business peoples experience and ideas.

    Provide each business with a gift package of say, 10 Cranio Sacral assessments as a limited special.

    There are some important things to consider when offering this:

    • Make sure the business is conducive to offering such a gift
    • Be sure that you make up your own vouchers to be offered
    • Do not present it as a “FREE” treatment but as a
      Cranio Sacral assessment “VALUED AT $XX.00”

    This last point is very important, if you don’t put the value of the free gift then the people who come for the free assessment will find it hard to reconcile the value of your treatment when they come to you as a patient.

    Encourage the businesses to give these free gifts to customers that they feel might benefit from your treatment.

    As you can see there is quite a bit to marketing and there are new ways to market coming up all the time.

  • Cranio Sacral Therapist and Student Newsletter 34

    May 25 – 2008

    Questions and comments for this issue:

    + The interweb thingy.
    + Twitter.
    + Book recommendation from Renee in Australia.
    + Comment from Etienne in Belgium.
    + Comment from Joyaa in Australia.
    + Comment from Eva in Australia.
    + Question about contact pressure and effectiveness.
    + Question about intracranial hypertension.

    Hello,

    Very Important Breaking news: Russia won the
    Eurovision song contest.  Personally I think
    Israel should have won but you decide for
    yourself and let me know.
    Russia:
    http://www.youtube.com/watch?v=_XR5xrU02yo&
    Israel:
    http://www.youtube.com/watch?v=sw_6gdieBRY

    If teaching new mothers how to make nutritious
    meals for their new babies sounds like a good
    idea to you then have a look here
    http://www.indiegogo.com/mouthofbabes
    and if you like what you see then make a
    contribution and help Rene, who is also a cranio
    sacral therapist as you will see below, get the
    project off the ground.

    I obviously think it is worthwhile having
    already put my money where my mouth is.
    A-har!! and I didn’t even mean that pun.

    I want to ask a question. Now I don’t want you
    to get anxious but it’s about the internet.

    Are you on it?

    While you are thinking about that let me tell
    you some things about my practice.

    1. EVERYONE who comes to see me comes from the
    internet.
    2. I don’t do ANY other advertising.
    3. Currently my waiting list is 6 weeks long.
    4. I charge more than most natural
    therapists in Ireland. [It was the same in
    Australia]
    5. If you search for cranio sacral therapy in
    Ireland or Australia on Google my website
    will be in the top ten.
    6. When I moved to Ireland I was able to set up
    my practice from scratch with no drop in
    patients or income all because of the way I
    use the internet.

    I’m not telling you the above to blow my own
    trumpet, you don’t want to hear that racket once I
    get started, no I’m telling you to highlight how
    powerful the internet is.

    Now back to my question.  Are you on the
    internet?  If not, is that because your practice is
    as big as you would like it to be thank you very
    much or because the internet is a complex and scary
    place?

    If you are on the internet, are you getting the
    sorts of results you want?

    It has been my experience that, with a few
    exceptions, most cranio sacral therapists are not
    very computer friendly.

    Well let me correct that they are friendly to
    their computers, if they own one, they just don’t
    feel like their computers are very friendly towards
    them.

    How to create a successful website that actually
    gets the sort of people you want to treat to call
    you and then get that site to the top of the google
    ranking is a big subject and not something I am
    going to go into here.

    I am thinking of putting together a special
    training on the subject so if you’re interested let
    me know.  Whether I do it or not will very much be
    determined by the level of interest.

    Something you can do right now for free is get
    yourself on TWITTER.

    Twhatter??

    Twitter.
    Without getting too technical, Twitter is what
    is called a ‘micro-blogging’ platform.

    And no that’s not a kiddies toilet step.

    On Twitter, users post short updates about what
    they’re up to.  (Max. 140 characters. So it’s short
    and to the point.)

    When I first heard about Twitter I didn’t really
    get it.

    It just seemed like a load of back and forth
    ‘chat’ between people.  My initial thought was, ‘I
    don’t have time for this.’

    But not being one to allow good sense to stand
    in the way of having a go, I dived in.

    Within a week it really started to dawn on me
    how deceptively powerful Twitter was.

    And you don’t have to be sitting in front of
    your computer to use it, you can post from your
    cellphone.  That’s one of the things I really like
    about it.

    Because Twitter posts happen so fast (i.e.
    someone could witness an event and instantly post
    about it from their phone) it’s becoming a valuable
    source for REAL-TIME information.

    The typhoon in Burma and the earthquake in China
    come to mind immediately.

    Here’s a story that illustrates how powerful it
    can me.  James Buck, a graduate student in
    journalism from the University of California-
    Berkeley was arrested last month in Mahalla, Egypt
    while covering an anti-government protest.

    Thinking quickly, James was able to send a one-
    word Twitter update: ‘Arrested.’

    The people who were following him on Twitter in
    Egypt and the US reacted by contacting the
    university and the consulate on his behalf.  Before
    long, James was updating Twitter with another one-
    word message, ‘Free.’

    Twitter is also becoming a powerful ‘crowd
    sourcing’ tool.

    Someone can post to Twitter and ask ‘What’s the
    best digital camera for under $400?’ and in a
    matter  of minutes have tons of replies from other
    people giving great feedback and advice.

    This is one of the ways it can be useful to you
    and your practice as the number of people who talk
    about their health and emotional life is huge.

    You can use twitter to grow your practice by
    specifically searching for and connecting with
    people in your country, area or city.

    You do this by ‘following’ which simply means
    letting Twitter know you would like to be informed
    whenever the particular person posts a comment.
    Most people will reciprocate and in turn ‘follow’
    you.

    Some of the more popular people on Twitter have
    10,000’s of people following them.

    Think about that for a minute in relation to
    your practice.  You could let 1000’s of people know
    if you were moving offices or had a particularly
    successful case or were giving a talk.

    You can also use Twitter to connect with other
    cranio sacral therapists around the world.  This
    means that should you need to refer someone to a
    therapist in another country or city you will have
    someone you know.  I have already been asked for
    referrals like this a few times.  As you connect
    with more cranio sacral therapists, they too will
    refer to you.

    Okay so here’s what to do.

    Go here http://www.twitter.com and get yourself
    an account.  It’s free and quick and takes about 3
    minutes.   Make sure you include ‘cranio sacral
    therapist’ or  ‘cranio sacral student’ in your bio,
    which is also limited to 140 characters.

    If you want to get an idea of what sort of
    things I twitter about you can look at my Twitter
    page here.

    If you want to ‘follow’ me, and I encourage you to
    and any other cranio sacral therapist you can find
    on twitter, make sure you click ‘Follow’ under my
    photo.

    Once you do that you will be notified whenever I
    make a Twitter post.  I will ‘Follow’ you back.

    If the whole thing makes no sense to you just
    try it for a week.  I found it took about that long
    for me to get into it and to know what was worth
    posting about.

    -o-

    Now, lots of response to the last newsletter,
    so let’s get on with the mailbag.

    ***COMMENT FROM RENEE IN AUSTRALIA***

    Hi John,
    I love reading your newsletters whenever you send
    them.  I have been reading this book which is
    absolutely phenomenal.  And I would just like to
    share it with the cranio community:

    The Secret Teachings of Plants In The Direct
    Perception of Nature by Stephen Harrod Buhner.

    It is a really revolutionary book that has been
    around for a while so maybe many people already
    know about it.  Stephen looks into the energies
    coming from our hearts and how our hearts
    communicate with every other thing on earth.
    Plants is where he starts and speaks about how
    aboriginal peoples have been able to learn from
    plants themselves what and how they can be used to
    heal people through this vibrationary language.  As
    the book progresses he speaks of how we can use
    this heart awareness to communicate with each other
    and to learn the nature of disease and discomfort
    within each other.

    He calls this depth diagnosis, and reading his
    discriptions of his work it sounds just like
    cranio.  I just love the language he uses, the
    extensive quotes from Goethe and other Earth poets.
    I haven’t finished reading the book yet and I wish
    I could describe it better, but I highly recommend
    it to everyone…

    On a different note maybe I have missed some of
    your newsletters as well, but I was really excited
    reading about the village in SA and your comments
    on Open Source Cranio.  I would really love to hear
    more about that in your newsletters.  My mother
    works in Burma as a teacher trainer for
    kindergarden and upwards kids.  I believe
    craniosacral therapy could be so helpful in that
    environment when the population is under such
    stress, repression and poverty.

    Thanks again for the great work you are doing.

    Renee
    Australia.

    MY COMMENTS:

    Thanks for passing it on Renee.  I haven’t read
    the book myself so can’t comment.  From what I do
    know of it you may also like Connie Grauds work.
    http://www.spiritedmedicine.com/

    ***COMMENT FROM ETIENNE IN BELGIUM ABOUT JILL BOLTE TATLOR’S VIDEO***

    Hi John,
    I guess more Dr’s and scientists need a stroke.
    Etienne

    MY COMMENTS:

    That is so naughty – hilarious but very naughty.

    ***COMMENT FROM JOYAA IN AUSTRALIA***

    Hi John & Greetings from Queensland!
    Re. Karen & Orthodontics, I thought that I might
    add a couple of points?
    1. “Underdeveloped maxillae” (that’s the key
    phrase) are not uncommon, and are seen a lot in
    persistent mouth breathers.
    2. More progressive orthodontists tend to use
    expanders (sometimes maxillary alone, sometime with
    mandibular expanders too).  Breaking the mandible
    to try to reduce its size may be going the wrong
    way aobut things (as you suggested).
    3. There are progressive dentists and good
    orthodontists in Oz.  Whereabouts is Karen based?

    Love, Joyaa

    MY COMMENTS:

    Hello Joyaa and thanks for your comments.
    I never found much credence in the
    underdeveloped maxillae – mouth breather
    theory/approach myself.

    I haven’t come across an underdeveloped maxillae
    yet.  When there is a problem it is because they
    are compressed posteriorly or superiorly or
    medially or all three.  The compression coming from
    trauma of some kind or another.

    I’m not a big fan of expanders either because
    they are usually too tight and elicit a defensive
    response from the maxillae locking them down.

    ***COMMENT FROM EVA IN AUSTRALIA***

    Hello John,

    I have a case story that really shows how easy it
    can be to work with the teeth and bones they attach
    to.

    I treated my niece when she was 10 years old. She
    had sucked her thumb until the age of 8, so her
    front teeth (both upper and lower) were standing
    out at a pretty sharp angle.

    The orthodontist had of course said she would need
    braces.  She had some acute neck, back and pelvic
    problems and I only had the possibility to give her
    2 sessions with about 2 weeks in between, so the
    focus was not on fixing the teeth.  But I worked on
    the teeth and face for a bit any way in these two
    sessions.

    I worked individually with all the teeth as well as
    the associated structures in the face (maxillae,
    incisors, mandible, temporals, TMJ, vomer,
    palatines etc).  The front teeth really needed some
    serious unwinding.

    I saw her next one year later and her teeth had
    nearly completely straightened out. They only
    needed a tiny bit more adjustment.

    I have since worked with a few other children,
    mostly early teens, as well as my own daughter who
    is 7 and busy shedding teeth and the new big ones
    coming out with not enough space for them, causing
    them to come out crooked.

    They straighten out very easily, especially while
    they are still growing.  I must say I find teeth
    very cooperative to work with.

    Best regards,

    Eva
    Central Coast
    Australia

    ***QUESTION***

    Hi there. Was searching for someone to ask some
    questions to about CST and found you. Thanks. I
    have my two levels in CST. I totally love doing it
    on clients but feel guilty in a way because of the
    fact that they get up after looking at me like I
    haven’t done anything for the past hour to them. I
    always try to explain that they probably won’t feel
    anything but that things are occuring within their
    bodies. There is another therapist at my place of
    work who has been doing CST for a few years now and
    she does her treatments SOOO different. She uses so
    much force it is like a massage and I actually was
    sore the next day. So when one of her clients came
    to me on Monday she left feeling confused because
    she told me how different my session was from the
    other person’s so although I explained that how I
    do it is what I was taught I began to doubt myself
    that I wasn’t doing things correctly.

    I sometimes have a difficult time feeling the
    diaphragm releases happening in clients. Will this
    just come with more practice?

    Also I don’t know what this is about but when I am
    working on the cranium alot of times their heads
    will start to move around in circles or back and
    forth. Is this releasing or what is happening? I
    just try to go with what I feel and don’t second
    guess myself.

    But I really can’t say I have had anyone feel any
    change after a session. Can you give me any advice.
    Thanks for your time.
    Regards, Lorraine

    MY COMMENTS:

    Hello Lorraine,
    It’s hard for me to answer your question because
    I don’t know where you are training or what stage
    you are at in your training.   So bear that in mind
    as I answer your questions.

    With regard to how much pressure to apply, it
    shouldn’t feel as strong as a massage.  Sometimes
    in the releasing process the therapist may have to
    hold against a lot of pressure but that doesn’t
    happen too often.

    Far be it from me to pass judgement on the other
    ‘cranio sacral therapist’ in your practice but from
    what you have written it sounds like they either
    had poor or insufficient training or more likely
    they weren’t properly assessed, if at all.

    It would probably be wise to avoid sharing
    patients and if you do, you would need to make it
    very clear to the patients that you both have very
    different styles.

    Now to the diaphragms.
    The transverse diaphragms are not easy to feel
    because they are, . . . well. . . big.   Compared
    to some of the finer work we can be involved in,
    the size of the diaphragms can be daunting and too
    big to hold in your intention.

    You may find it easier to think of them
    individually rather than as a group.

    They each have a different quality and the more
    familiar you are with the quality of each, the
    easier it will be for you to feel releases as they
    occur.

    If you can’t hold the whole diaphragm in your
    intention do it in two halves.  Do one side first
    and then the other.  Aim to hold as much of the
    diaphragm in your intention as you can as you work
    on one side or the other.

    Over time you will be able to hold more and more
    of the diaphragm in your intention until eventually
    you can hold the whole diaphragm.

    Heads moving around in circles?
    Yes it can happen but if it’s happening for you
    with everyone then there’s a good chance that it’s
    your stuff.

    In fact you can pretty much apply that to
    everything you find in ‘everyone’, if you know what
    I mean.

    No?

    What I mean is if you find the same thing going
    on in everyone you would need to take a good look
    at what is going on for yourself. Chances are it
    will be your stuff.

    As to people not feeling different after a
    session. If they are getting better I wouldn’t be
    concerned about it.

    I have found that people will only give you a
    hard time about the things you expect them to give
    you a hard time about.

    So if you are concerned that people are going to
    feel like you are not doing anything, because they
    can’t feel it, then they will probably have that
    problem.

    On the other hand if you are saying that the
    people you are treating are not improving at all,
    well that’s a different kettle of much more serious
    fish.
    It’s serious because people getting better is
    kind of the whole point.

    You will need specific help with this. You will
    need to go to your trainer or mentor and get them
    to assess you.

    Get them to tune in as you are working. They
    should be able to give you specific feedback about
    how you are working, what your intention is like
    and so on.

    Don’t take it personally if they suggest having
    some treatment yourself.  It can often sort out
    obstacles in training.

    ***QUESTION***

    Hi John,

    Liane from Australia. I am a physiotherapist
    working in a new position with chronic pain
    clients.  Could you please give any experience you
    have had with this condition: intracranial
    hypertension. This lady has had 2 labours, (2
    caesarians with 2 epidurals). Symptomology came on
    following childbirth.  She is very overweight,
    looks to have a thyroid disorder.

    I look forwards to your insights and advice,

    Yours sincerely,

    Liane

    MY COMMENTS:

    Hello Liane,
    Let direct you to this case history about an
    overweight woman with intracranial hypertension I
    treated in Brisbane a number of years back.

    http://www.open-source-cranio.com/cases/intracranialtension.html

    As well as the intracranial membranes you may
    also want to look closely at the dural tube around
    the lumbro-sacral junction and her pelvis
    generally.

    The 2 caesareans and epidurals could have left
    patterns of trauma that are causing or exacerbating
    the intracranial hypertension.

    Cheerio for now.

    Till the next time.

    Your Mate,

    John D.

  • Do patients need to believe?

    + 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?’

    + 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?’

    + 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.