CranioSacral Therapy and the Multiple Therapist Approach

By John Matthew Upledger

CranioSacral Therapy and the Multiple Therapist Approach

By John Matthew Upledger

One of the qualities of CranioSacral Therapy that has always fascinated me is how well the modality lends itself to multiple therapist work. I have watched, as well as experienced, the coming together of two or more therapists as virtually one set of hands, assessing and responding to areas of restriction within a client's body. Through the process I have seen exponential improvements in a person's health.

The approach always reminds me of a concept I learned while working as a waiter in college. The restaurant brought in a wine expert to teach us about the "synergistic" effect of pairing certain foods with different wines. He explained that, while the food and wine were very good individually, when the right ones were combined they were even better.

I like how Sue Cotta, MSPT, CST, describes it in terms of the practice of CST, "In multi-hands work, one plus one equals more than two. More gets accomplished when two therapists treat for one hour than when one therapist treats for two hours." A longtime proponent of the multiple therapist approach, Cotta regularly joins with fellow CST practitioner Susan Steiner OTR/L, CST-D, to work on each others' clients. While they maintain their own practices in separate locations, Steiner in Providence, R.I., and Cotta in Swansea, Mass., they have developed a partnership of sorts, born of more than 20 years each of practicing and teaching CST.

Two of their most challenging cases on which they collaborate are a boy, now 4, with cerebral palsy (Steiner's client) and a girl, now 10, with microcephaly (Cotta's client). For both of these children, life has been a succession of medical and therapeutic interventions; it will be that way throughout their lives. Yet, in the years that each child has received CST, there have been profound breakthroughs — the kind that can't be attributed to anything but CST Cotta says.

The Cases

Steiner remembers the first time she saw Robbie (name changed). Six months old at the time, he presented with cerebral palsy and severe brain damage due to anoxia resulting from birth trauma. His behavior was characterized largely by screaming and posturing, particularly when placed in a seated position. Just getting him into a car seat to get to the appointment was almost impossible for his frazzled mother.

Assessment showed that Robbie held a restriction, like a whiplash, in his neck. His dural tube was so tight that his hips curled forward and his back arched, causing him to go into spasms. Through the course of the session, Steiner felt Robbie's neck restrictions begin to release and his dural tube to elongate. By the end of the first session, he was able to sit in the car seat without crying. "That was a huge change in quality of life not just for Robbie, but for his mother, too," Steiner said. "Imagine being able for the first time to drive your child around without him screaming."

In the case of Carla (name changed), the challenges to treatment were just as great. Legally blind and fitted with tracheostomy and gastrostomy tubes, the then 2-year-old reacted to her initial sessions in an unexpected way. "She would go upside down almost every session and wanted to stay that way the whole time," Cotta said. Asking the mother about her daughter's birth, Cotta was told that Carla had gotten stuck in the birthing canal. When the delivery actually occurred, she came out so quickly that her clavicle was broken. By going into the upside down posture during sessions, "It was like she wanted to relive her birth except slow it down this time," Cotta said.

CST treatments with both children over the years have been a combination of individual and dual therapist sessions focused largely on their dural tubes and cranial membranes. "To paraphrase Dr. John E. Upledger," Cotta says, "The cranium is like the foundation of a house. If we can get that foundation corrected, it will help the house to be balanced." In other words, "We'll improve the ability of the brain to function (more efficiently)." Over the course of time, both Robbie and Carla have experienced improvements and reached milestones that no one expected.

With Robbie, there is a visible decrease in his tone and pain, and an increase in his ability to sleep and eat. His facial structure has become symmetric and the quality of his skin is much better. His mother described the effect of CST on her son as being "intensely calming" and helping him to "transition from a traumatized, defensive, clenched being into a more relaxed baby, better able to absorb some of the world around him."

Carla, who started with vision of 20/1200 is now at 20/132 and no longer considered legally blind. Doctors are working to reverse the tracheostomy because the tracheomalasia (softening of the trachea) is no longer an issue. She also has seen improvement in the areas of digestion and communication. Just as significant as these physical and functional improvements are the issues that haven't manifested. For example, Carla hasn't developed scoliosis, which doctors expected to happen because of the severity of her diagnosis. Steiner says, "We may never know all the issues that have been prevented because of the cranial work."

Working In Tandem

When working as a part of a multiple therapist team, Steiner and Cotta emphasize that a key to success lies in letting go of ego. Just as in an individual session, the multiple therapist CST experience is about blending and meeting the client where they are. "If both therapists think of themselves as one therapist with four hands, you treat what you find," Cotta says. "Susan and I don't treat independently. Our hands are an extension of the other person's hands."

By working this way, Steiner says, "There is an increased energy and awareness, and more areas of the body can be addressed in one session. Oftentimes, Sue will have the neck and I'll have the sacrum. Sometimes there's a tension involved, and one will have to stabilize while the other mobilizes. We end up being able to treat the entire structure."

Robbie's mom describes the experience from her vantage: "As an observer, the sessions feel like a dance to me. There is an indescribable energy in the room, something that brings about an emotional fluidity, the same way music can strike your soul. The difference between the individual session and the multi-hands session seems to me like the difference between a dancer dancing alone to swinging with a partner. There is a mutual support between the therapists that both broadens the treatment and heightens the awareness of the client."

"Parents who bring their children to CST feel like their children are being touched and seen in a way that is important," Steiner says. "Sometimes we think of CST as helping those who have a pain or want a better quality of life or wellness. These cases show how CST is valuable for anybody with any challenge. When you meet the individual at the place where they are and treat from there, great things can happen."

So whether you are pairing the right wine with dinner or pairing the right therapists for a treatment, the concept that I learned back in my college days holds true. As these cases attest, CranioSacral Therapy and the multiple therapist approach has a synergistic effect.