My approach.
A longer reading. What I mean by complexity, by an enactive 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 Mémoire 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 answer I keep returning to: the body does not have discrete states — everything exists somewhere in a gradient. (The short version of that idea is on the approach page.) Perceiving where in that gradient a person is, in this session, is a different skill from applying a technique to a named condition. After twenty-three years of practice and reflection, that is still the frame I work inside — it has had plenty of time to mature.
Biopsychosocial — what it actually means
The biopsychosocial model is cited more often than it is applied — and the model itself is already being pushed further. 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 would waste your time and I would witness a reoccurrence of a symptom that could have receded otherwise.
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. I'm trying to get a clear picture so we can discuss it to see if it makes sense for you too.
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 all kinds of minute details — what shows on the outside, and how the body presents once my hands are on. Rather than tracking everything, I "listen to the sound" of how you drive your body, it usually feels less intrusive.
I pace the session according to what I find — sometimes much more slowly than a patient expects. Most of the time that is simply because I am still reading what the body is doing.
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. Even simpler than that, I am not allowed to do so by BC laws.
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 and safety practice, 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/midwife).
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 sessions actually run — pacing, frequency, the seasonal rhythm some patients keep — is on the approach page, and the practical details are on first visit.