onsdag 28. september 2022

Craniosacral Therapy

I wrote about Craniosacral therapy on this blog ten years ago. I wrote the article in Norwegian, intending to do an English version as well. I never got around to it, but the content is still relevant. I have now translated the text, and also rewritten it, aiming it more towards Alexander Technique teachers. At the end I have added a section with some questions our profession maybe should discuss.

The interview
The other day I was listening to an interview with an Alexander Technique teacher in the US who is also a professor of architecture. She was going to talk about ʻthe complexity of the headʼ, and about ʻhead forward and upʼ, subjects very relevant to the Alexander Technique. I was expecting to learn something new and interesting about the structures of the head and neck, and the balance of the head.

As every Alexander Technique teacher knows, head balance plays an important part in human functioning. It is a dynamic balance where there is an intricate interplay between the weight of the head and the structures of the neck, not to mention all the neurological processes involved. I was hoping that an architect could throw some light on at least the mechanical aspects of this.

I was very disappointed when the Alexander Technique teacher instead began talking about ideas from Craniosacral therapy. (She uses the term ʻcranial osteopathyʼ, but in Europe and certainly in Norway, what is described fits Craniosacral therapy). As she went on presenting these weird ideas about human physiology as if they were scientific facts, my disappointment turned to shock.

The therapy
Craniosacral Therapy is based on the idea that the cerebrospinal fluid that surrounds the brain has a distinct pulsating flow, (independent of breathing and heart beat). Craniosacral therapists claim the bones of the skull are highly movable, and that they are able to feel the pulse of the cerebrospinal fluid and influence the flow using gentle touch. They claim the facilitation of the flow of cerebrospinal fluid has numerous health benefits.

Studies involving Craniosacral therapists have not shown any ability to reliably detect the frequency of pulsation, and they show lack of correlation between therapists. Research has shown inspiration to be the main driver of cerebrospinal flow. Experiments on manipulation of cranial bones (albeit in rabbits), did not show correlation between movements of the bones and flow of cerebrospinal fluid, and the force required for the bones to move far exceed the force applied by Craniosacral therapists. (Thank God for that!)

Moving bones
In the interview the architect/Alexander Technique teacher explains how the idea of movable cranial bones can be used as an alternative to the traditional ʻhead forward and upʼ when giving directions. The occipital bone is thought to be moving back and up while the frontal bone is moving forward and up. Another description given is it that the occiput ʻstays back and up with the spineʼ, and the rest of the skull ʻflexes forward and upʼ,
She found this idea useful in teaching. The pupils were coming ʻup from the soles of their feetʼ, and this could be achieved in a first lesson.

Could this work? Absolutely! Some people find this kind of mental imagery very useful. Some find it useful to imagine that the head is a balloon, or that there is a silver thread in the sky lifting the head (an idea from Tai Chi). I don't see any problem with this as long as it is a short term solution, and as long as you don't believe that your head actually is a balloon.

Unhealthy and inefficient use of ourselves is very often associated with misconceptions about how our bodies actually works. Alexander Technique teaching should aim toward doing away with these misconceptions. Substituting them for other misconceptions is not a great idea. Sooner or later you risk running into trouble. A conception based on actual facts is the only sustainable one. In the long run, you can even risk drifting farther from, not closer to, reality. This interview was a case in point as things turned to the worse.

Swelling brain
The teacher interviewed in the podcast was very pleased with the idea of the moving cranial bones, ʻpatting myself on the backʼ. She then says this idea was later ʻrefinedʼ when she met Peter Grunwald, another Alexander Technique teacher with his own special take on the human brain. Grunwald is the founder of the Eyebody Method.

Now, not only the cranial bones, but also the brain itself is moving: ʻThe brainstem itself goes forward and up, and the associative cortex [she probably meant association cortices], stays back and up so we don't fall forward into our frontal lobesʼ.

She also claims you can feel the working of the brain. She explains that if you visualize something, the visual cortex is activated, (which is certainly true), but then she adds: ʻ... and you can feel it swell up a bit, ..., like a cauliflower or something, grow, expand a bitʼ.

This seems to be not only imagining that the head is a balloon, but believing it is one.

I must add here that the actual moving parts of the head, the jaw and the eyes, were mentioned in the interview, by the interviewer. The practical implications, which I had hoped an architect could elaborate upon, were not discussed much.

Personal experience
Some years ago I took part in a workshop run by an Alexander Technique teacher who is also a Craniosacral therapist. Through the workshop I gained some practical experience, and insight into how Craniosacral theraptists work and think.

There is some resemblance between what Craniosacral therapists do and what Alexander Technique teachers do when they put hands on a pupil lying on a teaching table. The Craniosacral therapist puts his/her hands on, waits and listens. But he/she is listening for something that does not exist. This results in a very calm and patient touch. When someone holds your head with a touch of this quality, it has a very calming effect.

This effect can easily be explained by well-known and generally accepted mechanisms. The explanatory model the Craniosacral therapists use themselves is useless. But, ironically, it can also be what gives the advantage of the ʻnon-doingʼ way of working. The disadvantage of the model is that it makes it difficult to take the therapy seriously.

Alexander Technique teachers are naturally drawn to this way of working. Being both Alexander Technique teacher and Craniosacral therapist is not an uncommon combination. A trained Alexander Technique teacher seems well-equipped for doing Craniosacral work: put the pupil on the table and let him/her lie there the rest of the session, skip instructions, put your hands on and let them stay on longer than you think is necessary. In addition, a vivid imagination and a lack of anatomical knowledge could come in handy.

Professional debate
Craniosacral therapy can inspire Alexander Technique teachers to put their hands on their pupils with more patience. But the therapy has other influences that raise some questions.

Is the training of Alexander Technique teachers good enough? Should the training include an introduction to critical thinking? Is the level of anatomical knowledge sufficient? How can we ensure a good understanding of Alexander Technique skills and principles? Several times I have heard or read about teachers who were frustrated during their training because something was outside of their grasp: understanding how to direct while exerting physical force for instance, or how to include some part of the body, like the feet and ankles, or understanding a concept like ʻhead forward and upʼ. This should be pretty basic.

Yet another question is why the influence from Craniosacral therapy is hardly discussed at all in the Alexander Technique teacher profession. I can, as an Alexander Technique teacher, claim to be able to feel that a part of my brain is moving without evoking scrutinizing questions from my colleagues. This despite all our knowledge about anatomy and physiology, and about the relativity of our sensory systems. I could give talks at congresses and write about it in Statnews without meeting counter arguments. Where is the professional debate?

Related blog posts
Kraniosakral terapi (Norwegian)

Podcast: What is the ʻheadʼ of ʻhead forward and upʼ. About our heads and why they are considerably more complex than most of us tend to assume and why it's important to understand these complexities.

Does Craniosacral Therapy Work?

Interrater Reliability of Craniosacral Rate Measurements and Their Relationship With Subjects' and Examiners' Heart and Respiratory Rate Measurements

Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum

Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons

Craniosacral therapy: the effects of cranial manipulation on intracranial pressure and cranial bone movement

Inspiration is the major regulator of human CSF flow

Even the Best Scientific Studies Can Lie: The Case of Craniosacral Therapy

The origins of Craniosacral therapy
Wired to the Kitchen Sink: Studying Weird Claims for Fun and Profit

søndag 11. september 2022

En livstid å mestre

Forrige gang skrev jeg at Alexanderteknikken tar «et minutt å lære, en livstid og mestre».

Prinsippene i Alexanderteknikken er enkle. Du lærer dem fort. Men lære å bruke teknikken i dagliglivet tar litt lengre tid. Hvor lang tid tar det før du mestrer teknikken, og hva vil det egentlig si?

At du mestrer teknikken betyr først og fremst at du kan bruke den på egen hånd. I en time der du får «hands-on» veiledning behøver du egentlig ikke gjøre noe. Du kan ha mange timer hos en lærer uten at du nødvendigvis får et bevisst forhold til teknikken, og ferdigheter nok til å mestre på egen hånd. Du kan ha stort utbytte av timene likevel. Du lærer noe gjennom kroppen som kan påvirke hvordan du beveger deg til daglig. For enkelte kan en slik passiv tilnærming være den rette, i alle fall for en periode.

Normalt vil en Alexanderteknikk-lærer be deg ta aktivt del i timen og be deg observere og tenke i forhold til det du gjør. Jo mer du bruker teknikken på en aktiv måte, jo mer nytte vil du ha av den.

I ro. 
For en nybegynner er det enkleste å bruke Alexanderteknikken når du er i ro. Det første du lærer er gjerne å tenke Alexanderteknikk når du ligger i aktiv hvilestilling. Aktiv hvilestilling kan du ha nytte av selv uten Alexanderteknikk. Det er en hvilestilling med mange fordeler. Men med Alexanderteknikken får du mer ut av den.

I bevegelse
Alexanderteknikken blir beskrevet som å kunne «tenke i aktivitet». Jevne og gjentagende bevegelser, som når du går, er ofte det letteste å begynne med. Enkle dagligdagse aktiviteter som å pusse tenner, ta opp mobilen eller plukke opp noe fra gulvet, kan også være passende utfordringer. Det meste av livet består av slike helt enkle bevegelser. Å endre kvaliteten på disse kan ha stor innvirkning på psykofysisk helse, og skal ikke undervurderes som middel til å lære, og etter hvert å mestre, Alexanderteknikken.

Nøkkelen til endring av vaner er å kunne la være å reagere automatisk. Å bli bevisst når du får intensjon om å gjøre noe, og å kunne velge å gjøre det eller ikke gjøre det, er en helt grunnleggende ferdighet. Dette er noe som mange allerede kan, men å bruke det bevisst kan også sies å være et første steg i å mestre Alexanderteknikken. 

Noen aktiviteter kan beskrives som komplekse. Dette er aktiviteter som krever spesielle ferdigheter, som bygger på vaner tilegnet gjennom trening. Ett eksempel er det å skrive for hånd eller på maskin/pc/laptop, et annet det å spille et instrument. Å mestre teknikken i forhold til slike ferdigheter kan gjøres på flere nivåer. En nybegynner kan få mye ut av å jobbe med å pakke ut og ta opp instrumentet. Men å mestre teknikken fullt ut i komplekse ferdigheter krever ofte en bevisstgjøring og omlegging av vanene ferdigheten bygger på. Dette kan kreve arbeid over tid, men er alltid verdt innsatsen. Små endringer kan gi stor gevinst. Alexanderteknikken integreres i selve aktiviteten og gjør at du mestrer teknikken på et avanserte nivå. 

Livets harde skole
Aller mest krevende er på mestre Alexanderteknikken når du er i en vanskelig situasjon. Dette kan være et jobbintervju, et prøvespill for en musiker, en vanskelig samtale, eller det å holde en tale for den som ikke er vant til slikt. Før eller senere møter vi situasjoner der vi må prestere under press. I slike situasjoner kan Alexanderteknikken være til uvurderlig hjelp, men det er også i disse situasjonene anvendelsen av teknikken krever et høyt mestringsnivå. Dette er ikke alltid noe som kommer av seg selv. Om du aktivt prøver ut teknikken i krevende situasjoner, vil du etter hvert opparbeide deg erfaring og ferdigheter som gjør at du mer og mer mestrer bruken av teknikken også i slike situasjoner. 

Livslang læring
Det som kjennetegner oss mennesker er at vi lærer så lett. Vi kommer til verden ganske hjelpeløse og er avhengige av å lære nesten alt for i det hele tatt å overleve. Denne egenskapen har også en bakside. Vi er også utrolige gode på å tilegne oss uvaner. Mange av disse (u)vanene kan du ha hele livet igjennom. Å lære Alexanderteknikken er derfor aldri noen avsluttet prosess. (Du kan til og med lære uvaner i forsøket på å lære Alexanderteknikk!). Å jobbe med Alexanderteknikken er en prosess som aldri tar slutt, som du alltid kan få mer utbytte av. Du mestrer Alexanderteknikken litt etter litt, og du mestrer teknikken i den grad du mestrer deg selv. 

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