I have been blessed with a busy clinical schedule recently, and have spent a good amount of time in the classroom as well. After a three week stretch of unusually long days in the clinic, I sat down to make a few observations about how my clinical approach has evolved over the years as I learned to practice more biodynamically. I thought it may be useful for newer practitioners.
For me, craniosacral work was a case of “Love at first sight.” When I first experienced the slow, soft, and authoritative movement of cranial dynamics, I was immediately hooked. My perception of the world and the body took on a much broader framework as I saw and felt new spatial movements that demonstrated the ability to consistently deliver health to various anatomical, mental, and spiritual planes of our being. When I took my first course in biodynamics this fascination deepened even more, and I found myself forming a vision of how I would like to spend my professional life. I felt called to the pervasive stillness and slowing of time so acutely present in the biodynamic craniosacral setting in particular. I had visions of the years ahead of me when I could sit at the table and explore in detail the interfacing of tidal movement with human fluidity and its potential for healing in thousands of suffering bodies.
Well, I have been chasing that youthful dream for awhile now, and I must report that it is going well. The scenery along the way, however, has been nothing like I expected when I first set out on this professional path.
The Persistent Clinical Dilemma
Working with the deep cohesive fluids and their inevitable lesions can open a great pathway to healing for many people. Those who have studied craniosacral biodynamics have undoubtedly experienced the surprising power that can be accessed through the use of our natural senses and focused intention alone. When we can find the doorway that allows the tide to enter into the client’s system, good clinical outcomes are almost always assured. I know this. And you know this.
But the problem is that the client isn’t usually in on the secret.
The fact that they are seeking therapy in the first place usually points out that their body is removed from the ability to remember and receive instructions for self-correction from the organizational forces of primary respiration. They are lost in a battleground of compensation and tensional stress. The tide waits at their door, but they cannot hear its voice above the noise permeating their experience of self.
For me, this dilemma is at the heart of clinical practice. How do we re-orient the client’s system to recognize firstly that the door is there, and secondly that it might be a good idea to open it and receive a long lost friend? Every client interaction presents this predicament to varying degrees.
The Early Mistake – “Stillness Nazi”
As a new craniosacral therapist, I was very confident in the ability of the tide to make significant and meaningful corrections in the bodies of my clients. My classroom training taught me to invite space into the dyad and take a grounded, patient stance while I waited for signs of neutrality and subsequent immersion into tidal forces of healing. And that approach worked great … in the classroom. We were all on the same page in a classroom setting. We had a common understanding and goal. We had days to sink into the experience. We had an understanding that we would encounter a period of waiting while the system worked out transient stresses and figured out how to adopt a deeper state of receptivity. Basically, we all knew what was going on. But the reality of taking this work to the streeets is that most of our clients do not know what is going on with this model of therapy.
As a rookie, I made the understandable mistake of sitting for long periods of time waiting for the client’s system to get on board with my intentions and naturally respond to the self-corrective forces I was hitching my senses to. In practice sessions and as a learner this patience always paid off, but with a new client on the table it created many problems. I spent way too much time observing the strain in the client while holding an alternative to that strain within my own awareness alone. I adhered strongly to the maxim that presence heals, and the scientific evidence from interpersonal neurobiology that their system would eventually connect with my system and take cues for re-patterning. While these concepts are valid, one of my early lessons was that it often required more active work to get to a place where the client’s body could even realize that I was offering something of value.
I hear echoes of this in the stories told to me by new practitioners attempting to work biodynamically in a clinical setting. A potential pitfall for new biodynamically-oriented practitioners is falling into the excessively passive “yin” mode of working. I call this being a “Stillness Nazi.” Passive observation is essential for tidal permeation and diagnostic clarity. But too much passivity on the part of the therapist leaves the inexperienced client abandoned in the midst of their internal struggle. This may sound obvious to those who have not spent much time learning to sense primary respiratory movement. But to the learner, staying in contact with the fluids requires tremendous presence, and when you are awash in them, the fluids can be mesmerizing. Stepping outside of a deeply passive reception of fluid action sometimes requires great effort!
When you are trying to stay in awareness of the tide and fluids as a beginner, extending too far outside of your self-sensing space feels like suffering and can feel very “unbiodynamic.” It can almost feel like you are abandoning the spirit of the work if you engage in active manipulation of the client. But I eventually learned that we must be active in the beginning of many treatments. Most modern clients inhabit a system that requires us to actively engage it to get its attention. When I realized this, my dreams of perpetual biodynamic bliss were shattered. In order to maximize efficacy and be of the greatest service to my clients, however, I made myself go through the difficult process of incorporating gross mechanical work into many of my treatments. For me, this was not easy. A colleague of mine summed up a similar frustration well when she said “I feel that when I am not working biodynamically with the client, I am wasting my time! That’s where all the good stuff is!”
After a while the sting wore off as I came to accept that every minute of my day would not be spent keenly yielding to primary respiration. I came to understand that at times I would be serving the client best by entering their world in a more mechanical manner addressing pressing issues that needed “direct intervention.”
The key to working biodynamically goes beyond just recognizing tidal forces. It involves building skill at augmenting those forces within the client. For most practitioners, this takes time. You have to know where you are in the process of skill development and adjust your approach to include direct work until you do not need it to be effective.
I promote and market myself to my community as a craniosacral therapy specialist. But I do many other things during treatment. I do whatever I need to do to help them the most. This may include trigger point therapy, myofascial release, even some Swedish massage. By bringing all of my training to the table, I increase my chances of meeting the client meaningfully. Primary respiration can loosen many types of strain in the body, but sometimes the most efficient way of balancing the system is to lay on a trigger point with an elbow! Mash that baby! Enjoy it. Because when it releases, the freedom on the other side may be just enough to allow the system to quiet into the receptive state through which deeper systemic change may come. So how and when do I decide to utilize direct action? By reviewing a few questions:
Clinical considerations: Is the client’s system capable of responding to spacious contact – are they capable of easing into tidal permeation? Are my efforts at biodynamic augmentation yielding fruit? Are they likely to be effective at some point during this session? If the answer appears to be no, then how can I best get the system’s attention? How can I help to facilitate an efficient release of the predominate strain pattern that holds the body in immediate fixed suspension? At what layer is the most immediate blockage present? What tools do I have that can more directly address the issue and increase chances of subsequent successful interchange with primary respiration?
Of course, every client is different. For some, simple waiting and patience will work. Or maybe augmentation will be enough to initiate a meaningful session. But for many of the people I work with in my community, direct action is the most appropriate introduction to our therapeutic interchange. It starts a conversation that can then move with greater ease into biodynamic spaces.
Flexibility is Your Friend
For those of you who are considering making craniosacral work your focus and promoting yourself as a craniosacral therapist to the public, be aware that you may be well-served to utilize a variety of direct techniques as you build a practice over the years. The good news is that as your practice grows, you are able to spend more and more time interfacing with fluid and tidal dynamics. As your clients come to understand your work and your skills of biodynamic augmentation increase, less time is spent with classical direct action and gross tissue work – for they come to understand that “that gentle thing you do” yields great benefit.
Luckily, there are a growing number of healthcare consumers who appreciate and understand the value of light-touch therapies like craniosacral work. These people will seek you out and arrive at your door ready to work at depth. This is a real blessing, for it allows you to go directly into the heart of the work and utilize the specialized understanding you have developed working with primary respiration. Good customer service and effective communication really pay off when defining your work for a public that is likely to have a poor understanding of your intentions and methodology. These factors along with consistency and patience over the long run will help you to create the practice you envisioned when you set foot on this path in the first place.