Holding Space, 3 Ways

on being neutral, kind and careful

Agnes Giberne’s The Story of the Sun, Moon, and Stars (1898)

In community acupuncture, a big part of the acupunk’s job is to create and maintain an energetic container where patients can rest and heal; that’s what we mean by “holding space”. At ORCCA we talk about creating containers in multiple contexts: clinical, practice-building, and organizational. I was working on a follow-up post about WCA’s succession planning when I realized that before I could get into those details, I needed to write something about the overlap between leadership and holding space.

And then, right on cue, first year student Alessa Midtlyng wrote a self-evaluation paper¹ that beautifully describes how community acupuncture students learn about holding space:

In my first year at ORCCA, I was happily surprised to learn that the school focuses on so much more than acupuncture theory. I have learned that though the points and channels are very important, there is so much more to being an acupuncturist than just memorizing a bunch of information and creating a diagnosis.

The school’s focus on accompaniment has been a beautiful lesson in the power of being present with another human’s experiences and struggles. I have always naturally felt inclined to listen and hold space for people. Having reestablished what the expectations of being a community acupuncturist are, I feel more equipped to hold this seat. I have also loved learning that creating the perfect treatment or hitting all of the “right” points is not a determinant of success in this profession. Creating a container in community and holding down the energy of the room is just as important.

I also learned that very simple treatments like Miriam Lee 10 can have profound results. As we have talked about many times in class, the frequency of treatments matters more than creating the ‘perfect’ treatment plan. I was surprised to learn that more points is not necessarily better, and even just the Four Gates can have a very powerful effect on the patient.

I (used to) see a Reiki healer who would spend hours talking with her clients. I remember feeling so nourished by the sheer amount of attention that she was able to give me in our treatments. I remember thinking that when I had a practice, I would be able to emulate this quality somehow, that I would be able to provide this service of deep listening and reflection unbound by time. It has taken me some time to grapple with the idea of having to give up this romantic idea of having unlimited time with each client. After observing at a few different clinics, it has made more sense to me as to why this is not possible under this model.

For both the sake of the patient and the practitioner, I think that it is actually to everyone’s detriment to hold an un-boundaried space. I do struggle with this, as I have a tendency to let people go on for hours, pouring out their hearts. Though I think that this all comes from a beautiful place, I think that it helps to protect both patient and practitioner to have boundaries and to honor limitations.

Through the classes on trauma informed care, and through my own personal experiences as well as examples that I have seen in clinic observation, I know that I need to keep learning more about the nervous system and trauma responses. Understanding trauma responses and the reasons why people have the reactions that they do in circumstances where they get triggered has helped me to be a lot more compassionate with people.

Even after just this first year of school I have been able to identify trauma responses as they have come up at work and in my yoga classes. I have noticed that I cannot unsee it. It has helped me immensely to remain neutral, kind, and careful of how I engage people. It makes me interested and curious to learn more, and grow more in my space-holding abilities. It makes me think of the times that I have been in situations with ‘healers’ where the space was poorly held, or trauma responses were not recognized as such, and the situation quickly escalated. I can see the importance of developing this skillset and being able to fluidly adopt this into my punk persona.

Patients will come in struggling with stress, grief, trauma, financial hardship, injury, aging, and illness. I seek to have the ability to set my biases aside in order to treat them from the most neutral and consistent place possible. In Dope is Death, community acupuncture grew out of a desire to make healthcare accessible by people who had been excluded by the healthcare system. I think that having the ability to help people who desperately need improvement or at least relief with their health carries a responsibility to make it accessible and affordable. The readings and videos that the school has asked us to absorb have made me think a lot about the kind of practitioner that I want to become.

Agnes Giberne’s The Story of the Sun, Moon, and Stars (1898)

Recently I had a conversation with an ORCCA clinic supervisor about what we want second-year students to learn about clinic systems, which led me to think about the second kind of holding space. It echoes Alessa’s theme of remaining neutral, kind and careful in how we engage people — because it’s not just individual human practitioners who hold space for patients, it’s also the clinic systems themselves.

Something I’ve noticed in my years of talking about community acupuncture to anybody who would listen (and some who wouldn’t) is that many acupuncturists assume that low-barrier, high-volume clinics must automatically be chaotic. But it’s actually the opposite. Chaos creates barriers to patients using acupuncture, especially patients who are already dealing with other kinds of chaos in their lives. Inclusion doesn’t mean “anything goes”, and inclusion isn’t ONLY about what happens at the threshold of your practice — who you welcome vs. who you don’t. What’s the point of inviting anybody in, if all you have to offer them is chaos?

Inclusion requires having solid, reliable, user-friendly systems for your clinic; it’s unlikely you’ll be able to maintain a high-volume practice without them. People won’t come back if being in your clinic is a draining experience — for them or for you.

And the more diverse your patient base is, the stronger your systems need to be. WCA pretty much worships systems. We want our clinics to run like clockwork because that’s how we can serve the most people — neutrally, kindly, and carefully. Good systems are the foundation for trauma-informed practice. We want our students to experience this first-hand during their clinical internship.

Someone has to be responsible for the care and feeding of those systems, though, which gets us to the third kind of holding space — leadership.

Agnes Giberne’s The Story of the Sun, Moon, and Stars (1898)

Just like individual practitioners hold space for individual patients by having good boundaries, and clinic systems hold space by making the clinic user-friendly and predictable for dozens or hundreds or thousands of patients, leaders hold space for organizations — because organizations are containers too, and someone has to tend to them accordingly.

Our goal is for leadership at WCA to also operate neutrally, kindly, and carefully. (Doesn’t that sound like Haley?) But the first step in succession planning was asking ourselves: is WCA a success-ible organization? Before we try to identify a future generation of leaders, is the organization itself in any shape to be handed over? To anyone? Without feeling like either a crushing burden, or an unmanageable collection of fragments crazy-glued together?

The initial answer was: wow, no — we’ve got some work to do! On the container itself! And even though we’ve found our next Executive Director, making WCA success-ible is an ongoing project. We want to make its organizational systems run as well as its clinic systems. We don’t want the next generation of leaders to inherit any chaos.

Honestly, I feel lucky to get to work on this project at all; most small businesses don’t have the resources to do succession planning. If you start a small business, by definition you’re responsible for meeting all of its needs. Your job description is always going to be open-ended; even when you have employees, you’ll be catching all the stray bits of work that overflow from their jobs. The invisible labor is endless; just trying to explain what you do is exhausting. It’s a challenge to find the energy to get out of that mode enough to build a structure — any structure — for somebody else to take on.

Not many small businesses outlive their founders; I really understand why, but WCA is a community resource that matters to a lot of people so I want us to figure this out. It helps that WCA’s a nonprofit, of course. But unfortunately in small nonprofits with limited resources, leadership is de-incentivized in all kinds of ways. There’s rarely any support, coaching, or leadership development. The unwritten job description for a leader tends to sound like: be responsible for everything, especially all the parts that nobody sees, while everybody’s mad at you for not doing more.

That’s really, really not what we want for the next generation of leaders at WCA.

Working on the organizational container involves multiple areas of effort; I’ll get into more of the details in a future post. In general, though, we’re trying to make invisible leadership visible and distributed, so that leaders feel supported. Part of this is building a leadership-positive culture at WCA.² Succession planning is like holding space for WCA’s future, and it’s something that we’re learning how to do as we’re doing it. Stay tuned for more notes on the process.

1. For another beautiful student self-evaluation:

2.