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Acupuncture Today
March, 2013, Vol. 14, Issue 03
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Practitioner/Patient Rapport: The Metal Imbalanced Patient

By Neil Gumenick, MAc (UK), LAc, Dipl. Ac

As discussed in my previous articles on the subject of Rapport, there is no "right" way to be with patients. Each is a unique individual with specific needs. What one patient will love another will loathe. However, paying attention to what it takes for us to be in rapport with the patient before us is useful diagnostically, as well as essential for gaining the patient's trust and compliance. This article will discuss rapport with the Metal imbalanced patient.

The Myth of Types

In Classical Five-Element Acupuncture, there are no elemental "types" in the sense that no generalizations as to behavior, body type, likes or dislikes, or personal history, will lead to a diagnosis of any element as the primary elemental imbalance (AKA Causative Factor or CF). What is common to Metal imbalanced people is revealed via four pillars of diagnosis: a rotten odor, the color white most easily seen lateral to the eyes, the sound of weeping in the voice, and a predominant emotion of grief. It is the expression of the emotion that will be the focus of this article.

The Emotion of Grief

Grief is a normal and appropriate emotion in the presence of separation and loss. Everything that had a beginning must also have an end, including those people, things, and situations to which we have grown attached and hold dear. Grief is the emotion that allows us to honor the memory of what we valued, release it, and move on with our lives. Most religions and spiritual traditions have specific rituals around death and dying which encourage the mourner to grieve fully, to let go, and experience a spiritual release and purification brought about by the emotional experience. People of any elemental Causative Factor will and must experience grief. With those who are predominantly imbalanced in Metal, the emotion of grief becomes excessive, or in some cases nearly disappears. Such people may grieve a loss long after its occurrence, or be unable to enter into grief at all. Others may grieve a loss before it has actually occurred. The fear and fantasy of loss becomes the central emotion and the lens through which everything is perceived. In some cases, there may have been no physical loss – only the regret and remorse of what has happened in the past and cannot be undone: missed opportunities, wrong decisions, mistakes, and tragedies. Such a person does not live in the present, but in perpetual grief and turmoil over what was. There is little, if any, room for anything new, fresh, and inspiring to enter. Deeper still is the Metal imbalanced person who perceives himself as not good enough. The grief here is the perceived separation and loss of one's essential goodness – that which we call spirit or pure and eternal consciousness. When we are secure in our identification with that eternal, unchanging, and most precious part of ourselves, we transcend imbalance. We are as innocent and spontaneous as a child below the age of one, with the wisdom and awareness culled from our life experience.


Thus, we can see how issues of self worth and unworthiness arise from the nature of Metal and its Officials: the Colon, who is responsible for eliminating old waste at all levels, and the Lung, who is responsible for taking in the new. In the same way that Metal gives value to the physical earth with its minerals and trace elements, it gives us our sense of self worth. As stated above, perceiving oneself as not good enough, one strives to prove his worth. Therefore, Metal CFs often crave respect, admiration, awe, and acknowledgment. They strive to be seen as worthy and often undertake spiritual or material quests to prove their worth and to find meaning, purpose and value. The perception of their inner self is unworthy, so they compensate outwardly. They may collect degrees, titles, awards, wealth, and impressive, ostentatious material objects. They may surround themselves with people who flatter them and make them look good. In the opposite extreme, they may be quite unkempt and uncaring, as if to express the idea that if nothing is of any value, why bother being clean or making a good impression? I have found, in 33 years of practice, however, that even with those Metal CFs who are scruffy and unkempt, there is still desire to attract attention and be special. I recall a Metal CF in my practice who was in his mid sixties, unkempt, unshaven, with long gray hair who was set upon buying a mean looking Harley Davidson motorcycle. He had never ridden a motorcycle and I asked him why he wanted one. He answered, "Without the Hartley, I'm just an old fart. With the Harley, I'm a biker!"

Reaching Beneath the Levels of Imbalance

The forgoing is not a judgment of good or bad, just a look at the process of how imbalance can manifest. I responded to the patient by saying that with or without the Harley, he was a man of wisdom, one who had learned many tough life lessons the hard way, and could be an inspiration to so many young people. He visibly changed on hearing this, as I was reaching him at a more essential level than that of mere ego gratification. If we can see through the layers of imbalance to the pure essence beneath, we can communicate to that essence with our own. In such a state, we are absolutely in rapport and there is no striving to attain it. This is not false flattery, but acknowledging freely who the person is (whether a Metal CF or not) in wholeness, as well as where the person is in the ever changing process of evolution. As practitioners, the more we can make that distinction of who patients are in perfect wholeness AND where they are in their process, the less our own subjective process gets triggered and the easier it is to be in rapport with anyone.

Manifestations of Imbalance

What, for us as practitioners, are some of the more challenging ways in which Metal CFs can manifest? They may be cold, cutting, dismissive, sarcastic, disrespectful, judgmental, haughty and superior acting, and critical of you. I wish to emphasize again that a practitioner cannot base a diagnosis of CF based upon any singular expression of voice or emotion. Any person can, and will, in a given set of circumstances, be cutting, dismissive, etc. To determine CF, we must observe the emotional expression to be present almost continually and inappropriately, or strangely absent. This, combined with the other diagnostic pillars of odor, color, and sound, confirms a diagnosis. All people want to be respected. Metal CFs tend to want it the most, and are most sensitive to its perceived absence.

Practical Solutions

We must attend to the needs of all, and the following is important to every patient who walks through our door, regardless of CF. As well, these suggestions will be especially helpful to the Metal imbalanced person.

  • Have an office setting that is as professional looking as you can afford. Do not skimp on office or personal charisma. First impressions go deep and are deeply retained. Make the quality of yours high.
  • Radiate confidence and success. The patient must respect you in order to comply with what you will ask of him. After all, the patient has sought you out, probably as the result of a personal recommendation. He is coming to you for your professional evaluation and treatment, for which he is paying an appropriately respectable fee.
  • Have all your paperwork, insurance arrangements (if any), payment arrangements, methods of collection, superbills, etc. clearly handled and smoothly operational. If you come across as amateurish, you lose credibility and the patient's respect. More than that, you make a statement about our profession.

Be assured that the impression you make on your patient will be the filter through which he will likely perceive all of acupuncture and Oriental Medicine and will be the source of whatever he repeats to friends, relatives, and associates. You will be taking a detailed personal and medical history which the patient may not be comfortable in sharing; you may be burning moxa on the patient which he may fear, you will be inserting needles which may be painful; you will be assigning the patient homework which he may not want to do; you will be telling him when to come for the next treatment with which he may not readily agree. As practitioner, you, not the patient, must be in control of all of these components. To accomplish all of this requires that the patient respect you. To get respect, give respect.

The Metal CF wants acknowledgment, and when he receives it with sincerity, you will see/feel a perceptible change in the patient. As the patient shares with you, respond to those moments when you can acknowledge what he has done well, when his virtues were apparent. The following statements are a very short list of words that tend to give acknowledgment when delivered with sincerity. When the message is sincere, it will be conveyed by the sound of your voice (not just the words), your facial expression, body language, physical contact, and the look in your eyes as all one congruent communication.

Wow, that was awesome" "You did a fantastic job" "I so admire you" "You are one of the most talented and persistent people I know, and I know you can get through this" "You are bigger than these problems" "I have faith in you" Sincerity Versus Play-Acting How do you make these messages sincere? If they are not, they will sound disingenuous, will be confusing to the patient, and will be diagnostically confusing to you. You might think, "I gave him acknowledgment and he got angry. What happened?" You cannot give acknowledgment with words alone. That is akin to play-acting. In the above example, the patient might have taken the words as mockery if the energy behind them was not respectful.

Can you be genuinely moved by the beauty, accomplishment, perseverance, heroism, dignity, wisdom, and honor of another person? If so, you will express it in every aspect – your sound, body language, facial expression, etc.

Consider a time when you were feeling particularly proud of something larger than yourself, perhaps a patriotic moment when your national flag was raised in recognition of winning an Olympic gold medal, for example. Your eyes were tear filled and you had a lump in your throat.

Any words that would have come from you in that moment would simply ride upon that feeling and could not help but be genuine. You do not need to wait for the Olympics to have such a feeling, as such moments are available to us all the time, and with any patient. If you need help in opening to the energy of Metal, here is a homework assignment that I have occasionally given to patients who needed such support.

  • Write up a list of 10 people you admire and why you admire them.
  • Write 3 things that are unique and special about you.

If the patient has difficulty coming up with the 3 things, I suggest one to get started. I suggest the patient take the time between now and our next appointment to work on this when we'll discuss it. If you are having difficulty coming up with your own 3 things, I'll get you started. You have chosen a profession that requires you to serve others. You have chosen to become deeply and personally involved with the lives of sick people.

Most people avoid such involvement, but you have chosen what most people avoid. You have made a heartfelt choice to confront illness, pain, and suffering directly, to extend love and compassion, and do everything in your power to help sick people. For that, I acknowledge you. Now, go write up two more!

Click here for more information about Neil Gumenick, MAc (UK), LAc, Dipl. Ac.


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