The Pillars of Cultivation for Clinical Compassion

A COMMENTARY ON THE PATIENT-PRACTITIONER RELATIONSHIP IN ACUPUNCTURE

Within the scope of a Chinese Medicine clinician there is an array of perspectives to diagnose and treat various conditions that walk through your door. We, as students, are given opportunities to hone the skills that are defined through a Classical Chinese Medicine Education, but the approach to bring therapeutic value to a patient is underscored within that matrix. This likely occurs due because it is not easy to teach — or easy to learn — but fundamentally essential. To this end, I have the opportunity to study psychology in relationship to Chinese Medicine as a beneficiary of the work of Dr Leon I. Hammer, MD. I have chosen four approaches to embracing the patient with an emphasis on the therapeutic relationship which I consider to be both stellar, and essential for the student who wishes to enact genuine healing principles with which to guide their practice.

Contact

Any relationship in the manifest world is intertwined with the wisdom of wholeness, and wholeness is a direct experience of universal wisdom. We are never in a moment of isolation, and always in a moment of holistic integrity. Our felt experience may not bear witness to this visceral reality, but it is nonetheless a truth in the grand scheme. It is Yin and Yang - the ever evolving necessity for interaction.

Dr Hammer emphasizes two aspects of how contact is characterized in a therapeutic dynamic. He speaks of “what” and “how” as to define that nature and quality with which we engage. The essence of contact is proactive and does not typically rest in passivity: It is a dynamic engagement that establishes a bond between practitioner and patient. Of the two aspects, the “how” is primary, but the first, the“what”, guides us along the ground on which we stand and move as we work. Both can be learned, but the “how is more subtle”. The enlightening and motivating quality of this statement is critical to a student in their beginning steps to see someone clearly and make a bridge of holistic treatment real.

Awareness

This awareness is a two-way street, especially in an intimate medicine such as acupuncture. We certainly want more for our patients than they are aware of, yet that is not what we offer in treatment — what we offer is who we are. Of course, the skill in our modality is precise and the treatment has a direction based on clinical finding. We can offer the best treatment through the application of Chinese Medicine principles — but questionably, how did we find what “we” found? The thing I have inherently learned by being present — fully present — is that awareness makes itself available because it is rooted in service. Awareness yields to being present. Being present generates presence. Patients respond to presence as an anchor that allows them to surrender to hope. Dr Hammer states: All of the devices discussed are in the service of advancing awareness. Being completely in the moment is the fulfillment of being. I was told once that awareness becoming aware of itself is what propels humans to seek. It resonated strongly, so I sought out to embrace an opportunity to be of service to awareness. Chinese Medicine is my vehicle. Awareness is very powerful, and is an essential skill to cultivate as the garment of service. Completely in the moment and unbroken receptivity to the mystery of being allows awareness to rise fully in the silence between thoughts.

Humility and Empathy

Humility is hard to speak about due to its nature: if you talk about your humility you have already lost it. How can we embody a skill that leaves only what is essential when in contact with another, when in contact with someone who is at the brink of the utter loss of self? Humility is directly tied to empathy, as they are both qualities that are components of pure awareness. This is the aspect of the medicine that we are not taught, — because it cannot be taught-it must be observed. Truthfully, this is personal cultivation that becomes ripe with time and internal redirection of intention. Dr Hammer states: The patient generally comes heavily burdened by repeated failure to establish successful relations with other people, to achieve satisfaction and the self-esteem and sense of security that are essential to self-fulfillment. How do we position ourselves to sit in the presence of someone’s shattered sense of self that presents as disappointment and lack of fulfillment? It is akin to tuning in, to finding and resonating with another person’s wavelength of perhaps a cosmic vibration. We must come back to contact, refresh our awareness and sink beyond our mental chatter to feel what the patient is trying to convey. This is the vibratory aspect of treatment that doesn’t always play out in a call and response nature. It takes place in the presence of a practitioner being able to bring something of themselves that is essential to the patient that feels alone. This is true communion, to offer oneself solely in service and then go about your work.

Intuition

If empathy is the sixth sense, intuition is the seventh. The person using intuition over time comes to know it and trust it as a fine instrument, becoming free to use it as an artist uses a familiar medium. Beyond empathy lies intuition, a tool that is in fact real, but somewhat elusive. Upon cultivation, intuition is more than a guess or a hunch — it is an understanding that may be unspoken — a sort of whisper that dances on the periphery of your awareness. From my experience in clinic, I have started to sense my intuition in the privacy of my own thought process, but am often reluctant to trust it in the face of the diagnostic process that receives so much emphasis. The discernment of whether to apply your intuition in a clinical situation lies in how much you trust it, and like all of our Chinese Medicine modalities, it must be cultivated over time. The nature of insight that is received through intuition must be regarded as private, or sacred, as there is no permission from the patient to look beyond what they have told you in person. Intuition pairs with empathy similar to the way acupuncture points pair with point actions. Intuition is delicate ground to be treading, as it is not always clinically relative, but may be valuable to understanding the patient as a whole. It is not a guessing game to see if you are right about something, but a subtle notion that may point in a direction in which to treat the picture that is created between the patient and practitioner.

As with anything that borders on mystical or psychic, there is a measure of skepticism to that which patients or other practitioners may not understand. It is with the intention of personal cultivation as the method that these “sense” skills are practiced and developed.

It is with gratitude and respect that I have come upon practitioners and mentors that share the interest that I do in offering service to lasting healing treatments to humanity defined through the merit of Chinese Medicine.

ENDNOTES

1 Hammer LI, The Patient-Practitioner Relationship in Acupuncture New York, NY: Thieme New York; 2009

2 Hammer LI, The Patient-Practitioner Relationship in Acupuncture: New York, NY: Thieme New York; 2009

3 Hammer LI, The Patient-Practitioner Relationship in Acupuncture: New York, NY: Thieme New York; 2009

4 Hammer LI, The Patient-Practitioner Relationship in Acupuncture: New York, NY: Thieme New York; 2009

5 Hammer LI, The Patient-Practitioner Relationship in Acupuncture: New York, NY: Thieme New York; 2009

6 Hammer LI, The Patient-Practitioner Relationship in Acupuncture: New York, NY: Thieme New York; 2009