Safe, Effective, Accessible – Part 1

You’ll often see these words strung together on a community acupuncture website: SAFE, EFFECTIVE, ACCESSIBLE. In the first blog in this series, we’ll be focusing on the first word, safe, and the idea of safety in an acupuncture treatment.

Before starting, we should probably offer a definition:

Safety: “the condition of being protected from or unlikely to cause danger, risk, or injury.” — Oxford Dictionary

Also, I’d like to point out the special context that safety occurs in this domain. The context of someone sticking needles in you! As a student, I always found it hilarious how people would want to make something so potentially scary and unusual to most folks seem completely normal. I would always think: what if we applied the same logic to skydiving? Could I convince people to get over their fears and jump out of the plane if I could just make myself and the method appear safe and chill enough as their instructor? That’s an aside.

As usual, these definitions give us a mere taste of what the word is about. I think everyone should have an intuitive sense of what safety is, or what it could potentially feel like, but even that is not a guarantee of truly understanding it. Safety can be viewed through many micro and macro observations of people and society and institutions.  We won’t be focusing on the science of acupuncture needling safety itself, though, as that is covered in various literature.

We’re living in a world of socio-economic injustice, patriarchy, racism, and various other -isms that might potentially influence one’s sense of safety by just being alive somewhere on Earth! If there are bombs going off or being dropped in your neighborhood nightly, you probably won’t feel very safe. Additionally, we can see how trauma influences someone’s default settings of safety, in particular someone who has lived through adverse childhood experiences (ACEs). 

As a privileged, cisgendered, white man – I benefit from a default state of “safety” by just existing in the Western world.  I can walk around, laugh gregariously, have a strong and deep voice, say what I want, and act more or less how I want, without carrying a sense of worry about what might happen to me at any given moment. I’m not generally concerned with what will happen if I agitate someone or unintentionally trigger them (outside of just wanting to apologize and make it good). Not only that, but I’ve trained martial arts as well, so I feel as though if there was an altercation, at least I could go down swinging, etc. But — it’s clear, not everyone feels this way, and for completely understandable reasons. I have a lot of privilege, and my goal is to use it to help other people feel more safe. 

So, our sense of safety can be impacted by who we are, how we’re seen in society, where we are, etc. But, do feelings of safety also have a mechanism in the body from which they arise? Safety also appears to also have neurophysiological connections, as described in Polyvagal theory:

“Feeling safe functions as a subjective index of a neural platform that supports both sociality and the homeostatic processes optimizing health, growth, and restoration. Operationally, feeling safe is our subjective interpretation of internal bodily feelings that are being conveyed via bi-directional neural pathways between our bodily organs and our brain” (Porges, 2022)

Some people will try to optimize their internal systems to maximize feelings of safety, and some people will favor exterior changes to stimulate the feelings they would like to have more of inside. These approaches are not exclusive, but in fact quite synergistic. We are inseparable from the environment.

Feelings of safety can sometimes feel arbitrary – we might feel safe in certain situations, around certain people, or in our case around certain procedures, practitioners, or settings. The entire idea of acupuncture might creep us out entirely, being in a room with a person who sticks needles in our most delicate spots. Our mental thoughts about this can go on for quite some time until we’ve experienced it enough to feel safe and relaxed. The goal of providing safety in an acupuncture clinic is actually to help people feel more regulated and safe in general. Just being in our space can be a healing event, without any needles at all. 

Qigong also can play into how we are helping people feel more safe. Being able to embody the space around you, breathe deeply, hold a good posture – all can create a sense of safety. Feeling like you can move around with less resistance or drag while your sense of energy is improving can assist you with overcoming challenges that are mildly unsafe. In a way, learning Qigong is a form of somatic exposure therapy. We offer this to people who are interested in learning more, but not as a default offering. There are numerous models of psychological safety, and we will perhaps share more in the future, but as usual we like to keep things simple and practical if we can, but refer out if more is needed.

To be honest, all of this Chinese Medicine stuff used to scare me slighty. I remember having all sorts of thoughts about the person I was going to see, what they would be like, if I would have to take my clothes off, and what I would do in certain scenarios at the clinic. These ruminating thoughts were a side effect of my own personal history, state of mind, and perhaps poor communication on the part of the providers I was seeing. Something in me still decided to go though, and I have formed several opinions on what I need to have to be able to see a provider these days, and a feeling a safety is big on the list. 

So, out of consideration for other people who may have various lived experiences, trauma, ACEs, etc., we consider SAFETY to be an essential part of our clinic, and it’s baked into the DNA of how it’s designed:

1. We don’t ask people to remove their clothes beyond their knees and elbows in most situations, especially without prior rapport and planning.
2. We ask people before we touch them anywhere on their body, and in particular in sensitive or delicate areas.
3. We don’t put needles in spots people don’t want them, and can always find a workaround. We can remove them from anywhere, anytime. No one spot is seen as a make it or break it moment in a treatment plan.
4. We obtain consent in an ongoing, non-threatening manner during all parts of the treatment, with the ability to stop at any time without blame or shame.
5. We conduct our treatments primarily in a shared treatment space. Everyone can see everything we’re doing, so there’s less chance of misconduct. We’re like a restaurant with an open kitchen for all to see.
6. We allow patients to pick their providers and switch at will, for any reason they want. We have both a male and female practitioner who is able to assist you, and for people with preferences in who provides them acupuncture.
7. We provide a space with ample parking, ADA accommodations, in a safe neighborhood, to the best of our ability.
8. All of our practitioners have studied and reviewed trauma informed care (TIC) and are up-to-date with social and psychological sciences as much as possible.
9. We wear normal clothes, possibly even street clothes, to reduce the white lab coat effect, and to make our relationship as equal as possible. We truly just see ourselves as friends in a community helping one another, not as mystical scholar-saint doctors lording over you.
10. We use a style of acupuncture that generally prefers shallow needling techniques that do not require intense stimulation of the needles to produce effective results.

What makes you feel safe in a clinic? I want to know! Make sure to share with me during our next session together, or by sending us an email or a message in the patient portal. Our goal is to do everyhing we can to reduce the barriers to treatment.

References:

Porges S. W. (2022). Polyvagal Theory: A Science of Safety. Frontiers in integrative neuroscience, 16, 871227. https://doi.org/10.3389/fnint.2022.871227