Homeopathic Casetaking from a

Homeopathic Casetaking from a Communication Perspective (published in The American Homeopath, volume 11, 2005, pages 77-78)

By Kenneth Silvestri, CCH, RSHom (NA)

Before I received my formal training in Homeopathy, I began collaborating with several homeopaths in my practice as a psychotherapist. After having worked with individuals and families in that capacity for many years, I could pretty much recognize when someone reached that special moment that is needed to make a difference or change.

That moment is a true understanding of the presenting emotional and physical problems and then the difficult process of dealing with those old habits that die hard and sustaining the change really begins in earnest. When I began referring and working with homeopaths, there was an obvious reduction in that readiness time, usually within days of gradual or striking improvement related to the action of a correct remedy. However finding the simillimum was not always easy or that quick.

It has been several years since I have personally integrated homeopathy and psychotherapy in my practice. The lessons of collaborating and communication are worthy considerations for the practice of Homeopathy. I am convinced that it is not just finding the facts for the introduction of a remedy nor does one have to be a trained psychotherapist to sustain the healing process, it is good empathic communication interfacing with the action of the vital force throughout the whole homeopathic process.
In my practice I regularly use an exercise consisting of a metaphorical “Stereoscopic Lens” to point out the value of widening one’s perspective. I ask those seeking help to imagine that they are seeing their current situation through a presently focused lens, the view that we most often use each day. It’s within this framed sense of perspective that we can mistakenly come to depend on content and narrow our sense of what may be happening. We can also, if we choose, begin to use this lens to recognize mistakes, wrongs, and anomalies (the strange, unusual and peculiar symptoms), which can allow for profound insight into one’s current life situation, learning style, temperament and family legacy.
I initially suggest during this presently viewed framework that a few deep diaphragmatic breaths be taken that fill up the stomach, before moving up to the chest. Before exhaling, with a stress releasing exhalation, I ask them, for a second or so, to widen their lens and see things in a peripheral vision, whether it is the distant corners of the room or the wider perspective of their physical and emotional environment.
This, in most cases brings up from the subconscious a larger framework or context about their originally viewed problem, of which I ask them to revisit and share with me any revisions that they would like to make of that view. With very few exceptions, this simple exercise results in profound insights regarding the causation and sensations of their presenting problem. I use this exercise progressively in treatment, which leads to more empathy and insight regarding the multi dimensions of our remedies. It also motivates life style directions over time as one articulates their experiences and continues with me in a homeopathic relationship.
My sense of Hahnemann’s case taking methods was that he readily recorded these systemic images by contextualizing how local befallments manifested themselves (§86-89, refers to the sections in Hahnemann’s Organon of Medicine, sixth edition). The “unprejudiced observer” was more than a mere recorder of verbal information. Today’s enormous amount of information sharing dictates that we politely dialogue and sensitively ask for clarification, especially since most communication experts agree that 90% of communication is non-verbal. This is eloquently pointed out with examples of appropriate communication skills in Brian Kaplan’s book The Homeopathic Conversation (Natural Medicine Press: London, 2001, p.49.).
In the footnote to § 96, Hahnemann states that for instance “the high pitch of the expression about their sufferings becomes, in itself, a significant symptom in the remaining set of symptoms from which the image is composed.” He undoubtedly saw interpersonal communication as more than a linear recording of content.
Hahnemann knew that tuning into content alone only contributes to disharmony and for us, as homeopaths today; it leads to a chase through the repertory without the needed context to match a remedy. When enacting change within a larger holistic or communicational frame, the vital force can be freed to help articulate feelings and give rise to the striking, unique and peculiar symptoms. Hahnemann in § 7, points this out in that the essential nature (Inbegriff) of the “-symptoms is the outward reflected image of the inner wesen (essence) of he disease, that is, of the suffering of the life force.”
The framework I use to further record a case and to share in the state of one’s narrative is a three-generation relationship family tree called a “genogram,” (see M. McGoldrick, R. Gerson, and S. Shellenberger, Genograms: Assessment and Intervention, Norton: New York, N.Y., 1999) which is used regularly in systemic psychotherapy.* This allows me to understand the emotional and physical descriptions of one’s life and legacy.

The genogram format encourages a guided narrative of one’s self identification in the context of their significant relationships and developmental stages. It provides a familiar backdrop (not always comfortable) to answer all of the questions suggested in the Organon. Hahnemann regularly investigated entire family trees to better determine the befallment of issues effecting the vital force and chronic maisms (§ 82-99) because for him “the cause of a thing or an event can never be at the same time the thing or event itself” (Organon, introduction, p. 10).

This is relevant today since we are constantly influenced by cultural and language constraints, what Martin Buber called the “I-it,” which is antithetical to the “I-Thou” of optimal health. For me the genogram offers a wider format to join with another and avoid the “name is the thing” trap by understanding patterns that point to a constitutional state through one’s own description and perspectives. There are an infinite number of frameworks and inductions similar to what I described above, my point is that for homeopathy, the “widening ” of its lens can provide more opportunity for identification of fundamental beginnings, awareness of exciting influences and the altering of disease states from the life context of the individual.
The process of homeopathy is more akin to interpersonal relations and communication skills than it is to the “medical model” that predominate our literature. The ongoing conversation is what depicts the essence of our remedies and the many possibilities of seeing them in different and updated contexts. Learning good communication skills is also the vehicle for learning more about ourselves. This only enhances the biological connection we all have access to when we tune into and “be” together rather than “do” things to each other.

As I experience the above each day, the following ingredients have emerged for me as a recipe in progress to sustain homeopathic treatment. Firstly, celebrate interpersonal communication with all its nuances of being connected. Secondly, understand the interconnections of nature so to have a peripheral vision in casetaking. Thirdly, explore homeopathic psychology as Hahnemann believed that “this preeminent importance of the emotional state holds good to such an extent that the patient’s emotional state often tips the scale in the selection of the homeopathic remedy.” and “can least remain hidden from the exactly observing physician (aph 210-11).” Fourthly, respect constitution and temperament for contextualizing symptoms and lastly, allow collective connections which describes how those seeking our help construct their world by resolving subjective and objective experiences.

*(footnote) A very concise view of ecology or systemic thinking, was described by Anthropologist Gregory Bateson. He defined “love” as the recognition of how our everyday contexts are all inter-connected and “wisdom” as understanding this process. If we see nature this way, an aesthetic experience, we see repetitive patterns of entropy (how all systems move toward disorder) and how new patterns can develop and be maintained. This was further elaborated by Nobel Prize winner Ilya Prygognia who saw our species, with all its fallibility evolving through context. It is the rearranging of energy, the balancing of our vital force that moves us in context.

The differences between Allopathic and Holistic frameworks in medicine are similar to that of systemic psychotherapy and the more prevalent content oriented psychotherapy methods. It is systemic therapy with its focus on relationships and context that is more complementary to homeopathy.

My concluding ingredients are explained in more detail in “The Art of Sustaining Change: A Personal Framework for Homeopathic Emotional Healing,” in Simillimum, summer 2002, Vol XIV, pp. 85-98.

**Kenneth Silvestri has a practice in Psychotherapy and Homeopathy in Green Village and Montclair, New Jersey. He is a certified classical homeopath (CCH) and has his doctorate in anthropology and psychology from Columbia University. He studied with Luc De Schepper and David Little and he is an active student of Aikido, a martial art dedicated to peace and harmony. E-mail: ksilvestri@nac.net; Web-site: www.drkennethsilvestri.com