My approach.
A longer reading. What I mean by complexity, by a biopsychosocial frame, and by trauma-aware — and why those are not marketing terms but actual constraints on how the work gets done.
The starting point
My honours thesis in 2003 — written at the end of five and a half years of full-time training in Aix-en-Provence — was on complexity in osteopathy. The question it started from: what does it actually mean to treat a system rather than a symptom?
The body does not have discrete states. Tissue is not locked or free. A nervous system is not regulated or dysregulated. Everything exists somewhere in a gradient — a particular quality of tone, restriction, fluidity, or ease. Perceiving where in that gradient a person is, in this session, is a different skill from applying a technique to a named condition. Twenty-three years later, that is still the frame I work inside.
Biopsychosocial — what it actually means
The biopsychosocial model is often cited. Less often applied. In manual therapy it can become a formality: you ask about stress, you note it in the chart, you proceed to the structural work.
What it means to me in practice: the same presenting complaint — chronic neck pain, say — can have meaningfully different shapes depending on whether it is primarily postural and mechanical, or primarily held in the nervous system as a bracing pattern, or primarily driven by what the previous year demanded of the person. The treatment for those three is not the same. Getting it wrong wastes your time and mine.
This is not psychology. I am not a therapist. But the clinical assessment has to extend past the structure to the person carrying the structure, or it is incomplete.
Eclectic Practice
Robert Fulford used the term Eclectic Practice to describe what he thought skilled osteopathy required: holding many tools lightly, and using what each particular body and each particular moment requires. Not choosing a school of thought and applying it to everyone.
Over two decades I have worked seriously in structural, cranial, visceral, myofascial, biodynamic, and trauma-informed approaches. None of them work for everyone. None of them work for everything. The discipline is in resisting the pull toward a favourite technique and instead following what I actually find.
This means that two people with the same diagnosis will often receive quite different treatment. That is not inconsistency — it is the work.
What trauma-awareness changes
Most manual therapy training focuses on what to do with the hands. Trauma-aware training focuses on what to perceive before the hands move.
The 300-plus hours I have spent with Kathy Kain, Steve Terrell, and others in this field taught me primarily one thing: a defended nervous system does not receive treatment in the same way as a regulated one. If I proceed technically without reading system state first, I can do work that is technically correct and clinically counterproductive.
In practice: I pay attention to the quality of your breathing, the tone in your face and hands, how you hold yourself on the table in the first minutes. I pace the session according to what I find — sometimes much more slowly than a patient expects. That pacing is not timidity. It is the reading.
For patients who have found other bodywork overwhelming, difficult to settle into, or ineffective despite technically competent care, this tends to be the difference that matters.
What I do not do
I do not diagnose medical conditions. I do not treat pathology directly. I do not make promises about outcomes — not because I lack confidence in the work, but because the evidence for osteopathic care, while solid in several areas, does not support that kind of certainty.
What I can say honestly: for the presentations I commonly see — chronic musculoskeletal pain, headache, pelvic and post-partum patterns, nervous system dysregulation, infant feeding and early developmental presentations — the work tends to help. Sometimes significantly. I will tell you before you invest more sessions if I think it is not serving you.
The referral instinct
I refer regularly. I think of this as a clinical ethic, not a limitation.
The presentations I most commonly pass on: patterns that are primarily relational or psychological rather than somatic (to trauma therapists); post-surgical or complex orthopaedic presentations where a specialist physiotherapist is better placed; situations where a working medical diagnosis would change what I do (to a GP); pelvic floor dysfunction that requires internal assessment (to a pelvic floor physiotherapist).
I will tell you early — not after you have committed to a course of treatment — if I think something is outside my scope or would be better served elsewhere.
How long this takes
Most people work through a first course of three to four sessions. The gap after the first session is typically two weeks; subsequent sessions run about three weeks apart. The aim of that arc: clearing what has accumulated, establishing a more stable baseline.
After that, the pattern is theirs to choose. Some return when something new comes up. Others keep a seasonal rhythm — once or twice a year, often going into winter or coming into spring — to work with what the preceding months have deposited in the body. I will suggest it only when I think it is warranted.
I will tell you when I think you are done.