6 Case takingVariableI have been asked to tell a bit more about how I do consultations, case takings. This has always been difficult to tell, because it's always variable. Every case and thus every consultation is different, because every patient is different. Every situation of the case taking is different. And every case is different because every therapist or doctor is different. Each doctor has his own style of doing consultations, and has his own strengths and weaknesses. All this makes every consultation so different that is difficult to set up strict rules.
Presence Curiosity CompassionHaving said the above, it doesn't mean that there are no general guidelines. There are three prerequisites for good case taking. The first is presence, just being there for the patient and not being distracted by other things. The second is curiosity, having a real interest in the patient and his problems. It is desire to understand him in his pain. The third one is compassion, feeling with the patient. It is empathy, trying to feel the patient, as if one is the patient. It is the same as love, but that word has been hollowed out in our culture (which is weird, because that is what people need the most).
See, feel, understand the patient.For me, it is important to see, feel and understand the patient. It is a kind of going into his atmosphere, a kind of resonating with the patient. This goes together with guiding the patient to his pain, the centre of it. It is a good sign when a patient starts weeping, as one then knows one is very near the source, the essence. Then the patient can explain his pain, describe the qualities and circumstances better. It is a sensing of the patient. One could say doing a proving of him.
The opposite of pain is regularly present too, in the form of laughing together about the strangeness of situations en emotions. Laughing has a healing quality, a quality of letting go.
HiddenThe main objective of case taking is to find out what the problem is, and more precisely to find out what the essence, the core of the problem is. That is not always easy. The real essence of a problem is unknown to the patient himself. If he would know the essence he would have no problem solving it in a short while. A disease is like labyrinth, in which the patient cannot find the exit. So the therapist has to deduce the essence of it from the symptoms.
ProblemIn general, I start with asking about the problem. What is the pain, what is the trouble, what is going wrong, what is the obstacle? Next is to ask more about what is connected to the problem, what makes the problem better or worse, what is connected to the problem, how does it feel? It is asking as much details of the problem as one can?
Discussing the problems will give the patient the feeling of being heard and seen. This can give him also more awareness of what is going on. Awareness can already have a healing effect.
CauseThe next question is what is the cause of the problem. What happened in the life of the patient before the problem started? What triggered it? What were his sorrows, worries, irritations, discords in life? In my experience, most patients are aware of those kind of events, in about 75%.
What the real cause is, is disputable, because there is often already a sensitivity beforehand. When there wouldn't be a sensitivity, how can some event cause the changes? But for practical purposes that is not a big problem.
There is always some kind of trauma, a traumatic experience. One can see all diseases as post traumatic stress syndromes, PTSS. But it is not the event as such that is traumatic, rather how the patients experiences and handles it.
EssenceThe above describes the process of finding the essence of the problem. It is going from the symptoms to the source of the symptoms. It is following the threads. It is like fishing, where the fish, the essence, gradually becomes visible.
PersonalitiesFor me, it is a big help to see diseases and remedies as personalities. A personality is a state of being, with its special ways of thinking, looking at the world, its own judgments and prejudices, its own fears and emotions, and its own action and reactions to the world. A personality is a consistent way of being to prevent traumas, most often a special kind of trauma. They have probably been developed after traumas, in this life, in pregnancy and childhood, in adult life, in the life of ancestors, or in past lives. That is why they are hidden, at least partly. In this way, one can see all personalities, and thus all remedies, as post traumatic stress syndromes. This way of thinking is obvious in for instance post war traumas, where even second and third generation issues come up after some time, mostly in older age when the defence mechanism has less energy left. But the principle is general: a personality that has not been relieved, needs some form of expression and healing.
Thinking in personalities makes it also clear that the problem is always in the now, at this moment. A personality is a reaction to a trauma, not the trauma itself. The search for the trauma though is important to understand the personality, to find out what he is defending against.
Another advantage of thinking in personalities is that people are not their personalities, but have them.
Personalities are actors, roles, we have taken on. It that sense they are fake, unreal, they are not what we really are. They can come and go. We can free ourselves of them, at least in the sense that we are not a victim of them anymore, but can give them their place. Then they are not a painful wound anymore, but a scar.
BlockageCase taking can be difficult for the patient. This is because there is always blockage in disease. It is like a knot that has to be entangled. It makes the patient unfree, it limits him in going everywhere in the world. Some parts are hidden in his subconsciousness. What can help is to ask why is something bad? For instance, sleeplessness can be experienced as bad. But the question remains why that is bad, because most people are sleepless in the daytime anyhow. So there is always some thought that makes sleeplessness feel bad. But that judgement is so obvious for the patient, that he doesn't realise it easily.
Sometimes the patient can get annoyed by the questions asked. There can be an aversion to go to the pain. But in the pain the cause is hidden, the essence. It can be helpful to tell the patient that he doesn't have to answer, but that he only has to try. It will give him a kind of freedom and relaxation which can be helpful to direct his awareness to the problem instead of his resistance.
EventsIt can be very clarifying to go through the details of problematic life events, for instance a divorce. And then ask the patient to tell in such a way that it becomes like a movie with all the details in it. How did it start, who started it, what was the reaction of the other, what was the reaction of the patient, how did he feel about it, what happened next, and how did it end?
In principle, one can find all the essential elements of a disease in the causative event. Where the problem is, is an expression of which series of the Periodic table is indicated. How one feels and reacts in that event, gives indications for the
Phases and the
Stages.
Events are very revealing. They show the personality in action. One can see personalities in stories, novels and movies. It is like a theatre play where the personalities are the actors. The
Self is the director.
Sensations, Emotions, JudgementsVery important are the emotions and sensations of the patient in difficult situations. Often they are not so easily described, and the patient has to search for the right words. Often they are expressed as emotions of sadness and anger. But sadness and anger are more expressions of how they handle emotions. Underneath are the real emotions, for instance like feeling rejected.
Important are connected judgements. They can be difficult to find out, as the patient is often so identified with them that he doesn't express them regularly. When one asks about it, they can say that that is normal for everyone. This is an indication that it's really important for the case.
It is often helpful to ask about other events in the patient's life where there were similar emotions and sensations. This can clarify and confirm the essence and diagnosis.
Search processCase taking has a lot of similarities with other search processes. It looks like the process of identifying plants. It can be like working as a detective or journalist. The search process is done by doctor and patient together.
This search process is not limited to a single consultation. In many cases it continues over several consultations to find the essence, where each consultation can give a kind of deepening of the understanding and more awareness about it in the patient and the doctor.
Incorrect prescriptions can bring about reactions that give a clue about the real problem, the essence. This can be in the form of clarifying dreams.
Symptoms can arise that shed another light on the the disease. They mostly show which aspect of the disease was missing in the prescribed remedy. Then I search for a similar remedy, for instance out of the same family, with similar
Phases or
Stages, that also has the new symptom.
AnalysisCase taking and analysis have become more and more intertwined. In the past the analysis started after the case taking. The analysis mostly took the form of a repertorisation. It is like a detective who not only notes facts, but directly asks himself what it means, where it is coming from and what one can conclude from it. It leads to the important question of why.
In the past there was the notion of not asking “why” in homeopathy. My experience though is that the why question is very important, especially about the choices the patient made in his life. Choices show the character of the patient, his personality.
ClassificationGreat guiding principles for me are the classifications, as has been found in the Mineral kingdom:
Series,
Stages and
Phases.
The series express the level of life: from the personal level to the cultural level, from the existence level to the spiritual level. They express the need of the personality, their goal, what it wants. Here the question of why shows its importance. Why someone does something shows what he tries to reach, what level of his life is important for him. For example, a girl is sleepless, because she fears to be sleepy next day at school, which is problematic because then she fears to fail in examinations, and then to fail the school year, and then the final school examination and that is bad because then she will not be allowed to go the ballet school. All these steps came up from the why question. The need to enter the ballet school is an expression of the
Silver series, the cultural level of life.
The desires and aversions of a patient are very important, as they can indicate the goal they want to reach, showing the
Series. The favourites are telling much, with the example that some people know their remedy in the form of their favourite plant or animal.
The
Stages and
Phases are quite similar and express how far the personality is in reaching his goal. They show life stages of everything, from start to finish. Here the question of how sure the patient is can be very revealing. The beginning
Stages on the left are insecure, hesitating and shrinking from criticism. The later
Stages on the right are more sure, decisive and angry from criticism.
These classifications are worked out in the
Element theory for the Mineral kingdom and
Plant theory for the Plant kingdom. They find their concentration in the Remedy code, which is a short compressed
Materia medica, a picture of the state of being of a personality. The Remedy code describes the
Series, the levels of being, and the
Stages and
Phases in one code.
Many entrancesThere are also many other entrances in case taking.
When all of the above have not resulted in the correct diagnosis, correct in the homeopathic sciences, then the search process can be extended to other fields to find a solution. Important are the life stories of the patient, stories about how they were as a child, how the relationship with their parents was, the relationships with relatives and friends, the attitude and kind of job they have. Clues can be found in desires and aversions to all kinds of aspects in life, like food, weather, hobbies, plants, nature etcetera.
Dreams can be very clarifying, especially dreams that the patient had the night before the consultation.
We can also ask the patient about things that touched him very much, for instance novels, documentaries movies and the like. It will be very clarifying to ask about which part was the most touching.
When this doesn't help, we can ask the patient about family constellations.
Further, we can ask about regression therapy, in this life or in past lives. It does not matter if one believes in those phenomena or not. When they are important for the patient, then it's part of the case.
Intuition SynchronicityI also use intuition and synchronicity. But that cannot be taught, only appreciated.
Summary1 Start with the complaints.
2 Complete the picture: sensations, emotions, thoughts, aggravations, ameliorations, connections.
3 Find cause: triggers, problems, worries, fights.
4 Find the essence.
5 Handle blockages.
6 Events: what, why, actions, reactions, feelings, sensations, outcome.
7 Emotions and sensations.
Reactions to stories, novels, books, movies, news, documentaries.
Reactions to emotions, anger, commands, prohibitions; of oneself or others.
8 Life stories: pregnancy, birth, childhood, work, colleagues, life philosophy, religion, politics.
Relations with parents, siblings, relatives, family, partners, friends, colleagues.
9 Desires and aversions: weather, food, hobbies, travel, nature, plants, animals.
10
Dreams.
11
Family: history, traumas, wars, violence, poverty, losses, famine, divorce, murder. These themes can also arise in family constellations.
12 Regression therapy, karma, reincarnation.
FernsIn principle the case taking is the same for Ferns as for other remedies. But they have aspects that ask for a special treatment.
Autistic fernsIt is difficult to find the cause in case of retarded autistic children. They cannot tell much about their feelings and experiences. Expressions can be found in the physical, emotional, social, and mental development. Causes can be found in pregnancies, labour and vaccinations. I have regularly found the right Fern in the family stories, events of ancestors in war situations.
AdultsIn adults, fern personalities are more hidden. They can easily be compensated and overshadowed by Lanthanide or
Silver series personalities. I come to think of ferns when I have given many remedies but there is still a lack of joy, a flatness. It feels like a kind of low self- worth. There is no curiosity. It feels grey, but is is not even an overt depression. In those cases the Fern personality can often be found in their upbringing, by parents and later by school.