Dr Kenneth Silvestri

Abstract: In this chapter a conceptual framework is described that integrates psychotherapy and homeopathy. This includes a discussion of communication skills, supporting theory, the use of the “Genogram,”(a multi generational psychological tree) and the Stanford University Forgiveness Methodology that can help the practitioner determine the core “grievance” in selecting the simillimum and establishing a treatment plan.

I would like to share a conceptual framework of how psychotherapy and homeopathy can work together to enhance the healing process. Psychotherapy (in its systemic essence) is defined here as the process where one is assisted in recognizing how problems and grievances are interconnected to past and present contexts and resolution is the understanding of this pattern and being empowered to change for the better. Homeopathy is the second-most used healing method in the world according to the World Health Organization. It is based on the principle of “like cures like.” Homeopathy’s safe, non toxic and regulated remedies stimulate one’s immune system to follow its natural direction to heal the mind and body from recognized trauma. The correct remedy or “simillimum” is determined by its match with the gestalt of the presenting symptoms.

Thomas Kuhn (1967) in “The Structure of Scientific Revolutions,” describes how change comes about when anomalies or mistunement is recognized. However “change” will be co-opted and sabotaged if it is not supported and maintained in a new framework or “paradigm.” Traditional psychotherapy has struggled with resistance and “back to business as usual.” Homeopathy, although having a long history of clinical successes, has been plagued with the difficult process of determining the “simillimum.” Together psychotherapy and homeopathy offer complementary means to recognize the pattern of suffering and consequently strengthen and maintain the immune system to balance the body and mind.

In my practice I regularly use an exercise consisting of a metaphorical "Stereoscopic Lens." I ask those seeking help to share with me what it is that they are not getting in their life that causes pain. I then ask them to imagine that they are seeing their current situation or “grievance” 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 narrow and skew our sense of what may be happening. We can also, if we choose, begin to recognize mistakes, wrongs, and anomalies within this perspective, which can allow us profound insight into our current life situations, learning style, temperament and family legacies.

I initially suggest during this presently viewed framework that a few deep diaphragmatic breaths be taken that softly fills 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. I then share a specific homeopathic like induction consisting of an emotional simillimum i.e. a statement or narrative related to the change of the presenting problem or grievance that is desired. Within this statement I suggest that it would be beneficial to focus on being grateful for something in their life. For example, a male patient who was 50 years old told me his grievance was that his mother never acknowledged or praised him. She was a single mother who worked long hours and never had time for him. I shared several stories with him about single mothers who made all kinds of sacrifices to raise their children. I also asked him to focus and be grateful for little things that his mother did for him that made him feel good, like shopping for food etc.

This, in most cases brings up from the subconscious a wider perspective about their originally viewed context, of which I ask them to revisit and share with me any revisions or feelings that they would like to make of that view. With very few exceptions, this simple exercise results in a new and positive response to their presenting problem. This process also illicits the core “grievance” or “tale of woe,” that forms the basis of one’s imbalance of their vital force (Luskin, 2002). I use this exercise progressively in treatment, especially relating it to information from one’s Genogram (explained below) which leads to more empathy and insight regarding remedy and psychotherapy directions over time as one articulates their life.

My understanding 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 2002, Organon of Medicine). 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 (2001). 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.

As I experience the above each day, the following ingredients have emerged for me as a recipe in progress to integrate homeopathy and psychotherapy. Firstly, celebrate interpersonal communication with all its nuances of being connected. Secondly, understand the interconnections of nature so to have a peripheral vision in case-taking. Thirdly, explore 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 (apt 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

The ingredients to integrate homeopathy and psychotherapy

Celebrating Interpersonal Communication

Maintaining change necessitates not only an understanding of our systemic connections but also an understanding of interpersonal communication. When we communicate there are superimposed rhythms that join humans. Participants synchronize their underlying biological rhythms. Implicit rules are part of communication although the process is out of the explicit awareness of the speakers. Listening involves rhythm matching which is also found in body movements. Communication is "the process by which any two pieces of the universe find their relationship to each other." It is thus important to see how humans "tune" into each other rather than seeing humans as "doing things to each other." Interpersonal rhythms lie between or across the biological and cultural, clear distinctions occur and conversations systemically correct themselves. This is similar to what Greg O'Connor (1998) says about Aikido, where "one dances in the flash and flow of 'win-win' energy." Flaws in this process can cause and identify pathology

The frame or context equals the rules of communication. This allows, encourages or penalizes behaviors. Without context that is shared by the speaker and hearer, meaning is unclear. It is the sharing of frames or contexts that allows for the recognition of anomalies to be changed. By understanding how multi-level frames work, we can avoid "right-wrong" labels. When sharing states you can tune into the "love, sacred, ecstatic, transcendent, aesthetic, peak, turned on, art, music, dance etc.

Hahnemann knew that tuning into content alone only contributes to disharmony as 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 “symtoms is the outward reflected image of the inner Wesen (essence) of the disease, that is, of the suffering of the life force."

This shared time frame is like a hologram; in that we all share fixed biological rhythm and a subjective modulated one. The aesthetic is possibly the largest available frame. When we recognize its reflection, we can feel it. Paul Byers (1985) believed that "tuning to content contributes to disharmony - when i.e. evil is enacted within a larger aesthetic frame, the inner, natural ideal can shape our feelings and frame our attempts at a solution." The "aesthetic is the name of the ideal human game." If we can understand change in larger and larger frames, we can find ourselves sustaining it in the natural flow of things.

Implications:

It is important to “join” those seeking our assistance. A comfortable interpersonal environment is essential as we synchronize and form shared rhythms. The unprejudiced observer needs to go to the next level and see things in “context” in order to truly understand the essence of one’s inner existence. This can only be accomplished as the homeopath becomes an active participant observer.

Understanding Context and Systemic Treatment

In developing an understanding of someone who is seeking assistance, we have been taught by Hahnemann and Boenninghausen to listen to the narrative that fills their presenting context. The open questioning (“as if.”) brings forth information regarding the location, sensation, quantity, time, circumstances, modalities and concomitants. My bias of using the family Genogram (see Genogram format end notes below) allows me to have a peripheral vision in case taking. Each bit of narrative information can be seen not as facts and content but as being simultaneously part of the interconnected levels of the wider lens.

In the ecological movement of the past few decades, it was pointed out how the chemical DDT was able to kill the predators of certain wounded agricultural crops. In this context there were cheers and accolades especially as crop values increased. However within a few years, DDT was seen to enter the biological food chain, soon entering mothers' milk of humans. Many species of insects and animals either became or were soon to be extinct.

It became apparent that something that seemed good in one context may not be good in a simultaneously connected wider context. Similarly, using corporal punishment on a child in one context may alleviate the presenting problem, yet on a wider psychological level it can do harm. It turned out that marigolds (Calendula) could have and did heal the crops, keeping its natural predator safe and restoring that particular ecological pattern. What we learned from ecology is that the patterns of these contexts connect to form our "Gaia” (Silvestri, 2007).

The beginners’ mind of case taking is the ecology of the mind. The mind/body narrative that is seen within this context allows for the emergence of unique stories. The strange, extraordinary, unusual and odd, is the kind of every snowflake being different theory. The nature and essence of a person can only be determined from this framework if we are to truly sustain the change we are looking to assist. The alternative is to have the dog chasing its tail syndrome.

Since Homeopathy is the only healing form that so extensively records the mental and emotional patterns of its' remedies, it stands to reason that contextualizing case taking can better help find the simillimum. "These [patterns] above all, must correspond to the very similar ones in the symptoms set of the medicines sought" (§153). Other common symptoms also need the defining context of sensations, modalities and accompanying symptoms to become useful in this framework. Stepping outside of content and organization of the facts is to recognize the anomaly that Kuhn mentions and helps us to perceive the "mistuning of the psyche" and the "instinctual nature" of the pattern that needs to be changed to restore the "vigor vitae.”

Hahnemann developed a holistic view of human nature. It was the "conscious spirit," the psyche and its consequent functioning; "instinctive vital force," the essence (inner Wesen); and the "physical organism," the essential nature (Inbegriff), that worked together to become more powerful than the disease that was mistuning the vital force. The mistuned energy (innate and acquired) is the subconscious language of the vital force. To effect change the anomaly is articulated from that inner voice. To hear it necessitates recognizing how "emotions circle like satellites around archetypal complexes. Every person is a mixture of feeling and thinking, every symptom has a circle of possible related symptoms. By knowing how the concentric circles of the symptoms fit together in the individuals we come to understand the essence and the totality” (Little, 2001). This is how patterns can be described as systemic, holistic or ecological.

One has to tune into this inner voice and empathize with the contextual connections that qualify the totality. This means using whatever variations, be it the stereoscopic exercise in paragraph one or the various repertorizing methods stressing mental (Kent) in some cases; physical generals and particulars of Boger; the more clinical and organic pathology that may be more suited to Boenninghausen's methods and/or others. If the recognition of the needed change is not supported by a combination of systemic means to address the fundamental, exciting and maintaining causes, the patterns of business as usual will sabotage any possibilities of sustaining it.

The framework I use to record a case and to look for solutions to one’s problems and hurt is a three-generation relationship family tree called a "Genogram," (M. McGoldrick, et, .al, 1999) which is used regularly in systemic psychotherapy. This allows me to understand the emotional and physical descriptions of one's life, legacy, and presenting grievance. A Genogram is a transgenerational depiction of one’s family pattern and legacy. It is a tangible and visual means to map large amounts of information in a concise manner. At a glance one can see the complexity of a family context and its’ connections to past emotional issues. It allows a clear introduction and way to get to know one’s life patterns. Providing a sense of history and psychological attributes, the Genogram portrays the ongoing evolutionary journey and interconnections to larger contexts of education, employment race, culture, ethnicity, class, religion, and health and many other structures and issues (see attached Genogram symbols.).

The wider perspective of the Genogram also reveals hidden information and magical connections creating a perspective that frees the individual in many cases from blame or a deviant label. The theoretical basis of the Genogram is from Family Systems Theory (McGoldrick, 1995) which describes how the family system moves to maintain and adapt to input within a given context that is simultaneously part to whole connected to wider contexts. Within this framework I have added another dimension that in my mind is the foundation for successful psychotherapy which is “Forgiveness.” It is here that I emphasize how one deals with their “grievances’” or “a tale of woe’” which is when someone does not get what they may want. Usually this is the window to how one manages stress, creates demands, and attempts changing what may not be in their power to change.

Implications:

Understanding how our world works in part-to-whole connections is understanding nature. By recognizing that Homeopathy is in tune with how nature works, using a wider ecological framework such as the Genogram, can depict multi-levels in ones legacy. It is within this map that unique patterns, miasms and coping skills emerge and are learned and determined to match with needed remedies and subsequent life style changes..

Explore Psychology

Hahnemann supported the use of humanistic psychology in treatment. "In all the so called somatic diseases as well, the mental and emotional frame of mind is always altered (§210)." In §211 he comments 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. This is a decidedly peculiar sign, which, among all the signs of disease can least remain hidden from the exactly observing physician." Homeopathy's context includes detailed information of psychological states produced and cured by its' remedies.

The importance of using homeopathic psychology is further supported by how physical symptoms disappear as mental illnesses appear. Documented cases demonstrate how serious physical disease can suddenly turn into deep one-sided mental and emotional dysfunction (§216). The physical symptoms improve as the mental problems become worse and in some cases can go back and forth (§220). Hahnemann used crisis remedies when physical or mental symptoms worsen then returned to the chronic remedy when appropriate to sustain his treatment. In §221, he recommends acute intercurrents when flare ups of acute crisis occurs. At this point, retaking the case and using Boenninghausen's concordance and relationship of remedies is very helpful in continuing psychological assessment and ongoing treatment.

The differential assessment of psychological symptoms can point to old habitual patterns of bad life style and be assisted with psychotherapy. In §228, Hahnemann writes that psychology is "diet for the soul" and that the use of "honesty" and "empathy" is essential to join with a patient and insure continuing trust. David Little (2001) points out that being sympathetic for the suffering of others is part of our own healing process and the power behind cure is compassion.

Homeopathic mind cure must be homogeneous to the symptoms and in context of the individual. The "disease mistunements can be caused by imagination and therefore similar remedies can cure them" because strong similar powers extinguish a weaker similar power (footnote to §26). "Both physical affections and moral maladies are cured this way" i.e. grief cured by hearing another greater grief even if fictitious. Hering for instance resolved his emotional grief while seeing a ballet based on a Greek tragedy that was similar to the origin of his situation. J.T. Kent in his Lectures on Homeopathic Philosophy talks of being empathetic, "Sympathy and similar can go a long way in the realms of the psyche." The blending of homeopathic psychology and mind/body represent a largely unexplored region of the Organon and can be used effectively when following homeopathic principles of being similar and in a minimal dose (Silvestri, 2002).

Fred Luskin (2002) in “Forgive For Good: A Proven Prescription For Health and Happiness” emphasizes a forgiveness methodology based on rigorous research that documents the effects of unresolved grievances on one’s emotional and physical health. Forgiveness is not condoning or minimizing one’s hurt. It is for oneself to be in the present and not allow their grievance or pain to take up unnecessary space in one’s head. When a grievance is embedded and shows no resolution, the sympathetic or “fight or flight” reeved up part of our nervous system becomes over used. This part of our nervous system is great for reacting to a life threatening situation, but injurious to our mental and physical health if over used. When we have unresolved pain there is a tendency to become the victim and create demands that are ”unenforceable.” Statements of “how could this happen to me,” do not recognize that the world says “no.” However, we can have choices and wishes to change our framework and utilize our parasympathetic nervous system (the “calm down” part). This can be accomplished by mindfully focusing on and being grateful for the good in the world. It is here that homeopathy can help the immune system to recognize any mistunement and allow it to continue its natural direction to heal the mind/body (Silvestri, 2009). For Luskin’s nine steps for forgiveness see fig. 1.

Nine Steps To Forgiveness

1. Know what you feel so you can allow empathy to produce a “non-denial” of feelings. Soul sickness is lack of perspective. Widen the lens to view what is the “wrong” that hurts you. Our good side, persona, is constantly overtaken by our shadow side when we lose perspective.

2. Forgiveness is for you and it is a process to make peace with yourself.

3. Forgiveness is not about minimizing the hurt it is about changing your grievance story. Forgiveness does not necessarily mean reconciling with the person who upset you or condoning their action. It is to set a goal to let yourself go to a spiritual side that does not blame or hinder your well being. It is in a sense a way to stop relieving the grievance and stop unnecessary dwelling on the negative.

4. Choosing to forgive. Is choosing health or being a victim. Get the right perspective on what is happening. Recognize that your primary distress is coming from the hurt feelings, thoughts, and physical upset you are suffering now, not what offended you or hurt you two minutes or even ten years ago. Uncomplicated grief is easy to handle, i.e. you missed your movie or the grocer was out of your favorite food. Complicated grief is when you credit your bitter bank and become a millionaire in bitterness. The tale of woe gets bigger and keeps you connected to negativity in the past. The gap between what you want and what you got is an important gauge as to your health. Life says “no” in so many ways, it is part of the natural suffering we encountered everyday. As Richard Carlson wrote “don’t sweat the small stuff.” How serious we take ourselves manifests in how we balance our mind and body. We need to make peace with the “no.” This is not to minimize your hurt but to realize that the grievance story may not be reality. The map is not the territory but our flight or fight mechanism will nevertheless react to the map. If the threat is gone don’t continue to have your body injured. Think of the grievance, take a deep breath and create a loving image of your positive possibilities.

5. Have positive emotions as you cope with confidence. At the moment you feel upset, practice the Positive Emotion Refocusing Technique (PERT) to soothe your body’s flight or fight response.You can choose the TV. Channel that you wish to see. Why not choose the life view that you want to live within.

6. Give up expecting things from those who will not give them to you. There are certain unenforcable rules that strengthen the grievance story. If we cling to a grievance we will live the grievance. We can not demand a return to desire. Let go and soften yourself. You may become more vulnerable but you will be more human. Learn to forgive yourself, smart people can do stupid things and good people have good intentions. My friend John Welshons writes in his recent book When Prayers Aren’t Answered, (Novato, California: New World Library: 2007) that “..the acceptance of things as they are in this context does not imply complacency…the acceptance of things as they are is merely intended to alleviate suffering we habitually create in our minds with the desire to change things we simply cannot change (p.151).”

7. Put your energy in a positive place. Have self compassion. It is what we learn from suffering. Embrace positive intention. We cannot write off the other who hurt us. It may have just not worked out or the other had karma beyond your control. If you apply your intent in a non-demanding way your interactions will synchronize if the other is willing to join you in an honest win-win volley. Acceptance of who you are and your evolving growth is love. We are all fallible and we have choices to have noble intents.

8. Remember that a life well lived is your best revenge. Instead of focusing on your wounded feelings, and thereby giving the person who hurt you power over you, learn to look for the love, beauty, and kindness around you. When you look inside your enemies you see their pain. When there is no revenge you are forgiving and a life well lived is your response. If you seek revenge you are digging two graves and we become what we don’t forgive. It is our choice not to define ourselves by the others who have hurt us.

9. Amend your grievance story to remind yourself of the heroic choice to forgive.

The above forgiveness framework; articulates causation/solution in conjunction with the Genogram; which provides context/information, produces an integrative process for determining the sensation, modalities, location and other associated symptoms needed for determining remedy and counseling directions.

Mindfulness, forgiveness, and health

In my own practice I employ and teach mind/body techniques with “mindfulness” at their core. My clients are willing and eager to explore the benefits of using these techniques, but for many of them it is easier said than done. Our complex and fallible nature often needs assistance in overcoming unhealthy patterns. This is where homeopathy’s role in getting us “un-stuck” is so evident.

The main tenet of being mindful or to have a “beginner’s mind” is to pause and focus while viewing the world as a part-to-whole interconnected process. The consequence of not recognizing our mutual interdependence with nature and others can lead to stress and “fight or flight” patterns, all of which have been linked to compromised immune systems and other health threats. Thich Nhat Hanh, a Vietnamese Buddhist monk who has helped popularize mindfulness, urges us “to be fully alive” and to “look at living beings with the eyes of compassion.” This sounds simple but it can be very difficult to enact. Forgiving the past – oneself and others – is a key step in fostering this kind of mindfulness as well as improving health. Fred Luskin (2002), as mentioned above, further describes how we form “grievances” as a result of not getting something we desire. When it becomes “personalized” (“why me?”), the grievance has enormous power to distort our perceptions and harm us both mentally and physically.

We cannot erase the marks that our wounds leave on us, but we do have a choice between uncomplicated grief that is put into perspective and complicated grief that stays connected to the past. The grievance or tale of woe keeps the connection. Luskin’s main point is that the “offender” need not be the star of the story at our expense. Continuing to live in the story keeps us in “fight or flight” mode, whose constant overuse can cause physical damage as well as mental and emotional problems. Forgiveness is a mindful process that can disconnect us from the past and empower us to heal, but it is not easily accomplished without help and nurture.

Between the lines of the above description of grievance and forgiveness are the clinical experiences of generations of homeopaths using homeopathic remedies to awaken self-awareness and balance the immune system after all kinds of trauma. The homeopathic repertory (a reference work that lists symptoms and the remedies that are known to address them) contains a host of information about mental-emotional symptoms related to “grievances” such as; brooding, disappointment, grief, anxiety, anger, humiliation, reproach, resentment, hatred, and holding on to the past. We also know that certain remedies address physical ailments that can result from withheld grievances, such as exhaustion, nervous affections, heart problems, immune system problems, and hypertension.

Many homeopathic remedies have the potential to address nearly all of the traumas one may encounter, however I have found that the framework of the forgiveness methodology facilitates the recognition of the needed “constitutional” remedy when one is holding on to a “grievance.” The remedies shown below are examples of just a few that might be indicated for any particular individual in need of forgiveness and psychotherapy (Silvestri 2008).

Selected “Forgiveness Remedies”

Aurum metallicum (pure gold, a mineral remedy) can help people who are full of self reproach and blame and may address depression that arises from this. People who need Aurum have very high standards for themselves, so they tend to feel failure and guilt keenly. Their sadness is intense and can be suicidal usually as a result of not achieving their high goals. Aurum is indicated when a sense of loneliness is prevalent and there is a tendency to be very quarrelsome. The temperament of people needing this remedy shows strong duty bound and workaholic tendencies. There is much self reproach, despair and shame within their tale of woe. They feel worse from cold and boredom and usually feel better with music. This remedy can be called for when someone has difficulty expressing anger because of their depressive state, whereas people who need Staphysagia (see below) will still function and outwardly express their dissatisfaction. Other Aurum remedies may be more specific for certain differentiating symptoms such as when there is enormous anger when thinking of one’s ailments, especially after mortification (Aurum muriaticum; chloride of gold). Aurum muriaticum natronatum (double chloride of sodium and gold) would be indicated when there is extreme unrest and impatience and Aurum sulphuricum (sulphide of gold) when there is a strong sense of despair regarding recovery from one’s trauma.

Ignatia amara (Ignatia bean, a plant remedy) can help people who exhibit hysteria and a sense of being stuck in grief. In people needing Ignatia, bitter and longstanding disappointment manifests in deep brooding and despair. The grievance pattern is supported by a worsening with criticism and being alone. There can be suspicion about what others think of them, and they are prone to contradict even though they crave attention. The sentimental yet quarrelsome nature of people needing Ignatia makes them vulnerable to taking affront. When they have a grievance, they come across as being beside themselves as they hold on to their insult. They may have a sensation of a lump in the throat. The person needing Ignatia feels better with heat, cries easily and improves from eating unlike a Natrum muriaticum person who is aggravated by heat, suppresses tears and is worse eating.

Nitricum acidum (Nitric acid) is indicated when the lack of forgiveness is characterized by anxious, complaining, irritable behavior and strong resistance to resolving their “tale of woe.”. People needing this remedy can be very abrupt, unforgiving and vindictive with aversion to any conflict which produces strong resentment. Negativity, peevishness and nasty can be traits leading to this remedy. They are prone to hold on to their grievances with a grudging manner. They can be restless and dissatisfied with everything. Anxiety about health is a keynote as well as not admitting to any obvious improvement to their health. There is a strong oversensitivity to what people may think about them, which supports their holding on to hurts and blaming others for taking the joy out of their life. Food cravings revolve around fats and salts, and they are chilly by nature and complain of splinter like pains. They have a strong sensation of inner uneasiness or constriction throughout their body and are usually better when lying down.

Natrum muriaticum (common salt) may help those who are romantic, responsible, somewhat fastidious, introverted and prone to produce grievances based on their great sensitivity in relationships. The grief and taking things very personal keeps their tale of woe very silent and suppressed. They are better for solitude, worse for consolation, yet with extreme dwelling on past offenses, reminiscent of visions of the biblical wife of Lot, who on looking back turned into a pillar of salt. There is a clear vulnerability with fears of rejection and affects of loss, separation, resentment and humiliation. There is a liking for salt, symbolic for the dried up tears of long term grief, and other characteristics of dryness. There is much exhaustion but usually amelioration with fasting when this remedy is indicated.

Phosphoric acid has an affinity to being needed when there is an overwhelming sense of disappointment and loss, especially of loved ones.. They become negative and longing for acceptance. There is a flat indifference, doubt and weak apathetic quality to their grievance story which differentiates them from the other remedies. The need for this remedy is also indicated when there is a collapse and forgetful state. There is a yielding and slow disposition with a silent holding on to their grief.

Staphysagria (Stavesacre) is warranted when there is difficulty expressing the grievance clearly. There is much anger and apathy about all things, yet has an underlying sense of being mild and sweet which can confuse their sense of expression. Constant dwelling of unpleasant thoughts with low self confidence is evident. Betrayal with indignation and an irritable temperament is a characteristic of this remedy. Horrible and sad stories affect those in need of this remedy and they can easily throw things as a substitute for verbally expressing their anger. There is an aversion to physical exertion being touched, and confrontation.

Implications:

Psychology is the framework where solutions are found. Using the forgiveness methodology can produce the means and information to create solutions. Rubrics appear in the articulation of “grievances” and relevant mindfulness skills, which in conjunction with homeopathic treatment, takes the healing process to new levels.

Respect Constitution and Temperament

In homeopathy we are taught that causation, constitution, and the totality of symptoms are three critical factors. Boenninghausen writes about the importance of understanding who, what, why, with what, modes, when. He also emphasizes the need to understand causation and how imbalance in ones' make-up opens the door to the need for change. David Little (2001) describes how remedies have multi-polar nature having been tested on a wide variety of people. Constitution and temperament is what we view first in the patient. This helps contextualize symptoms that are similar and places them in the perspective of, for instance, the thin and dry constitutions (the twin biles of melancholic and choleric) or the heavy and wet constitutions (the sanguine and phlegmatic) metabolisms.

How one feels, radiates and adapts are further cues to their ways of gathering information and handling their evolving contexts. Their family legacy and life cycle narration play a part in this determination. Learned communication and somatic foundation is the basis to confirming complex emotions "that circulate around the center like satellites." Reactions from dialogue can lead to exploring essential patterns that define striking extraordinary, unusual and outstanding symptoms. Respecting constitution and temperament allows the observer to participate in patients over lapping states i.e. Nervo-Choleric, Sanguine- phlegmatic etc. and through homeopathy's wonderful case narratives and provings point to remedy resolutions and life style changes.

Implications:

In continuing the homeopathic treatment, understanding one’s temperament and constitution produces resources to maintain improvement. Psychotherapy, especially using the forgiveness methodology can help create life style and mind/body skills to support and adjust the changes (including complementary remedies) that accompany the healing process.

Allow Collective Connections

The final considerations in sustaining change deals with a deeper understanding of how our patients construct their world. Reconciling subjective and objective experience is one of the ongoing challenges within our human fallibility. Jung believed that the subjective part gets its information from symbols of inherent instincts, ancestral connections and universal archetypes. "The collective unconscious communicates from the timeless space that is the source of all religious, myths, visions, dreams, fantasies, altered states, fairy tales and folk stories." It is a holding place for all the experiences of humanity and a means to wholeness. As ignorance can misguide us, the grasping of one's potential as well as constraints can enlighten us. "When we confront the mythological core of our experience it offers transcendental meaningfulness of our lives" (Silvestri, 2002).

The objective psyche is an energetic field of experience lived through these archetypes. Edward Whitmont, who himself was a psychiatrist and homeopath further elaborates that psychological happenings are processed and manifested in language of symbols. This is a demonstration of the “purposeful direction of movement that expands that which is deficient and balances what is exaggerated.” This natural movement toward wholeness is what Jung called the “self.” If this is the case, “Then all psychosomatic phenomena can be given meaning, intent, and provide information about the state of the unconscious if interpreted symbolically” (Silvestri 2002, 2008). It can also be the source for articulating one’s grievance story or “tale of woe” which perpetuates the “fight or flight” part of our sympathetic nervous system, It is in this realm that Fred Luskin (2002) demonstrated the injurious effects of unresolved grievances to one’s emotional and physical health.

As humans we have an inherent nature that moves toward collaboration. Neurosurgeon Karl Pribram describes how our brain acts holographic ally within a holographic wider context of our world (Byers, 1977). This can easily demonstrate the archetypal development and accessibility to our interconnectedness (i.e. yin-yang, I-Thou etc.) that all of us need in order to be awakened from ignorance. Jung demonstrated how the ego provides our conscious with content yet the shadow; our compensatory sub conscious provides subliminal experiences.

The collective unconsciousness and the self are information sources that go much beyond personal experiences. The blend of the conscious and unconscious dialogue is constant and the symbols that arise in consequent dreams are the language of the unconsciousness, and could be a medium of inspiration and art. It is this process that can also be the driving force behind psychosomatic problems. Being out of "sync" is an indication of imbalance. Although we never see the invisible pure form of the archetypal thing, we can strive to harmonize with its manifestation pattern and essence. The simultaneous awareness of these connections, the "Ah" experience, is the spontaneous automatic reactions that do not follow the rules of the rational mind. Jane Cicchetti (2001), in an interview, said that "Jung felt that symbols were the best possible expression of a reality and wholeness that is greater than the intellect can conceive; that symbols point the way to a greater reality.” She also points out that when we open our minds to this reality, we are able to make connections and see the wholeness of a homeopathic case more readily."

Implications:

Being aware of connections and how symbols give us understanding of life’s paradoxes and potential creativity is the basis for moving toward wholeness. Homeopathic remedies resonate with natures plan and they can be identified and matched with the emerging articulated “self.” Homeopathy and psychotherapy when integrated provides ongoing assistance to this process.

Genogram Format (McGoldrick, 1995) and case example

The Genogram is a transgenerational and psychological family tree. Using the symbols above one can depict an individual’s relationships, family patterns and influences. Factual information about illnesses etc., help determine miasmatic patterns and legacy. Parental traits and communication (i.e. open, closed, nurturing, controlling, abusive etc.) from one’s own narrative allow for an understanding of how one was raised and reared relevant to developing communication and cultural traits. Constant recording of “grievances,” sensations, modalities, locations, and other related ailments will produce an ongoing narrative and openings for striking and unique symptoms applicable to determining homeopathic remedies and psychotherapy directions.

Some initial questions:

• How do family members think about one another? (Look for characteristics that are brought up i.e. the loudmouth, spendthrift, softie etc.). This provides articulation of joys and pains. Patterns of emeshment and cut-offs can be the “not-well-since” beginnings of past and present aggravations, resentments, grievances leading to symptoms found in homeopathic repertories.

• Who was named for whom in your family? (Look for how names reveal roles, hidden meanings, historic connections and psychological patterns).

• Were there coincidences between the births of family members and moves or migrations, illnesses or death, changes in family finances, etc.?

• How much did the family conform to gender stereotypes of their culture and era, which members did not conform, how were they viewed and how did the family demonstrate flexibility (or inflexibility)?

• How did the family deal with rituals, stress, rules, leisure, beliefs, and explaining or telling stories of death, money, education, betrayal etc.?

• What kind of relationships did one’s parents have with their parents? How did you relate to your parents, the good, the bad, any grievances, traumas, life cycle and developmental issues etc.?

• How did you relate to your siblings? How were siblings expected to behave? What roles did you and your siblings have in the family?

• What are the patterns of couples relationships in your family? Divorce, power struggles, gender roles, employment, attraction, strengths, weaknesses, and how did this effect your development etc.?

• Class, culture and diversity questions can include narratives of ethnic background, celebrations, stress management etc.

Implications:

The above suggested questions provide background and support for assessing the presenting problems, grievances (what one is not getting), unenforceable rules (see the nine steps in the forgiveness methodology), coping skills, and stress management. This allows for more concise ways of describing sensations, modalities, location and other related symptoms. The recorded narrative, information and behavioral patterns can then used for determining a constitutional remedy and through the forgiveness methodology (explained above), a therapeutic framework.

Using the forgiveness methodology and the Genogram format provides qualifying information that will help determine the core grievance and differentiate between indicated remedies (see selected forgiveness remedies above).

Example:

A condensed case example was a woman in her early thirties who presented with a Phosphorus persona. She was very intuitive, extroverted, open and impressionable. There was a sense of self importance and desire to be the center of attraction. She however was very concerned about her sense of physical weakness (chief complaint) especially when things were not going her way.

She had been treated by a homeopath previously with Phosphorus, but felt there was little change in her symptoms and disposition. Her family of origin depicted in her Genogram indicated many stories about the lack of structure, encouragement and affection received from her parents. She felt like she could not succeed at her job (retail/sales) and narrated trouble organizing herself. However her evaluations and performance was acceptable to her employers. She articulated being criticized by her parents for her choice of employment. Her narration of her early family dynamics stressed that she never was “good enough,” and even when she was motivated or excited about doing something her parents and older sibling would “bring her down.”

She was not able to express this or show disagreement since this was unacceptable. Asked how she dealt with this, she explained how she would become very introverted and held her anger inside when at home but would constantly discuss her sense of dissatisfaction (not anger) with her life with anyone who would listen (a strong Phosphorus trait). When asked what it was that she was not getting in life, she expressed it as wanting “her integrity,” that her parents destroyed. She thought of this daily and blamed her parents for her dissatisfaction with work and life. She would become exhausted whenever she focused on this feeling or was involved with her parents. When she was sad and tired she would become yielding and feared losing her integrity and “self control.”

What emerged from her family narratives and her grievance story was someone who had clear extroverted intuitive traits who would move to an angry introverted state. This would be what Carl Jung described as one moving from an outgoing sanguine state to her inferior side which was an inward choleric state. Her outgoing “persona” was one of being impressionable, artistic, intuitive, and the center of attention. The “shadow” side or inferior trait (usually where the strange, peculiar and unique symptoms needing attention are located) was characterized by false pride, self pity, and dwelling on her problems. This produced an inability to finish her objectives and feel a sense of integrity.

Repertory rubrics that came to the surface revolved around her “loss of position,” shame regarding her parents and sibling dynamics, lose of control, and a distorted sense of self importance. The remedy Staphysagria was further confirmed by her aversion to being touched when she was exhausted, desire to throw things when angered and her recent articulation of indignation toward her parents behavior.

She was given the remedy in a 30C medicinal solution, followed by a Q1 potency with striking improvement. Her follow-up sessions focused on her changing her “grievance story,” using relaxation exercises and having positive intent following the forgiveness steps. After six weeks she began taking Phosphorus (medicinal solution of the Q1 potency) which was now clearly indicated as the Staphysagria symptoms dissipated. She articulated continued improvement in her total well-being and felt “invigorated and confident.”

Conclusion

I have always believed that the process of psychotherapy or for that matter life itself is to recognize and “differentiate” from injurious patterns that hinder one’s optimal health. We cannot isolate ourselves from the many contexts of life, but we can keep our integrity and simultaneously see the larger picture that we are part of and within. When homeopathy is combined with psychotherapy, the process of becoming “whole’ is much more attainable. Understanding one’s role in a family system can for example unveil dynamics connected to

grievances and consequent symptoms that represent universal archetypes opening up new avenues for understanding what is needed for cure. If the goal of classical homeopathy is to intervene with remedies representative of the whole person, then homeopathy can help with psychological assessments and how family/community contexts can foster or hinder better health..

Anthropologist Paul Byers (1977), when explaining how systems worked, used the metaphor of a watch with its many parts placed on a table. It showed little resemblance to a timepiece. Yet when put together it could either tell the “correct” or “wrong” time. Like a thermostat regulating a heating system, it is the input of setting and maintaining that allows a system to avoid the ever-present forces of entropy (movement to disorder). The human system with its regulating forces of communication, temperaments, ethos and other homeostatic elements can be the source of conflict warranted by our fallibility but also exciting grist for creativity and joy. Being in touch with this map can help with understanding possible avenues of change and the resources to sustain that direction.

I am not suggesting a replacement of existing case methods in homeopathy; however, using a visual map of family dynamics enhances the questions of who, what, where, with what, why, what modalities of the homeopathic assessment. This in turn, demonstrates how homeopathy helps provide new solutions and understanding for life style changes and other psychological interventions. Looking at the part to whole connections allows for depth of analysis and avoids self fulfilling “cookie cutter” quick fixes. The qualifying interactions and chronological data in such a process put into context the qualitative attributes of the individual and their system. David Little (1998) describes this process as how “conceptual thought is a manifestation of the archetypal drive toward order and meaning.” The format that I am suggesting helps depict this “meaning.” All the institutions and contexts that have influenced one’s development can be understood in their part-to –whole connections. In this framework, the chief complaint for instance can be a portal to the essence of the case, as can be gestures and themes, however using a wider lens allows for the multi layers to unfold and to qualify and avoid superficial diagnosis.

Using the Genogram and probing for “grievance formations” allows a participant observer (Homeopath) to trace and interact with the different types of temperaments and their psychic manifestations (i.e visual, auditory, feeling etc.). The energy of one’s legacy literally and figuratively “jumps out.” If the self and the collective conscience are more than conditioned reactions, then this mapping of interactions and relationships can be part of the larger archetypal drive for balance. Sometimes a map, which is really not “the thing,” can still help visualize the manifestations of one’s “Wesen.” Responses to how one feels (“as if ...”), are the interplay of the unconscious mind’s associative functions and the rationality of the conscious quest for explanations. In this map, the invisible energy of the archetype emerges as form. Feelings and tones can give many messages, as well as silence and tears. All this can be used to assist the self’s innate move toward wholeness, and the symbols of the system are a key to understanding and changing any psychosomatic dysfunction which can be achieved by homeopathy’s clinical provings.

The integration and reciprocity of psychotherapy and homeopathy 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 Hahnemann’s Organon. Hahnemann regularly investigated entire family trees to better determine the befallment of issues effecting the vital force and chronic miasms (§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 (1970) 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.” The ongoing conversation or dialogue with those seeking help is what depicts the essence of homeopathic 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 us as humans with our own fallibility. This only enhances our role as homeopaths but also the biological connection we have access to when we tune into and “be” together rather than “do” things to each other.

References

Byers, P. (1977). A personal view of nonverbal communication. Theory Into

Practice. Vol. XVI, Number 3, 134-40: Columbus, OH, USA

Byers, P.(1985). Communication: cooperation or negotiation?. Theory Into Practice.

Vol. XXIV, Number 1, 71-76:Columbus, OH, USA.

Buber, M. (1970). I and Thou. New York, Charles Scribner

Ciccchetti, Jane.(2001).”Symbolism, Dreams and Homeopathy:" A Discussion With Jane Cicchetti and Barbara Osawa, Simillimum, Fall, pp. 22-23:Redmond, WA, USA

Hahnemann, Samuel. (2002). Organon of the Medical Art, 6th edition, edited by Wenda Brenster O'Reilly, Palo Alto, Calif.: Birdcage Books

Luskin, Fred. (2002). Forgive for Good: A proven Prescription for Health and Happiness, New York, Harper.

Kaplan, Brian. (2001). The Homeopathic Conversation, Natural Medicine Press: London

Kuhn, Thomas. (1967). The Structure of Scientific Revolutions, Chicago, Ill.: University of Chicago Press

Little, David. (2001). Hahnemann Online Education, V. 4, (www.simillimum.com)

McGoldrick, M., Gerson R. & Shellenberger S. (1999). Genograms in family assessment. New York: Norton

O’Connor, Greg. (1998). The Elements of Aikido, Boston, Mass: Element Books

Silvestri, Kenneth. (2002).“The Art of Sustaining Change: A Personal Framework for Homeopathic Emotional Healing,” in Simillimum, summer, Vol. XIV, pp. 85-98: Redmond, WA, USA

Silvestri, Kenneth. (2005). Homeopathic case taking from a communication perspective. The American Homeopath. Vol. 11: 77-78:Sunrise, FL, USA

Silvestri, Kenneth. (2007). “The Joy and Wisdom of Systemic Thinking: Teaching and Understanding the Aesthetic, The Journal of Systemic therapies, Spring: New York, USA

Silvestri, Kenneth. (2008). Steps to an Ecology of Self: implications for homeopathy, Homeopathic Links, Summer, Vol 21: Stuttgart

Silvestri, Kenneth. (2009). “Remedies for Forgiveness,” Homeopathy Today, February: Alexandria, VA, USA