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F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
July, 2011, Vol. 11, Issue 07
The Inside-Out Paradigm: The Intake Interview
By Dale G. Alexander, LMT, MA, PhD
"The appointment begins when the client makes the call."1 This phrase, spoken by Dr. Richard MacDonald, DO, 25 years ago, was a turning point in my comprehension of just how important the initial interview with a client is both over the phone and in the office.It is the beginning of a healing contract that might last for a few appointments or for many years. This article will detail the basics of what has served me to assist my clients.
Over the 31 years of my clinical massage therapy practice specializing in chronic ailments, the problems that clients present are increasingly complex, layered and continue to inspire me to explore the "many dimensions of healing." To date, I still do all of my telephone interviews with prospective clients.
Initially, I seek to gather information about how committed they are to their healing, whether we are beginning with a third person trust based on a personal or professional referral or not. In addition, whether they have ever felt injured or misunderstood by other health related practitioners.
The emotionality conveyed by the tone of their voice generally is my best guide. When their voice tone is loud, demanding or commanding, I often ask whether they are scared, hearing impaired, or have been mistreated by other health related practitioners. I give them a chance to start over. I endeavor to keep this initial call to 10 -20 minutes. I give myself permission to encourage that they see a physician before seeing me, if they haven't already. I often refer prospective clients to other alternative health practitioners.
People committed to their healing consistently inquire first about your confidence to assist them and will add additional special circumstances and needs second, once they have established whether or not they sense you have the competence and experience to help them.
When prospective clients place their initial emphasis on money or time convenience for them, this is a flag to me that they are wanting professional care, but only if it meets their conditions. When someone calls to make an appointment for someone else, another flag goes up. Yes, there truly are people that busy, including me at times, but it stills says something about how they run their life including how they drive themselves. I typically book the appointment with the caveat that the named client will call me before the appointment so I may personally interview them.
When a client is looking for a named style of massage or bodywork, I ask them to describe their ongoing difficulties. The nature of what I do along the continuum of bodywork skills has become rather broad such that it no longer fits a specific label. When they ask me whether I have ever worked with their polysyllabic medical difficulty, I am specifically honest as to whether I have or not. And, if not, I request that they educate me. This might seem paradoxical yet it demonstrates from the beginning that I am willing to learn from them. I want to create healing partnerships where they are the star character of their own movie. I'm the hired help.
The Key To The Interview
The key intention of the initial "office interview" is for me to engage the person fully as a human being as well as a practitioner. I endeavor to gather a gestalt of how they see their problem and to assist their perception to include the internal functioning of their bodies and the potential influence of their mental habits and emotional fluctuations. This means I rarely listen to long stories anymore and correspondingly infer that I do not endeavor to convince them of anything. They have the choice to move forward, as do I.
When presented with a vague description of what is bothering them such as, "I have so little energy" or a more psychological inference such as anxiety or depression, I ask them an existential question, "what do you sense is your life purpose?" The turbulence related to identity consolidation in the midst of exquisite life transitions has an enormous influence on our human physiology. Examples of such transitions include the death of a loved one, a job loss, a relational break-up or a financial crisis, among many others.
When presented with a series of physical complaints, I often ask a layered question first. What have you been told about your problems, what do you believe is the root cause, and do you feel as though your mortality is threatened by it? This latter phrase is crucial to include because it flushes out people who really are scared that something has been missed in their medical care and that they might indeed be in serious trouble.
I ask questions to fit the person as I experience them. That is why I don't use standard written questionnaires. However, there is a philosophy and a method to how I ask questions. At the physical level, I seek to discover the earliest sign or symptom that has the longest history as this has assisted me most often to unravel what is happening within their physiology, accreted trauma or might be an indicator of a genetic link or deficit/defect. At the cognitive level, my job is to assist them to connect the dots between the events of their lives and to unhook from the ones that are acting as a drag on their healing. Assisting clients to find their way toward acceptance and/or forgiveness is still a higher octave of our work. We are all challenged to reconcile the difficult transitions of our lives. And, by assisting clients to connect the dots within their lives empowers their capacity to prevent future difficulties.
The following 10 questions and their time line will often trigger a light bulb for them, as well as myself:
Just yesterday, a prospective client with an identified aortic valve regurgitation responded to the flu question by saying that when he does have the flu it was most often of a respiratory variety and that it would last a week to ten days. He had not made the connection between his valvular regurgitation and how this might have extended his illnesses in the past. Such subtle yet revealing information allowed me to orient my skills to relieve the pressure within his chest to allow his heart more ease to do its crucial job.
Interspersed with, or following these questions, I go through the history of their organ systems quickly to ascertain any dysfunction or repetition of illnesses in their lives. I also will ask the same question in a different way if I instinctively am drawn to it. With a recent client who came to me with a rare form of cancer, we had identified that notwithstanding the official diagnosis, she had the beginnings of diabetes that once confirmed by her internist, has begun to radically change her life for the better. Improving a client's quality of life is perhaps our profession's highest service.
Another key to an effective interview is to personalize it. Be more vulnerable than your client.3 Invite a healing contract and define what this means to you while altering your language to include their sense of such a contract. Accept that they will not be able to give you a complete physical history because much of it has been compartmentalized or repressed. During your first appointment, the real opportunity is for both you and your client to decide whether you wish to move forward working together.
People have a tendency to get sick or to injure themselves as a way for their physiology to discharge its excess tension and thereby to rebalance itself. When a client reports a pristine medical history without either, I become quite curious. Typically, there is something they have forgotten or repressed which eventually comes to light over a series of sessions. And occasionally, what emerges is that they have had severe allergic reactions to one thing or another. Again, this is when I refer clients back to their physicians.
Part of our role as massage therapists is to be part of our clients' early detection team. The mathematical normal curve does allow for exceptional individuals to experience amazing health yet, as we age, the probabilities increasingly point to cardiopulmonary, cancer or orthopedic difficulties. In having followed my local newspaper for 15 years, the age of death so often occurs between 50 and 65, which is within the 40 - 70 demographic of those people who most often seek our care. We have a responsibility to assist them to discern those personal events which often signal something is amiss from the "inside-out."
Chronic ailments often have an accreted history involving multiple minor and major traumas underlying a recent physical event or might be the "canary in the coal mine" of the organ systems endeavoring to signal that something deep inside is in need of attention and care. Those chronic problems that seem to have no related physical event associated to their onset are the ones we need to be especially encouraging to our clients to seek consultation with their physicians.
The purpose of this column currently continues to be oriented toward assisting you to understand the "Waves of Aging," their most common origins, and their progressions that fly under the radar of typical medical detection, especially when clients present with chronic somatic ailments.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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