The Vital Approach - Anamnesis - Step 1: Define the Territory
- Anne Vervarcke, www.thewhiteroom.be ,http://walkforhomeopathy.wordpress.com/,
http://annevervarcke.com/blog/
By define the territory I mean that whatever the patient talks about at the beginning of the interview, answering the homeopath’s general question (like: What brings you here? What can I do for you?) is a marker of the territory. This especially applies to his spontaneous remarks or questions: (‘what a nice office you have!’ ‘Should I start at the beginning?’ ‘I used to work there and there but because of the system I changed to’ etc.), all are important and meaningful. A patient never says anything haphazardly and certainly not at the beginning of the consultation. These spontaneous remarks are also important throughout the whole consultation, and even if the homeopath misses a few, the patient will repeat them more than once.
Some patients may answer a simple question with just one line while others may take three quarters of an hour to answer the same question. In the first case the homeopath will need to help the patient, they may be shy or be unsure about how much time they can take. The questions must be as general as possible, for example: ‘Can you tell me more about this? ‘Can you tell me even more?’, ‘Can you give me some details about this? ‘Anything else?’
The first thing we need to do is determine the Chief Complaint.
This may be anything. A patient might start the interview with a clear physical complaint and medical diagnosis, or have seven minor complaints, distributed on different levels. When the patient names more than one complaint, we must ask: ‘What complaint is troubling you most?’ The answer may be a confirmation or a total surprise! Sometimes the patient comes up with a whole new and unexpected subject.
As a homeopath, never assume that we know something. We don’t! We know how the world looks from our point of view and we have our definitions and understandings of words, meanings and context, but the patient has a whole different experience of the world. In fact it is exactly this different experience of the world that we are trying to unveil during the interview. Every time we are not asking for clarification because we assume we know what the patient meant or we ‘know’ what a word means, we risk missing the point.
Some homeopaths might find it uncomfortable to ‘not know’ during case taking, but it’s important to remember that we are not sitting there in a meditative state, somewhere in the clouds, trying to blank out our minds or doing something vaguely spiritual. On the contrary: we are sitting there with full attention, and with full trust in the technique we are using (because it works!) with interest and a determination to understand the uniqueness of the person in front of us. How this uniqueness looks in each case we don’t know, we will explore it during case taking. How we are going to get there, we have a fairly good idea because we use an established strategy. We studied the theory, we practiced the tools, we’ve seen it demonstrated many times and we ourselves have done it many times. It is like solving a puzzle: even when you know how to do it, each puzzle is a new challenge. You know what to do but you don’t know the outcome.
This ‘not knowing’ doesn’t need to be uncomfortable; one can be a super expert at solving puzzles/riddles and still not know what the outcome might be of any individual puzzle.
The ‘not knowing’ therefore means that we don’t know how the patient will express his vital experience until we questioned him carefully.
Subjects are chosen by the patient
The questions we ask at the beginning of the case-taking invite the patient to respond:: ‘Can you describe what it feels like?’, ‘How is the tiredness/ restlessness/ stress (etc.)?’, ‘Is there anything else that troubles you?’
Very often, after summing up the chief complaints and minor complaints, the patient will give some reason or explanation for his troubles. He might think they are due to a weak immune system, to a shocking event, a loss or stress of any kind. He might give a medical explanation or he may have visited alternative healers before and tells the homeopath what their conclusions were. Patients have often already been through psychotherapy or read books and attended workshops to come to terms with their sufferings and will share their ideas with the homeopath. Although they may sound like rationalizations, they are still important. Man’s mind works in mysterious ways!
The homeopath needs to listen very carefully to the patient’s conclusion about his sufferings. What does the complaint prevent the patient from doing or how does it affect him? How does he feel about this complaint? How does he cope with it?
We must first try to identify the symptoms, which are incongruent with the patient’s pathology.. In the beginning we may get hints of the vital sensation when the patient reveals, often between the lines, what the complaint ‘does to him’: make him less attractive; make him less capable; produces a certain feeling; makes him conclude that he is not normal, etc.
We repeat our question, ‘anything else?’ until the patient himself agrees that there is nothing more.
We should ask a question two, three or more times until we are sure we have all the information possible!
In fact during consultation, when the homeopath perceives there must be more underneath, any question may be repeated. In order to make it sound more natural to the patient, the question can be rephrased, although the patient is often not even aware if the question is literally repeated.
In the first part of the interview where there is minimal intervention by the homeopath, the spontaneous emotions of the patient become important. Any spontaneous remark by the patient is considered twice as important. Or conversely: any answer to a question by the homeopath is of less importance. We risk getting what we’ve asked for and very often that is not what the patient was going to tell us.
By spontaneous emotions I mean: those kind of ‘extra’ lines that the patient offers during their report: ‘what I found difficult’, ‘I was shocked by’, ‘this head ache makes me irritated’, ‘I’m afraid this spot will spread’, ‘this really knocked me down’, ‘the blocked nose is hindering me’, etc.
In the first part of the case taking we get sensations and feelings interwoven with the symptoms given by the patient. Many of those sensations might be common, many will be local, and some might be vital. This is what we need to discover during the consultation. But first we must give the patient the space to tell whatever he thinks is important, we will for clarification later. It is always better not to direct anything at all, not to ask anything at all in the beginning, lest we decide the direction of the case!
We do not know.
The patient is the only one who knows, even though he may not be aware of it. Who besides the patient can tell us how it is to be him or her? How it is to experience the world and himself? The patient is the only one who knows. When he tells us, we are allowed to understand and to see the pattern. This process of seeing what something is, is very different from understanding why. It is almost like looking at a picture in a 3D modus: it is necessary to look a in a special way, almost looking behind the picture, and then all of a sudden the image, always there but previously invisible, becomes clear. Once seen, it’s hard to imagine how we could not see the image before! It is not a matter of interpretation, understanding why the house or the tree is in the picture, nor is it a question of the house being good and the tree being bad. The judgment we make must be about what is a piece of the pattern, not what is desirable or not.
http://annevervarcke.com/blog/
Some patients may answer a simple question with just one line while others may take three quarters of an hour to answer the same question. In the first case the homeopath will need to help the patient, they may be shy or be unsure about how much time they can take. The questions must be as general as possible, for example: ‘Can you tell me more about this? ‘Can you tell me even more?’, ‘Can you give me some details about this? ‘Anything else?’
The first thing we need to do is determine the Chief Complaint.
This may be anything. A patient might start the interview with a clear physical complaint and medical diagnosis, or have seven minor complaints, distributed on different levels. When the patient names more than one complaint, we must ask: ‘What complaint is troubling you most?’ The answer may be a confirmation or a total surprise! Sometimes the patient comes up with a whole new and unexpected subject.
As a homeopath, never assume that we know something. We don’t! We know how the world looks from our point of view and we have our definitions and understandings of words, meanings and context, but the patient has a whole different experience of the world. In fact it is exactly this different experience of the world that we are trying to unveil during the interview. Every time we are not asking for clarification because we assume we know what the patient meant or we ‘know’ what a word means, we risk missing the point.
Some homeopaths might find it uncomfortable to ‘not know’ during case taking, but it’s important to remember that we are not sitting there in a meditative state, somewhere in the clouds, trying to blank out our minds or doing something vaguely spiritual. On the contrary: we are sitting there with full attention, and with full trust in the technique we are using (because it works!) with interest and a determination to understand the uniqueness of the person in front of us. How this uniqueness looks in each case we don’t know, we will explore it during case taking. How we are going to get there, we have a fairly good idea because we use an established strategy. We studied the theory, we practiced the tools, we’ve seen it demonstrated many times and we ourselves have done it many times. It is like solving a puzzle: even when you know how to do it, each puzzle is a new challenge. You know what to do but you don’t know the outcome.
This ‘not knowing’ doesn’t need to be uncomfortable; one can be a super expert at solving puzzles/riddles and still not know what the outcome might be of any individual puzzle.
The ‘not knowing’ therefore means that we don’t know how the patient will express his vital experience until we questioned him carefully.
Subjects are chosen by the patient
The questions we ask at the beginning of the case-taking invite the patient to respond:: ‘Can you describe what it feels like?’, ‘How is the tiredness/ restlessness/ stress (etc.)?’, ‘Is there anything else that troubles you?’
Very often, after summing up the chief complaints and minor complaints, the patient will give some reason or explanation for his troubles. He might think they are due to a weak immune system, to a shocking event, a loss or stress of any kind. He might give a medical explanation or he may have visited alternative healers before and tells the homeopath what their conclusions were. Patients have often already been through psychotherapy or read books and attended workshops to come to terms with their sufferings and will share their ideas with the homeopath. Although they may sound like rationalizations, they are still important. Man’s mind works in mysterious ways!
The homeopath needs to listen very carefully to the patient’s conclusion about his sufferings. What does the complaint prevent the patient from doing or how does it affect him? How does he feel about this complaint? How does he cope with it?
We must first try to identify the symptoms, which are incongruent with the patient’s pathology.. In the beginning we may get hints of the vital sensation when the patient reveals, often between the lines, what the complaint ‘does to him’: make him less attractive; make him less capable; produces a certain feeling; makes him conclude that he is not normal, etc.
We repeat our question, ‘anything else?’ until the patient himself agrees that there is nothing more.
We should ask a question two, three or more times until we are sure we have all the information possible!
In fact during consultation, when the homeopath perceives there must be more underneath, any question may be repeated. In order to make it sound more natural to the patient, the question can be rephrased, although the patient is often not even aware if the question is literally repeated.
In the first part of the interview where there is minimal intervention by the homeopath, the spontaneous emotions of the patient become important. Any spontaneous remark by the patient is considered twice as important. Or conversely: any answer to a question by the homeopath is of less importance. We risk getting what we’ve asked for and very often that is not what the patient was going to tell us.
By spontaneous emotions I mean: those kind of ‘extra’ lines that the patient offers during their report: ‘what I found difficult’, ‘I was shocked by’, ‘this head ache makes me irritated’, ‘I’m afraid this spot will spread’, ‘this really knocked me down’, ‘the blocked nose is hindering me’, etc.
In the first part of the case taking we get sensations and feelings interwoven with the symptoms given by the patient. Many of those sensations might be common, many will be local, and some might be vital. This is what we need to discover during the consultation. But first we must give the patient the space to tell whatever he thinks is important, we will for clarification later. It is always better not to direct anything at all, not to ask anything at all in the beginning, lest we decide the direction of the case!
We do not know.
The patient is the only one who knows, even though he may not be aware of it. Who besides the patient can tell us how it is to be him or her? How it is to experience the world and himself? The patient is the only one who knows. When he tells us, we are allowed to understand and to see the pattern. This process of seeing what something is, is very different from understanding why. It is almost like looking at a picture in a 3D modus: it is necessary to look a in a special way, almost looking behind the picture, and then all of a sudden the image, always there but previously invisible, becomes clear. Once seen, it’s hard to imagine how we could not see the image before! It is not a matter of interpretation, understanding why the house or the tree is in the picture, nor is it a question of the house being good and the tree being bad. The judgment we make must be about what is a piece of the pattern, not what is desirable or not.
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