Book Review of “Case Taking: Best Practice and Creating Meaning in the Consulting Room” by Alastair Gray

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Case Taking, Alistair GrayHomeopath David Johnson reviews Alastair Gray’s new book, “Case-taking: Best Practice and Creating Meaning in the Consulting Room.”

’s “Case-taking: Best Practice and Creating Meaning in the Consulting Room” is the first in a series of seven books viewing the landscape of current homeopathic practice. What better place to start an exploration of homeopathic practice than ?! This book is an excellent, thought-provoking review and critique of homeopathic case-taking, beginning with our roots in Hahnemannian practice and continuing to the present time. Gray describes the historical evolution of “best practice” case-taking by starting with Hahnemann and his 19th century adherents, followed by Kentian and post-Kentian ideas, and culminating with thoughts by modern-day practitioners. By reflecting on the background from whence we’ve come, and articulating where we are now, this book helps us to take a critical look at our professional standards as a whole, as well as to examine our own individual approaches to case-taking, comparing them with the wealth and breadth of clinical experience both within and “outside” of homeopathy.

As much as we might imagine homeopathic practice existing in a vacuum, Gray reminds us that major shifts have occurred in the past 200 years and it’s appropriate to reflect on the directives Hahnemann gave us. We can appreciate how well they’ve stood the test of time, yet also examine how those same directives shaped by 19th century medical culture, may be adapted to 21st century practice. The exploration of Hahnemann and the Organon begins with aphorisms 83-98, includes a discussion of other pertinent aphorisms and key concepts, and concludes with a summary of Hahnemann’s general directives for “best practice”, including “what to do” and “what not to do”.

In subsequent chapters this very clear, easy to read, and succinct format outlines “best practice” advice by leading homeopaths since Hahnemann. Important or mandatory skills and qualities for homeopathic case-taking are described by 19th century homeopaths Boenninghausen, Dunham, Bidwell, Guernsey, Farrington, Hering, Hughes, Burnett, Clarke, Boger, Nash, TF Allen and HC Allen. Gray then discusses the tremendous influence that Kent and Swedenborgian thought played in shaping homeopathic practice in the later 19th and early 20th centuries, and summarizes Kent’s ideas for best practice. Advice given by post-Kentian homeopaths Schmidt, Tyler, Wright-Hubbard, Roberts and Close is also examined, and a full chapter is then devoted to common themes of “best practice” as recommended by Hahnemann and this entire group of homeopaths who followed him.

Early in the book Gray states, ‘Modern teachers can project their own values and perspective onto the words of Hahnemann. At worst they distort the original meaning, and at best they’re able to place the original directives in a much more sophisticated framework and with a much deeper perspective’. This statement seems to summarize the concerns and hopes for stretching the bounds of homeopathic practice through the use of psychotherapeutic interviewing strategies or the “Sensation Method”. Having grounded the reader in the historical roots and fundamentals, Gray moves to a discussion of how we might learn from other disciplines to inform our case-taking. Post-Jungian approaches such as dream work, art therapy and sand play often reveal information that is difficult to obtain solely through standard interviewing. Other psychotherapeutic strategies are also explored, including humor and provocation, optimizing the practitioner/patient interaction, and Carl Rogers’ “unconditional positive regard”.

Gray then includes a discussion of the “Sensation Method”, as well as an in-depth interview with Rajan Sankaran addressing many of the concerns voiced by other homeopaths. In the interview Sankaran goes to great lengths to clarify how sensation is not necessarily a stand-alone technique, but how it may at least be used to complement fundamental principles. Here and throughout the book Gray strives to convey an unbiased assessment of different case-taking tools, allowing the reader to join him in “sifting through the evidence”. He balances this with a concern that students may lose a sense of grounding in fundamentals if stretched too far, too soon, and that because sensation case-taking is still in a process of refinement and evolution, it has not reached a point of unquestioned and unqualified use within the profession.

An enlightening chapter by Gray’s colleague Ben Gadd explores the therapeutic relationship between practitioner and client, and includes a great deal of research supporting the assertions. Gray’s concluding chapter includes a wonderful summary of gems and therapeutic tips gleaned through the common experience of homeopaths in all ages and cultures. He shows how case-taking is neither a linear process, nor one where we adopt one strategy for all patients.

Different ways of practicing homeopathy are aligned with different styles of case-taking, and as Jeremy Sherr points out in the forward, prejudice enters in once we adapt our case-taking to our prescribing techniques. In order for each of us to develop our best and most-flexible case-taking skills–matched to the “tempo and frequency” of each patient–we first need to examine the foundations and perhaps biases for how and what we are doing when we take a history. As Gray points out, ‘All judgments aside, best practice is determined by the practice employed, and it is the most amazing privilege to sit and hear someone’s story and take their case’. He makes the very good point that one should be grounded in a solid foundation of homeopathic essentials, and then once we are comfortable with our own interviewing style, other advanced options can be explored to expand our case-taking repertoire.

In essence, tens of thousands of hours of invaluable clinical experience by different practitioners over the past 200 years can be found in this comprehensive, but very user-friendly book. It’s difficult to convey in a few short paragraphs how much potential this book holds for refining and expanding one’s case-taking skills. As Gray states, ‘ I’m no longer of the opinion that the homeopathic remedy is the most crucial thing in a positive curative intervention . . . it is the therapeutic relationship and the ability of a homeopath to listen and receive a full case that is at the heart of the good prescription.’ This book helps one to enhance that therapeutic relationship, as well as optimizing one’s clinical skills. It’s an example of the highest standard of homeopathic writing, a one-of-a-kind book that will undoubtedly improve the practices of homeopathic students and practitioners at all levels of experience.

Reviewed by David Johnson

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