Chapter 1 The AcuDetox Provider Training Manual What is Acupuncture? What is Transformative Change? My Entry into the Field I am both an acupuncturist and a psychotherapist by training in addition to having studied and practiced Western medicine. I met Dr. Michael Smith at a meeting in Toronto arranged by the Alcohol and Drug Research Foundation - 22 years after graduating in medicine, and 14 years after having taken up acupuncture. I had no inkling that this meeting would change the course of my professional career. Nevertheless, I need to acknowledge that the pump was primed for me before I walked into that meeting room in Toronto. Had I not been practicing acupuncture for 14 years, the results which Dr. Smith was extolling (closing in on 100% success) would have seen unrealistic, as they had when I first started my own training in 1976. Added to my experience with acupuncture - which had swept away my modest expectations of Western medicine - I had also been a major player in the field of transformative change3 - a program designer and facilitator who had seen several people transform completely and stay that way permanently. I had remained on the lookout for such change, even though my experience had led me to believe it was something that happened for the lucky and the few. Suffice it to say, I knew that it was possible! These two pieces of my background were to help considerably - firstly to get me started in the first place and to keep me on the path of discovery once I began to see results which I understood in only the most rudimentary ways, and secondly to help me understand, in a hands-on way what my patients needed from me both during and after their treatment with three weeks of AcuDetox. It is now clear to me, partly from my own experience and partly from seeing the success of NADA’s training of nonacupuncturists to administer the AcuDetox Protocol, that the adoption of a set of expectations which are closer to those of of a Chinese-trained acupuncturist than those of a North American health care professional are critically important when it comes to shepherding the recipient from the initial, hardly-recognizable stirrings of change to the fundamental shift in worldview which becomes available during and after AcuDetox. Expectations of success are important - and their hands-on application, critical. One has a brief window of opportunity after AcuDetox to leverage the subtle stirrings which bubble up into a fundamental shift in worldview. This requires the development of an ability to be the midwife of transformational change. This begins with one’s own AcuDetox experience - which gradually leads one to a new, lighthanded way of being with those in the midst of transition. When these pieces come together, one is ready to begin. I put AcuDetox on the shelf for five years after meeting Dr. Smith - a charismatic psychiatrist with a talent for overturning the belief systems of his audience. Somehow I knew from that first exposure that there would be a place for AcuDetox in my own work, even if not right at the time. My practice was not involved with substance addiction, so I had asked Smith at the time of our meeting about the use of AcuDetox with patients who weren’t fighting alcohol or drugs. His reply was one I could both appreciate and agree with “ My patients are addicted to substances. Yours are addicted to their behaviors. 3 transformational change is change at a very fundamental level - not merely the learning of new skills and capabilities (Level 1 change) not just reshaping of one’s patterns of thinking (Level 2 change) but creating a shift in one’s point of view of ourselves and of reality itself. 3. Everything’s addiction in the end!” “Yes, yes! “ I reflected at the time. “Everyone is addicted - if not to substances, to patterned (and therefore unchangeable) behavior - not just patients - everyone.” Reflecting back, I realize that my sense of my task as a psychotherapist as the unraveler of patterns of behavior had been gradually growing in the five years prior to that conversation. That construct had not always been with me. Most observers would not, without looking deeper, grasp the equivalency of substance addiction and the ever-repeating personality patterns which become the grist -for-the-mill of psychotherapists working outside the addiction community. This is because these patterns do not present themselves nearly as obviously as the more surface phenomenon of the substance addicted person ingesting the substance to relieve anxiety. While personality patterns work the same way, but with greater subtlety, it will be the task of this chapter to make this clear. It may seem like getting a little ahead of ourselves to elaborate on the addiction-personality-pattern equivalency statement here without offering supporting evidence (which will follow as this Chapter unfolds), but I am mindful as I write that this Manual is being composed for health care practitioners who have experienced AcuDetox yourselves. Thus, at the very least, your own personal experience and perhaps additionally, your observations of others - are helpful in bridging a gap which took years for me to sort out and see clearly prior to my own experience of the AcuDetox phenomenon firsthand. By watching both our own and our clients’ responses, it becomes more and more obvious that we as humans learn a rather limited repertoire of thoughts, feelings and actions during childhood - which congeal by the time one reaches school age into one’s personality. This personality is specialized in reducing life, as it has been experienced in one’s early years, to manageable proportions. Attending school reinforces the patterns which are already favored. Eventually, whether it is sooner or later, these patterns will be too limited to address life situations which lie outside one’s preschool experience. By this time, our own personality’s way of responding is cemented in place, and we apply the patterns we have learned compulsively - just as an addict takes a drug. We lose, in the process, our spontaneity, flexibility and resilience. - but we don’t see that we are losing it. And this is describing the human condition for each and every person - as true of me, as true of you - as it is of anyone - and patients are simply those whose patternedness has created sufficient suffering for the person to seek outside help. It is a minority viewpoint which sees all persons, not just those who have opted to be seen as patients, as caught up in (i.e. addicted to) a rigid patternedness of behavior which deprives us of true choice. The majority of people see themselves as freer and more in touch with the truth than they actually are - because they rarely experience themselves outside of the box of patternedness. The outside-the-box exceptions in our lives - those rare events which challenge the way we operate - are the times when our sense of what to do is overwhelmed, often by the magnitude of the circumstances, following which we experience ourselves as more than we usually are - “rising to the occasion” to perform in exceptional ways previously unknown to us. Heroes and leaders of society - like Winston Churchill and Abraham Lincoln, are those who “rise to the occasion” and stay in that state. 4. As an illustrative lead-in to this Chapter’s discussion of acupuncture and transformational change, I would like to tell the story my post-AcuDetox interaction with an AcuDetox-RFCC participant whose personality patterns replicated the Churchill-Lincoln dynamics. When I say “tell the story” - I mean tell the story as it would come in to play in an AcuDetox provider- recipient conversation. In doing so I mean to illustrate how the practitioner’s own AcuDetox experience interacts with the client’s experience as a teaching which informs and enhances one’s interventions. The interaction between the provider’s experience of AcuDetox and the recipient’s experience is a unique feature of the conversation which springs up. Here we will see it in small measure - and in a later Chapter we will return to it in full measure. My Post-AcuDetox Interview With Evelyn I knew almost nothing about the background of this middle-aged woman who was presenting in my office a week after her AcuDetox had ended. Sometimes we know a lot, and at other times little has been revealed when we see people before they undertake AcuDetox. While it often really helps to ”know nothing” I sometimes observe my concern coming into play that I know too little, and then usually I remember my bias for knowing - and this helps me smile inwardly and then step into the situation freshly. Knowing nothing I can only ask the person about their experience in the interim. Often, as was the case here, the person is not forthcoming with either a story or an insight about what is bubbling up . If they are able to be forthcoming (which is the case in 2o-40% of AcuDetox recipients versus the 60- 80% who aren’t), your task is complete at this stage, and what I am about to say does not apply. The fact that at least some of the recipients can complete the process without any real input on your part begins to show you that AcuDetox has a power of its own which is independent of your interpersonal skills. So, I asked “Evelyn4 , what has been your experience since the end of your AcuDetox?” There was a reticence on her part to answer, and I began to detect a tearfulness which she was trying not to show. My own INSTINCTUAL RESOURCE5 enters the scene as a knowing that my engagement in the conversation will revolve around knowing spontaneously what to say and when to say it, to get the best possible result. I relax a little, knowing that I have just to be present, to know what to do next. I went on “Is there something that is upsetting you?” Even before she answers, I am discovering a lot about Evelyn. She has experienced something which has elicited tears, and she is not in the habit of bringing these kinds of things to the surface. This may contrast her with others whose sad experiences are all too easily tripped into occurring. “I’m a failure. I didn’t learn anything. I always mess things up!” Evelyn blurted out. It took some urging on my part to get Evelyn to tell the story. She had to feel safe first - as she feared that it did not paint her in a good light. She finally decided to risk it. My experience is that without her recent AcuDetox treatments, she would have found a way to keep the story under wraps, but the facts were that she had already told it to her husband. Even this was out-of-pattern for her, and a refreshing bit of risk- taking on her part. But she still had the image of herself as a failure to hold her back - an image which was simply a revisitation of an old image she had carried since childhood. The story was that shortly after her AcuDetox a friend had invited her to a community event. She understood that she was to bring something - but somehow got what was expected wrong. When she arrived, she was embarrassed by bringing the wrong thing, and she wanted to run away. But she stayed, and when it was revealed that she had misunderstood she felt further humiliated. She fought off the 4 as is usual in relating such stories, the name of the person has been changed to protect the person’s privacy. Sometimes, for the same reasons, the story’s details are altered - but the gist remains. 5 The notion of there being certain “RESOURCES” - including the INSTINCTUAL RESOURCE - will be known to you as a recipient of AcuDetox and the RAPID FUNDAMENTAL CHANGE COURSE. We will be returning to this often, so, for those who want to know more, you will not be disappointed. 5. tears which were close to the surface. She had to do this. She couldn’t be seen in tears. She left the event with her tail between her legs - but the next morning she decided to call the friend who had invited her and find out what she might do to participate like everyone else. This was also out-of-character - which is, of course, what I look for, and a signal for me to move in and invite her to look at this more closely. “Do you like what you did in the end?” I asked. “Yes I do!” said Evelyn. A big smile came over her face. This is the place where the intervention gathers steam. My next and defining interjection was to point out the smile and to give her the chance to see herself in a smiling mode. This is essential - because the tendency still exists for her to return to her old self-image - something which is less likely to happen if she has a tangible memory of her pleasure. I have sometimes, in such a situation, asked the person to leave the room and look a themselves in the mirror of a nearby washroom. The appearance of pleasure is so important to capture, as it allows the person to substitute anew self image for one which is no longer current. What happens here is that both within the story and in the present moment of the storytelling, there is ACTION where there would usually have been passivity or withdrawal. The ACTION itself is usually (but not always) insufficient to bring about permanent change. What is needed, additionally, is the person’s seeing themselves in action, and an updating of their self-image - a validation of the self in its new expression. Nor is it sufficient that the validation comes from another. Outside validation will not alter a very fixed self-image. The alteration must come from the self ultimately or it will not “stick.” We can only imagine how this fundamental shift must have occurred for a Lincoln or a Churchill - but we can infer that it happened by seeing that each of these public figures was distinguished as a heroic leader by the proclivity to inspired ACTION occurring suddenly after a lifetime which did not include inspired action up to that point. A part of the newly-occurring proclivity to action which is identifiable as the INSTINCTUAL RESOURCE6 in such persons is the ability to know what to say when the task is to inspire others to action. We see this in Lincoln’s memorable, even spine- tingling Gettysburg Address7 and in Churchill’s 1940 “This was their finest hour”8 radio address which galvanized the British people into refusing to buckle under the Nazi bombings of London and elsewhere. The work with Evelyn is complete when she can see herself as having the capacity for inspired action. 6 ibid. 7 Fourscore and seven years ago our fathers brought forth, upon this continent, a new nation, conceived in liberty and dedicated to the proposition that all men are created equal. Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated, can long endure. We are met on a great battlefield of that war. We have come to dedicate a portion of it, as a final resting place for those who died here, that the nation might live. This we may, in all propriety do. But in a larger sense, we cannot dedicate, we cannot consecrate, we cannot hallow, this ground. The brave men, living and dead, who struggled here, have hallowed it, far above our poor power to add or detract. The world will little note, nor long remember what we say here; while it can never forget what they did here. It is rather for us the living, we here be dedicated to the great task remaining before us--that from these honored dead we take increased devotion to that cause for which they here gave the last full measure of devotion--that we here highly resolve that these dead shall not have died in vain, that this nation shall have a new birth of freedom, and that government of the people, by the people, for the people shall not perish from the earth." Nov. 19 1863. 8 Let us therefore brace ourselves to our duties, and so bear ourselves that if the British Empire and its Commonwealth last for a thousand years, men will still say, 'This was their finest hour.' “ radio broadcast - June 18 1940 6. What is Acupuncture? Most readers of this Manual know what acupuncture is in considerable detail. I realized, however, in undertaking this Manual that I would need, at some point, to talk about acupuncture in the context of its role in this specific application - the creation of a window of transformational change. I did not, nevertheless, want to made this a digression from the task at hand - the training of acupuncturists and psychotherapists to benefit from AcuDetox which works so powerfully in the recipient’s favor. Thus I will leave general discussions of acupuncture to others and try to bring some topic-specific thoughts to this discussion. Thus I will use the story of Evelyn to keep me on track. No Prompting Needed for AcuDetox To Have Major Effects Evelyn had never been a psychotherapy patient, and had not, until just before her AcuDetox, felt like she was stressed. It’s fair to say that the three weeks she had of AcuDetox acupuncture has been the only intervention for stress she had undergone. In keeping with Smith’s noninterventionist approach during AcuDetox, the group which Evelyn joined to do AcuDetox was anything but a psychotherapy group - where issues arise for individuals and are brought to resolution by the dynamics of the group. No resolutions are sought in an AcuDetox group. While participants are invited to share their experience, it is explained that this 3 weeks is a period of flux - and that the arising of certain impressions or experiences along the way is part of the flux - and that there is no need for their resolution. There were no suggestions about how group members should act, about what they might do to make things work, and just the opposite, they were told not to do anything to change things - as they would be in this state of flux for the three weeks at least. It is important not to suggest that certain experiences will occur - as the recipients could respond to flux by becoming suggestible. The point I wish to make is that anything that Evelyn experienced during or after her group was not suggested. Rather, it happened spontaneously. It’s hard to prove this, but I am satisfied that there are, at the least, no overt suggestions as to how to behave or how to bring about change. Thus, I conclude that whatever arose during or after the AcuDetox group, happened as a result of the AcuDetox acupuncture. So what did it do? I think that it’s fair to say that acupuncture, mysterious as it often remains for us in the West, acts in more or less the same way in each of its applications. Certain conclusions are available from the widening usage it enjoys - following its appearance in North America in the early 70’s as a remarkable sports medicine injury treatment. It has been shown to stimulate endorphins - which exist within the body to combat pain and promote healing. It has been shown not to act as a placebo effect - which would have been an easy way to dismiss its power. Its effects appear to be diminished or cancelled in patients taking prescribed cortisone. Acupuncture came to North America because Western medicine has areas which are not well addressed by the assumptions which underlie our Western way of thinking. Relying broadly on “germ theory” in which a specific medication is designed to match a specific pathogen, Western medicine places less emphasis on enhancing the body’s natural defenses. Thus, conditions or diseases which might respond to the body’s defenses being altered, may respond better to acupuncture than to Western medicine. Psychotherapy in the West - Synonymous With Talking Things Out It may just be that mental-emotional problems fit in this category. But the fit is not an easy one. In the East where acupuncture has its roots - “talking out” one’s problems would seem quite unnatural, just as, in the West - the suppression of talking about one’s problems is seen as a large part of the problem itself. We shall need to return to this. Suffice it to say here that an AcuDetox group is a delicate bridge between two ways. Before my awareness of this bridge in a hands-on way, I treated my psychotherapy patients with psychotherapy and my acupuncture patients with acupuncture. 7. The Public Perception of Acupuncture as a painkiller Acupuncture finds its applicability where balance needs to be restored. Often this amounts to neuroendocrine balance (thus explaining why taking cortisone throws this balancing act off). It happens that many of the successful applications of acupuncture have been in conditions which involve pain. More people know that acupuncture has a high success rate with migraine headaches than know that acupuncture has a similar success with asthma9 . Despite interest in the East, virtually nothing appeared in the literature in the West between 1970 and 1990 about acupuncture in stress management - a period in which the modality was attracting acclaim particularly in its pain-related applications. This discrepancy has tended to focus public attention inordinately on pain relief - and most people I see as patients continue to assume in 2005 that acupuncture functions solely as a painkiller. To understand its usage in stress management, we must look beyond this assumption - which exists only because pain relief attracts public interest more easily. Acupuncture may all too easily (and erroneously) be seen as equivalent to a psychoactive medication - which it is not. Unlike the results of treatment with medication - feelings and thoughts are not suppressed by acupuncture. The major influences which have brought attention to acupuncture’s remarkable role in stress management are the quiet buildup of experience and support around acupuncture in addiction by Dr. Michael Smith at the Lincoln Hospital in New York City, and the more public US National Institute of Health (NIH) funding of a study by Dr. John Allen Ph. D. at the University of Arizona showing promising results in two thirds of patients suffering from depression - without concomitant medication use10 . From the work of Dr. Michael O. Smith at the Lincoln Hospital in New York City and others, and the studies of Dr. John Allen at the University of Arizona we can make certain statements about acupuncture which apply to its use with stress management. First, we can say that despite the fact that acupuncture does not suppress feelings or thoughts, recipients report experiencing less anxiety, less depression, less insomnia, less somatic effects of stress, improved self image and an internal shift of locus of control11 - whether or not they receive any psychotherapy or counselling, and whether of nor they have been concomitantly treated with medication. In fact, psychoactive medication use has consistently seen to be reduced by patients treated with acupuncture (by their own decision). Allen saw positive results in some 2/3 of patients in his study. Studies conducted by Smith and others - at the Lincoln Hospital and elsewhere suggest positive results in substance addiction and underlying stress disorders as high as 80%. Our own results support these findings and enlarge on the opportunity which is available here. While it is clear in our usage that AcuDetox needs no help in bringing a new dynamic to the surface, it has become equally clear that those who are exposed to this new dynamic will either integrate it or not. Some will do this - spontaneously - while others will require at least some help to do so. 9 A National Institute of Health consensus panel in 1997 determined that acupuncture has been proven to be effective against nausea from surgery and chemotherapy, addiction, headaches, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, lower back pain, carpal tunnel syndrome, and asthma, and to assist in stroke rehabilitation. Other studies have looked at pain, ADHD, pregnancy complications, and other diseases and conditions.( http://www.mcmanweb.com/article-16.htm) 10 NIH (National Institute of Health) funded the University of Arizona study which has become the subject of a book by the researchers ( reference: books.kelkoo.co.uk/b/a/ cpc_5101_vtl_author_c18931871.html - 28k ) 11 These effects were reported in a comprehensive article written by Dr. Sherwood Appleton which describes as well , the introduction of Acudetox into both the United States and Canada Ref: http://www.vitanova.on.ca/article1996_9.htm 8. The Help We Can Be - Beyond AcuDetox It is interesting, to say the least, that those who have a lot of experience with acupuncture in stress management (Allen and Smith in particular) seem to lean to administering it in a noninterventionist way. Is this merely trial and error and finding that it works best this way - as it was with me? Certainly, this seems to have its parallels in the use of acupuncture for physical conditions? While it is well known among acupuncturists that those who are physically active get better results, activity which is not repetitious and not following a plan or schedule is considerably better than a laid-on exercise regime. Often it is better, in such instances, to encourage recipients to merely go out for a walk. I have my own notion about the value of noninterventionist stance during AcuDetox. Dr. Smith and other NADA practitioners seem to feel that AcuDetox recipients “learn to learn” through the process - suggesting that addiction is equivalent to stopping learning in its tracks. It makes sense. If you have a thing you do when you feel stressed -i.e. take in a chemical which temporarily relieves tension, and, if it works to relieve this symptom, wouldn’t one’s tendency to experiment with different options (ones which might actually relieve the source of the stress) wither on the vine? The conclusion among its practitioners that AcuDetox acupuncture restores the ability to learn seems to reflect the fact that educational programs which were available to substance- addicted persons prior to treatment but which showed very modest results and attracted modest interest, suddenly become useful and interesting after AcuDetox treatment. This resonates with our own experience - that AcuDetox recipients appear to get much better results from psychotherapy after treatment. Acupuncture Promotes Discovery Learning There are (at least) two kinds of learning - learning by imitation - which makes up about 97% of new learning and learning by discovery (the experimental basis of science) which makes up about 3% of new learning. Of these two methods, learning by discovery is by far the more powerful, the most creative and the most likely to be impactful over a period of time stretching into the future. It follows a four-step cycle as described by Kurt Lewin, following the mental process a scientist uses to conduct an experiment. Certain consciously-chosen actions are taken, and simultaneously observed for results. The experimenter reflects on the results, and creates mental abstractions of them - which allow the experimenter to form a new set of hypotheses - leading to a new set of experiments - and so forth. This is a very lively dynamic, and it carries the experimenter into new places, and away from operating without questioning one’s actions. Several years ago I was attending a seminar on creativity. In one of those moments which tend to be remembered years afterwards, the facilitator, who was exploring with us how our creativity is limited by our inability to change our beliefs - asked the audience what each of us thought was the reason we didn’t change our beliefs. Several answers were given. The facilitator then asked us if we would agree that all of our answers weren’t subsets of a larger answer that - for all intents and purposes - we don’t change our beliefs because we are sane. He went on to postulate that beliefs which are held constant are are requirement for our sanity (without beliefs which provide stability we ourselves begin to lose our stability) - and that while creativity requires that we be able to change our beliefs, our sanity demands that we only change those beliefs which, after experimenting with alternatives, are supported by experimental evidence and the opportunity to rethink our beliefs. Discovery learning would seem to be favored during AcuDetox - and particularly when the provider allows space for reflection and abstraction. 9. The reflective and abstraction phases of Lewin’s four-step process of discovery learning require that the mind is temporarily emptied of activity or perhaps that one shuttles back and forth from using one side of the brain to the other. However one describes the process - an environment in which competing-for-attention intervention has been stilled - would certainly enhance it. We will see later in the Chapter that discovery learning is the only learning pathway leading to transformational change and that other pathways lead to the more commonly encountered imitative change - which is temporary, recursive, and subject to retrenchment. This both sets the optimal conditions for utilizing AcuDetox (and by talking of optimizing a process) leads one to understand further the process which one seeks to optimize. My own observations have lead me to postulate that learning by repetition (imitation) creates certain electromagnetic fields within the body which work by excluding alternatives. Thus in the end, only the favored choice is accepted. All other options cease to be choices. This energy field is strong and resistant to change, but from time to time a stronger field effect is produced by overwhelming circumstances, and at these times a new and inclusive field is created which allows for multiple alternatives. This is a rare state, yet familiar to most, and phenomenologically known as “rising to the occasion”. Sometimes the field is sufficiently strong that this “rising to the occasion” becomes a permanent rising to a new level of complexity - a desirable outcome to be sure. AcuDetox vs. “Regular” Acupuncture Before returning to answer the question ”What is acupuncture?” I need to say one more thing about AcuDetox. While all acupuncture would seem to work in the same way - to create balance where imbalance has come to predominate, AcuDetox is a very rudimentary form of acupuncture - based on a “formula” of five points (or at times three) provided as a one-size-fits-all treatment. Formula-based acupuncture is generally looked down upon in acupuncture circles - as it does not enfold the acupuncturist’s skill of locating the points favorable to the particular individual recipient. The tradeoff here is that this formula treats all of the possible change-favorable points, and thus none is ever left out. By accepting the formulaic nature of AcuDetox on the basis of its remarkable effectiveness and not on how well it conforms to full knowledge of acupuncture, training can be made available to those, who for these purposes, don’t have to know very much at all about acupuncture. Thus, in one way, it is legitimate to view acupuncture as a “black box phenomenon.” Regardless of how we explain it - we know it works! So, ”What is acupuncture?” Broadly speaking (and inclusive of the narrower definition below), acupuncture is an electromagnetic field phenomenon, mediated by the insertion of metal pins - in which the organism’s homeostatic and self-regulation capacities are optimized by enhancing communication among existing resources within and beyond the organism’s borders so as to support the optimal functioning of that organism. To Evelyn, as a recipient of AcuDetox, acupuncture is a “black box” phenomenon - mediated by 15 or more insertions of three to five specifically-located pins, which acts like an expanded electromagnetic field. This field, though not experienced itself, gives rise to impressions on one’s consciousness which have been excluded by the previously-existing field - and thus, may at times, feel expanded or spacious. The impressions are valuable - as they are nothing short of an expanded sensitivity to one’s world, mediated by a specific, identifiable RESOURCE or latent ability. Such impressions occur spontaneously - i.e. they do not need to be prompted or chosen by the participant. Both provider and recipient can enhance the field to a certain degree by being present and by not trying to shape the results. AcuDetox acupuncture spawns a bubbling up of spontaneous “impressions” from within - which tend to lead to new experiences. The critical identifier of these “impressions” is that they are “out of character” - and this allows a questioner to locate them relatively easily. Only a minority are able to volunteer this information - as our “out-of-character” experiences are usually ablated from memory. 10. Identifying such impressions and experiences and talking about them allows the experiencer to make some sense of them, to see where they are leading, and to embrace them as elements of change. In fact, their “out-of-character” quality is an indicator that what is available here is nothing less than transformative change. What is “Transformative” (or Transformational) Change? There are (at least) three levels of change. Transformational change (Level 3 change) is change at a very fundamental level - not merely the learning of new skills and capabilities (Level 1 change) not just reshaping of one’s patterns of thinking (Level 2 change) but creating a shift in one’s point of view of ourselves and of reality itself. While setting the stage for Level 3 or transformational change and executing the steps which will bring it to fruition are often not easy, the half-formed impressions which begin to arise during AcuDetox, and which precipitate as fully-formed experiences afterwards - are the precursors of transformational change. As such, one cannot treat them as less than this - or else they will be wasted. Here our very way of viewing our world shifts from its lifelong stance and becomes fluid - and with this shift substantial and sustainable change becomes possible. Acupuncture operates at the most fundamental molecular-intracellular level of homeostasis, several layers beneath our learned responses to illness and injury. We would like acupuncture to conform to our current understanding of illness/injury. We tend to take a skeptical stance when it doesn’t. During the Mao Tse Tung-inspired cultural revolution, acupuncture became an “endangered species” because it defied modern explanation. The Chinese wanted to be taken seriously, and were not happy being seen in the world as hanging on to traditions which could not stand up to scrutiny in the modern world. Acupuncture survived attempts to expunge it from the medical system of China. The end result is a system where Western medicine and traditional Chinese medicine exist alongside each other. One can do some things better and the other can do others things better. Often there is room for both. Whenever one wants the body to return to a fundamental balance - acupuncture gets the call! May I illustrate with a personal example. When I was first learning acupuncture, I remained largely influenced by what I had learned in medical school and what I had practiced before encountering acupuncture. I had enjoyed some early successes - but each of these had come as a matter of trial and error - and my shift in belief was only accomplished by seeing results which I could not explain in any other way than being the result of acupuncture. Treating migraine was an example of a condition which yielded early on. My Western learned belief was that the treatment of migraine with medication often did not work. This gave me permission to experiment -treating a number of people and seeing that results began to appear where no results had occurred with medication. This reached a culmination when I was asked to see a doctor’s wife who had been subjected to 80 medically-documented approaches to treatment - and each had failed. Within 3 treatments she was free of migraine. While this was exceptional, it is the exceptional which knocks us off our previously fixed beliefs. Soon I believed acupuncture was a successful treatment for migraine. To return to my personal example, I was painting my house, sitting on a scaffold, a story and a half above the ground, when the scaffolding collapsed. I hit the ground with my ankle under the board on which I had been sitting. All of my weight came crashing down on my ankle. I was unable to put weight on my ankle and could see that the ligaments had been highly stretched, if not torn. The Western medical approach to ankle sprains varies from practitioner to practitioner, and depends on the severity of the sprain (Type 1 to Type 111) involving various degrees of immobilization, followed by various depress of mobilization once swelling is reduced. This injury was a Type 111 sprain - which means that it was severe enough that weight bearing was impossible. These sprains are most certainly immobilized 11. at the outset. Without thinking I went to the hospital and had my ankle immobilized. Despite crutches and major Elastoplast and Elastocrepe support for my ankle, I could not put my foot on the ground. It was only as I got back into my car that I thought of aupuncture. Luckily my colleague was available and I went to see him immediately. He took off all the splinting, inserted some pins and within half an hour I was back walking on my foot with no crutches. I have never had a twinge of pain in that ankle in the intervening 20 years. Treating sprained ankles with acupuncture joined my list of things best treated with this modality. Splinting a sprained ankle presupposes that there is a bodily return to balance which occurs when the inflamed area is immobilized. Applying acupuncture presupposes that there is a faster return to balance without immobilization, which utilizes some sort of feedback mechanism from the motion itself to spur the body to do what it needs to reduce the inflammation. Both rely on a return to balance. Western medicine knows how to use surgery to repair torn ligaments, if the severity of the problem merits it, but short of surgery, which is the more powerful modality? Acupuncture! It is of critical importance to make the point that the experiential phenomena that occur as a result of AcuDetox (and indeed all acupuncture) with seeming spontaneity, are emanating from a rebalancing which reaches down to the deepest levels of change possible. The experiences which start popping up in the patient who is receiving AcuDetox need to be seen in this light. They are not associated with superficial change (which come from a mind which continues to function in the way it learned during our childhood), and one should not rush in to interpret them merely because the recipient feels better when things are explained. These are, indeed, the precursors of transformational change. How do we know? The proof is in the pudding! When we hold them in this light, they actually do lead to permanent shifts in our very beingness - and when we don’t, we reconfigure back around our old patterns, our comfortable, pre-existing vantage point of viewing all things. The way we hold these new experiences will determine whether they move us forward - or not! We need, at this juncture, to get a handle on transformational change - because this is the level at which change is unfolding here. To see and explain things in a more superficial light will cause us to miss the boat. Observations outside of our own experience will carry us so far, but ultimately we can only make use of them when they resonate with our own deepest levels of experience. Luckily, we have our own AcuDetox experience of transformational change to rely on and not just the observations of our patients. And even from this vantage point - looking from inside transformational change - any attempt to nail it down conceptually, tends to make us lose touch with it - in the process, defeating the purpose. It seems we are destined, in the words of St. Paul “to see through a glass darkly.12 ” The Hoving Effect The task is difficult but not impossible. Transformational change is best grasped, in my experience, by coming at it from several angles. I will start with one angle in which the flavor of transformation begins to rear its head. Meet Martin E. Seligman a brilliant psychologist from the University of Pennsylvania whose work with depression-prone children has set a new standard in the bringing about of profound change. Seligman, voted Psychologist of the Decade for the 1990’s for his work with learned helplessness, and later President of the American Psychological Association was inspired by his daughter to investigate the possibility that positive change could be 12 First Epistle of Paul to the Corinthians (Bible, 1 Corinthians 13, verse 11) When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things. For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known. 12. learned as well. In his book Learned Optimism, Seligman describes how he went about designing an intervention for depression-prone children. Firstly, he determined that depression-proneness and the way one views one’s world are linked if not identical. Depression occurs in people who view good things that happen to them as accidental and temporary, and bad things as occurring through some personal defect, and more likely to be permanent. The work he saw in front of himself was to see if he could arrange it to have the depression-prone viewer shift in viewpoint in a fundamental and lasting way. Seligman’s unique contribution was to devise an intervention which worked. It was no small task to arrange for a person to shift the place from which they viewed their entire world, and then to stay shifted without perpetual external reinforcement. To undertake to engineer such a shift - which at the time was rare if not nonexistent in psychology, Seligman invoked the so-called Hoving Effect. Exploring The Hoving Effect A “Hoving Effect” is a sudden and dramatic change - brought about by external circumstances (intentional or otherwise) which surprise the participant by exposing a quality which has a profundity not previously recognized - and which then motivates the recipient to manifest this quality in a fuller and more complete form. Among psychologists, this rare one-moment-you're-here-the- next-moment- you're-there movement, has largely been seen as highly fortuitous and desirable, but, in practice elusive and hard to engineer. It was named The Hoving Effect, after the experience of one Thomas Hoving, former curator of the Metropolitan Museum of Art in New York between 1967 and 197713 . Seligman writes: Thomas Hoving “Hoving was known for not only his exquisite taste but also his ability to sniff out fraud and his unshakable confidence in his own artistic judgment. But he was not always of such confidence. He tells of being 19 at Princeton University, flunking out, anxious. low of self- esteem, and unsure of judgment. Before dropping out, Hoving decided to venture one more course, an upperclass sculpture seminar. on the first day, the professor placed on the podium a gleaming metal object with streamlined fingers. “Gentlemen,” the professor instructed the eight Princetonians, “comment on the aesthetic merits of this piece.” “Mellifluous fluidity.” asserted the Ivy Club senior. “ Harmony of the spheres.” agreed a junior in plummy tones. On went the plaudits around the room, until only the sophomore, pimpled, quaking Hoving remained. “Well, it is too well tooled, too mechanical, too cold and too streamlined. It's too functional. This isn't art.” mumbled Hoving apologetically. The object was an obstetrical speculum. “After that,” Hoving tells us, “there was no stopping me!”14 Hoving's transformative event was a highly positive one, and evidently quite permanent in its effect. Indeed, he went from being a marginal student to an avid learner in one fell swoop, rising to the top of his class, distinguishing himself as a student,then as an art critic, then as the startlingly successful curator of the Metropolitan Museum of Art and a well-respected expert in several artistic arenas. Seligman: “ ... I am convinced that a single crucial event that shatters the routine of childhood or adolescent life ... can markedly alter pessimism or optimism by changing the child's theory of who he is and what he's worth.” 13 Thomas Hoving has also been one of the subjects of Malcolm Gladwell’s Blink! - where he is seen as having an unusual talent for focussed presence - and through this a talent for discerning genuine art from forgery. It appears that gladwell does not know that Hoving’s transformational change which an art appreciation student is also the inspiration for Seligman’s work. 14 quoted from Seligman’s Learned Optimism 13. Seligman was successful in putting together a program which was highly successful in altering the way depression-prone Grade 5 and 6 students in Philadelphia's elementary school system saw their world. In an intervention which consisted in its final form of 12 hours of sessions with these students, Seligman asked the students to respond to typical scenarios which arose in their age group in ways which were non-typical. The methodology involved creating cartoons depicting typical 11-12 year old interactions - with blank bubbles, so that the students supplied their own thoughts, feelings and interpretations. In short order, the students began to supply interpretations which were out-of-character for them - with the result being that with no other intervention but this 12 hour series of sessions, the number of students displaying overt depression in the following year was half that of the control group. This highly successful construct drew in the interest of several other researchers and clinicians who made modifications to Seligman’s work which further improved results. As the results got better and better with each added insight and modification, worldwide interest grew and today the work Seligman began is available in every school in Australia and a study which was begun in 2004 at Toronto’s Sick Kids Hospital by Dr. Katharina Manassis is adapting it further for a Canadian audience. Transformational change manifests as the kind of trial-and-error experimentation seen in Seligman’s blossoming elementary schoolers - where spontaneity, flexibility and resilience allow for new learning to take place. There is a freshness - a sense of possibility in the air. Seligman’s youthful participants do not start off manifesting these qualities. Far from it! They start, in truth, with self-deprecating thoughts and their capacity for agency (the ability to make things happen) is notably absent at the outset. These are particularly pessimistic kids at the start. Thus the trial-and-error must be triggered by an experience akin to Hoving’s discovery that there was something he was very good at. Seligman found out how to engineer that shift - and this is solely why his intervention succeeds. Gaining an understanding that AcuDetox functions in the same way as a Hoving-like kick start to transformational change may throw us back to the way acupuncture works when treating a sprained ankle. It makes sense, and reflects our past experience, to immobilize an ankle whose ligaments have been stretched or torn - but when acupuncture is applied, the ankle instead benefits from mobilization - the trial and error of weightbearing and exercise. Western medicine also prescribes exercise and weightbearing as parts of its regime, while acupuncture balances the body at a cellular level so that this phase occurs right away, rather than days weeks or months down the road. When we watch our AcuDetox clients, we see much the same rapid advancement of the process of trial and error which culminates in new learning, much as it does in Seligman’s kids. In subsequent Chapters I shed a light on the process in greater detail. Our patients need us to be supportive of this process without trying to bring it to closure prematurely. This will happen in due course. SUMMARY: AcuDetox is a form of acupuncture - a treatment approach which rather than ridding us of something, as much of Western medicine does - supports balance and homeostasis at the cellular and molecular level. Transformational change is third level change - a fundamental shift in how we view ourselves and reality itself. While this level of change is much sought after - many of the things we do to feel better, move us further from it - making it a rather rare phenomenon. When we are under stress, we use our energy to dismantle the stressors, and in the process may fail to strengthen ourselves. AcuDetox dismantles the electromagnetic field which supports our learned responses of a lifetime. Instead of experiencing this as vulnerability - which prompts us to defend ourselves - our AcuDetox patients begin to experience it as openness - which prompts them to experiment with it. Experimentation allows us to discover, and discovery lifts us to a higher level of integration (as suggested by Prigogine) Our task as providers - either of AcuDetox itself or of the support during and after the process is to be respectful of the unfoldment by seeing it for what it is. In this way our patients mirror us - gaining confidence to act less and less defensively in the face of stress - such that stress now produces advancement rather than retreat. To do so, we must learn to mobilize - when the common wisdom would be to splint! 14.