How I read a case.

The enactive frame

Bodies as agents actively constructing predictions about their world, not passively receiving sensation.

The clinical frame I work from is embodied and enactive. Bodies are not passive receivers of sensation; they are agents actively constructing predictions about their world, and continuously updating those predictions in light of incoming information. Treatment, on this view, is not something done to a body — it is a negotiated encounter between two systems, each of which is already predicting.

The work of Draper-Rodi, Thomson, Esteves, and Sposato on active inference in manual therapy has given precise language to what practitioner training often left implicit: that palpatory attention is a mutual encounter, not an extraction of information from a passive tissue. When I assess a presentation, I am not reading a fixed structure. I am reading how a person's system is currently organising itself — and what that organisation says about its predictions and their costs.

This frame maps usefully onto the biopsychosocial model and the current literature on predictive processing and pain science. It also maps onto somatic-experiential frameworks: what somatic therapists call nervous system regulation, and what manual therapists call tissue tone, are both expressions of the same underlying predictive activity. The vocabulary differs, but as far as I can tell it is the same phenomenon.

The biodynamic formation

My clinical formation is in the cranial/biodynamic tradition. Drs Fulford, Becker, Wales and Jealous shaped how I was trained to attend — with patience, with a quality of listening that precedes any technique decision. That lineage does not mean I work only with breath and tide; it means that the quality of attention I bring into a clinical encounter was formed in a tradition that takes sustained observation seriously as a clinical act. I hold my fair share of opinions on those models, but their insistence on open listening is still golden in my view.

Cranial/Biodynamic practice at its core is about the sequence of attention: what you notice before you intervene, how long you stay with that noticing, and what emerges from sustained contact before any deliberate technique. The technical vocabulary of biodynamic work — inherent motion, fluid fluctuation, primary respiratory mechanism — is less important to me than the quality of presence that the tradition cultivates. That quality travels across frameworks; it is not confined to any particular model of the body.

Bach, Bohlen, and observational precision

I use Edward Bach's framework not only as a safe system of available remedies but as an observational structure — a vocabulary for reading how a person organises their relationship to difficulty. The thirty-eight states Bach described are observational categories: how a person positions themselves relative to fear, relative to exhaustion, relative to uncertainty. Used clinically, they function as a precision instrument for noticing what a person does with constraint, rather than only what the constraint is.

Researchers like Cerritelli and Bohlen have kept this kind of observational precision alive in clinical research. Attending to what a person does with difficulty — how they hold it, whether they contract into it, whether they attempt to exit it before it has been fully read — changes what treatment is required and when.

Current research engagement

I am currently completing a Master's in Osteopathy at Metropolia University of Applied Sciences, Helsinki, developing knowledge in neuroscience, enactive approaches, person-centred care, pain science, and sustainable leadership. That engagement keeps my clinical reasoning in active conversation with the current literature on central sensitisation, predictive processing, and evidence-informed practice in manual therapy.

The research does not replace the clinical orientation described above — it refines it. Central sensitisation, allostatic load, and the evidence base for manual therapy are not separate topics from enactive cognition and biodynamic formation. To me they are the same territory, mapped at different scales. My interest is in where those vocabularies converge and where they genuinely diverge — and what that means for a clinical encounter.

What this means in practice

A consultation session is structured around the case you bring. I will listen to the presentation, ask questions that probe its edges, and then offer what I can see from my clinical frame. I will tell you where my reading agrees with yours and where it diverges, and why. I will not soften a disagreement to make the encounter comfortable — that is not what peer consultation is for. Expect a conversation that is kind, realistic, and opinionated.

I learned directly from older and contemporary osteopaths in France, England, the USA and Canada — which I think puts me in a good position to help if you are looking to liberate yourself from the often rigid and proprietary teachings of most osteopathic schools. It all boils down to the same principles that have been complexified and mystified — the French are partly to blame for that, as we do prefer things on the complicated side.

What I will not do: offer a proprietary method that explains everything you have been unable to explain. The offer is a second read from a specific clinical orientation, not a new single model. If you are looking for a framework that resolves all complexity, this engagement will disappoint.