How I read a case.
Twenty-three years of practice have refined a clinical orientation, not a method. What follows is an account of that orientation — where it came from, what it borrows, and how it functions in practice.
The enactive frame
Bodies as agents actively constructing predictions about their world, not passively receiving sensation.
The clinical frame I work from is 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 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 language differs; the underlying phenomenon does not.
The biodynamic formation
My clinical formation is in the biodynamic tradition. Fulford and Becker 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.
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 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 Bach's framework not as a system of 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.
Bohlen and Draper-Rodi have kept this orientation alive in clinical contexts where it can look like soft thinking but functions as precision. 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. It is not separate from the somatic; it is another register of the somatic.
Current research engagement
I am currently completing a Master's in pain science and person-centred care at Metropolia University of Applied Sciences, Helsinki. 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. They are the same territory mapped at different scales and in different vocabularies. 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.
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.