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The Homeopathic Conversation - The Art of Taking the Case

by Dr Brian Kaplan MBBCh. MFHom

listed in homeopathy

[Image: The Homeopathic Conversation - The Art of Taking the Case]


It took me nearly two decades to realise something obvious about classical homeopathy – the conversations we have with our patients are the most important part of the whole process.

Why is this so obvious? Picture in your mind a homeopath who has an encyclopaedic knowledge of the materia medica, an intelligent and flexible approach to case analysis, including the use of computers and a comprehensive, homeopathic library. However this homeopath is simply not very good company. Patients feel slightly uneasy in his consulting room and his friends and family have always found it a little hard 'getting through' to him.

Now picture in your mind another homeopath. This one is the sort of person everyone just can't help opening up to. He is just so understanding and sympathetic. Such a good listener. His only problem is that he doesn't know much about homeopathy. He knows what sort of information you need to get from your consultations but as for the materia medica, well, there are just so many remedies, how on earth can anybody expect him to remember any of them. As for books on homeopathic theory, they are just so hard to read.

If you had to make a choice, which of these two would you consult? It has to be the latter for one good reason. The homeopath who is able to take good case histories at least has a chance of finding your remedy. He is able to leave the consulting room with your main symptoms, in particular your emotional profile. He can use repertories, computers and the materia medica to help him find a remedy to match what he knows about you. He can phone up a colleague, better-versed in the materia medica and ask for advice or take your case to a supervision group.

As for the former homeopath, I guess he will be left wondering why he doesn't have much of a practice considering the thousands of hours he has spent studying homeopathy. And why do his remedies just not seem to work? He knows their drug pictures so well. Why can't he find any patients to fit them?

The sad truth is that such an 'homeopath' might as well give up homeopathy and go and study surgery or massage. Maybe his talent always was in his hands.

People become homeopaths for different reasons. Some are so grateful for what a remedy did for them that they become determined to study this amazing subject. Others are fascinated by homeopathic theory. There are those who are smitten by the idea that every mineral, metal, plant, poison or animal secretion has specific healing qualities that can potentially be matched to the whole of the patient physically and psychologically. There are even those, like Hering, who studied homeopathy in order to refute it but ended up falling in love with it. Few students of homeopathy choose the discipline because they are good listeners and enjoy talking to patients.

The ability to listen well and say the right thing at the right moment is central to the homeopathic process. It is surprising that so little has been written about taking the case and the homeopath-patient relationship.

This book is an attempt to draw attention to what actually happens in the homeopathic clinic. To do this it is necessary to examine what is going on in the mind of the patient, the mind of the homeopath and in the space between them. Although homeopaths have not, until quite recently, focused on the practitioner-patient relationship, the disciplines of psychotherapy and counselling have always recognised that relationship to be a vital factor in the prognosis of the patient. It is the contention of this book that this relationship is even more vital in homeopathy, not only because we have less time to spend with our patients than counsellors and psychotherapists do, but because the reward for effective communication between homeopath and patient is the prescription of the correct remedy.

The value of the correct prescription is inestimable and yet it is not the only reason for learning to have more authentic conversations with patients. The syndrome of 'burnout' is far from uncommon among homeopaths. Many of us end up feeling drained by our patients. It can be a heavy burden being a homeopath. We know the potential of our remedies but we have to live with the shadow of feeling guilty about patients suffering because we have not been able to find the right remedy. As we learn to have more meaningful conversations with our patients, this guilt gradually diminishes and the responsibility for finding the remedy begins to be shared by homeopath and patient.

I have written this book for fellow homeopaths and homeopathic students alike. We are all students of homeopathy and I have yet to meet anyone who claims to have mastered the materia medica or the taking of the case. It takes decades of both study and clinical practice to make serious inroads into the materia medica and there are no short cuts. The study of books on homeopathic theory, especially the Organon, can be inspiring, but are only fully appreciated after many years of consulting.

Fortunately, when it comes to taking the case, I feel that it is possible to make some progress quite quickly if the teachers and students of homeopathy choose to focus on this aspect of homeopathy from the very beginning of any course of training. If anything, it can be a lot more fun than trying to memorise the materia medica. Taking the case should be of equal interest to us all. Experience in the clinic is the greatest teacher, but when it comes to communicating with patients, it is quite possible for the 'master' to learn something from the 'absolute beginner'. This is because authentic conversation is more about life itself than it is about the homeopathic consultation.

This book is the result of a long, personal journey of exploration into anything that I felt could help me communicate better with patients. This journey included forays into psychotherapy and psychoanalytic theory, counselling, philosophy, and, of course, what both homeopaths and orthodox doctors had to say about the practitioner-patient relationship. I have tried to collate here only what I consider to be of direct relevance to the homeopathic paradigm. This is not to say that the rest of the journey was a waste of time. I found psychoanalytic theory, for example, fascinating, perplexing and elitist – but finally, amusing.

I have deliberately been transparent about my own learning process in the hope that others will choose to do the same. I have attended so many homeopathic seminars and masterclasses where I have been dying to ask the teacher about what happens in the consulting room. It has nearly always seemed inappropriate to do so as the subject matter of these courses always seems to be about theory, case analysis and the materia medica. This needs to change as case-taking skills are at least as important as these aspects of homeopathy.

As we live in politically correct times, I guess I have to make the usual, grovelling apology for the use of the masculine form of the third person pronoun for the homeopath. When describing hypothetical consultations. I thought long and hard about the alternatives but decided 's/he' looked clumsy and contrived, 'she' patronising and an alternation of 'he' and 'she' a mess.

As for the spelling of 'homeopath', publishing conventions and usage in databases and search engines dictate that I use this modern form, despite my preference for the more traditional version, 'homoeopath'. However, this latter is retained if it is part of a proper name for an institution or if it appears in the title of a book.

Finally I would like to say something about the style in which this book is written. If it feels chatty and a little irreverent at times, please know that this is quite deliberate.

I wanted the book to feel a bit like a conversation between reader and writer.

I apologise that this conversation had to take the form of a monologue but what could I do? Still, the world of homeopathy is quite small and perhaps one day we may meet face to face and enjoy a real homeopathic conversation.

Sandra Goodman PhD
Natural Medicine Press

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