Q: Rolfers™ have traditionally operated outside of the traditional healthcare system, yet more and more clients seek our assistance for issues that relate to pain and various health conditions. Have you engaged or interfaced with the healthcare system, and how have you done so while maintaining the integrity and identity of our work of Rolfing Structural Integration (SI)?

A: The healthcare system was vastly different when I was certified thirty years ago. During the intervening years, my practice and the healthcare system have developed and evolved into an unexpected and oddly satisfying relationship.

During the mid-1980s, there was more time and discretionary income available for ventures into modalities such as Rolfing SI and exploring human potential. At that time, I found it easy to sidestep taking on new clients through workman’s compensation or auto accident claims who sought out Rolfing SI to relieve the pain and discomfort of their injuries. But inevitably former ‘cash’ clients would be injured either at work or in an auto accident, and eventually I acquiesced to taking the extra time necessary to fill out and submit the required forms and SOAP notes, to bill according to diagnostic codes, etc., in order for them to receive the treatment they were entitled to according to their insurance claim.

Initially, I was fairly shortsighted: I was more invested in assuring my clients got the help they sought without incurring additional cost, and that my services would be covered by their insurance, than I was concerned with any long-term ramifications. I didn’t particularly enjoy the extra time involved doing paperwork or the time lag for payment, however it usually (but not always) worked out.

Unexpectedly, what did ensue from this interface with the healthcare system was requests from these various clients to make presentations on the efficacy of Rolfing SI at their various workplaces – which have included Shriner’s Children’s Hospital, University of Hawaii School of Nursing, Kapiolani Community College Massage License Program, Institute of Clinical Acupuncture, etc. What began as a reluctant one-person endeavor ended up having a the favorable and far-reaching impact of raising public awareness of our work in the healthcare field in my local community. This pleases me as it’s a lot more fun to share what I know about Rolfing SI than to fill in the appropriate boxes on those silly forms.

Sally Klemm Advanced Rolfing Instructor

A: You can look at the question from different perspectives. One is a kind of ‘administrative’ (insurance) or even governmental (licensing) point of view. This has different implications in different countries, even within the EU where healthcare systems are not interrelated – there are lots of different histories of how healthcare systems developed within Europe. One example is that in Germany we have the so-called Heilpraktiker license, which allows the practitioner to treat clients outside of the traditional allopathic-oriented healthcare system. In France, there are very rigid regulations that almost prevent practitioners from treating people unless you are a medical doctor. (From my perspective, this is one of the reasons we still have almost no French Rolfers, even though France is part of the EU. Additionally, in Germany there are ‘systemic’ hierarchic regulations; for instance, even as a physical therapist (PT) you are not allowed to diagnose and treat clients without a prescription from an MD. You can imagine how delicate, difficult, and sometimes impossible it can be for Rolfers to interface with the healthcare system. Another point is that Dr. Rolf’s method goes beyond the clinical frame of the healthcare system. Clinical work focuses more and more on details and seems to have lost the ability to look at people from a holistic point of view.

Sometimes I perceive myself as being caught between two opposing directions: staying with our method and our tradition on the one hand, or finding a meaningful response to increasing demand from what is outside – let’s call it ‘clinical’. As I have the situation of being a PT and a Rolfer, I see the need to find answers that allow an attitude of ‘as well as’ instead of ‘either/or’. I have no satisfying answer to this challenge, but I am more optimistic about the future given the latest research results and a slight movement towards the acknowledgment of complementary medicine methods. The challenge for us as SI practitioners might be how we answer the question of how to relate ‘clinical aspects’ (which needs to be defined) and the tradition of Rolfing SI in a meaningful way.

Jörg Ahrend-Löns Rolfing Instructor

A: What is the relationship between structural integration and traditional health care? To answer this question we confront our historical ambivalence and ambiguity about our work: ambivalence about who we are as practitioners; ambiguity around what it is that we do. What makes our work traditional? What makes our work non-traditional or distinctively different?

It’s a puzzle: to the casual passerby, we apply hands to soft and bony tissue. We claim to affect things in the domain of physiotherapists, osteopaths, chiropractors, and even orthopedists. Is this comparison and apparent similarity apt? How do we wish to be perceived? Do we want to be categorized with physicians?

When we have clients who also see medical professionals, we notice an important conceptual difference. The medical field offers a paradigm of treatment. Rolf steered us away from the idea that we treat people, telling us we are not, in fact, therapists. She insisted we are educators. It’s accurate to say ‘body educators’ – we coax forth the body’s latent intelligence. This is not a trivial point.

Medically trained practitioners don’t think in terms of patients’ bodies needing better information. We don’t hear physicians or physical therapists speaking about how to improve the ingredients to motor control as manifested in posture and movement. People who come to see us have usually not heard medical professionals use words like coordination, conflicted motor pattern, premovement, eccentricity/palintonicity, or self-regulation. During intake, clients tell us the names of their problem body parts. We rightly get the impression that traditional/ medical models are mechanical models of dysfunction: an ‘identify and fix the part to relieve the symptoms’ approach. This isn’t wrong; it’s the medical point of view. How might we characterize something different from a mechanical model?

Rolf had the chance, almost a century ago, to discern the difference between mechanical and systems approaches. In the 1920s and 1930s, holistic forms of thinking achieved popularity in the scientific world. Rolf conceived her work during a time in which ‘systems views’ of biological activity gained influence. Systems models posit that looking at parts can obscure a bigger picture. When we look at the big picture we ask different questions; we start, as Rolf put it, from a different premise.

Medicine plays a vital role. Parts need attention and medical models have their place. However, there is essential value in practitioners who offer a model, and a means, to help people function more intelligently, especially if they find little useful or lasting remedy from traditional fields. We have been educated to think about body systems holistically.

A concise example can be gleaned from an article I wrote for an earlier issue of this journal. A PT referred a man with trauma to his pelvis; he had undergone two surgeries to correct the source of his pain. The PT, who had worked with this individual continuously for several years, is skilled and intelligent. When I watched this new client move, it was obvious that his attention was directed toward control of his anatomy. He was working diligently to manage the ‘parts’, to make the right things move in the correct shape. Missing was a broad spectrum of skills to organize or reboot normalized movement. Missing were simple things like: a reasonable sense of weight and how this weight translates into support; perception of spatial orientation that translates into support; capacity to allow automatic governance to orchestrate his movement; evidence that fascial touch was used to differentiate his sensory and motor maps. The PT had done diligent work – but within a paradigm in which body parts are assessed as too weak or too strong, or incorrectly positioned. It’s a mechanical model: what we often called a ‘body-as-soft-machine’ model. Structural integrators offer an information model – a system model – that posits that when a body behaves poorly, it’s often not the fault of bad parts. Rather, it’s the result of blocked intelligence and faulty information. Blocked intelligence and faulty information are remedied through a process of differentiation and integration, in which a system organizes, learns, and anchors more intelligent motor activity.

The good news is that structural integrators occupy a niche in which soft/bony tissue manipulation and positioning don’t have to become a limiting focus. We work within a field of inquiry that holds more complex and holistic questions about why a person does not spontaneously heal. To articulate this viewpoint, in words that are accessible, is a challenge – but hardly an insurmountable one. Words that do justice to Rolf’s work are, moreover, less prone to imitation. We have the chance to offer clients a new perspective, a refreshing perspective. We offer a different model for those seeking new answers to a range of nagging physical and psychological issues. We have the opportunity to confront our field’s historical ambivalence and ambiguity about who we are and what we do.

Kevin Frank Rolf Movement® Instructor

A: Perhaps it is an illusion to try and find a sort of objective answer for this question – there are so many subjective dimensions involved. I can only report my personal experience, more than forty years ago. I had ten sessions of Rolfing SI, later four sessions of the old advanced series. My Rolfer did not say a word about what this work is about, or should be about. He did the Ten Series with ninety-four people in my circle of acquaintances (yes, ninetyfour! – this was during the 1970s). Most of them appreciated the ten basic sessions a lot, but not so much the old advanced series. There was no philosophy of Rolfing SI involved, no talk about alignment, no talk about gravity, and no talk about symptoms. There was almost no talk using words, but the touch of the practitioner talked to me on several levels. I experienced two dimensions of the process: the serious dysfunction in my left knee was handled brilliantly, and something happened to my organism as a whole – sort of a general ‘lightness’ and definitely a subtle correction of the way I was used to moving. It was a deep experience, and I am glad I wrote something down about it – as we know, our memory changes the content of our experiences all the time.

Later, when I came to the Rolf Institute® in Boulder as a young Rolfing instructor, I listened to the battles happening between some of us instructors. Are Rolfers allowed to fix things or not? Sitting there, I thought this was a funny question. It is perhaps more meaningful to ask, “Are Rolfers able to fix things or not?” I experienced that some were, and still are, able to do so. Louis Schultz once stated, “We are all either balancers or fixers.” In my opinion, a Rolfing instructor helps students most if he opens both avenues for them, then the young Rolfer has a choice. If s/he learns only one dimension of the work, s/he has no choice and will face difficulties making a living.

Occasionally I work with people who had sessions with Ida Rolf. They report that they felt her work had these two dimensions: She would take any opportunity to work with people with serious problems who were seeking help from manual medicine – ask Jim Asher about the story of the woman and the iron lung! And Ida Rolf worked under the license of her son, Richard Demmerle DC.

I learned from my first experience of this work: the reality of Rolfing SI is not so much what we intend it to be, it is much more what the client experiences. And as soon as the client finds a way out of dysfunction and pain, it will be easier to follow a process of global alignment and balance and free movement.

Of course there is the question of licenses and insurance. We have to wait to see what comes out of the involvement of Rolfing SI in healthcare, if something ever happens. Let’s see what the Swiss are able to accomplish by making Rolfing SI a part of the recognized complementary medicine scene. Swiss watches still seem to work pretty well!

Peter Schwind Advanced Rolfing Instructor

A: In Switzerland there are two organizations – EMR (Register of Empirical Medicine) and ASCA (Swiss Foundation for Complementary Medicine) – that recognize certain therapies and certain therapists. The EMR and ASCA are each recognized by a group of different complementary health insurances that refund recognized therapies or therapists. ASCA is more present in the French part of Switzerland and approximately ten insurances work with them; EMR is present in the whole of Switzerland and around thirty-five other insurances work with them. A Rolfer needs to sign up and pay a yearly fee to both organizations (around $600 total) if he wants his sessions to be refunded by all complementary insurances. He can only do that if he has done a certain number of sessions already, if he has studied a minimum of 150 hours of anatomy in an approved school, and if he can prove that he is doing a minimum of three or four days of continuing education per year.

This general scenario will probably change in the future as a new métier is slowly taking place in Switzerland: Therapist of Complementary Medicine. There is already a course in place that allows therapists of all kinds to register to earn this designation. Our Swiss Rolfing board, and in particular our former president Marlene Sonderegger, have worked hard to have our curriculum accepted as a training in Structural Integration (Rolfing). Guild for Structural Integration practitioners are recognized as well, so to be more precise, structural integration is recognized and Rolfing Structural Integration is a brand. In our Swiss Association, we have both Rolfers and Guild Practitioners. Further down the line, schools for this new métier will be created. A few exist already. In such schools, there are two years of common-core studies in which anatomy, physiology, psychology, etc. are taught. Then there is another year of study for the particular method the therapist is working with (there is a minimum of hours, and Rolfing SI meets the criteria). This Swiss initiative has been recognized as a possible future project for recognition of complementary therapists in different European countries over the long term. We are not there yet.

France Hatt-Arnold Rolfing Instructor Rolf Movement Instructor

A: I have been practicing Rolfing SI for more than forty-five years. During that time I lived in Northern New Mexico, and for the past six years in the heart of Los Angeles. I have never advertised my services, and did not have a website until I came to LA. All of my business has come to me by wordof-mouth referrals: that is the means where one person I have served well tells friends and family, and this grows a reputation. I have also ridden the wave of awareness of Rolfing SI as a useful adjunct to other means of healthcare.

Rolfing SI’s fortunes have risen and fallen with changes in the culture. Starting with Ida Rolf herself, treating one person at a time, and then teaching small groups of other interested professionals in parallel lines of work, like chiropractors, osteopaths, and related disciplines. By now thousands of people have benefitted from Rolfing SI, but we have never been able to breach that magical area of ‘third-party payments’. We have accomplished some research to demonstrate that our ideas are valid, and done some clinical research to show that what we do helps some people, but it has not been enough to get the recognition of the value of Rolfing SI.

Rolf took an important position regarding her work. She insisted that we did not fix anything. She insisted that gravity was the therapist. She carefully avoided ever claiming that Rolfing SI was any kind of practice of medicine. She insisted that it was a process of manipulation and education. She even went so far as to say that if a person were interested in relieving symptoms, that they had no business being a Rolfer.

Given a public stance like that, it is no wonder that our profession has never made any headway into recognition by the establishment, or serious competition for the other professions that reach for the consumers’ dollars. We have relegated ourselves to a very particular corner of the therapeutic market in which we are not medical, not therapeutic, but educational. At this point, I have to say that no thirdparty payers in North America pay for education. In fact, when times are harder, as they have been recently, teachers are among the first to lose their jobs.

Most people who find Rolfing SI also find that they pay for it with what is called discretionary income. That is, money not dedicated to essentials like food, gasoline, or rent. It is in this milieu that we exist. We exist on referrals, and on the good will of people we have worked with who got benefit. We exist on a tiny amount of advertising, and the very occasional sports testimonials about higher performance. Most of us do Rolfing practice to make a living, or part of a living. Very few of us practice as a hobby, or sideline.

In this period of the history of Rolfing SI, we have become part of a larger field of hands-on therapeutic practice. My website (remember, new to my time in LA) hooks Google searches with keywords embedded in my front page, like ‘deep tissue’, ‘structural integration’, ‘Rolfing’, ‘myofascial release’, ‘visceral manipulation’, ‘craniosacral therapy’. When a potential client searches for any of the above, Google will hook on my keywords and show my links to the client. That is how I get a good 25% of my business here in the sunny south land. Once the potential client sorts me out from the other links, and calls me, then it becomes my job to either reel him in, or send him on, depending if I think it is a good match for my work.

I almost never get referrals from the ‘medical’ community. That includes the docs, and chiropractors, the acupuncturists, the dentists, et al. Now and then a nurse will refer, or an occupational therapist, or a Pilates, yoga, or other non-medical worker, but almost never from the upper echelon of medical practitioners. This is reinforced by the new wave of ‘evidence-based’ practices, aimed at actively discrediting work like ours to the extent that they want to put us out of competition for clients’ dollars. That is the same battle that Abraham Flexner prosecuted for the medical profession in 1910 (the Flexner Report), successfully putting many of the ‘alternative medical schools’ out of business. Make no mistake, these champions of evidence-based practice are not your friends.

Given this cultural context, my own drive is to develop skills that are useful to my community, and reliable for increasing performance, raising adaptability, alleviating suffering, and bringing referrals based on good results. I don’t care about proving that Rolfing SI works to some amorphous scientific body who will eventually approve of us and admit us into the lofty realm of third-party payments. In that realm, our practices will be constantly challenged, our fees regularly reduced, and our claims denied, leaving the practitioner on the losing end. This situation is already driving many doctors out of business as they can’t cope with lowered fees and fumbling bureaucrats.

I think that our school must prepare our students with a solid education that will enable them to work competently and draw people to them who need them. Rather than struggle to gain acceptance from other professionals who have no interest in opening their doors to us, we should concentrate on proving to ourselves what works and what does not, and developing the work so that we can serve the communities that we live in. I think we are more related to folk healers than medical practitioners, and we should strive to be very good at that.

Six years ago I moved to LA and had the very unpleasant experience of building a business from scratch. I discovered that the high recognition that Rolfing SI enjoyed in the 1970s had given away to questions like “Are they still doing that?” It took me a year and a half to do a full weeks’ work – this in spite of having a pretty wellestablished personal reputation in the field. From this perspective, I think that the Rolf Institute needs to concentrate on producing graduates who can deliver the work across a spectrum of clients. We need to concentrate on the development of solid skills, and good understanding of structure. We need to also teach our grads how to speak about the work, and how to listen to clients’ anecdotal accounts of their state and make sense of it. We need to teach our grads how to listen with their hands, and their hearts, because when people are paying out of pocket, they also need to feel heard and recognized.

Jan Sultan Advanced Rolfing Instructor

A: I will address the two parts I see in this question. The first is “more clients seek our assistance for issues that relate to pain and various health conditions.” The great majority of my clients come for Rolfing sessions because they have a ‘problem’ related to a lack in their health, pain that bothers them, discomfort more or less all day long. Very few clients come to improve their posture. Almost no one comes for personal development in these past decades. So, yes, I constantly face clients’ requests to reduce their pain. What they discover during the Rolfing sessions is a broader field – that involves many aspects of their lives – that needs to be looked at and addressed. This could range from lifestyle to specific coordination and repetitive movement patterns to fixed attitudes in their behavior and worldview that reflect in rigidity in their facial web. What I do is working the fascial net.

Next, you ask if I have been “engaged or interfaced with the healthcare system, and how have you done so while maintaining the integrity and identity of our work?” Yes, I have interfaced with several medical doctors, physiotherapists, and osteopaths, and their responses have been very different. Some doctors simply deny that Rolfing SI could be of any help, and have no recognition of the value of our work simply because it is not formalized by a degree recognized by the healthcare system. Other doctors are totally enthusiastic and had send clients. Pediatricians suggest Rolfing SI for scoliosis for instance, because they noticed remarkable improvement in patients after Rolfing sessions. Medical doctors who have come for Rolfing sessions themselves have no resistance to suggesting it to their patients.

I myself never feel obligated to adapt the principles of our work to a request that comes from rules written by the healthcare system. Clients come for sessions of their own volition, decision, and wish to improve their wellbeing.

Pierpaola Volpones Rolfing Instructor Rolf Movement InstructorRolfing® Structural Integration and Healthcare[:pb]Rolfing® Structural Integration and Healthcare[:]