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Acupuncture Today – August, 2009, Vol. 10, Issue 08

From a Patient's Perspective: Creating Rapport

By Constance Scharff, PhD

When my calendar has a notation for an acupuncture appointment, I am elated. I've never felt like that about visiting any other type of medical practice. I don't smile at the thought of going to the gynecologist or the dentist.

But acupuncture makes me happy. I think my enthusiasm for acupuncture comes not so much from its effects, which have been tremendously positive, but from the fact that my acupuncturist seems to truly understand and care for me. Although I have seen this practitioner only a short while, I have developed a deep sense of trus with himt. I can share absolutely anything and know I will receive a thoughtful, compassionate response. Not only does my acupuncturist listen, but he has specific skills and ways of work that have allowed him to build a solid rapport with me.

My acupuncturist knows me. Not in a superficial way of history-taking and the little observation one can do in an office setting. I mean he really understands what constitutes my physical, mental, emotional and spiritual makeup. He has taken time to develop a relationship with me, ask questions, probe deeply and broadly into my life in a way that is respectful yet inquisitive.

Although on occasion the questions I am asked are quite personal in nature, I have always felt as if answering them has a clinical purpose. My acupuncturist takes the first 10 to 20 minutes to talk with me and see how I am doing. Instead of checking my tongue and pulse, stabbing me with needles and racing out the door to meet another patient, he sits and listens. This practice allows me to trust him.

It is not my nature to talk about myself. Sometimes, I cannot give voice to what needs to be said. My acupuncturist noted this in my first session, and asked me to send him a weekly e-mail update of before we meet. This has been liberating and is often a springboard from which the two of us can discuss problems I would not bring up to him otherwise. Because he has taken the time to get to know me in a meaningful way, he has been able to understand the reasons why I have the medical issues I have and treat issues which I never dreamed would be resolved.

I am definitely the focus of the sessions. My acupuncturist engages me meaningfully and also has clear personal boundaries. Our relationship is professional. As a clinician, he walks a fine line of being personable, while clearly remaining an authority. He does not gratuitously offer up information about his life that has no bearing on my treatment.

I have noticed that like all clinicians, acupuncturists seem to like to tell people what to do. Eat this. Don't eat that. Do these exercises. Wake up at this time. And for goodness sake, don't ask for ice in your water! I've heard it all before. As a patient, all these directives make me silently roll my eyes. I am a 36-year-old woman who has managed multi-million dollar projects, has a household to run, and has earned a PhD. Believe me; I know that it is better for me to eat broccoli than chocolate cake without my acupuncturist telling me so. Further, when I can do what is best for me, I do. I don't lie in bed watching TV when I should be at the gym to spite my acupuncturist or circumvent his treatment plan. Quite frankly, there are times when I cannot muster the time, energy or force of will to do what is best, and I leave the broccoli in the fridge while taking the ice cream from the freezer. In those times, that's the best I can do.

My current acupuncturist recognizes my humanity in this area. In fact, I'm sure that like everyone else he has experience staying up later or drinking more than he should. He's never suggested that I lose weight; it's clear enough to me what needs to be done when I put on my pants in the morning. Instead, he engages me in conversation, listens to what I have to say and then focuses in on what psychotherapist Bradford Keeney calls my "resources."

A resource-focused approach to change uses the abilities, interests and attributes of a patient to their advantage. It requires that the clinician listen carefully to what the patient says, paying no attention to the problem or a solution to that problem, but rather helping the patient find a way to use their own strengths to break free of problematic thinking patterns or actions.

Like many people, I can get stuck in a negative thinking rut. I have a voice in my head that tells me I'm not pretty, smart, talented or thin enough to complete the task at hand. This voice is vicious and relentless. When it gets going and I listen to it, I find it difficult to accomplish even the smallest undertaking. Instead, I allow my thinking to cut me to pieces and make me feel lower to the ground than an ant.

I recently shared with my acupuncturist that I was having difficulty with this negative-thinking loop. He knows that I enjoy writing fiction. What I love about fiction is that I can create characters to do all sorts of things. Knowing that the creation of fictional characters is a resource of mine, my acupuncturist stopped my conversation about the "problem" of negative thinking and suggested instead that I name the voice in my head Mildred. He then made up a voice for Mildred (who is quite a whiney, know-it-all sort of character) and essentially told her in her own voice that she's not really that interesting and can share her observations elsewhere. What a creative way to address the issue! Although I had been close to tears when I entered the treatment room, I was laughing at Mildred and all her stupid ideas before I was on the table to have my pulse taken. I can't say if it was the suggestion to address the thought pattern as "Mildred" or the acupuncture treatment that did the trick, but I have not been caught in a negative thought loop since that session.

Acupuncture treatments are not transparent. A clinician might look at a patient's tongue, feel the radial pulse, palpate the abdomen, and then stick needles in before leaving the room. As an American patient, that lack of transparency is unnerving. My medical doctor explains my problems and treatment options and we decide together on a course of action. I've noticed that acupuncturists rarely do this. When they do try to describe an issue, I'm told something about damp heat or wind, or some other poetic metaphor that has absolutely no meaning to me.

Despite my willingness to try acupuncture, I want and expect to be involved in decisions about my treatment. My acupuncturist understands this. Although he does not offer up information about what he's doing, he will explain any concept I ask about. In my case, I could care less which points he chooses or why he chooses them. However, I often ask in a general way about what he's doing and why he's doing it. Sometimes, it's just curiosity. When he filled my navel with salt, for example, I wanted to know why, because that is not his normal practice. When he said that he was going to stick a needle in the corner of my eye because I had an entry/exit block, I wanted to know what an entry/exit block was. I was given considerate, unwearied responses. This is part of what has built the rapport between us, and why I trust my acupuncturist and return to him week after week.

Constance Scharff has a PhD in transformative studies from the California Institute of Integral Studies. The focus of her research is on the spiritual and transformative experiences of alcoholics and addicts. She can be reached at .

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