The osteopathic therapeutic cycle represents a basic treatment method or approach that unifies a number of abstract ideas, strategies, and techniques. It is called a therapeutic cycle because its prime objective is to bring about a healing effect or beneficial outcome.
Essentially, it involves a progressive cyclic change process that is driven by the specific intention of promoting optimal breastfeeding; a concept that is inextricably linked to improving a dyad’s state of health and wellbeing. When the term, therapeutic is used within the context of an Osteopathic therapeutic cycle, it is linked to notion of treatment and aligned with the traditional idea of practice routines, and medicinal or remedial interventions. The word ‘treat’ is used loosely by osteopath participants to encompass a number of situations and means by which they provide assistance to mothers and babies.
Generally speaking, osteopaths, and their patients perceive manual therapy as the distinguishing feature and central element of their clinical work. It is the means by which the body’s structure and function is improved and the patient’s self-regulating mechanisms are enabled or stimulated. This is, however, only part of the treatment process.
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In the current study, osteopaths talk about treatment in different ways. Its meaning can be used interchangeably with the term therapeutic, which implies a broader curative, healing or normalising characteristic. They discuss treatment as a response to a problem or as an impediment to achieving a state of normality or freedom to express health and wellbeing.
Osteopaths were observed to simultaneously treat from a broad conceptual perspective, or as required, with a sharp more concrete focus. For example, they might apply a specific manual technique to address a movement restriction in a precise direction while, at the same time, attend to the person and environment as a whole. In the current study, this typically involves the baby’s specific and general behaviours, the mother’s responses, and the dyad’s health and social situation; factors that influence and modify the overall treatment approach. Broader holistic considerations include the inter-relatedness of mind- body connections147, the mother-baby bond, individual circumstances, and contemporary expectations of breastfeeding, new mothering and osteopaths’ professional responsibilities. Elements of this idea are expressed by Edward (osteopath) in the exemplar below.
Well, osteopathy works on a lot of levels … a mind, body, spirit [concept]; so the whole [person]. I don’t like to break a person down too much into those separate components because we’re just a single organism. So we treat the individual; we treat the baby; we treat the mum; and try to allow that physical process to happen as naturally as it can … so whatever levels you think that occurs on, I don’t know;
we’ve all got our [theoretical] models; we just give people a treatment (O 6/04).
Edward acknowledges that people are complex beings and any interaction with them involves many interconnected underlying therapeutic mechanisms. He deals with the intricacy of the task, however, by adopting a familiar pattern of action that fits with the idea of applying manual therapy within the structure of a progressive cyclic schema. This schema, however, inculcates a range of therapeutic strategies that extend beyond manual therapy of the baby and which are directed toward influencing the way mothers’ think, feel, and act in response to their personal and breastfeeding circumstances. One common example involves osteopaths advancing mothers’ understanding of their babies’ bodily responses and functions and how they might be contributing to their babies’ behaviours.
Hence the therapeutic processes involved in the osteopathic therapeutic cycle relate also to more subtle, but nonetheless important, effective interpersonal and communication skills.
147Discussion of mind-body connections is a common theme in the data. A few osteopath participants allude also to a spiritual element but this dimension is not well developed.
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Taking a focused yet broad holistic perspective is generally representative of osteopaths’
approach to responding to dyads, regardless of individual breastfeeding difficulties.
Treatment is not necessarily applied in response to disease but also to prevent disease.
Dyads, struggling to breastfeed satisfactorily are not typically ill; they are encountering difficulties, while undergoing significant life challenges, which, for some, might potentiate illness. In the current study, the meaning of therapeutic is linked closely to the notion of addressing dysfunction rather than disease; of ‘normalising’ or restoring a state of physiological balance148; physical and emotional. The therapeutic cycle is specifically osteopathic because it rests upon osteopathic principles, and science-based educational and treatment models that use manual therapy as their prime techniques or tools. It is structured in order to provide a practical clinical framework that fosters consistency, predictability and an ordered, schematic approach, yet is also open to creativity and flexibility. The former qualities satisfy professional, medico-legal, and public expectations of osteopaths and the latter qualities enhance their scope to respond to the core problem on an individual basis and according to professional and personal judgement.
At its simplest, the osteopathic therapeutic cycle represents a basic treatment cycle whereby manual techniques are applied to facilitate physically-based changes such as relaxing a tight muscle. As a basic process, it can be repeated a number of times within a treatment session or over a series of treatment sessions. From this perspective, the therapeutic cycle embodies the scientific medical paradigm which, in general terms, upholds traditional views relating to osteopathic education, professional conduct, and community expectations regarding what a visit to a health professional entails. This approach involves making a diagnosis, providing a structured intervention and evaluating treatment effects, which in turn, link back to the beginning by influencing the diagnosis and events of the next cyclic phase. Hence the diagnosis is often referred to as a working diagnosis that is reaffirmed or altered according to recent responses and events.
As well as its more systematic and technical characteristics, the osteopathic therapeutic cycle also has a broad dimensional range according to participants’ personal goals and responses that take place, over time. Participants engage with the therapeutic cycle by becoming actively and mutually involved in it. Essentially, it represents a dynamic change cycle that feeds back into itself to influence the whole, and begin again. It thus implies ongoing momentum; flowing and evolving according to present and changing circumstances. Its course, however, does not always follow a linear trajectory but varies according to whether the struggle to breastfeed satisfactorily is resolving (or worsening) or
148 See Chapter 10.2.
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changing direction. Overall, the osteopathic therapeutic cycle follows a course that is influenced by three underlying transitional themes, which are now presented.