The Goldilocks prescription: not too little, not too much, finding the ‘just right’
Can you remember the last time you felt overwhelmed by a visit to a professional in an area outside your comfort zone?
I don’t know about you but I struggle to remember to do the simplest stetches my yoga teacher has prescribed, let alone recall whether I took my ‘every second day’ iron supplement — yesterday or the day before.
Like many ‘experts’ I can be great at doling out the advice but not always so good at taking it! So what’s it like for those without any health knowledge, seeing a naturopath for the first time?
Lynn Hsu @newyorkercartoons
Understanding the impact of overwhelm
A few years ago, I went with my elderly father to see his GP about a chest infection. He left with a prescription for antibiotics, sprays, inhalers and multiple over-the- counter medicines, as well as two pages of handwritten notes. It was a lot for anyone, much less a 92 year old who was ill and fatigued. The next day he asked me what a ‘steam bath’ was. He’d stumbled at the first instruction on the list! While he could somehow manage the plethora of medications, the additional lifestyle directives were too much to contemplate.
New clients often come to us when they’re overwhelmed. It might be a new diagnosis, change of life circumstance or period of increased stress. Being conscientious practitioners, we want to give them everything — not just half the dispensary but all the information as well.
In an attempt to impart our knowledge we might throw around a mix of medical and naturopathic terms like HPA axis or adrenal fatigue, provide recipes for our favourite smoothie and prescribe a complex regime of remedies.
But is this always the best approach for the client, or our business?
First dates
An initial consult is a bit like a first date. How the first meeting goes often determines whether there’s a second.
There might have ‘baggage’, as a result of a preconceived ideas or a previous interaction with a naturopath. Or for the practitioner there may be echoes of a troublesome client with a similar presentation.
There’s a trend for emerging naturopaths to go into a consultation with new clients armed with assumptions based on prefilled questionnaires and a fully formed treatment plan. But let’s face it, sometimes the information supplied is about as accurate as a dating profile!
When we approach the consultation with an open mind and allow the dialogue to unfold, together we can create the blueprint for collaborative and effective treatment.
Finding the Goldilocks spot
Over-researching or crowd-sourcing treatment is often a symptom of under-confidence, which frequently results in a complicated plan. Even the most motivated client can have difficulty following a plan with too many remedies and instructions.
We might have a touch of imposter syndrome and be afraid of under prescribing. Surely if we fire off enough suggestions, diet changes and prescribe a full suite of remedies, something will work?
So how do we find the sweet spot? What’s too much or too little? Is there a perfect amount of information and remedies to provide?
Everything in naturopathy comes down to the individual, which includes understanding the client’s capacity (energy, time, mental load, motivation, etc) and meeting their most acute need. What do they believe is the most important health issue that needs to be addressed immediately and how can I deliver a simple and effective treatment plan?
Setting clients up for success rather than failure
As naturopaths, we’re experts at seeing the bigger picture. It’s one of our super powers. The new client may just want to get over their latest chest infection. However we could see this health event as a constellation of long-term food intolerances, household mould exposure, poor breathing technique, dreadful sleep hygiene and general over indulgence.
It’s in our professional DNA to want to treat the underlying condition in order to prevent recurrence. But this might be outside of our client’s experience if they’ve only used conventional medicine. They might only see their GP again if the condition doesn’t resolve or when a new one emerges.
There’s an art in setting expectations. If someone is used to their doctor putting out spot fires, the idea of returning for follow up when they’re feeling better may take some explaining.
Sometimes we need to build trust and allow our client to experience the power of natural remedies, without overwhelming them with information about the constellation of health events that lead to them being acutely unwell in the first place. But set the expectation that there’s an opportunity to continue to work together when they feel a little better, to find out why they’re getting recurrent infections or feel tired all the time.
Value for money
After more than three decades in practice I’m still guilty of wanting to do it all sometimes. I want to map out all the steps, share a stack of resources and provide ‘value for money’.
The desire to create a comprehensive therapeutic plan the new client can benefit from, even if they choose not to have follow up, may be counterproductive. Too much information when overwhelmed can reduce our ability to take in all those helpful nuggets — let alone follow them.
The biggest learning experience I’ve had as a practitioner was being the patient. I consulted a trusted overseas colleague when I was reeling from a cancer diagnosis and surgery, while contemplating the next phase of conventional treatment. The lifestyle advice was relatively light on but the herb and nutrient regime involved taking up to 30 remedies a day. This required a spreadsheet with a daily check list to navigate. I could manage 90% of the supplements but only with a lot of help.
I learned first hand about the impact of overwhelm and reduced capacity, while being a patient. I hope it’s made me more empathetic when working with people in crisis or newly diagnosed with a life challenging condition. Despite how well someone may appear, it can belie their true physical and mental capacity. This isn’t limited to oncology clients. It can happen with anyone — like the stressed woman in perimenopause working full-time while caring for teens and elderly parents, or the person struggling with chronic pain, insomnia or Long Covid.
Negotiating and co-creating a treatment plan
Sometimes we achieve more by doing less.
Like building trust, negotiating with our client to understand where they’re at and what they’re truly able to undertake, is another key to compliance.
“X, Y and Z could really help improve your energy. I know you can’t do much at the moment, so which of these would be easiest for you to put in place this week?”
Treatment can be most effective when layered. If prescribing multiple remedies and a long list of lifestyle tweaks, how do we know which element has made the biggest impact? Was it all synergistic, or were only one or two of the components responsible?
When it’s easy to comply with the first step, there’s more energy to build on this and explore another layer. When we set our clients up for success, they’re more likely comply and improve their wellbeing. Feeling enabled to succeed is also the basis of an ongoing therapeutic relationship, which is also a cornerstone of a great business plan.
If you’re a naturopath, herbalist or nutritionist struggling with treatment plans, patient management or under confidence, it makes good sense invest in 1:1 mentoring with Gill.
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