Case Analysis and Prescribing
It is generally recommended in Bach flower therapy that no more than 6 remedies be given at a time. In your casework, however, you might come up with a much longer list of remedies. How do you narrow this down and prioritize what the client needs?
There are different models for prescribing in Bach flower therapy. The most common approach is to base your prescription on what you are seeing in the present totality. As treatment progresses, you may see that a given state resolves and reveals another underlying state. We therefore treat that newly revealed state, then re-evaluate, see what else has emerged, and treat the newly revealed state accordingly.
In other words, treatment proceeds in layers. We trust that what needs to be healed at a given moment is what is showing up. The Higher Self is showing the way.
Keeping all this in mind, here I will present some very practical suggestions on how to analyze your case to determine what most needs to be addressed.
Start by reviewing your case carefully and try to synthesize the core issues presented by the client. You might draw a visual map distinguishing the central or major issues and the peripheral or minor issues. You might also make a timeline or a map of significant life events. In this way, you will be able to better understand aetiology, susceptibility, patterns of response, and the depth of what is uppermost at the present time.
After you have done this initial analysis, review your case again, underlining any emotions, feeling, moods, attitudes and mental states or patterns that the client is expressing. Note the possible corresponding remedies in the margins. Then review, and if necessary revise, your previous analysis, filling in the remedy names for each key state you have identified.
Finally, narrow down your remedy selection to no more than 6 remedies.
What needs to be healed
It is best to begin our case analysis by asking what most needs to be healed in this moment. Is there an acute situation that is dominant and needs to be managed right now, or is the client seeking help for an ongoing, long-standing issue? Or perhaps a mix of both? The questions to ask yourself here might be:
Is this an acute or a chronic situation?
What is the intensity of the client’s state?
What impact is this having on their life?
If the client is in an acute, emergency or high-intensity situation—for example, relating to recent trauma, bereavement, or extraordinary, high-stress circumstances—this should be the priority. If you have already identified 4-6 remedies that are appropriate, you might simply give those until the person has stabilized. Then, when the present events have been processed and integrated, and when perhaps you see more clearly the underlying chronic state, you can shift to a focus on that. (Even so, this is just a theoretical distinction because it is also possible that the remedy for their acute state and their chronic state be one and the same.)
Let us say that a person with a lifelong tendency to express as Vervain has just experienced a traumatic event. They may still be in shock and numb, or perhaps experiencing panic attacks, repetitive thoughts, fear, anger, grief, or any combination of these. There are a number of appropriate remedies you might give initially—but Vervain is unlikely to be one of them. In other words, the situation is acute and dominant and needs to be the priority in treatment. The fact that Vervain is a chronic pattern or possibly their “type” remedy is likely irrelevant until this situation has been processed, integrated, and resolved.
In general, when prescribing for both acute and chronic states, you can narrow down your remedy selection by asking yourself the following questions:
What is bothering or affecting the client the most?
What are the client’s own priorities for treatment?
Is there a cycle or pattern of related states that need to be addressed together?
Is there a deeper state that can explain the various surface manifestations?
Use the answers to these questions to narrow down your remedy choices to a maximum of 6.
A note on "type" and other remedies
In The Twelve Healers and the Seven Helpers, Bach explicitly introduced the idea that there are two kinds of remedies: type remedies and helpers. He believed there are twelve universal types or constitutions that we are born into, for which he identified twelve “type” remedies. He called these type remedies the "Twelve Healers." They are Impatiens, Mimulus, Clematis, Chicory, Agrimony, Vervain, Centaury, Cerato, Scleranthus, Water Violet, Gentian, Rock Rose.
According to Bach, each type has a lesson associated with it and this lesson is our reason and our goal for our incarnation. The seven helpers and the nineteen remedies he discovered subsequently, on the other hand, refer to compensations that we develop in response to life circumstances.
For the homeopath, whose materia medica consists of 6,000+ potential remedies, it may be difficult to relate to the idea that there are only twelve universal types and to agree with Bach’s categorization of type and other remedies. From a homeopathic perspective, for example, is there any reason why Rock Water might not be considered a type or "constitutional" remedy? Or conversely, if we are to buy into the idea of types, why is Rock Rose, which is for panic, a type remedy since panic is hardly a constant or defining personality trait?
Still, many accept Bach’s taxonomy and find it philosophically and clinically useful, often claiming that it is important to identify a person’s type remedy from the start and to include it in their remedy blend along with any other remedies. You are encouraged to explore Bach’s taxonomy and see for yourself if it resonates with you. However, it is not necessary for practice and you may discover other ways of understanding the constitutional or dominant lifelong type versus other compensatory states. It can be helpful to distinguish between constitutional types and other states even if we do not classify the remedies as exclusively type- or non-type-related.
At each follow up, you will evaluate the previous remedy blend to determine which remedies are still needed and which are no longer needed. You may continue a particular blend without any modification for a few months at a time (though this is rare), or change some or all of the remedies at each appointment. Each person is different so there are no rules about length of treatment on a given remedy.
A good remedy selection should provide at least some minor relief within a few days or a week at the most. If nothing has shifted after 7-10 days, the selection was likely inappropriate. Alternatively, there may be some block related to a past shock or trauma, a maintaining cause (for example, an abusive relationship), or a resistance to change that should be explored.
Keep in mind that everything we experience serves a purpose for us. If feeling like a victim helps us to justify our lack of accomplishments in life, we may have a deep-seated attachment to believing we are powerless. If being sick gets us the attention we need, there may be a cost to healing that we are not yet ready to pay.
Often, there is a point in treatment when a person begins to “forget” to take the remedies and either takes them less frequently or stops altogether. This can be a sign that they no longer need them. You should confirm this in your interview, however, before deciding to discontinue all the remedies in a blend based on this.
Finally, a person may need to cycle through a given remedy at different times. For example, you may have given Mimulus at the start of treatment and then discontinued it. The person continues to make progress in different areas and then seems to “relapse” into a Mimulus state. This is not to be understood as a setback or a lack of progress, but simply as a deeper layer or another aspect of their life that is ready for healing.