My Methodology in Homeopathic Case Management
by Deborah Olenev, C.C.H. RSHom (NA)
What I want to write about in this article is my methodology. The nuts and bolts of how I work, from when the client first contacts me, through the case taking process, case analysis, repertorization and case management. I have cured many hundreds of cases over the years, and have been refining my method of working over time, and would like to share what I have come up with lately that works for me.
These days I ask all of my new clients to complete a questionnaire, which I e-mail over to them, and ask them to e-mail back to me with their responses. Then when I see the client I work directly off of the questionnaire. I use different questionnaires for adults and children. I do this for a number of reasons:
1) I learn a lot about them, just from how they complete the questionnaire. Do they complete it in detail, without detail, with self-knowledge and awareness, or without? Do they even have a computer? Are they dyslexic? Do their minds work clearly or not?
2) It gives me an opportunity to review their information even before they walk in the door. I can see which areas we need to focus on, and what information they have provided well. Sometimes I know the remedy they need without ever having seen them, just by reviewing the questionnaire.
3) Some of the questions, which take up a lot of consultation time, such as, “What do you have for breakfast, lunch, dinner and snacks,” but don’t give you much meat, would be already provided, and we can use our time together to explore what’s really going on on a deep level with the client.
4) The questionnaire is very thorough, and it gives us a format to follow, where I know nothing has been neglected.
5) I type much faster than I can write, and all the information can be put where it belongs in the appropriate category.
6) When I go to review the case, and I want to see what the client said about thunderstorms, I know exactly where in the questionnaire to look, under the section on responses to the weather, which saves me a lot of time.
7) I request e-mail updates from my clients at weekly or biweekly intervals after they take their remedies, and I can post them directly to the chart I have for them in the computer. This serves as a record of their progress, and gives us good follow-up and contact.
Review of the Case
When it is time to work on the client’s case, I print out their typed case, then go through it and make two lists as follows:
1) The first list is of the measurable symptoms. I put this on large yellow post-it notes. This list contains all the physical symptoms, generals that are measurable, such as aggravation times, and measurable emotional symptoms, such as depression, anxiety, anger, and fear.
2) The second list is of the symptoms that are pertinent homeopathically, but not necessarily measurable. This will contain the food preferences, likes and dislikes, sensitivities, fears, modalities, environmental sensitivities, etc.
With these two lists I am ready to repertorize the case. These days I am using Kent Homeopathic Software, namely ReferenceWorks Pro and MacRepertory. To study the cases, I am actually doing the review in Reference Works and not MacRepertory. The reason for this is that, I can do materia medica searches on each symptom, by going directly to the original sources and seeing what was written about that symptom, and check if that is really what I am looking for. This is important if it is a very crucial symptom to the case. I want to be able to compare what was written about that symptom in all the remedies that are listed for it.
Usually I can see right away what remedies I need to consider, and which are way off the mark, even though they were present in the word search. To me this feature is invaluable, and has enabled me to make far more accurate prescriptions than I have in the past. This is particularly important when it is a very precise symptom that you are looking for. The other reason I like to work with ReferenceWorks is that if I don’t know exactly what to call the symptom, but I am guessing that it should have certain words in it, I can do a search on those words, and get wonderful hints about related words I can be using, or even a diagnostic name that I didn’t know for that symptom. Also one can see how important a symptom is in a remedy, by how many sources have mentioned it. Is this symptom a clinical symptom that was mentioned by only one author, or has it been mentioned by twenty authors? Do they each have something unique to say about it, or all they each parroting one another? This is a great way to learn how the materia medicas are compiled? How reliable do you feel the symptom is for this remedy based on the sources that you see mentioning it?
All of these wonderful features are not available by just looking at a Repertory alone. When I was using book repertories, I would try to do this by going to the original encyclopedic materia medicas, such as Hering’s “The Guiding Symptoms of Our Materia Medica.” This was well worth doing, but simply easier using a computer.
Once I have the repertorization up, I will often export the material to MacRepertory, where I can use the Elimination Rubrics feature. This way I can look at the case in manifold ways. I can pick and choose which symptoms I feel are absolutely necessary to the case, and which are not. I can combine them this way or that way till I feel I have a grip on what is going on. The fascinating thing about this is that you can see how just one symptom that maybe does or doesn’t belong there, can totally change the list of remedies that you are working with. Then you need to make a decision, if I put that symptom in, it brings us to a completely different set of remedies. Is this the right set or not? A lot may ride on that decision.If I am still stumped I will go back to ReferenceWorks and reexamine each symptom and see if this is exactly what I am looking for or not.
When I have finally narrowed the range of symptoms to one, two, three, or four, I will then go to the materia medicas and read about them. One of my favorite books is Rajan Sankaran’s, “The Soul of Remedies.” I will look here to see is this really on the deepest level what is going on with the client? Is this where the center of gravity of the case lies? Is this what the pain really is? Has the client’s perception of reality found its complement in this remedy? I may read from many other materia medicas as well, including Kent’s Lectures on Homeopathic Materia Medica, and Tyler’s Homeopathic Drug Pictures.
Finally, I have to look inside myself. I have to go deep within to the place in me, which is connected to everyone else and everything else in the universe, and tune in. I have to forget my thoughts and ideas, and drop down into my heart and beneath my heart, and see what feels right. Of course, everything is known, but not by my ego, which is masterful at confusing me. I will go into a meditative state and ask myself is so and so remedy right for this person? Yes or no? Is so and so potency right for this person? Yes or No? Is the 1M better?
When I feel that I have congruence on the mental (my mental) and spiritual level, I can make the prescription with confidence, and know that I have selected the right remedy for that client.
After I mail it off, or they pick the remedy up, I forget about it, and let all of this go, as if I had never seen that person before. A thought of them will not cross my mind. I have done my job and I have done it well, and now I am not attached to the outcome. I trust in the universe that what needs to happen will happen. I have done my work in the spirit of Karma Yoga.
That said, I do feel for my clients and love each and everyone of them, and I do endeavor to make contact, and receive updates from them as to what they are experiencing. The first follow-up is usually set for seven weeks from when they take the remedy, and as I said before, I request weekly or biweekly e-mail updates in the interim period. This keeps me posted as to what reactions they are experiencing, and it gives me an opportunity to answer their questions and say some words of encouragement and love. They know they are cared about.
The First Follow-Up
At the follow-up at seven weeks, I ask the client to tell me what has happened since they saw me last. A lot of this information, I will already have, as it is in the e-mails. What is their general perception of how they are doing? Then we go over the list that I had made of measurable symptoms and we chart what has happened. My chart consists of five categories: Symptoms that are better, symptoms that are the same, symptoms that are worse, symptoms that are old, and symptoms that are new.
After all the symptoms are categorized, I tell the client the significance of the placement of each symptom in the chart, and how I use this as a guide to repetition. Much of what I tell them is based on my experience working with clients over many years and the timings that I have observed.
The symptoms in the better column: I tell the client that we base repetition of the remedy on the symptoms in the better column. If a certain number of these symptoms (perhaps three or four) return for a certain number of weeks (perhaps two or three) to give me a call, as it may be an indication that it is time to repeat the remedy. On average I have found that a 200C potency holds eight months to a year and longer, and I let them know this information, which gives them an idea of what they may expect.
The symptoms in the same column: These symptoms are usually the ones that have deeper roots and may take longer to shift. Often the generals, such as cold hands and feet fall into this category. It is possible that these symptoms may be characteristic of who they are an not shift at all, or only slightly. I tell the clients that the symptoms in the same column should start to move into the better column by five to six months from when they took the remedy. In my experience this is the case, and when we do check at the six month follow-up most of these symptoms will have gotten better.
The symptoms in the worse column: These are the symptoms that are still in an aggravated state after taking the remedy, and I tell them that these ought to shift very soon, usually within a month’s time. I will often ask them to call or send me an e-mail in a month to let me know if this has happened.
The symptoms in the new column: I usually tell the client that if a new symptom appears, it is the remedy trying the symptom on for size to see if it fits. If the symptom does not belong to the person, than it will not hold on and should drop away shortly, usually within a month’s time. Often by the seventh week follow-up, these symptoms may have already come and gone, but we just record that they had been there and are better now. If a lot of new symptoms appear, it may be that they are proving the remedy. It is also possible, if many symptoms have gotten better, and now suddenly new symptoms appear, that they may be indicative of the next remedy that they need, as in one layer peeling off and a new layer showing itself.
The symptoms in the old column: If symptoms that the client has not had for a long time suddenly show up again, this usually indicates that we are on the right track with the remedy, and that the client is replaying his or her symptoms backward, with earlier states coming up. These symptoms should come and go quickly without any interference on the homeopath’s part. I often ask the client to report back to me in a month to let me know if these symptoms have moved on yet. If these symptoms linger on for a long time, it may be necessary to repeat the remedy.
Obstacles to Cure
The clients generally do not leave my office with just a chart in hand, but also with an investigation into obstacles to cure. We may review their lifestyle, eating habits, living situation or other factors, which may stand in the way of healthy living. Over work, over worry, obsessive thoughts, unhealthy work or living environments, lack of exercise, all of these things can be investigated and recommendations developed together that the client can live with. I also recommend meditation, or self-awareness to almost everyone who walks in the door. I tell the clients that the homeopathic remedies stop short of fixing the client. It does a great deal of work to help restore health to the client, but that they must meet the remedy halfway, with effort and an intention to get healthy. Breaking unhealthy patterns cannot be done by the remedy alone. The client must be an active participant in her or his own recovery. Learning how to meditate, so as to be able to break unhealthy thought processes is highly recommended, but cannot be pushed on people who are not interested in it or ready for it.
I hope that this glimpse into the way I work will help other homeopaths. I have attended many seminars over the years, and very few of them talk about methodology. I am sharing my methodology; I would love to hear how you work. Every time I attend a seminar I learn something new, and sometimes it sends me into a tailspin. When this happens it is wonderful. It means the doors of my perception are opening wider. Is the way I did things in the past right? Is the new way better? Let me try it on for size. Let me run it through my own being. Let me revolutionize myself. Let me become better and better at what I do? God bless all of you lovers of homeopathy. I love you all.
Deborah Olenev CCH RSHom (NA)