The Practice Charter

Eleven principles this work runs on. For anyone who holds real responsibility with almost no structure around it, and wants to hold it with care.

What we are actually for

Someone sits down in front of you and, often within twenty minutes, tells you something they have never told their doctor. Not because you are cleverer than their doctor, but because you gave them an hour and did not interrupt. That is the real currency of this work, and it ought to frighten us slightly. Being trusted quickly is not the same as having earned it, and the space between those two things is where harm tends to happen.

I do not believe we heal anybody. The body does that, or it does not, and mostly it is already doing its best under conditions nobody chose. What we do is work on the conditions. We take away some of what is in the way, add some of what is missing, and pay close enough attention that the person in front of us starts paying attention too. That is not a small job, and it is not a lesser one. It is simply a different job from the one people imagine when they hear the word healer.

The strange thing about our field is that it asks us to hold real responsibility with almost no structure around it. A nurse who makes a poor decision has a colleague, a protocol, a manager and a regulator between her and the consequence. A coach or a therapist has none of that. She has her own judgement, her own reading, and whatever she happened to be taught by whoever taught her. And then she is left alone with people who are frightened, unwell, and inclined to believe her.

Rigour and soul are not opposites. To check a medication interaction is the same impulse as the work itself, which is to take the person seriously enough to get it right.

The practitioner who cannot be bothered to know what her recommendation might do alongside someone's prescription is not more spiritual than the one who checks. She is simply less careful, and the person paying her cannot tell the difference.

Nor do I think this work is meant to be done alone. Almost every client I have ever helped meaningfully was also being helped by somebody else, whether they knew it or not. The osteopath, the counsellor, the somatic therapist, the GP who kept an eye on the bloods. Healing is rarely a solo achievement and it is almost never our achievement. Practitioners who work in isolation, referring to nobody and checking their thinking against nobody, are not being independent. They are being unsupported, and they usually know it.

So the standard I hold, and the one I would ask anyone I work with to hold, is not perfection. The standard is the willingness to be checked. To be asked why you did that, and to have an answer, and to change your mind when the answer is not good enough. Evidence is the gold standard and I hold to it, but experience sometimes sees what the evidence has not yet caught up with, and that is allowed too. What is never negotiable is that whatever I choose to do, I can defend it.

The willingness to be checked is not a weakness in this work. It is the whole of it.

The principles

Eleven I hold to

I am responsible for the hour, not the outcome.

I bring skill, attention and honesty to the time we have. What happens afterwards belongs to the client and to a hundred things neither of us controls. Taking on their recovery is not devotion, it is a category error, and it will eventually eat me.

I am one part of someone's care, never the whole of it.

Whatever I do sits alongside their doctor, their medication, their family and their circumstances, and I work with those things rather than against them. Sometimes the honest aim is to help someone safely need less medication over time, which is a legitimate goal, but only ever gradually, only within my scope, and only in discussion with the medical team looking after them. I do not tell anyone to stop a medicine, and I never set myself up as the alternative to proper medical care.

iii

I say I do not know, and I say it early.

Not knowing is ordinary. Concealing it is the dangerous part. The practitioner who can say I am not sure, let me find out, is the safer one every time, and clients trust it more than confidence.

What I do not ask, I have chosen not to know.

Medication, diagnoses, what else they are taking, what their doctor said. If I do not ask, I cannot later claim I was unaware. Ignorance I could have prevented is not innocence.

When something worries me, I say so, however awkward it is.

If a symptom needs looking at, I say it plainly and kindly, and I write down that I said it. Saying nothing to avoid alarming someone is a decision I would have to defend later, and it is not defensible.

I would rather do too little than too much.

The urge to add one more supplement, one more protocol, one more intervention is strong, and it is usually mine rather than theirs. Doing less, and watching carefully, is nearly always safer than doing more. When I am not sure, I go gently. The body is not waiting for me to rescue it.

vii

Their autonomy outranks my opinion.

An informed adult may decline my advice, keep taking the thing I would not have chosen, or stop coming altogether. My job is to make sure they understand, not to make sure they comply. Persuading someone out of a decision that is theirs to make is not care.

viii

I say only what is true, even when hope would sell better.

I do not promise outcomes, imply cures, or let someone believe more than the evidence supports. Overclaiming is not optimism. It is a transfer of risk from me to a person who cannot see it happening.

What is said in the room stays in the room.

People tell me things they have told nobody, and that is only possible because they trust where it goes. I keep what I am told private, I hold as little as I need and I keep it safely, and if I ever have to break a confidence because someone is at genuine risk of serious harm, I say so first and I say why. When I bring a case to someone I think with, I take the person's name out of it. Confidentiality is not secrecy. It is the condition that lets someone be honest.

Boundaries are the kindest thing in the room.

Clear times, clear fees, clear limits on contact, clear endings. A frame is not coldness, it is what makes it safe to bring difficult things into the hour, and it protects the client at least as much as it protects me.

I do not practise alone.

I have people I refer to and people I think with. I bring my difficult cases to someone experienced rather than carrying them home. Working in isolation is not independence, and my judgement is not so good that it never needs checking.

If this is how you want to practise

You do not have to hold it alone

The last principle is the one nobody builds for themselves. I mentor coaches and practitioners who want an experienced clinical eye on their work, their protocols and their difficult cases. If the charter reads like your own practice, come and think alongside someone.

The mentorship

One day you will be able to sign this and put it on your wall. For now, it is enough to practise by it.