Dealing with Diagnosis: What to do when you don't know what to do

Last year we sent out a survey about your bodywork studies & practice. It included a question asking what your biggest questions & challenges were with shiatsu. Over the next few months, we will be sharing our responses to many of your questions. Below is our response to one of the most common questions we were asked:

Question - I often get overwhelmed with diagnosis. There are so many things to consider and so many methods of diagnosis (kyo/jitsu, pulse, meridian, face, tongue, voice, structure, motion, etc.) that often I just shut down and can't figure out what to do. How do I find the most important thing to work on at each moment in a treatment? 


Response - The word diagnosis itself can be a trap. A broader way to think about it is being responsive to the receiver. Watch, listen and let yourself respond naturally to what you notice. You simply have to listen, receive and respond. What comes to you, no matter how basic, has value.

Let yourself focus on what you do notice, instead of what you don't. Don't force diagnosis, don't go chasing after information. If you find yourself struggling, go more simple and more general. This applies to both diagnosis and technique.

Use Primitive Diagnosis for a Primitive System

If you have studied shin tai work, remember that the 'diagnosis' for the central channel and Governing Vessel/Conception Vessel is more primitive because they are a more primitive level of energy in the body. We use motion as the main diagnosis for this part of the system. That might sound boring or unimportant or not very 'professional' compared to finding constrained liver chi or a racing SP pulse, but motion can give potent information regarding the condition of life force and how to enhance it. 

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Beginning a treatment by addressing this primal part of the energy system (GV/CV) will naturally have you beginning with observation of motion. If and when the treatment moves into working with more specialized aspects of the energy system, like the 5 elements or 12 meridians, you can apply the more specialized types of diagnosis that you know for guidance. Notice what you are drawn to and what comes to you rather than looking to figure out every possible type of diagnosis. For example, you may find yourself becoming very aware of a client's hip structure partway through a session. If your attention is drawn there repeatedly and then you notice that motion is quite restricted through one side of the pelvis/sacrum, you might decide to do a structural evaluation and go through the structural adjustments. Another example could be that you find a client's voice particularly distinctive and all the sudden it comes to you that their cadence is very sing-songy.... this indicates imbalance in earth energy (ST/SP). But if a type of diagnosis is not coming to you with relative ease, it is not necessary to chase after it. 



Clear Perception Requires a Clear Condition

Being able to perceive a client’s condition requires that your system is clear and balanced. The best way to set yourself up for clarity of perception during a treatment is to prepare ahead of time. It is optimal to be rested, clear, aligned and relaxed. Good quality sleep, food, self-development practices, and treatments for yourself are key factors. When you are in balance and full of vitality, your physical body is clear, your information system is giving accurate feedback, and you are in alignment with the higher vibrational aspects of your being. This enables the flow of accurate diagnosis regarding the person you are working with and how to best facilitate freedom in their system. 

In your everyday life it may not always be possible to be in optimal shape for every treatment. In that case, make sure to do at least a few minutes or even moments of relaxation, meditation, proprioceptive exercise or conscious breathing before beginning a session. Getting more aligned is a part of the treatment process; it is ok to sometimes do that at the beginning or even during a session. Otherwise you will be floundering around, kind of faking it and not really making headway in introducing more flow of life force.   



Receive Information, Don’t Look for Information

If you find yourself struggling to figure out what to do during a treatment and what level of diagnosis to focus on, the best thing to do is take a few deep, quiet breaths, relax a little more and go into listening mode. Often when a practitioner is struggling they begin to look harder for things to see/diagnosis/understand - they thrust their energy outward, searching for information. This is a natural response. However, it is more helpful at that moment to actually soften and go into a more listening and receptive mode. You want to receive information, not look for information. Let yourself relax in the unknowing for a little bit without freaking out that you don't know what to do and you have to find something. You can do something general while you are in this process, like palming down the back, a fascia release or gathering in the hara.

While you are relaxing into this listening mode, notice where your attention goes in the receiver's body. Let yourself receive what their body is communicating. There is no need to label what is 'wrong' and figure out everything that is not working well. There is only a need to listen, notice and respond in a way that enhances the flow of life force. Maybe you don’t know which meridians in the legs are kyo or jitsu but you do notice the legs look very still and empty. Do some stretches, apply pressure to stimulate chi, rock and press on the sacrum. Simple, basic techniques executed with sincere intention will have a therapeutic healing effect. If you can keep this in mind it will be easier to relax and offer touch that is truly supportive to a receiver's well-being. It may be that you naturally move into some more specialized methods of diagnosis & technique during a treatment, but this is not always the case, especially when you are doing shin tai work. 

A note of caution: Sometimes when a practitioner is struggling to find a direction during a treatment, they initiate conversation with the receiver. Sometimes this is a way to open a door to some helpful information and can lead the treatment into productive bodywork, but often it derails the session into an experience that will not initiate much change. Of course, every treatment does not need to be transformative to have value; some very powerful sessions are more integrative and soothing. But be aware of the tendency to engage in verbal dialogue when you are not sure what else to do. This serves to perpetuate the receiver's story rather than move beyond it, and prevents moving into deeper levels of experience that have inestimable value to both of you.


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