Homeopathic Practitioners' Experiences Regarding Their Use Of

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Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD. (Chemistry)/ M.Sc. (Physics)/ M.A. (Philosophy)/M.Com. (Finance) etc. [Unpublished]: University of Johannesburg. Retrieved from: https://ujcontent.uj.ac.za/vital/access/manager/Index?site_name=Research%20Output (Accessed: Date).

Homeopathic practitioners’ experiences regarding their use of Bach flower remedies in practice

A Research Dissertation presented to the Faculty of Health Sciences, University of Johannesburg, as partial fulfilment of the Masters Degree in Technology: Homeopathy by:

Cecilia Gorete Dos Santos (Student number: 201008083)

Supervisor: ______Dr. J. Pellow: M. Tech Hom (TWR) Date

Co-Supervisor: ______Dr. R. Patel: M. Tech Hom (UJ) Date

DECLARATION

I, Cecilia Gorete Dos Santos (Student Number 201008083) declare that the Homeopathic practitioner’s experiences regarding their use of Bach flower remedies in practice is my own work. This work is being submitted for the degree of Master of Technology: Homeopathy at the University of Johannesburg. Permission to carry out this study was granted by the Higher Degrees Committee of the University’s Faculty of Health Sciences Committee (HDC-01-38-2017) as well as the Research Ethics Committee (REC-01-9-2017). This work has never been submitted for any other qualification to any other university.

______Signature Date

ABSTRACT

Bach flower remedies are a set of 38 individual remedies developed by Dr Edward Bach in the 1930’s. These remedies are categorized as complementary medicines, and focus mainly on the restoration of mental and emotional balance. While these remedies are available to the public at selected health shops, they are frequently prescribed by homeopathic practitioners. Research studies done on the effects of Bach flower remedies are limited and have shown conflicting results. The extent of the use amongst homeopaths as well as their experiences leading to their use has not yet been explored. The investigation into Bach flower remedies from a homeopathic perspective is of use to homeopathic practitioners, educators and researchers.

The aim of this study is to explore and describe the experiences of homeopathic practitioners in the Gauteng area who are making use of Bach flower remedies by means of individual interviews with information rich participants.

This qualitative phenomenological study serves to provide insight into the experiences of homeopathic practitioners who make use of Bach flower remedies in the context of professional homeopathic practice in South Africa. Registered homeopathic practitioners in the Gauteng area with experience in using Bach flower remedies were recruited for the study by means of snowball sampling and contacted via telephone or email and provided with information about the study. Practitioners who were willing to take part had to meet the inclusion criteria as well as consent to both participation and the audio recording of their interview before commencing. The audio recordings allow for data to be accurately captured and transcribed, followed by an analysis for any trends and themes. There were fourteen practitioners who participated in this study. Interviews were steered by one central question, “Describe your experiences using Bach flower remedies in homeopathic practice”.

Data was coded using three coding methods, as described by Johnny Saldaña (2013). These were grammatical methods, elemental methods and affective methods. Five themes emerged, these being: value in practice, remedy application in practice, practitioner perceptions, education and Bach flower remedies outside of homeopathic practice.

This study explored the practitioners’ experiences and found that in general, practitioners have had positive experiences with Bach flower remedies. Participants acknowledged the safety and value that these remedies have in practice and perceive them to be a useful adjunct to their treatment iii approach. Remedy preparation and dispensing methods vary widely; practitioners may dispense either a single Bach flower remedy or multiple remedies at a time in the form of a complex, or a Bach flower remedy complex prepared together with well indicated homeopathic remedies. Due to a perceived shared philosophy between homeopathy and Bach flower remedies, many practitioners have embraced the use of Bach flower remedies in their practice.

Participants were divided on the desire to pursue further training on Bach flower remedies. Participants encouraged the inclusion of Bach flower remedies as part of the homeopathic course material and the reaffirmation of this information when beginning work at the campus clinic.

The availability of Bach flower remedies at health retailers was met with some resistance. Although participants noted that the remedies are safe, the concern arose that patients may not achieve the desired outcomes from these remedies without the necessary guidance and management. Some participants felt that Bach flower practitioners, with their limited medical knowledge, may mismanage patients’ symptoms when depending on Bach flower remedies alone, however many welcome the assistance and view their skills as a helpful contribution to society.

As practitioners expressed positive outcomes from using Bach flower remedies, Bach flower remedies may be found to be a useful adjunct in homeopathic practice. Homeopathic educators should reiterate and reinforce the role of Bach flower remedies for students of homeopathy, both theoretically and in a practical, clinical setting.

Through this study, a fundamental understanding of the role that Bach flower remedies have for the homeopathic practitioner has been established, creating an opportunity for further study in this field.

DEDICATION

This work is dedicated to Love and its endless acts of kindness, without which these chapters would have never been written.

To Mom and Dad for being examples of it, Fatima, Jorge and Paulo for sharing it, And Michael for the promise of a future filled with it.

ACKNOWLEDGEMENTS

I would like to share my sincerest gratitude and thanks to those who made this all possible.

To all the practitioners who offered me time from their busy schedules to participate in this study, thank you. This study would not have been possible without you.

To Dr Pellow, thank you for your guidance and willingness to take on the qualitative research challenge as my supervisor. I am so grateful for your open door, and all the help, direction and advice you offered me throughout this process.

To Dr Patel, thank you for your advice and input as my co-supervisor. I so appreciate it.

Thank you to Owen Manda for taking the time to discuss qualitative ideas and methods with me. Thank you for guiding my data analysis and validating this research study. You assisted in enhancing its value and accuracy.

To Dr Razlog and all the members of the Department of Homeopathy at the University of Johannesburg, thank you for sharing your knowledge with me during my years of study. You’ve all enriched my life.

To those who gave me words of motivation and inspiration along this journey, and those who offered me some guidance and direction along my path, I am incredibly grateful.

To my family and friends thank you for your endless love and support. Thank you for every word of encouragement, your daily care and continuous prayer throughout my studies and research. I am so richly blessed to have you all. To my special Avó Eliza for being an inspirational healer and always believing in me, thank you and we miss you. You are all angels who have lit my path. You have shared guidance and hope in dark times. You will all forever be dearly kept close to my heart.

TABLE OF CONTENTS

AFFIDAVIT ...... i

DECLARATION ...... ii

ABSTRACT ...... iii

DEDICATION ...... v

ACKNOWLEDGEMENTS ...... vi

TABLE OF CONTENTS ...... vii

LIST OF TABLES ...... xi

LIST OF FIGURES ...... xii

CHAPTER 1: OVERVIEW OF THE STUDY ...... 1

1.1 INTRODUCTION ...... 1

1.2 CONTEXTUALIZING THE STUDY ...... 1

1.2.1 Homeopathy ...... 2

1.2.1.1 Introduction to Homeopathy ...... 2

1.2.1.2 History of Homeopathy ...... 2

1.2.1.3 Principles of Homeopathy ...... 3

1.2.2 Homeopathic Education in South Africa ...... 4

1.2.3 Homeopathic Scope of Practice ...... 5

1.2.4 Bach Flower Remedies...... 5

1.2.4.1 Introduction to Bach Flower Remedies ...... 5

1.2.4.2 Dr Edward Bach ...... 5

1.2.4.3 The Thirty-eight Bach Flower Remedies ...... 8

1.2.5 Production of Bach Flower Remedies ...... 15

1.2.6 Method of Prescribing Bach Flower Remedies...... 16

1.2.7 Safety of Bach Flower Remedies ...... 16

1.2.8 Regulation of Bach Flower Remedies in South Africa ...... 16

1.2.9 Possible Mechanism of Action of Bach Flower Remedies ...... 17

vii

1.2.9.1 Energy Transfer ...... 17

1.2.9.2 Psychoneuroimmunology ...... 18

1.2.9.3 The Placebo Effect ...... 19

1.2.9.4 The Hawthorne Effect ...... 19

1.2.9.5 The Patient-Therapist Relationship ...... 20

1.2.10 Bach Flower Remedy Education ...... 20

1.2.11 The Link between Homeopathy and Bach Flower Remedies ...... 20

1.2.12 South African Flower Remedies ...... 22

1.2.13 Related Research on Bach Flower Remedies ...... 22

1.3 PROBLEM STATEMENT ...... 24

1.4 RESEARCH QUESTION ...... 25

1.5 AIM OF THE STUDY ...... 25

1.6 OBJECTIVES OF THE STUDY ...... Error! Bookmark not defined.

1.7 POSSIBLE OUTCOMES ...... 25

1.8 KEY CONCEPTS ...... 25

1.9 RESEARCH DESIGN AND METHOD ...... 27

1.10 SAMPLING ...... 27

1.11 DATA COLLECTION TECHNIQUE ...... 27

1.12 DATA ANALYSIS ...... 28

1.13 TRUSTWORTHINESS ...... 28

1.14 ETHICAL CONSIDERATIONS ...... 28

1.15 CHAPTER DESCRIPTION ...... 28

CHAPTER 2: METHODOLOGY ...... 29

2.1 INTRODUCTION ...... 29

2.2 RESEARCH DESIGN AND METHOD ...... 29

2.2.1 Qualitative Design ...... 29

2.2.2 Phenomenology ...... 29

2.3 SAMPLING ...... 30

viii

2.3.1 Purposive ...... 30

2.3.2. Snowballing ...... 31

2.3.3. Inclusion Criteria ...... 31

2.4 RESEARCH PROCEDURE ...... 31

2.5 DATA COLLECTION AND ANALYSIS ...... 32

2.5.1 Data Collection ...... 32

2.5.2 Data Analysis ...... 33

2.6. TRUSTWORTHINESS ...... 37

2.6.1 Credibility...... 37

2.6.2. Transferability ...... 38

2.6.3 Dependability ...... 38

2.6.4 Confirmability ...... 39

2.7 ETHICS ...... 39

2.7.1 Autonomy and Respect for Persons ...... 39

2.7.2 Non-maleficence and Beneficence ...... 40

2.7.3 Justice ...... 40

2.8 CHAPTER DESCRIPTION ...... 40

CHAPTER 3: ANALYSIS, RESULTS AND DISCUSSION ...... 41

3.1 INTRODUCTION ...... 41

3.2 DATA COLLECTION ...... 41

3.3 DEMOGRAPHICS ...... 42

3.4 DATA ANALYSIS ...... 44

3.5 DISCUSSION OF RESULTS ...... 45

3.5.1 Theme One: Value in Homeopathic Practice ...... 47

3.5.1.1 Category 1: Practitioner Experiences ...... 47

3.5.1.2 Category 2: Grounds for Prescribing ...... 67

3.5.2 Theme Two: Remedy Application in Practice ...... 68

3.5.2.1 Category 1: Symptoms and Context of Use ...... 68

3.5.2.2 Category 2: Remedy Preparation and Dispensing...... 71

3.5.2.3 Category 3: Bach Flower Remedies in Practice ...... 78

3.5.3 Theme Three: Practitioner Perceptions ...... 78

3.5.3.1 Category 1: Patient Response ...... 78

3.5.3.2 Category 2: Bach Flower Remedies and Physical Symptoms ...... 81

3.5.3.3 Category 3: Relevance ...... 83

3.5.3.4 Category 4: Practitioner Opinions ...... 85

3.5.3.5 Category 5: South African Flower Remdies ...... 86

3.5.4 Theme Four: Education ...... 88

3.5.4.1 Category 1: Bach Flower Remedies at University ...... 88

3.5.4.2 Category 2: Bach Flower Remedy Exposure ...... 91

3.5.4.3 Category 3: Sources of Information ...... 92

3.5.4.4 Category 4: Additional Training ...... 94

3.5.5 Theme Five: Bach Flower Remedies Available Outside of the Homeopathic Practice 98

3.5.5.1 Category 1: Bach Flower Remedies in Stores ...... 98

3.5.5.2 Category 2: Bach Flower Remedy Practitioners ...... 108

3.6 RESEARCHER’S BRACKETING, REFLEXIVITY AND OBSERVATIONS ...... 111

3.7 CHAPTER DESCRIPTION ...... 112

CHAPTER 4: CONCLUSION AND RECOMMENDATIONS ...... 113

4.1 INTRODUCTION ...... 113

4.2 CONCLUSION ...... 113

4.3 LIMITATIONS ...... 117

4.4 RECOMMENDATIONS ...... 119

4.4.1 Recommendations for Homeopathic Practitioners ...... 119

4.4.2 Recommendations for Homeopathic Educators ...... 119

4.4.3 Recommendations for Bach Flower Remedy Trainers and Retailers ...... 120

4.4.4 Recommendations for Future Researchers ...... 121

4.5 CHAPTER DESCRIPTION ...... 121

REFERENCES ...... 122

APPENDIX A

Permission letter to the Registrar of the Allied Health Professions Council of South Africa ..... 131

APPENDIX B

Information Sheet ...... 132

APPENDIX C

Participant Consent Form ...... 136

APPENDIX D

Consent for Audio Recording ...... 138

APPENDIX E

Confidentiality Agreement - Editor ...... 139

APPENDIX F

Confidentiality Agreement and Research Validation from the Qualitative Analyst ...... 140

APPENDIX G

Higher Degrees Committee Letter ...... 141

APPENDIX H

Academic Ethics Committee Letter ...... 142

APPENDIX I

Transcript Example...... 143

APPENDIX J

Table of Codes ...... 153

LIST OF TABLES

Table 1 Themes, categories and sub-categories Page 45

LIST OF FIGURES

Figure 1.1 Dr Edward Bach Page 7 Figure 1.2 Mount Vernon Page 7 Figure 1.3 The three components of the human existence Page 21 Figure 2.1 Data analysis process Page 35 Figure 3.1 The relationship between the number of years in Page 43 homeopathic practice and the number of years making use of Bach flower remedies Figure 3.2 The extent to which Bach flower remedies were covered in Page 44 the course material Figure 3.3 The interest of homeopathic practitioners to pursue further Page 44 learning on Bach flower remedies

xii

CHAPTER 1: OVERVIEW OF THE STUDY

1.1 INTRODUCTION This chapter illustrates the framework in which the study was carried out. It describes the research problem and aim of the study, as well as the theory and background knowledge on which the study is based.

1.2 CONTEXTUALIZATION OF THE STUDY Bach flower remedies are a set of thirty-eight individual remedies developed by Dr. Edward Bach, an English medical doctor and homeopath in the 1930’s. In South Africa, this collection of remedies is categorized as complementary medicines. Bach flower remedies are used to restore mental and emotional balance. Dr. Bach’s philosophy on health and disease suggests that all illness is rooted in emotional instability and he believed that the body is able to heal itself more effectively when in emotional balance (Vlamis, 1994). He established these remedies to address seven specific negative emotional states, these being: Fear, Uncertainty, Insufficient Interest in Present Circumstances, Loneliness, Oversensitivity to Influences and Ideas, Despondency and Despair, and Overcare for the Welfare of Others. Most of these remedies were discovered by Bach in the English countryside (Weeks, 1940), however the flower remedies Olive and Vine were obtained from friends living in Europe, where they grow naturally. The remedy Rock Water, although listed as one of the flower remedies, is in fact not made from a flower at all. This remedy is essentially water which is gathered from a pure water spring in the English countryside (Ball, 2013).

Bach flower remedies have been incorporated into the homeopathic field of study as one of several contributions made to the field by Dr Edward Bach (Weeks, 1940), a medical doctor who turned to homeopathy later in his career. Today, homeopathic practitioners may make use of Bach flower remedies to treat the emotional state of the patient and encourage healing (Vennells, 2001). In her book, Applying Bach Flower Therapy to the Healing Profession of Homoeopathy, Psychology, Psychiatry, Psychosomatic Medicine, Dr Cornelia Richardson-Boelder states that Bach flower remedies have a complementary action to homeopathic remedies when used in combination, and may result in a greater improvement, particularly on the mental and emotional plane of the patient (Richardson-Boelder, 2002).

The homeopathic consultation and treatment provides great consideration for all facets of the patient, these being their physical symptoms as well as their mental and emotional state. In this 1 way, the patient is viewed in totality and treated with a remedy which may accommodate every state of being experienced by the patient. As studied in the field of positive psychology, a negative state of mind is thought to negatively affect health while positive emotions enable the thriving of an individual; this indicates the importance of treating the mental and emotional state of the patient as part of the treatment plan (Fredrickson, 2003).

Homeopathic practitioners may prescribe Bach flower remedies in combination with homeopathic remedies or in isolation. Bach flower remedies are also available to the South African public at certain health shops and pharmacies nationwide.

Education regarding these flower remedies has been incorporated into the homeopathic training programs at the University of Johannesburg and at the Durban University of Technology in South Africa, as they are clustered with homeopathy, as well as western herbal medicine, by the Medicines Control Council (MCC) due to the overlap “on the basis of their method of production” (Medicines Control Council, 2016).

1.2.1 Homeopathy 1.2.1.1 Introduction to Homeopathy Homeopathy is a form of complementary medicine founded by Dr Samuel Hahnemann, born in Germany on the 10th of April 1755. Hahnemann, being a linguist, doctor and promising chemist of his time, found himself on a quest for a more gentle form of treatment, as medical treatments of his day appeared brutal to him and included therapies such as bloodletting. Hahnemann was ahead of his time in terms of his understanding of the mind-body relationship, and acknowledged that health is also maintained through diet and hygiene. These were relatively novel concepts at the time (De Schepper, 2006). The therapeutic system of homeopathy became well established within Hahnemann’s lifetime and is still a leading form of complementary medicine today. The name homeopathy is derived from two Greek words, “homoios” meaning similar and “pathos” meaning suffering (Grollmann & Maurer, 2002).

The substances used to make homeopathic remedies are derived from natural sources (Chappell, 1994) such as plants, animals, metals and minerals among others (Grollmann & Maurer, 2002).

1.2.1.2 History of Homeopathy Hahnemann abandoned allopathic medicines to pursue and cultivate homeopathy. Despite being met with much criticism from colleagues, he was persistent in his pursuit, only prescribing 2 remedies which he had first tried on himself. Hahnemann’s growing field of health and treatment made its mark when he used homeopathic medicine successfully to treat the victims of several epidemic outbreaks in Europe throughout his career, these being scarlet fever, typhus and cholera. As homeopathy proved to be successful, Hahnemann gained many followers, who would later continue his work (De Schepper, 2006).

1.2.1.3 Principles of Homeopathy Hahnemann perceived symptomatic manifestations of disease as the body’s attempt to heal itself (Shealy, 2011). He built homeopathy on the Law of Similars and its supporting principles: the infinitesimal potentized dose, and the single remedy, all of which are applied on the foundation of the principle of the vital force.

In homeopathic philosophy, the concept of a life energy is vital to promote healing. Hahnemann termed this energy the vital force and described it as that which “animates the material body (organism)…and retains all the parts of the organism in admirable, harmonious, vital operations”. The vital force ensures that the body remains healthy, allowing full advantage to be taken of life and one’s personal potential to be fulfilled. Hahnemann explained that the vital force is necessary and responsible for all of the body’s functions and without it the body would be completely lifeless (Hahnemann & Dudgeon, 2002)). The vital force is therefore that which maintains homeostasis on all facets of the patient: mental, emotional and physical, and the homeopathic remedy aims to stimulate the vital force so that it may adequately maintain or restore this balance (De Schepper, 2006).

• Law of Similars This is a fundamental law of homeopathy. Hahnemann first established it when he was 35 years old, while doing a translation on Cullen’s pharmacopoeia in 1790 (Grollmann & Maurer, 2002), which described the therapeutic effects of Cinchona bark. After experimenting with it on himself, a healthy man, he found that he developed malaria-like symptoms which disappeared when he stopped taking Cinchona. After several other personal experiments, or “provings” as they became known, this principal of the Law of Similars was born, which states that any substance that causes a specific collection of symptoms in a healthy person can also be used to cure that particular collection of symptoms in the ill. In this way, like cures like (Vithoulkas, 1986).

• The Infinitesimal Potentized Dose Because a crude dose of a remedy could be dangerous, Hahnemann implemented this law which states that a remedy must be diluted before administration. Remedies go through several serial dilutions during their preparations (De Schepper, 2006). With succussion (vigorous shaking) taking place between each dilution, kinetic energy is added to the remedy. This whole process is termed potentization. Through this process, remedies become heightened in their therapeutic properties and their toxicological properties are reduced. In chemistry, Avogadro’s number refers to the number of dilutions which can be made while still being able to trace the original substance. Homeopathic dilutions above 12cH exceed this number, therefore traces of the original substance are almost undetectable (Vithoulkas, 1986). In this dilute form, remedies still offer the desired healing effects without displaying the substance’s toxicological properties (Chapella, 1994).

• Single Remedy Homeopathy is classically practiced by assessing the totality of symptoms being exhibited by the patient. The remedy chosen to restore health for the patient must be indicated in a symptomatic picture that matches the patient’s symptoms as closely as possible (De Schepper, 2006). This principal accounts for the individualization of homeopathic treatment, as only one remedy is selected for the combination of mental, emotional and physical symptoms being displayed by the patient (Grollmann & Maurer, 2002).

Hahnemann affirmed the importance of the single remedy, believing that a single remedy that is carefully selected could adequately fit all the presenting symptoms of the patient (De Schepper, 2006). Hahnemann stated that combining remedies would produce an unknown picture, as the provings had only been done on individual remedies, otherwise known as simplexes (Hahnemann & Dudgeon, 2002). Simplex prescribing is a classical approach to homeopathic prescribing. Clinically orientated homeopaths may prefer to combine remedies, making remedy complexes to cover the desired symptomatic picture of their patients when a single remedy cannot be found or is believed to be insufficient for the presenting case (Homeopathic Dispensary, 2016).

1.2.2 Homeopathic Education in South Africa In South Africa, homeopathy Master’s degree programs (Masters of Technology: Homeopathy) are offered by the Durban University of Technology (DUT) and the University of Johannesburg (UJ). This five-year course provides training as a homeopathic practitioner, a primary health care professional who can diagnose, treat and manage patient care within the homeopathic scope of practice. Once qualified, students may register with the Allied Health Professions Council of South 4

Africa (AHPCSA), a statutory body regulating the profession, as a homeopathic practitioner (University of Johannesburg, n.d.)

In the Master’s program, Bach flower remedies are taught in the third year Auxiliary Therapeutics module and the fourth year Clinical Homeopathy IV module. In the fifth year, students gain experiential training on the practical application of these remedies, at the Homeopathic Health Training Centre, located on the UJ Doornfontein campus as well as the Homeopathic clinic at the DUT Ritson Campus (Brijnath, 2016).

1.2.3 Homeopathic Scope of Practice As per the Allied Health Professions Act 63 of 1982, a homeopathic practitioner registered with the AHPCSA may diagnose, treat or prevent physical and mental disease, illness or deficiencies in humans, and prescribe or dispense medicine or treatment for such conditions (Allied Health Professions Council of South Africa, 2000). Homeopaths may treat or prevent any physical defect, illness or deficiency with remedies, dietary advice or dietary supplementation, in accordance with homeopathic principles (Allied Health Professions Council of South Africa, 1996); including Bach flower remedies (Medicines Control Council, 2016). Today the field of homeopathy is considered a gentle and safe form of treatment for a variety of medical complaints (Allied Health Professions Council of South Africa, n.d.).

1.2.4 Bach Flower Remedies 1.2.4.1 Introduction to Bach Flower Remedies Bach flower remedies are a collection of thirty-eight flower remedies that were discovered by Dr. Edward Bach. This system of complementary medicine is prescribed in cases where emotional disorder is noted. According to Dr. Bach’s therapeutic philosophy, emotional disease is the trigger and root for all disease and illness (Vlamis, 1994).

1.2.4.2 Dr Edward Bach Dr Edward Bach (1886-1936) was a physician who practiced in London. He was also a well- established bacteriologist and immunologist. Once qualified as a physician, he worked at the University College Hospital, among other places, where he developed vaccines against certain bacteria (Vlamis, 1994). Dr Bach was committed to bettering the lives of others but remained driven by the idea of seeking out gentler and simpler means of healing and wellbeing. It was during his time at the London Homeopathic Hospital, working as a bacteriologist, that Dr Bach was

5 introduced to the works of Dr Samuel Hahnemann. He found that homeopathic philosophies resonated with his own. Hahnemann’s work expressed the quest for gentler treatments and also acknowledged the importance of an individualized approach, considering the mental, emotional and physical state of the patient, rather than only the disease (Weeks, 1940).

With new found inspiration, Dr Bach adjusted the way in which he prepared and administered his vaccines. He prepared them homeopathically and directed that they be taken orally. These developed into what is now known as the bowel nosodes. The seven bowel nosodes are made from different strains of intestinal bacilli and have been used for the treatment of many chronic conditions (Richardson-Boelder, 2002). Their use in clinical settings produced positive therapeutic outcomes and the investigations into the effects of intestinal flora earned Dr Bach several publications in distinguished medical and homeopathic journals. These remedies are still in use by several homeopathic practitioners and demonstrate another way in which Dr Edward Bach contributed to the field of complementary medicine (Vlamis, 1994).

Dr Bach abandoned conventional medicine to adopt homeopathic philosophies and treatment methods. He later abandoned these too, feeling that even homeopathy was a complex system with many variables to consider when selecting a remedy (Vohra, 2005). He later dedicated his career to focus only on the remedies he would go on to discover: the thirty-eight Bach Flower Remedies. Dr Bach believed that disease was more than just a physical manifestation of symptoms, but that it rather stemmed from a disharmony between the body and the mind, with the mind being the most sensitive component of the body, which demonstrates the first signs of illness though emotional imbalance. He suggested that negative emotions cause the body’s natural defences to become weakened and vulnerable to illness. He wrote “behind all disease lie our fears, our anxieties, our greed, our likes and dislikes” (Bach, 1941). Such theories had already been proposed by early philosophers and healers such as Hippocrates and Paracelsus. To Dr Bach, the mental and emotional states were key factors in both a patient’s disease and recovery. In this way, the disease itself was not the most important feature demonstrated by the patient, but rather the emotion which underlies that ailment (Vohra, 2005).

Dr Bach acknowledged that spiritual, emotional and mental harmony were important to obtain good health, and that healing came from stimulating the body to move into a state of balance. Dr Bach’s love of nature and his innate desire to be submerged in it caused his relocation to Wales in 1930, where he searched the English countryside and established the Bach flower remedy system as a means to restore the balance between mind and body and thus restore health. Dr Edward Bach 6 wrote, “Seek for the outstanding mental conflict in the patient, give him the remedy that will assist him to overcome that particular fault and all the encouragement and hope you can, and then the healing virtue within him will of itself do all the rest” (Vohra, 2005).

Dr Bach’s desire was to make this healing system simple to use. He wished to share his new-found discovery with everyone, not just practitioners, so that they may establish their own sense of wellbeing. By making information on Bach flower remedies so accessible to the layman, Dr Bach faced threats of being deregistered as a physician by the Register of the General Medical Council, to which he responded that it was the duty of a practitioner to provide the public with the knowledge and the tools to heal themselves (Weeks, 1940).

Dr Bach considered his discovery of the flower remedies as an addition and contribution to Samuel Hahnemann’s work, stating that through Bach flower remedies, he had allowed for Hahnemann’s work to progress in his absence (Vennells, 2001). Bach felt that the Bach remedy system had been completed and wished for it to remain forever in its simple form. He wanted the system to remain pure and free from science, emphasising the simplicity of this healing system. In this way, he never sought to uncover how the remedies worked, and lived in the satisfaction that they did (Ball, 2013).

Dr Edward Bach passed away in 1936, leaving Nora Weeks, a friend and co-worker from his time in London, as well as Victor Bullen, to continue on his work at the Bach Centre at Mount Vernon, in the United Kingdom. While continuing Dr Bach’s legacy, Weeks authored The Medical Discoveries of Edward Bach, Dr Bach’s biography (Vlamis, 1994).

As seen below, are two postcards from the Bach Centre at Mount Vernon, one being of Dr Edward Bach (Figure 1.1) and the other of Mount Vernon (Figure 1.2).

Figure 1.1: Dr Edward Bach (Olver, 2016) Figure 1.2: Mount Vernon (Olver, 2016) 7

1.2.4.3 The Thirty-Eight Bach Flower Remedies Dr Bach discovered the thirty-eight Bach flower remedies, thirty-six of which he found in the English Countryside. He classified the remedies into seven categories of emotional states which are: Fear, Uncertainty, Insufficient Interest in Present Circumstances, Loneliness, Oversensitive to Influences and Ideas, Despondency and Despair, and Overcare for the Welfare of Others. Each remedy within a particular category varies slightly and has specific features which provide its unique contribution to the category (Vlamis, 1994). As guidance for the prescription and use of these remedies, Dr Bach stated that the presenting disease required no attention. What did require attention to make the best remedy selection was taking note of the outlook and emotional state which the patient was experiencing (Bach, 1941). The characteristic indications for each remedy are given below and classified among the seven categories as identified by Dr Bach.

A. Fear • Rock Rose (Helianthemum nummularium) “The remedy of emergency cases where there even appears no hope” (Bach, 1941). Indicated in emergency situations where hopelessness is paired with intense fear or terror. This remedy may be well indicated after trauma or sudden illness or after frightening nightmares. It is most suitable for use in acute cases, generally a result of a particular crisis (Master, 1994). • Mimulus (Mimulus guttatus) Indicated for “fear of worldly things, illness, pain, accidents, poverty, of the dark or being alone, of misfortune” (Bach, 1941). Mimulus is commonly referred to as the remedy for fears derived from known causes and tangible things. It is well indicated for the timid, sensitive and shy patient. These fears are present in their daily lives although they rarely share these fears with others (Master, 1994). • Cherry Plum (Prunus cerasifera) For those who fear losing control of one’s mind, “of reason giving away, of doing fearful and dreadful things, not wished and known wrong, yet there comes the thought and impulse to do them” (Bach, 1941). They fear that they may behave wrongfully, all the while knowing it to be wrong but doing it regardless (Master, 1994). • Aspen (Populus tremula) For “vague unknown fears, for which there can be given no explanation, no reason” (Bach, 1941). Aspen is commonly referred to as the remedy for fears derived from indefinite causes. There is a tendency to feel anxious. Fears may be present both at night and during the day and cannot be explained or justified. There is a reluctance to share their fears with others as they cannot adequately describe the reasons for it (Master, 1994). 8

• Red Chestnut (Aesculus carnea) “For those who find it difficult not to be anxious for other people” (Bach, 1941). These people’s fears are fuelled by over-concern for their loved ones. There is little worry for their own wellbeing but intense concern for those around them, worried for their safety and well-being and often anticipating the worst from ordinary circumstances (Master, 1994).

B. Uncertainty • Cerato (Ceratistugma willmottianum) For “those who have not sufficient confidence in themselves to make their own decisions” (Bach, 1941). Cerato is indicated for low self-confidence or a deep lack of trust in oneself. It is often necessary to seek advice from family and friends before making even simple decisions. At times, this results in being misguided from their true desires, which they may be aware of but too apprehensive to choose (Master, 1994). • Scleranthus (Scleranthis annuus) “Those who suffer much from being unable to decide between two things, first one seeming right then the other” (Bach, 1941). Because of their quiet nature they do not share their indecision with others or seek their advice. They often fluctuate between two extremes of being and are found to be changeable in temperament while bearing their indecision alone (Master, 1994). • Gentian (Gentianella amerella) “Those who are easily discouraged…any small delay or hindrance to progress causes doubt and soon disheartens them” (Bach, 1941). For those who are very easily dispirited, even by minor setbacks or challenges. Their defeated outlook comes about even when there is progress in their lives. They are left with a sense of doubt and despondency. In a Gentian state, they are able to identify the source of their uncertainty (Master, 1994). • Gorse (Ulex europaeus) “Very great hopelessness, they have given up belief that more can be done for them” (Bach, 1941). Indicated for intense hopelessness and despair. There is a sense of futility with a general pessimistic outlook as a result. They may seek help under the persuasion of others yet are convinced there is nothing more that can be done (Master, 1994). • Hornbeam (Carpinus betulus) “For those who feel that they have not sufficient strength, mentally or physically, to carry the burden of life placed on them… though they generally succeed in fulfilling their tasks” (Bach, 1941). For those who feel overwhelmed by the burdens of daily life and doubt their ability to get through the day and complete the necessary tasks. They feel that additional strength is 9

required in order to meet all of their responsibilities. Despite their uncertainty, their resistance and lack of enthusiasm, all tasks are accomplished (Master, 1994). • Wild Oat (Bromus romasus) “Their difficulty is to determine what occupation to follow; as although their ambitions are strong, they have no calling which appeals to them above all others” (Bach, 1941). Wild Oat is indicated for those who are filled with enthusiasm and will to live but are unsure of the path or direction they should take. As a result, they are left feeling dissatisfied, unfulfilled and even bored (Master, 1994).

C. Insufficient Interest in Present Circumstances • Clematis (Clematis vitalba) “For those who are dreamy, drowsy, not fully awake, no great interest in life” (Bach, 1941). For feelings of disinterest accompanied by a sense of detachment from the real world. Their thoughts are preoccupied and filled with the ideals they hold for their future. They spend less time actively working toward progress in the present where they may feel unfulfilled or unhappy. They are likely to withdraw from others, avoid confrontation, spend time alone, lack energy and may pine over lost love and opportunities (Master, 1994). • Honeysuckle (Lonicera carifolium) “Those who live much in the past, perhaps a time of great happiness, or memories of a lost friend, or ambition which have not come true” (Bach, 1941). For those living in their past, constantly reminiscing about happier times, times filled with loved ones, regrets they may feel or the inability to separate from difficult, or fond, past experiences. They become uninterested in the present as they feel that the future will not be filled with any of the happiness they once enjoyed in their past (Master, 1994). • Wild Rose (Rosa carnina) “Those who without apparently sufficient reason become resigned to all that happens, and just glide through life, take it as it is, without any effort to improve things and find some joy” (Bach, 1941). For intense apathy and a complete loss of interest in their surroundings or current circumstances. They do not complain about their circumstances but are also unwilling to actively seek more joy. Although filled with potential, their apathy leaves them unfulfilled and dull as well as over-accepting of unpleasant life circumstances (Master, 1994). • Olive (Olea europea) “Those who have suffered much mentally or physically and are so exhausted and weary that they feel they have no more strength to make any effort” (Bach, 1941). For a disinterest in one’s surroundings as a result of an intense sense of exhaustion from a prolonged period of stress or 10

overstrain. Their lack of energy leaves them unable to make any effort for present circumstances and daily activities that appear too demanding. Exhaustion may result in tears, an increased desire for sleep and an inability to enjoy previously loved activities (Master, 1994). • White Chestnut (Aesculus hippocastanum) “For those that cannot prevent thoughts, ideas, arguments which they do not desire from entering their head… They seem to circle around and around and cause mental torture” (Bach, 1941). For those that feel that unwanted thoughts or ideas constantly invade their minds. These thoughts are recurrent and repetitive. Obsessing over these worries or ideas causes suffering and as a result interfere with their ability to focus on present circumstances (Master, 1994). • Mustard (Sinapis arvensis) “Those who are liable to times of gloom or even despair, as though a cold dark cloud overshadowed them and hid the light and the joy of life” (Bach, 1941). For those that feel completely overcome by a deep sense of sadness which robs them of their happiness. They find it difficult to identify the reason for their apathy. This state of being may come on suddenly and may also dissipate suddenly. This sensation of sadness may be overwhelming and extremely difficult to rise from at will (Master, 1994). • Chestnut Bud (Aesculus hippocastanum) “For those who do not take full advantage of observation and experience, and who take a longer time than others to learn the lessons of daily life” (Bach, 1941). For those that do not learn from previous mistakes. It is often needed to make the mistake several times before the lesson is learnt from it. This may lead to a very slow progression through life and delays in dealing with the true cause of their mistakes or misfortunes (Master, 1994).

D. Loneliness • Water Violet (Hottonia palustris) “For those who in health or illness like to be alone” (Bach, 1941). For those that enjoy their own company and like to be by themselves. There is a tendency to be quiet and gentle, intelligent and talented, peaceful and calm. They are independent, follow their own path and are unaffected by the views of others. They do not impose on those around them and remain private about their own affairs. They may appear proud, anti-social and superior. Due to their self-reliant qualities, they are unlikely to share their sufferings with anyone and may keep distant relationships with others (Master, 1994). • Impatiens (Impatiens glandulifera) “Those who are quick in thought and action and who wish all things to be done without hesitation or delay” (Bach, 1941). For those whose impatience results in their own loneliness 11

as they cannot tolerate hesitancy and indecision in others. As a result, they would prefer to work alone. They are generally quick, efficient in their ways and independent (Master, 1994). • Heather (Calluna vulgaris) “Those who are always seeking the companionship of anyone who may be available, as they find it necessary to discuss their own affairs with others, no matter who it may be (Bach, 1941). For those that drive company away as a result of their self-centred and needy nature. They do not like to be alone but rather feel the urge to share their personal matters with anyone who may be willing to listen; however, they are seldom willing to listen to others. They become discontented if they have to spend time alone (Master, 1994).

E. Oversensitive to Influences and Ideas • Agrimony (Agrimony eupatoria) “The jovial, cheerful, humorous people who love peace and are distressed by argument or quarrel, to avoid which they will agree to give up much. Though generally they have troubles and are tormented and restless and worried in mind or in body, they hinder their cares behind their humour and jesting” (Bach, 2014). For happy and sociable people who use their merriment as a mask to cover their feelings of pain, worry, anxiety and suffering. Although good company to keep and a wonderful friend to have, they may overindulge in substances to better cope with and hide from their struggles (Master, 1994). • Centaury (Centaurium umbellatum) “Kind quiet, gentle people who are over-anxious to serve others” (Bach, 2014). A remedy for the kind-hearted who enjoy helping and serving others and who cannot say ‘no’. Their eagerness to please others often results in being taken advantage of, easily persuaded and over- worked. Their timid and passive nature may result in neglecting themselves to serve and fulfil the desires of others (Master, 1994). • Walnut (Juglans regia) “For those who have definite ideals and ambitions in life and are fulfilling them, but on rare occasions are tempted to be led away from their own ideas, aims and work by the enthusiasm, convictions or strong opinions of others” (Bach, 1941). For those who are committed to their own ambitions in life, but who do at times experience weakness as a result of the convincing persuasion of others. This remedy is indicted for times of change, as adjustment may be difficult, because at this time they may be easily persuaded to drift off course (Master, 1994). • Holly (Ilex aquifolium) “For those who are sometimes attacked by thoughts of such kind as jealousy, envy, revenge, suspicion” (Bach, 1941). They often suffer because of their own feelings of insecurity. They 12

may be hard-hearted with a deep reluctance to love those around them. Their own unhappiness is often unjustified (Master, 1994).

F. Despondency and Despair • Larch (Larix decidua) “For those who do not consider themselves as good or as capable as those around them, who expect failure, who feel that they will never be a success, and so do not venture or make a strong enough attempt to succeed” (Bach, 2014). For those who lack confidence, feel inferior to those around them and always anticipate disappointment. Despite their potential, they are reluctant to actively strive for their goals for fear of the catastrophe they feel certain of (Master, 1994). • Pine (Pinus sylvestris) “For those who blame themselves” (Bach, 1941). For those who blame themselves for all problems or mistakes around them. They constantly feel that they have not done well enough despite their successes. They set very high standards for themselves and are committed, hard workers; however, they always highlight their perceived flaws, claim faults that are not their own and make themselves responsible for all that goes wrong. They are eternally apologetic. Although they are not responsible for wrongs, their continuous state of self-blame and guilt leaves them in despair (Master, 1994). • Elm (Ulmus procera) “Those who are doing good work, are following the calling of their life and who hope to do something of importance, and this is often for the benefit of humanity. At times there may be periods of depression when they feel that the task they have undertaken is too difficult, and not within the power of a human being” (Bach, 1941). For those who have dedicated their lives to something which fulfils them, yet often feel overwhelmed by the demands of their chosen path. At times, they lose themselves resulting in sadness or despondency. Despite their enormous responsibilities, they are committed and proficient in their work (Master, 1994). • Sweet Chestnut (Castanea sativa) “For those moments which happen to some people when the anguish is so great as to seem to be unbearable… When it seems there is nothing but destruction and annihilation left to face” (Bach, 1941). For those who become extremely overwhelmed by life’s circumstances and they feel as though all hope is lost. In this case, it seems as though all mental and physical limits have been stretched and they are left absolutely defeated and give up (Master, 1994). • Star of Bethlehem (Ornithogalum umbellatum) “For those in great distress under conditions which for a time produce great unhappiness” (Bach, 1941). Indicated for states of shock, be it mental or physical, as well as in instances of 13

acute distress. This may be a result of various circumstances or experiences such as an accident or sudden loss. This remedy may bring relief, even for those who in their state of shock refuse comfort (Master, 1994). • Willow (Salix vitelline) “For those who have suffered adversity or misfortune and find these difficult to accept, without complaint or resentment… They feel that they have not deserved so great a trial that it was unjust, and they become embittered” (Bach, 1941). For those who cannot accept previous calamities and brood in self-pity and bitterness as a result. They feel they have been treated unfairly by life and as a result become apathetic and despondent, even enjoying less those things that previously brought them delight. In this state, they will not look kindly on anyone’s good fortune. This ‘victim-type’ state causes one to prefer to be left alone in the company of their own misery (Master, 1994). • Oak (Quercus robur) “For those who are struggling and fighting strongly to get well, or in connection with the affairs of their daily life” (Bach, 1941). For those who continue, hopefully and bravely, despite their exhaustion. This remedy is indicated for those who refuse to quit regardless of the difficulties they may face. They are reliable and duty orientated and patiently continue even when over- tired. This lack of rest may result in depression and despondency (Master, 1994). • Crab Apple (Malus pumilia) “This is the remedy of cleansing. For those who feel as if there is something not quite clean about themselves” (Bach, 1941). This remedy is indicated in cases where the sensation of uncleanliness is felt either emotionally or physically. It may be something of little importance or a source of great anxiety. There is a desire to be rid of this unclean feeling, without which despondency and despair may result (Master 2008).

G. Overcare for the Welfare of Others • Chicory (Cichorium intybus) “Those who are very mindful of the needs of others, they tend to be over-full of care for children, relatives, friends, always finding something that should be put right” (Bach, 1941). For those who love in a way which is selfish and possessive. They over-care for their loved ones so much so that they become overcritical of them, wanting to better and correct what they deem is lacking. In this case, an overcaring nature smothers loved ones and makes separation from them very difficult (Master, 1994).

• Vervain (Verbena officinalis) “Those with fixed principals and ideas, which they are confident are right, and which they very rarely change” (Bach, 1941). For those who are dominant, extreme and fixed in their beliefs and ideas leading to a controlling form of care for their loved ones. They want very much for others to share in their ideas and will demonstrate this through words or actions. The confidence they have in their beliefs and the courage to implement them often makes the way they care for others very rigid. They often over-exert themselves, have a busy mind and take on more than they can manage (Master, 1994). • Vine (Vitis vinifera) “Very capable people, certain of their own abilities, confident of success” (Bach, 1941). Their confidence and over-enthusiastic nature can make them good company. However, they often impose on and belittle others as they believe they are always right. They are domineering and enjoy being in a position of power and control. This is done with good intentions as they genuinely believe they are making a positive contribution (Master, 1994). • Beech (Fagus sylvatica) “For those that feel the need to see more good and beauty in all that surrounds them” (Bach, 1941). With a general sense of intolerance, this remedy is indicated for those who are unaccepting of things as they are. As a result, they become critical of what they believe are the imperfections of others. They are easily frustrated and can appear arrogant; constantly failing to see the good in their surroundings and perceive everything to be lacking. While they are always right, everyone else is wrong (Master, 1994). • Rock Water (Aqua petra) “Those who are very strict in their way of living, they deny themselves many of the joys and pleasures of life because they consider it might interfere with their work” (Bach, 1941). For those who are unwavering and have fixed, even dogmatic, ideas. They prioritise their work and are exceptionally dedicated and disciplined to it. They are constantly striving to better themselves despite the high standards they set; hoping to be an example to others who might follow a similar path (Master, 1994).

1.2.5 Production of Bach Flower Remedies There are two methods used to prepare the Bach flower remedies. When preparing delicate flowers, the flowers are carefully picked and soaked in pure water in direct sunlight for three hours. This is known as the Sun Method. Woodier plants would be prepared using the Boiling Method, by which the plants are picked and boiled in pure water for 30 minutes. Equal amounts of the medicated/energized water and brandy, the preservative agent, are mixed together to form a mother 15 tincture (Richardson-Boelder, 2002). Bach flower stock bottles are made by adding two drops of the desired mother tincture to 30mL’s of brandy (The Bach Centre, n.d.a). The treatment bottle, usually a dropper bottle, is made up of two drops of the selected Bach flower remedies in 30mL’s of spring water. The treatment is completed by taking four drops from the treatment bottle, four times daily (My Best Remedies, 2014).

1.2.6 Method of Prescribing Bach Flower Remedies Bach flower remedies are prescribed based on the emotional presentation displayed by the patient and may be used individually or in combination. The most suitable remedies should be selected, although not more than six should be used in order to get the maximum benefit of the remedy complex (Ball, 2003) without compromising the effects of the remedies (Richardson-Boelder, 2002).

The best-known flower complex is Rescue Remedy. This remedy complex is made up of the following five flower remedies: Cherry Plum, Clematis, Impatiens, Rock Rose and Star of Bethlehem (Kayne & Kayne, 2017). It is specifically used to stabilize the emotions and bring about calm in times of shock, anxiety and grief (Vlamis, 1994).

Dr Bach suggested that two drops of each of the most suitable remedies be added to a solution of mineral water in order to create a Bach flower remedy complex. Should Rescue Remedy be one of the remedies added to the complex, it is advised that four drops be added. His standard prescription was four drops of the remedy complex to be taken four times daily (The Bach Centre, n.d.b).

1.2.7 Safety of Bach Flower Remedies The use of Bach flower remedies for treatment is regarded as simple to use and safe. It can be used in collaboration with other methods of treatment (Vohra, 2005), be it conventional or complementary medicines (Master, 1994). Bach flower remedies are considered safe for use in the treatment of everyone including babies and children, as well as during pregnancy (Ball, 2013). Bach flower remedies are also suggested to be safe for pet and plant care (Vlamis, 1994).

1.2.8 Regulation of Bach Flower Remedies in South Africa Bach flower remedies are currently available in South Africa; individual remedies may be found at certain health shops, while the Bach flower box set of all thirty-eight remedies is only available to practitioners, or those having completed the Bach flower remedy course, directly (Botha, 2016). 16

Bach flower practitioners may only use the treatment modality in isolation, while other healthcare providers may use them in combination with other treatment modalities that fall within their scope of practice (Olver, 2016).

In South Africa, all medicines are regulated by the MCC, which monitors and standardizes the manufacture, production and availability of medicines in the country (Medicines Control Council, n.d.). As per the MCC, Bach flower remedies are classified as complementary medicines (Medicines Control Council, 2016). According to the 2011 amendment made to the Medicines and Related Substances Act, Act 101 of 1965, all complementary medicines must become regulated. The MCC’s aim is to achieve this by 2019. Bach flower remedies are however not yet registered with the MCC (Medicines Control Council, 2013).

1.2.9 Possible Mechanism of Action of Bach Flower Remedies The exact mechanism of action of Bach flower remedies is unknown. There are several theories of varying scientific basis that suggest the possible mechanisms for their proposed effects. These will be discussed below.

1.2.9.1 Energy Transfer Dr Shealy, neurosurgeon and psychologist as well as author of Energy Medicine, expresses that the concept of energy medicine is not as foreign as it may seem. He suggests that conventional medicine also uses energy based tools to assist with diagnosis and treatment. Examples of such tools would be found in the field of radiography and in nerve conduction studies. He recognises that drugs and nutrition can also be perceived as forms of energy. While various different forms of energy are known and explored, such as kinetic or thermal energy, another such form can be termed “subtle energy”. This refers to the life force, chi or what homeopaths may refer to as the vital force. It is this form of energy or energy transfer that is thought to be at play in various forms of complementary or alternative treatment methods. As said by Dr Shealy, “There are subtle energies that we cannot, at this time, measure, but we can sense and sometimes measure the effects of most subtle energy” (Shealy, 2011).

Energy, as known in the field of physics, is the ability possessed for doing work (Encyclopaedia Britanica, n.d.). The human body relies on energy to function optimally. Therefore by energising the body where energy may lack, healthy physiological balance may be re-established. Oschman (2000) defines energy medicine as that which can “stimulate the repair of one or more tissues, or

17 that enables built-in healing mechanisms to operate more effectively”. These medicinal energies can come from people, from the environment or from a medical device (Oschman, 2000).

Energy medicine was founded by Dr Elmer Green in the 1980’s. Dr Green was a physicist with a PhD in biopsychology as well as a researcher in the fields of consciousness and spiritual development. He discovered and practiced clinical biofeedback, a means to control bodily functions which are thought to be largely involuntary. He was instrumental in the establishment of the International Society for the Study of Subtle Energy Medicine (Shealy, 2011) and acknowledged that the state of mind was instrumental in determining physiological functions (The Science of Consciousness, n.d.).

Sue Lilly, author of The Essence Practitioner: Choosing and Using Flower and Other Essences, states that the most essential aspect of energy transfer is found in the carrier, which is water. Through the investigation of Professor Bernd Kröplin, it has been discovered that water can collect and store information even from weak sources (Lilly, 2015) and for this reason is very easily affected by its surroundings. This may substantiate how the two preparation methods used to produce Bach flower remedies allow for the healing properties of the plants, which are not physical, to be transferred into the water and captured there until their administration (Master, 1994). Through their preparations, it is known that no physical part of the plant is present in the remedy. The energy that is harnessed through these preparation methods, sun method and boiling method, are thought to harness the dynamism or vibration of the plant which is responsible for restoring emotional balance (Lilly, 2015).

1.2.9.2 Psychoneuroimmunology Psychoneuroimmunology (PNI) is a field of study which was founded by Robert Ader, a psychiatric researcher, in the 1970’s (Woodward, 2005). PNI investigates the connection between the mental state of the patient and healing, by exploring how the brain and the immune system affect one another. PNI research has established that emotional turmoil such as anxiety can lead to a suppressed immune system and altered cellular activity (Ball, 2013). PNI can provide insight into how healing is achieved by non-clinical methods (Encyclopedia.com, n.d.).

Studies have shown that because the brain and the immune system are connected and influence one another, a state of chronic inflammation will affect the functioning of the brain and that the state of the mind can influence the ability to resist and recover from disease or illness (Cutolo & Straub, 2017). 18

As this field of study suggests that emotional balance may assists the body to restore and heal, it may provide some understanding for how Bach flower remedies, which aim to alter the emotional state, may work (Ball, 2013; Vlamis, 1994).

1.2.9.3 The Placebo Effect A placebo may be described as an unmedicated treatment substance. A placebo effect occurs when a treatment elicits some effect, be it positive or negative, which is not directly attributed to the treatment (Merriam-Webster, 2018)). The placebo effect provides justification in circumstances where such a substance may elicit a favourable therapeutic outcome. Similarly to PNI, the placebo effect lends itself to the mind-body relationship, suggesting that should the mind perceive the treatment to work, there will appear a positive response to the treatment. While the placebo effect was previously thought to only affect emotional illness, current investigations show its effects on a physical level too (Nidamboor, 2017). Despite its shortcomings, the placebo effect can be appreciated for providing some positive and therapeutic effects within the context of treatment.

The placebo effect may substantiate the mechanism of action of Bach flower remedies for two reasons. As with homeopathy, some suggest that Bach flowers may show encouraging results simply because the patient believes that it is beneficial to them (Ball, 2013). However, with research into the placebo effect, some feel that it reinforces the theory behind the mind-body connection and that they work synergistically (Nidamboor, 2017).

Some authors suggest that the placebo effect theory could be counter-argued by indicating the success of the remedies in treating animals and small children (Ball, 2013; Master 1994).

1.2.9.4. The Hawthorne Effect The hawthorne effect refers to a noted change in behaviour in someone, occurring as a result of being watched (Andale, 2017). In this case, the patient may strive to meet the expectations of the healthcare provider and show progress in treatment, however when they continue treatment outside of observation of the healthcare provider, the treatment appears to be less effective. The hawthorne effect is not only noted in the field of health care but can generally be recognised when under observation. The extent of the hawthorne effect is largely dependent on the observer and as a result can produce positive or negative changes to behaviour (Berthelott et al., 2011).

As seen in this treatment bias, should patients feel they are being observed by the practitioner, they may show promising effects from using Bach flower remedies. Similar to a placebo, the 19 therapeutic action of the remedy may be absent, but due to the observation of the practitioner and the desire to meet their expectation, the patient displays a positive response to the remedies (Andale, 2017).

1.2.9.5 The Patient-Therapist Relationship The context in which the patient receives treatment may also greatly influence the success of the treatment. The interaction between the patient and the therapist may influence the patient’s expectations of and response to the treatment. Such interaction can include psychological factors such as providing empathy, listening and establishing trust, as well as instilling confidence in the patient by maintaining a professional demeanour and protocol. In this way, the treatment environment is a major contributing factor to the outcome of the treatment. Should the patient receive a placebo under favourable conditions, it may contribute to their display of favourable results (Bonfill et al., 2017).

1.2.10 Bach Flower Remedy Education In 2016, a training course on Bach flower remedies became available in South Africa. The Bach International Education Program is approved by the Bach Centre at Mount Vernon, in the United Kingdom.

The course is made up of three levels. The first and second level each consist of a two-day training program, while level three is made up of a four day training program followed by six months of correspondence assignments with the Bach Centre, as well as case studies. Levels must be completed in order. On completion of all three levels of the course, there is the opportunity to become a registered Bach Flower Practitioner at the Bach Centre. There are currently four registered Bach Flower Practitioners in the Gauteng region (Bach International Education Program, South Africa, 2016). The course is open to the public and anyone is welcome to take part.

Making use of this modality in isolation does not allow the Bach Flower Practitioner to make any form of diagnosis, and practitioners are not registered with the AHPCSA. The course is currently not Continuing Professional Development (CPD) accredited (Olver, 2016).

1.2.11 The Link Between Homeopathy and Bach Flower Remedies As discussed by prominent homeopath, Dr George Vithoulkas, human beings are complex, and are made up of three components, ranked in order of importance: the mental, emotional and 20 physical planes, from which symptoms, the appearance of irregular psychological or somatic features can arise. This is depicted in Figure 1.3 below. This philosophy suggests that an emotional state which is negatively affected can lead to a significantly compromised state of health (Vithoulkas, 1986). This philosophy is anchored in homeopathy and is reiterated by homeopath Dr Peter Chappell, who states that suffering and trauma can lead to the development of severe pathological conditions (Chappell, 1994).

Figure 1.3: The three components of the human existence (Vithoulkas, 1986)

It was through a similar observation that Dr Bach established the system of Bach flower remedies. Despite prescribing well indicated therapies, he noticed that emotions such as fear or worry interrupted and delayed the healing process of physical ailments. Together with this school of thought, Dr Bach believed that negative emotions appeared prior to the onset of physical symptoms and thus their treatment would avoid the development of physical illness (Vlamis, 1994).

As Bach was greatly influenced by homeopathic principles, he embraced the treatment of all spheres of the human being: mental, emotional and physical, i.e. a holistic treatment approach. It is important to note that although Bach flower remedies stemmed from a homeopathic doctor, their methods of preparation are vastly different. Dr Bach adopted homoeopathic techniques with the preparation of his vaccines for patient care, however he pursued the establishment of a simpler and more gentle treatment system for emotional imbalance with the Bach flower remedies, which do not undergo successive dilutions (Richardson-Boedler, 2002).

1.2.12 South African Flower Remedies South Africa has its own set of flower essences. Jannet Unite-Penny, who is based in Cape Town, has been producing the South African flower essences since the year 2000. Cape Town is home to its own floral kingdom, which provides the sources for these flower essences. The essences are used to breakdown mental and emotional barriers as it relates to the mental and emotional states. In so doing these essences help unlock one’s true desires so that happiness and joy might be achieved through rebalancing the emotions (The South African Flower and Gem Essences, n.d.). However, these remedies are not as widely used as the Bach flower remedies and homeopaths do not receive any formal training on them.

1.2.13 Related Research on Bach Flower Remedies There is limited evidence available regarding the efficacy of Bach flower remedies and research studies have produced conflicting results.

A systematic review assessing the clinical evidence of flower remedies (Ernst, 2002) was conducted through the Institute of Health & Social Care Research. In this research study, six databases were searched for human clinical trials in which Bach Flower Remedies were administered for any medical cause. The study evaluated four clinical studies which met the necessary criteria and found the remedies to have no action superior to that of a placebo.

Walach et al. (2001) conducted a double blind, placebo-controlled, randomised controlled trial (RCT) with partial crossover evaluating the effect of Bach flower remedy complexes for test anxiety. Fifty-five students from the University of Freiburg took part in this study. Participants had self-reported test anxiety due to upcoming assessments. Participants were administered a complex of 10 Bach flower remedies, made up of Impatiens, Mimulus, Gentian, Chestnut Bud, Rock Rose, Larch, Cherry Plum, White Chestnut, Scleranthus and Elm. The study lasted a total of four weeks. In the first two weeks, prior to the first test, one group made use of the placebo while the other group made use of the remedy complex. Thereafter both groups made use of Rescue Remedy for two weeks leading up to their second test. It was found that the remedies produced a response similar to that of the placebo group, eliciting an effective placebo response.

Armstrong and Ernst (2001) explored the efficacy of Bach’s Rescue Remedy complex for examination anxiety in students by means of an RCT. One hundred participants between the ages of 18 and 65 were recruited from the University of Exeter. Forty-five participants who formed the sample group completed this study. Anxiety was self-reported by students and measured against 22 standardised tools such as the 40-item Spielberger State-Trait Anxiety Inventory (STAI). It was concluded that Bach flower remedies were ineffective for the treatment of examination anxiety (Armstrong and Ernst, 2001).

The use of Rescue Remedy was tested as a means for treatment of Attention Deficit Hyperactivity Disorder (ADHD). A double-blind, RCT was conducted on forty children between the ages of 7- 11 years, who had been previously diagnosed with ADHD by means of DSM IV criteria. Children were asked to make use of their remedies for three months and were observed by their teacher throughout this time. The parents and teachers where asked to complete Conner’s questionnaire one month prior to beginning treatment and once monthly for the duration of the study. The results were analysed using the ANOVA test. The study displayed a large dropout rate due to poor compliance. Although children did show an improvement with time, this improvement was not significantly different to that found in the placebo group. Therefore, this study showed that Rescue Remedy did not display results superior to that of a placebo (Pintov et al., 2005).

In 2009, Thaler et al. conducted a systematic review on the use of Bach flower remedies for psychological problems and pain. The review included four RCT’s and two observational studies. The studies were found to have methodological flaws but the review did find the remedies to be safe for use. The researchers also concluded that the remedies displayed placebo-like effects (Thaler et al., 2009).

Bach flower remedies were analysed as a psychological method to pain relief in Howard’s retrospective observational study (2007). A total of forty-one case studies, occurring between the year 2000 and the year 2005, documented the use of Bach flower remedies in pain relief for a duration of three months. Participants presented with physical conditions such as headaches, heartburn, neck and shoulder pain as well as shingles, fibromyalgia, cystitis and cancer. Of all the participants, eighty-five percent of them also presented with emotional issues. Bach flower remedies were investigated as a means to provide emotional support in cases with anxiety and where the participant may be having distressful thoughts due to their physical state. This study found that forty-six percent of the patients who participated felt that the treatment offered pain relief and approximately eighty-eight percent of the participants reportedly experienced positive emotional changes while making use of the remedies (Howard, 2007).

The effects of Bach’s Rescue Remedy Complex on anxiety was explored once again by Halberstein et al. (2007). Over one hundred nursing students from the University of Miami School 23 of Nursing and Health Studies took part in this double-blind, placebo-controlled, clinical trial. Student anxiety levels were recorded during a deceptively stressful experience. Students were instructed to make use of their remedy throughout the experience. Student anxiety was measured using the state-anxiety subscale of the STAI. They were exposed to a designed deception aimed at increasing their anxiety levels. They were instructed to use their remedy bottles every 20 minutes for 110 minutes. Their levels of anxiety were recorded before, during and after the deceptive experience. Findings indicated a significant difference between the results of the two groups. It was concluded that the use of Rescue Remedy was effective in reducing high levels of situational anxiety (Halberstein et al., 2007).

In an animal study, Rescue Remedy was tested as a means to reduce cardiovascular disease risk factors in rats. This study was conducted as a randomised, longitudinal, experimental study. Three groups of six rats each were used to monitor the biological effect that Bach flower remedies may have. Group A was dosed with 200μl of water, Group B was dosed with 100μl of water and 100μl of Rescue Remedy and Group C was dosed with 200μl of Rescue Remedy, daily for twenty days. Group C showed lower glycaemic levels and group B and C showed higher HDL-cholesterol and lower triglycerides than group A. This study indicates the potential of Bach’s Rescue Remedy to control glycaemic levels, triglycerides and HDL-cholesterol and thereby reduce the risk of developing cardiovascular disease (Resende et al., 2014).

In 2015, a RCT investigated the efficacy of a Bach flower remedy complex as a topical application made in a solid petroleum base, in the treatment of carpel tunnel syndrome symptoms. The remedy complex consisted of five Bach flower remedies, these being: Elm, Star of Bethlehem, Vervain, Clematis and Hornbeam. It was administered to patients suffering with mild to moderate carpal tunnel syndrome, who had displayed signs and symptoms for three months or more. Forty-three participants ranging from 20 to 89 years of age were invited to take part while awaiting surgery for their condition. The cream was applied to the affected area twice daily for over three weeks. Physicians monitored any changes in the progress of the participant though clinical examinations. Patients also made daily reports of their symptoms through a Carpal Tunnel Syndrome Questionnaire and a visual pain analogue scale. On conclusion of the study, participants reported statistically significant pain relief and reduced severity of symptoms (Rivas-suarez et al., 2015).

1.3 PROBLEM STATEMENT Bach flower remedy use forms part of the homeopathic scope of practice in a South African setting and may therefore be prescribed by homeopathic practitioners. Research studies done on the 24 effects of Bach flower remedies are limited and have shown conflicting results. The extent of the use of these remedies amongst homeopaths, as well as their experiences leading to their use, has not yet been explored. The investigation into Bach flower remedies from a homeopathic perspective is of use to homeopathic practitioners, educators and researchers.

1.4 RESEARCH QUESTION What are the experiences of homeopaths who make use of Bach flower remedies in their practice?

1.5 AIM OF THE STUDY The aim of this study is to explore and describe the experiences of homeopathic practitioners in the Gauteng area, who are making use of Bach flower remedies, by means of individual interviews.

1.6 OBJECTIVES OF THE STUDY 1.6.1. To explore and describe the experiences of homeopathic practitioners as they relate to Bach flower remedies. 1.6.2. To assess the personal level of education held by homeopathic practitioners on Bach flower remedies and the possibility of furthering their education on the use and application of the remedies.

1.7 POSSIBLE OUTCOMES The researcher expected to uncover the influence Bach flower remedies have in homeopathic practice. By analysing homeopaths’ experiences the researcher hopes to establish the role that Bach flower remedies play in their practice. The knowledge gained from the study may benefit homeopaths and their education on the subject, and it will open up the field for further research.

1.8 KEY CONCEPTS The key concepts, together with their definitions that relate to this research study, are as follows:

Allied Health Professions Council of South Africa: A compulsory council which provides regulation and guidance to allied health professionals and ensures the public’s safety when treated by such a professional. The council monitors training for such professionals and liaises with the National Health Department with regards to its members. Homeopathy is an allied health profession, together with various other complementary treatment modalities (Allied Health Professions Council of South Africa, n.d.).

Bach flower remedies: A collection of remedies founded by Dr Edward Bach which aim to treat mental and emotional symptoms at times of stress and emotional disorder (Vlamis, 1994).

Complementary Medicine: A category of medical therapies that are outside of the scope of conventional medicines. They may be used in conjunction with conventional medicine to enhance treatment. Complementary treatments are used in conjunction with allopathy (online-medical- dictionary.org, n.d.a).

Disease: A pathological occurrence within the body which is displayed with signs and symptoms (online-medical-dictionary.org, n.d.b).

Experience: A specific instance of personally encountering, observing or undergoing something that may result in the gaining of knowledge or practical wisdom (Dictionary.com, n.d.b).

Health: A state in which the organism functions ideally and is free from disease (online-medical- dictionary.org, n.d.c)

Homoeopathic Association of South Africa (HSA): A voluntary association which represents the homeopathic practitioners in South Africa. It is recognised by the Allied Health Professions Council and interacts with the National Health Department as it may affect or relate to the profession of Homeopathy (Homoeopathic Association of South Africa, n.d.).

Homeopath/ Homeopathic practitioner: A practitioner who is registered with the AHPCSA can diagnose, treat or prevent physical and mental disease, illness or deficiencies in humans, and prescribe or dispense medicine or treatment for such conditions provided they have a valid dispensing license (Allied Health Professions Council of South Africa, 2000).

Medicines Control Council (MCC): An internationally recognised body which strives to regulate the production, supply, circulation and general access of medicines by adhering to the Medicines and Related Substances Act (Medicines Control Council, n.d.).

Perception: The act of apprehending by means of the senses or of the mind or understanding through immediate or intuitive recognition or awareness (Dictionary.com, n.d.d).

Philosophy: A system of thought or belief based on some form of investigation that may offer guidance on a particular subject (Dictionary.com, n.d.e).

Value: The relative worth value or importance of something, as well as to consider with respect, usefulness or importance (Dictionary.com, n.d.f).

1.9 RESEARCH DESIGN AND METHOD For this qualitative research study, a phenomenological research design was adopted (Creswell, 2007) as it relates to exploring the lived experiences of homeopathic practitioners using Bach flower remedies while bringing their commonalities to the forefront. Bach flower remedies are being investigated for the first time within the setting of homeopathic practice. Descriptive and contextual elements have also been incorporated into this research design as the most accurate representation of Bach flower remedies is uncovered within the context of homeopathic practice (Merriam & Tisdell, 2015). This design explores the experiences of homeopathic practitioners as it relates to the use of Bach flower remedies, the phenomenon, in their practice.

1.10 SAMPLING Both purposive methods, participant recruitment through the Homoeopathic Association of South Africa (HSA), as well as snowball sampling methods, in which participants refer other participants to take part in the study (Statisticshowto.com, 2014), were used to recruit information-rich participants. The study sample included homeopathic practitioners registered with the AHPCSA who are practicing in the Gauteng region, and either currently make use of or have previously made use of Bach flower remedies in their practice. In April 2017 there were 351 Gauteng-based homeopaths registered with the AHPCSA (Terry, 2017).

1.11 DATA COLLECTION TECHNIQUE Individual interviews were carried out with each participant. The research question formed the foundation on which the interviews were built, allowing practitioners to share their experiences on making use of Bach flower remedies. Probing questions were used to clarify and navigate the interview. The interview was scheduled to take between twenty to thirty minutes. During the interview process, bracketing was adopted by the researcher. This prevented the researcher’s personal feelings from influencing the interview process and assisted in maintaining an unbiased and objective stance (Creswell, 2007). While the interviews were being conducted and recorded, the researcher made memo notes where relevant, which could be used to better subsequent

27 interviews and further analyse the data. Interviews were carried out until data saturation was achieved, that is when continuous interviews did not contribute any new information to the study (Given, 2016). Interviews were transcribed, thereafter the original audio recordings were destroyed.

1.12 DATA ANALYSIS Data collected during the interviews was transcribed by the researcher, allowing for the familiarization of the captured data, which served to better organize and analyse its content. In this way, common themes began to come through. Data management began by getting acquainted with the gathered information, creating codes for the gathered data, categorising and sub-categorising these codes and noting emerging themes. Each of these were summarized and interpreted in order to discuss the findings (Moerman, 2016). The general outcomes or findings attained from the collected data is discussed in Chapter 3 based on the trends noted in the analysis process. These serve to ascertain the value and use of the Bach flower remedies in the context of homeopathic practice.

1.13 TRUSTWORTHINESS Trustworthiness is vital in providing a standard for validity and reliability in qualitative research. It is comprised of four main strategies used to ensure that trustworthiness is achieved and maintained for the duration of the study. These are credibility, transferability, dependability and confirmability (Shenton, 2004). These strategies are discussed in more detail in Chapter 2.

1.14 ETHICAL CONSIDERATIONS Ethical considerations were adhered to in this study. Participation in this study was voluntary and participants could withdraw their consent should they have felt the need. Participants gave their consent, remained anonymous and were granted privacy and confidentiality. All participants were treated equally and with respect. Regard for these ethical points was maintained throughout the study.

1.15 CHAPTER DESCRIPTION In Chapter 1, Bach flower remedies and homeopathy are introduced together with insight into their educational framework. The purpose of the study, its aim and the objectives of the study are outlined in order to establish the context in which this study was conducted. In Chapter 2 the study’s methodology, trustworthiness and ethical considerations are discussed in more detail.

CHAPTER 2: METHODOLOGY

2.1 INTRODUCTION In this chapter the applied methodology will be discussed in more detail allowing for a more in- depth understanding of how data was gathered and interpreted.

2.2 RESEARCH DESIGN AND METHOD 2.2.1 Qualitative Design According to Saldaña (2011), qualitative research is a broad term used to describe any methodology involving data analysis which is not numerical in character, such as written material and forms of media. In this research design, the observer or researcher submerges themselves into the surroundings or experiences of a particular group, where they may be explored and described to provide a better understanding (Creswell, 2009). Flick (2014) suggests that qualitative research has a unique role to play in capturing the social experience allowing individual experiences to be studied. Qualitative research is indicated in areas where the importance attributed, or lack thereof, to a particular issue may be discovered within the individual context of each participant (Creswell, 2007). In this setting the researcher acts as the key instrument, accounting for how data is captured as well as the predominant means by which the data is analysed.

This study aimed to reveal the homeopathic practitioners’ experiences regarding their use of Bach flower remedies in practice. In this way, this study was both descriptive and exploratory. Making use of the empirical data which was gathered, an inductive approach to research analysis was used. Information on the topic is limited and with this “bottom-up” approach, a foundation is created by establishing patterns and themes on the topic (Creswell, 2007).

2.2.2 Phenomenology Phenomenology refers to exploring the meaning of experiences or exploring a phenomenon. This research method was established when philosophical interpretation of written text was used in order to understand its true meaning (Saldaña, 2011) and today is frequently used in the fields of sociology, psychology and health sciences (Creswell, 2007). It allows a group of people to describe their personal experiences showcasing their similarities and dissimilarities. In this way, the phenomenon can be understood and a baseline understanding for the explored phenomenon is provided (Creswell, 2007). More specifically, a transcendental or psychological phenomenology is applied in this study. This refers to the focus of the study being less so on the interpretation of

29 the phenomenon but rather focusing on the discovery of the personal experiences of those taking part. The researcher used the data that was gathered to create sub-categories, categories and themes to better explain and define the researched phenomenon (Creswell, 2007). Bazenely (2013), defines phenomenology as that which connects “related empirical observations of phenomena to each other” and illustrates the relationship between them.

For a phenomenological study, it is suggested that the researcher have between five and twenty- five participants who share the experience that is under investigation, with interviews being the most common form for data collection (Creswell, 2007). All participants must have experience in the field of study.

A phenomenological approach was applied to this research study as practitioners described their personal, lived experiences of making use of Bach flower remedies in homeopathic practice. In so doing, the value held by Bach flowers within the field of their practices could be better understood in various spheres. The use of Bach flower remedies and its contribution to the homeopathic practice was explored as well as the attention they were given in the homeopathic course program in order to establish if practitioners showed any desire for further, more in-depth education on the topic.

2.3 SAMPLING Purposive and snowballing sampling methods were implemented for this research study. To achieve purposive sampling, practitioners that are registered with the Allied Health Professions Council of South Africa (AHPCSA) were targeted and snowballing began with practitioners with whom the researcher was familiar.

2.3.1 Purposive Homeopathic practitioners that are registered with the AHPCSA were recruited to take part in this study. The AHPCSA was approached to assist in the recruitment process. A permission letter (Appendix A) was sent to Dr Mullinder, the council’s registrar, requesting that the council send out an invitation of participation via email to all homeopathic practitioners practicing in the Gauteng area on behalf of the researcher. Through correspondence with Dr Mullinder, it was found that the council was unable to issue invitations of participation via email due to some technical problems held by the council (Mullinder, 2017). The Homeopathic Association of South Africa (HSA) was also contacted for assistance to carry out purposive sampling however they were also unable to assist. The HSA did however place a notice regarding this research study in its newsletter 30

(Chella, 2017). This was only put in place once snowballing had begun. Despite the pursuit for purposive sampling, these approaches, which were proposed, were unsuccessful.

2.3.2. Snowballing Snowballing was the predominant means for participant recruitment in this study. This research study was made known to practitioners through word of mouth as the researcher began by inviting practitioners with whom she was familiar to take part. The snowballing method, as described by Flick, (2014), was implemented by getting practitioners to recommend their colleagues who might share their interest and willingness to participate in this study (Flick, 2014). The HSA website contains a list of homeopathic practitioners who are registered with the association. The practitioner list generally contains the practitioner’s name, their location of practice and a contact number. This feature was helpful in contacting practitioners who were recommended by participants. By means of these channels, the researcher contacted the recommended participants. Should they have met the participation criteria and shown interest in taking part, a meeting was scheduled to conduct the interviews and collect the data.

2.3.3. Inclusion Criteria Practitioners had to adhere to the following criteria in order to take part in this study: • All participants have been registered with AHPCSA as homeopathic practitioners, and practice in the Gauteng area; • All participants have been making use of Bach flower remedies in their practice or must have made use of the Bach flower remedies at some point while in practice.

2.4 RESEARCH PROCEDURE As per Saldaña (2011), data collection may be gathered in various forms when adopting a phenomenological approach to qualitative research, if the essences of the experience which was under investigation is uncovered. In-person interviews were selected for this research study.

Prospective participants that were identified through snowballing were contacted via phone call or email by the researcher and invited to take part in the study. The interview process was discussed with each prospective participant prior to taking part in the study. Interviews were carried out by using open-ended questions based on the practitioners’ experiences using Bach flower remedies in homeopathic practice. Interviews took approximately twenty to thirty minutes and were conducted at a location and time of participant convenience, over a period of twelve weeks.

Before formally beginning the interview process with practitioners, a mock interview was carried out with a volunteering homeopathic practitioner. This served as a pilot study. It allowed for the researcher to conduct an interview where any flaws could be picked up, interviewing skills could be applied and the practitioner could provide feedback on how the interview was conducted. This mock interview assisted the researcher to better carry out subsequent interviews. The outcomes of the mock interview were not included in the coding and analysis of the study.

2.5 DATA COLLECTION AND ANALYSIS 2.5.1 Data Collection Data was collected by means of unstructured, face-to-face interviews. The interviews were based on open-ended questions. These interviews took place at either the interviewee’s practice or in a consultation room at the Homeopathy Clinic at the Doornfontein campus of the University of Johannesburg. Before initiating the interviews, the researcher discussed the nature of the study by going through the participant information sheet (Appendix B) with the participant. Having been informed, the participants were asked to sign a consent form (Appendix C) as well as a consent form allowing for the interview to be audio recorded (Appendix D). By signing these consent forms, participants agreed to their understanding of the study, their understanding of their rights as a participant in the study as well as their willingness to participate. The consent form also allowed for some background information to be gathered about the participant before commencing the interviews. The background information related to the participants’ educational background, their years of experience in the field of homeopathy, as well as their use of Bach flower remedies. By signing the consent form for the interviews to be audio-recorded, participants also confirmed their willingness to be audio-recorded with the understanding that their personal information and identity would be protected at all times.

The interviews were initiated with the research question to set the tone (Creswell, 2009). Participants were asked the question: “Describe your experiences using Bach flower remedies in homeopathic practice.” To assist in the progression of the discussion and to fully explore and navigate the topic, participants were asked leading, open-ended questions. In this way, important points on the topic could emerge, this is termed horizontalization (Creswell, 2007). These questions could be as follows:

• Why do you prescribe Bach flower remedies? How do patients respond to them? • How do you prepare and prescribe Bach flower remedies?

• How do you believe that Bach flower remedies compare with homeopathic remedies? • Where do you source your information on Bach flower remedies from? • What value do you believe Bach flower remedies have in the homeopathic course material and in homeopathic practice? • How do you feel about Bach flower remedies being available at selected pharmacies and health shops? • What is your knowledge regarding and feeling toward the Bach flower remedy course that has recently become available in South Africa?

After each interview, participants were thanked for their time. Shortly after the interview was conducted, the audio recording was transcribed precisely by the researcher, and the recording was deleted from the audio recording device. The transcriptions were kept in a password protected folder on the researcher’s computer. This process was repeated until data saturation was reached. Data saturation is obtained when it is deemed that sufficient information has been captured as no novel or further information is gathered from subsequent interviews, (Fusch, et al., 2015). In this research study, data saturation was achieved after conducting fourteen interviews. A transcript example can be found in Appendix I.

2.5.2 Data Analysis Qualitative data, following a phenomenological approach, is not numerically evaluated but provides some form of description with regard to the experienced phenomenon. It aims to interpret various written or spoken information such that the meaning of the whole may be discovered (Flick, 2014). In this way the phenomenon may be simply defined as the findings of the research study.

Before analysis can begin, the data must be adequately arranged. To follow through with this, each transcription was confirmed against the audio recording before its destruction in order to verify that the transcribed, digital copy accurately captured the experiences of the participants. Each transcription was saved and given a reference number: Int01, Int02 and so on, in order to keep the transcriptions organized within the password protected folder. Transcripts were read, several times and in detail, in order for the researcher to become familiar with the data and begin noting similarities and dissimilarities within the various sources of data. Transcriptions were also edited by an external editor to ensure the punctual and grammatical precision of transcription. Once

33 editing was complete, the editor signed a confidentiality agreement ensuring her discretion and preservation of the read information as confidential (Appendix E).

Once the transcripts were ready, the researcher began coding the data. This was achieved through line-by-line coding. Every response given by participants was considered and coded. Three of Saldaña’s coding methods were applied. Grammatical methods included the following forms of coding: attribution, magnitude and simultaneous coding. Elemental methods included the following forms of coding: structural, descriptive, in vivo coding and evaluation coding. Affective methods included the following forms of coding: emotion, values, versus and evaluation coding (Saldaña, 2009).

With qualitative coding, it is necessary to code and recode data to uphold accuracy (Saldaña, 2009). The researcher first separated the gathered data into groups that addressed similar topics. Analysing the arranged content, the researcher carefully worked through all the data allocating codes where applicable and repeating codes where similar ideas, feelings or experiences were shared by the participants. Codes were allocated both a number and a description. After a two week break, the researcher revisited the data with fresh eyes and re-coded. This time, coding was done from the transcribed interviews. The researcher found that coding from data that had already been gathered into similar ideas inhibited accurate coding because the researcher perceived the data as isolated information sometimes outside of context. On the second round of coding, coding was started again afresh and far more codes were applied. Again, each code was allocated a number and a description. The researcher felt that coding from the transcripts portrayed the information that was gathered during the interview process with more specificity.

These codes were then grouped into similar ideas. These groups of codes became categories. In certain cases, the categories were too large and the main ideas captured became lost. In these cases, the researcher applied sub-categories. The categories were further grouped into themes. The themes serve to demonstrate the main matters pertaining to Bach flower remedies that arose from the data gathered during the interview process.

Coding of the data allows for the clustering or grouping of data to be formed into categories, and themes. Coding acts as the link between data collection and uncovering the phenomenon. Segments of data were extracted and coded under an appropriate code-name which indicated its content. Data that shared similar trends or concepts were grouped under the same code. Each time a new concept or trend appeared, a new code was created. Once all the relevant data was 34 appropriately coded and no novel information was retrieved, data saturation was verified. The coding provided the basis for the establishment of categories, the grouping of codes that still share some common territory. Each category was labelled appropriately in order to illustrate the nature of the collection of data within the category (Smit, 2017). This process is illustrated in Figure 2.1 below.

Figure 2.1: Data Analysis Process (Smit, 2017)

When data analysis began, the researcher had revised the interview content several times already. The researcher personally gathered the data by conducting the interviews, transcribed said interviews, revised the transcriptions to ensure that they had been accurately documented, coded the data and created sub-categories, categories and themes. This process provided the researcher with an in-depth familiarity with the data prior to beginning data analysis.

Although the use of a qualitative data analysis software was proposed, the researcher opted to carry out manual coding. Despite having taken part in some training on the computer software, ATLAS.ti 8.0, which is designed to assist with qualitative data analysis and has been said to be “a program of considerable sophistication” (Silverman, 2013), the researcher felt most comfortable doing manual coding. This allowed for the process to be followed in a more tangible way and assisted the researcher in understanding the coding process rather than being isolated to what appeared on a screen. The researcher felt that physically working with the data and the codes facilitated the accuracy and understanding of the analysis process. Saldaña (2011) also suggests that for a beginner researcher, manual coding is preferable.

It must be noted that in striving for accuracy of data grouping and analysis, codes were edited and reorganised in order to be grouped most appropriately. Categories then gave rise to themes. Themes provided the outline of the analysis process by providing only a few important concepts to focus on (Smit, 2017). This facilitated the analysis process.

During the coding process, the researcher made memo notes in the margin of the transcripts (Saldaña, 2009). These served to draw the researcher’s attention to a specific selection of data and make notes about the interview experience, the attitude of the participant and to describe why coding was carried out in that specific way. These memos became relevant in the data analysis process as it served to reinforce the context of the codes. As transcripts were coded, the researcher created a code list simultaneously. This assisted in keeping track of the codes by number as well as description. This list also noted the interviews in which that particular code had been applied.

Once all codes had been categorised and themed, the researcher allocated a colour to each theme. The transcripts were revisited, and every code placed in the transcripts was colour-coded according to their theme. This was done for two reasons; it made it easier to notice trends in the transcripts as well as helped the researcher find segments of data with greater ease by being able to track them by colour and code number.

To oversee the coding process, a qualified qualitative data analyst validated the researcher’s analysis process and offered guidance and advice where necessary. The qualitative analyst provided an in-depth brainstorming session, as well as subsequent discussion sessions with the researcher. During these sessions the research process was reviewed while highlighting important points for data analysis and discussion. The analyst also monitored the progress of the study’s analysis (Manda, 2018). The qualitative analyst provided research validation and signed a confidentiality agreement (Appendix F).

Data analysis was carried out by carefully taking note of the ideas, feelings and experiences that were expressed by participants and noting the frequency with which they were discussed as well as the degree of emphasis expressed by the participants. Data analysis is reported in Chapter 3, with an in-depth discussion which unpacks the data by exploring the thematic characteristics.

Through the detailed discussion of the data, the codes, categories and themes, the interpretation of the findings was carried out (Creswell, 2009). The discussion of the findings as well as the interpretation allowed for a deeper understanding of practitioner experiences as it relates to their 36 use of Bach flower remedies in homeopathic practice. Moreover, this provides the outcomes of the study and the conclusion to this phenomenon.

2.6. TRUSTWORTHINESS Trustworthiness is applied in qualitative research in order to provide a framework for validity and reliability. Four main criteria are used to determine trustworthiness which serve to evaluate the worth of the study (Krefting, 1991). These strategies are discussed below (Shenton, 2004).

2.6.1 Credibility Credibility refers to the believability of the data gathered from the source (Bazenely, 2013) as well as the accuracy with which the human experience under investigation is captured (Krefting, 1991).

In this study, credibility was pursued by gathering data from practitioners who are registered with the AHPCSA within an adequate period of time (Krefting, 1991) by means of snowballing, which recruited fellow information-rich professionals until data saturation was noted. To further enhance credibility interviews were recorded using a reliable and good quality audio-recording device (Flick, 2014). Audio recordings were checked for accuracy by comparing the transcriptions with the recordings

Interviews were made up of one central question followed by a known set of follow up questions in order to maintain internal consistency with each interview which was conducted. This too adds to the enhancement of the study’s credibility (Krefting, 1991). During analysis, categories were formed which covered the data in entirety (Elo & Kyngäs, 2007) and data analysis was overseen by a qualified qualitative data analysist to assure accuracy and credibility.

Reflexivity (Krefting, 1991), the awareness of the researcher’s stance on the issues being discussed in the study, was noted and maintained throughout the duration of fieldwork and continuous reflection on the study was made by the researcher in order to draw awareness to any biased preconceptions that may have influenced the direction of the study (Shenton, 2004).

Establishing the authority of the researcher also contributes to the credibility of the study (Krefting, 1991). These are dependent on the researcher’s familiarity with the phenomenon under investigation, theoretical knowledge, ability to conceptualise large amounts of qualitative data and the researcher’s experience and skills in investigation and qualitative research methods (Miles & Huberman, 1984). The authority of the researcher is outlined as follows: the researcher has 37 completed the course work component of the Master’s degree in M.Tech in Homeopathy from the University of Johannesburg, she gained added knowledge on the topic of Bach flower remedies by attending level 1 of the Bach training course in August of 2016 and has done extensive reading of books written by those respected in the field of qualitative research. The researcher also attended an ATLAS.ti 8.0 training workshop for qualitative research in October 2017. Although this particular software program was not used for data analysis, it was beneficial in exposing the researcher to qualitative research analysis.

2.6.2. Transferability Transferability indicates the degree to which the results of a particular study may be applied to other circumstances (Shenton, 2004). The criteria is largely dependent on the quality and detail of the data which is presented. Transferability is enhanced when background information about the participants and the context under which the data collection took place is noted and discussed (Krefting, 1991) along with details of how data was arranged and analysed (Elo & Kyngäs, 2007).

Prior to beginning the interviews, participants were asked to provide information that pertained to their qualification, duration in practice and further training in use of Bach flower remedies. This served to verify their background and their experiences in the field. Information-rich participants were recruited through the snowballing sampling method. Participants shared their experiences as it related to the phenomenon under investigation: the practitioners’ experiences making use of Bach flower remedies in homeopathic practice. Interviews were audio-recorded and transcribed precisely. Themes that emerged from the data through the data analysis process are discussed in-depth with substantiations from participating practitioners.

2.6.3 Dependability Dependability outlines the ability to repeat the study under the exact same circumstances while obtaining the same outcomes (Shenton, 2004).

This is achieved through the thorough methodological outline provided earlier in Chapter 2. It also allows for others to understand and follow the decisions and journey taken by the researcher in conducting this study (Krefting, 1991). Dependability was further enhanced through the code- recode method, during which data was coded and recoded approximately two weeks later. At this point the results were compared and data analysis began. If it were possible to repeat this study under the exact same conditions the same results would be obtained.

2.6.4 Confirmability Confirmability asks the question: to what extent will the same findings be concluded by others (Shenton, 2004).

Confirmability was achieved by adhering to the research methodology, upholding accuracy in the gathering of data, its transcription to written information and its analysis. Once data saturation was achieved, it indicated and confirmed that the practitioners’ experiences surrounding Bach flower remedies had been captured. Data was coded by the researcher and analysed under the guidance of an experienced qualitative analyst from Ipsos, a marketing research company based in Johannesburg (Manda, 2018). Data was carefully analysed which allowed for themes, the study’s main outcomes, to be uncovered. The literature control as well as the interview transcriptions, the code list and the content analysis provide an audit trail indicating how conclusions were made (Krefting, 1991).

Once again, reflexivity and the researcher’s awareness of personal bias enhance the confirmability of a study (Krefting, 1991).

2.7 ETHICS Ethical considerations were upheld between researcher and participant during the conduction of this study. The outlines and guidance for ethical considerations that were set by Silverman (2013) and Flick (2014) were followed.

2.7.1 Autonomy and Respect for Persons Participants were informed and invited to take part in this study. All participants received an information sheet (Appendix B), which the researcher discussed with them prior to beginning the interviews. Upon discussion of the information sheet, those taking part were made aware of their rights as participants. This was inclusive of their right to withdraw from the study at any time without explanation, and the preservation of their autonomy and confidentiality by referencing their interviews with a participation number and omitting any identifying information. Interviews were conducted in a private room. The recordings of the interviews were destroyed once transcriptions were made and remained in a digital folder in a password protected computer belonging to the researcher. This information was only accessible to the researcher, the supervisor and the qualitative research analyst. Hardcopies of the data will be kept for five years at the Department of Homeopathy, on the Doornfontein campus of the University of Johannesburg before being destroyed. 39

2.7.2 Non-maleficence and Beneficence As discussed in the participant information sheet and again with the participant prior to conducting the interviews, this study posed no risks and no direct costs to the participant. Participation in this study served to determine the role and value of Bach flower remedies in the homeopathic profession.

2.7.3 Justice Participants were addressed and interacted with in a respectful and fair way. Any questions or queries that they had were addressed by the researcher. Interviews were arranged at a time and location most convenient for the practitioner. Practitioners may also have access to the information gathered from this study on request.

The proposal for this research study was viewed and assessed by the University of Johannesburg’s Faculty of Health Sciences’ Higher Degree Committee HDC-01038-2017 (19/06/2017), (Appendix G) and the Faculty of Health Sciences’ Research Ethics Committee REC-01-9-2017 (11/07/2017), (Appendix H). Both provided permission to carry out this research study.

2.8 CHAPTER DESCRIPTION In Chapter 2, the methodology of the study was outlined and discussed in detail. This was inclusive of how the study lends itself to trustworthiness as well as its compliance with ethical considerations. In Chapter 3, the data gathered through in-person interviews with practitioners will be reported on and discussed forming the data analysis.

CHAPTER 3: ANALYSIS, RESULTS AND DISCUSSION

3.1 INTRODUCTION As this study revealed the homeopathic practitioners’ experiences using Bach flower remedies in practice, the quality and standard of Bach flower remedy education as well as the value which they hold in homeopathic practice was uncovered. This study is a qualitative, phenomenological study whereby data was gathered by in-person interviews with individual homeopathic practitioners based in Gauteng, who have had experiences making use of Bach flower remedies either in their practice or at some point while in practice.

3.2 DATA COLLECTION The researcher recruited homeopathic practitioners who are registered with the Allied Health Professions Council of South Africa (AHPCSA) and who could share their experiences of using Bach flower remedies while in practice. Only practitioners from the Gauteng area were recruited in order to enable the researcher to travel to a location of their convenience where the interview would be carried out. As of April 2017, there were 351 Gauteng-based homeopathic practitioners registered with the Allied Health Professions Council of South Africa (AHPCSA) (Terry, 2017).

Potential participants familiar to the researcher were first notified by word of mouth and invited to take part. Each potential participant was also asked to recommend a colleague who may also have had experience on the topic of Bach flower remedies, which they could potentially share in this research study. During the recruitment phase of this study, five practitioners declined participation due to lack of experience with the Bach flower remedies and an absence of their use in practice, two practitioners showed interest in participation but did not meet the criteria for participation and three practitioners did not return the researcher’s phone calls and/or emails, thereby showing no interest in participation. Those who did not return the researcher’s communications were not repeatedly contacted by the researcher as those who made themselves available for interviewing and provided the data required by the researcher allowed for data saturation to be achieved. In total, twenty-four participants were invited to participate and a total of fourteen participants took part in this study.

Practitioners taking part in this study provided insight from various standpoints. Variation was evident in the extent to which practitioners used Bach flower remedies in practice, their duration

41 in practice as well as their knowledge of and participation in additional training on Bach flower remedies.

3.3 DEMOGRAPHICS Prior to beginning each interview, participants provided some background information together with their consent of participation (Appendix C). Participants of this study served as a representation of homeopathic practitioners and their feelings toward Bach flower remedies. This information was gathered from the varied group of practitioners that took part in this study.

Participants were asked the following questions: • How long have you been in practice as a homeopath? • How long have you been making use of or did you make use of Bach flower remedies in your practice? • What tertiary institution did you graduate from, and in what year? • Did Bach flower remedies form part of your course material during your studies? • Have you had any additional training on Bach flower remedies?

The wide-ranging backgrounds of participants and their feelings surrounding Bach flower remedies adds to the value of this study because it portrays a broad representation of the homeopathic practitioners making use of Bach flower remedies. These differences are illustrated in the figures that follow.

Participant duration in practice varied from five months to seventeen years. Figure 3.1 below shows the fascinating relationship between the duration of time in homeopathic practice as compared to the number of years of making use of Bach flower remedies.

The differences between participants is important to note as they not only provided insight from various standpoints in their professional careers but also from varying amounts of experience with using the Bach flower remedies. Some participants who had been in practice for many years had only recently been making use of the Bach flower remedies while others have been prescribing them since the commencement of their practice.

Figure 3.1: A table to show the relashionship between the number of years in homeopathic practice and the number of years making use of Bach flower remedies 18 16 14 12 10 8 6 Number YearsNumber of 4 2 0 Int001 Int002 Int003 Int004 Int005 Int006 Int007 Int008 Int009 Int010 Int011 Int012 Int013 Int014 Interview number

No. yrs in Practice No. yrs using Bach flower remedies

All of the practitioners who participated graduated from the same institute (TWR which later became UJ). This outcome was to be expected as participants were only recruited from the Gauteng area and the University of Johannesburg is currently the only tertiary institution offering this qualification in the Gauteng region.

When asked if Bach flower remedies were taught in their course material during their studies, nine of the participants were sure that it had, to a greater or lesser degree. Three participants stated that it had not been covered in the course material at all and two participants were unsure. Although some practitioners did not remember Bach flower remedies forming part of their course material, they have formed part of the homeopathy syllabus since the inception of the course at wits Technikon Witwatersrand (TWR), now known as the University of Johannesburg (Dr Pellow, 2018). The extent to which Bach flower remedies were covered in the course as per the study’s participants is depicted in Figure 3.2.

Bach flower remedies in the course material Unsure 14%

No 22% Yes 64%

Yes No Unsure

Figure 3.2: The extent to which Bach flower remedies were covered in the course material

It is also fascinating to note that as many as half of the practitioners who were interviewed had partaken in additional training on the subject of Bach flower remedies. This is shown in Figure 3.3. The forms of additional training completed by participants varied from formal, to informal training with qualified personnel, to taking a personal interest on the matter and studying it in their own time. Of those who had not taken part in additional training many did express their desire to do so during the interviews.

Additional training on Bach flower remedies

50% 50%

Yes No

Figure 3.3: The interest of homeopathic practitioners to pursue further learning on Bach flower remedies

3.4 DATA ANALYSIS In qualitative research, data is frequently analysed using an inductive approach, meaning that data is gathered to establish a framework and foundation for subsequent research on the topic under 44 investigation (Gabriel, 2013). The data gathered from this study was analysed inductively. As the first of its kind, this phenomenological study produced insight into the homeopaths experiences using Bach flower remedies in practice in order to determine the value that it holds to these professionals.

As per the methodology outlined in Chapter 2, data was collected through in-person interviews with volunteering practitioners followed by the transcriptions of said interviews. The transcripts were coded using the grammatical coding methods, elemental coding methods and affective coding methods (Saldaña, 2009). The researcher delved into the accumulated data by personally conducting the transcriptions, editing and re-reading the data to verify its accuracy and then reviewing the transcriptions several more times during the coding process.

For each transcription, everything experienced and expressed by the participant was carefully analysed line by line and codes were applied. From these codes, those that shared similar ideas were clustered together to create categories and sub-categories, which were then clustered to create themes. These themes outline the parameters and outcomes of this study.

3.5 DISCUSSION OF RESULTS On the topic of Bach flower remedies, homeopathic practitioners concurred that Bach flower remedies are a valuable component to their practice. The interviews brought up several topics pertaining to Bach flower remedies. These were as follows: practitioners’ background knowledge on the remedies, the way in which the practitioners prepare and prescribe the remedies, how and why they might be integrated into a homeopathic framework, the accessibility of the remedies and the desire for further study on the topic. These topics which were gathered from participants will be discussed in more detail below, within their organisation of sub-categories, categories and themes.

Table 3.1 Themes, categories and sub-categories Themes of Experience Categories and Sub-categories 3.5.1 Theme One: Value in 3.5.1.1 Practitioner experiences homeopathic practice A) Basic use and experiences B) Bach flower remedy criticisms C) Patient considerations

D) Use in practice

E) Bach flower remedies and homeopathy F) Contribution of Bach flower remedies G) Rescue Remedy in practice 3.5.1.2 Grounds for prescribing 3.5.2 Theme Two: Remedy 3.5.2.1 Symptoms & context of use application in practice 3.5.2.2 Remedy preparation and dispensing A) Complex versus simplex B) Dosage C) Frequency D) Complex components E) Preparation 2.5.2.3 Bach flower remedies used in practice 3.5.3 Theme Three: Practitioner 3.5.3.1 Patient response perceptions A) Negative B) Positive C) Unclear 3.5.3.2 Bach flower remedies for physical symptoms 3.5.3.3 Relevance 3.5.3.4 Practitioner opinions 3.5.3.5 South African flower Remedies 3.5.4 Theme Four: Education 3.5.4.1 Bach flower remedies at university 3.5.4.2 Bach flower remedy exposure 3.5.4.3 Sources of information 3.5.4.4 Additional training 3.5.5 Theme Five: Bach flower 3.5.5.1 Bach flower remedies in stores remedies available outside of 3.5.5.2 Bach flower practitioners homeopathic practice

It must be noted that some substantiations made as direct quotations form the transcripts as verbatim can be found under this sub-heading. Following each substantiation, the parentheses indicates the code number, followed by the interview or transcription number from which that segment of information came.

A list of codes may be found in Appendix J. This list demonstrates the code number and code description together with data verbatim, which was coded but not included in this section, 46

Discussion of Results. Data was organised in this way so that information which is most relevant appears in the above-mentioned section amidst the discussion while less relevant data, although not in the aforementioned section, remains accessible to the reader. Codes appear chronologically and are colour coded as per the theme under which they fall. Table 3.1 serves as a key demonstrating the colour associated with each theme.

3.5.1 Theme One: Value in Homeopathic Practice Determining the value of Bach flower remedies within the context of homeopathic practice is vital to this study. Exploring the practitioners’ experiences with Bach flower remedies in their practice provides the structure and foundation for subsequent themes discussed below. Participants had diverse expressions, descriptions and examples of the role Bach flower remedies played in their practice. This theme is made up of two main categories: Practitioner Experiences and Grounds for Prescribing.

3.5.1.1 Category 1: Practitioner Experiences The central question to this study and the opening question to the interview was: “Describe your experiences making use of Bach flower remedies in homeopathic practice”, therefore a large volume of data fell under this category. In order to facilitate its analysis, sub-categories were applied. Practitioner experiences will be discussed under each of the seven sub-categories which make up this category.

A) Basic uses and experiences Participants remarked on basic experiences while making use of Bach flower remedies. These basic experiences could be simplified into positive and negative outcomes. For the most part, practitioners had positive remarks to make on the topic at hand. One practitioner expressed how she has enjoyed making use of and incorporating the Bach flower remedies into her practice (code 187.6) and another noted that her overall experiences have been very good (code 187.8).

“I have had such lovely experiences with them” (code 187.6)

All participants who took part in this study stated that, in their experience of making use of Bach flower remedies, it serves to treat a patients’ emotional symptoms, the sphere on which the remedies are indicated (code 4). Practitioners stated that the remedies work quite well for the treatment of these symptoms because they cover emotional concepts very nicely (code 4.5). Bach flower remedies provide a means to address the patient’s emotional state. 47

“I purely treat emotionally with Bach flower remedies…. It’s an emotional sphere that you are treating” (code 4.6)

“I would imagine that some people can hold onto an emotional state or an experience that they had long ago, for their whole lives, until their system is ready to release it. But you can at least try with the Bach flowers, they definitely give you a nice scope to go with that” (code 4.14)

Participants noted that Bach flower remedies are most useful when the case’s leading symptoms are emotional (code 4.4) or when mental and emotional modalities come through very strongly (code 4.8).

A further eleven practitioners acknowledged that there is a noticeable connection found between the emotional and physical spheres of being (code 2). As holistic practitioners, this connection becomes relevant in that a state of poor emotional health may affect and perhaps perpetuate a state of poor physical health. Practitioners assure that this mind-body connection is noticeable in practice.

“…mental and emotional problems can be an aetiology to disease even if they might not be physiological” (code 2.9)

“Sometimes a physical symptom will actually disappear. For example, the kid’s tummy ache will disappear once the anxiety about school disappears” (code 2.4)

As noted here, and by several other participants, the mind-body connection is not easily separated or distinguished, but through their experiences in practice, practitioners have observed the relationship between the mental, emotional and physical states (code 2.4), to such a degree that some noted that many states of physical illness stem from one’s emotional state (code 2.11).

Of the basic experiences noted by participants, one such experience was that Bach flower remedies are convenient and easy to work with. The Bach flower remedy range is made up of a selection of thirty-eight flower remedies that can be blended together in any combination, without disturbing their therapeutic properties (code 49). The products are user friendly with clear indications of

48 where each can be found in the set, allowing for greater efficiency (code 49.2). These remedies are easy to understand and simple to use.

“And the Bach flowers are not hugely complicated…It is simple” (code 49.14)

The small remedy collection that makes up the Bach flower remedies contrasts greatly with the extensive range of homeopathic remedies. Which, it must be noted, also warrant careful blending to avoid adverse interactions and antidoting (code 12). This allows for better efficiency as well as accuracy in blending Bach flower remedies (code 12.2). As there is a large selection of homeopathics to choose from, which may share many similarities in indication, Bach flower remedies are welcomed because of the smaller and specific remedy options (code 12.1).

“…the nice thing with Bach remedies is, there’s a lot less of them… So, your ‘hit rate’ is sometimes better than on the homeopathic side” (code 12.10)

Because homeopathic complex prescribing needs to be done more meticulously than Bach flower complex prescribing, most of the participants noted and appreciated the gentle and safe nature of Bach flower remedies. One participant stated that Bach flower remedies are so safe, that should the incorrect remedy be taken the patient or consumer would feel no ill effect, allowing practitioners to confidently utilise the remedies and incorporate them into any appropriate treatment plan (code 42). The gentle nature of the remedies eliminates the concerns of overuse as they are viewed to be completely safe (code 42.2). Another practitioner remarked that its gentleness makes it a very child appropriate form of treatment (code 42.7).

“I know that I can safely mix three or four Bach flower remedies without there being any kind of adverse reaction” (code 42.2)

“I do think they are 100% safe” (code 42.4)

With this in mind, practitioners may treat emotional symptoms without concern for severe aggravation and exacerbations (code 252). Practitioners may find that emotionally volatile patients would benefit more so from a gentle Bach flower remedy, rather than a homeopathic remedy, which may result in an abrupt and intense emotional change.

“…(if) I’m concerned about giving them Aurum or Nat-mur (Homeopathic remedies), and their possible aggravations, I might go with a Bach flower and choose the most appropriate one” (code 252.12)

“So, I have to worry less about aggravations of remedies” (code 252.10)

When a practitioner treats emotional symptoms, a Bach flower remedy’s gentle approach allows the practitioner to treat without great concern for the consequences of an intense emotional shift. These remedies also eliminate practitioner concern about whether or not the patient is emotionally equipped to deal with such a shift (code 252.10). This emotional shift can be perceived as an aggravation but because Bach flower remedies are safe and gentle, there is less of a concern for intensifying the negative emotion (code 93).

“…I know that (it is) safer using Bach flowers because I am less likely to cause an aggravation” (code 93.12)

In some cases, participants have experienced using Bach flower remedies for themselves, for family or friends (code 140). Practitioners noted a difference with use, even within themselves, for symptoms such as study stress or sleep disturbances. In these circumstances, personal treatment and the treatment of loved ones has allowed for the initial exposure of these remedies to the practitioners and provided a platform to discover and understand the role that Bach flower remedies can play as a healing modality.

“…my daughter takes it. She was my first… test subject…She used to cry every day when I dropped her at school and cry when she had to do anything. Everything was just crying, and crying, and crying. It was amazing! Within a few days things started to change” (code 140.4)

“I see it with my kids… So, from personal experience, I think it’s excellent” (code 140.7)

Participants have determined the value of Bach flower remedies by relying on the feedback from their loved ones (code 220). At times, practitioners felt that their personal experiences and those of their loved ones would be expressed with greater honesty and truth. One participant noted that patients may not always give truthful reactions to treatment while loved ones can be more honest with their feedback (code 220.7). 50

“I first noticed it on myself and thought, ‘Ok well, it is myself so maybe you could be imagining it.’ And then I started on my family members and… I started noticing… how they had changed from a negative side to a more neutral or more positive side. And that’s when I thought ‘Ok, there must be something to this’” (code 220.11)

The value of the remedies is enhanced for participants by the simple specificity of each of the remedies (code 11). As noted by a participant, at times the patient will express a feeling, and because of the specific indications of the small remedy selection, the practitioner is quickly able to recognize that a Bach flower remedy is indicated, and which one would be best suited (code 11.3). This allows for precision in the prescription. In so doing, remedies may be combined to personally tailor a remedy complex for the presenting case (code 43). These factors enhance the appeal and facilitate the application of the remedies. It must be noted that a well prescribed Bach flower remedy for the patient’s specific state enhances the benefit of the treatment (Bach, 1941).

“I think it’s the fact that they are so specific toward specific emotional symptoms… I feel like they’re specific to emotional states” (code 11.1)

“…I usually like to add in my own version of the other Bach flowers for why that person is in that shock or trauma” (code 43.14)

Many of the participants stated that Bach flower remedies are a helpful tool to have in practice (code 127). Statements made by participants indicated that these remedies are beneficial to the practitioner and, more importantly, to the patient. In this way the remedies are a useful and important part of the prescription as they gently address the patient’s emotional state.

“I think it’s actually something that can really help practitioners help their patients more” (code 127.3)

“…Bach flower remedies are such a beautiful scope of practice…giving a bit of the participation hook in a way that they (the patients) don’t feel vulnerable or exposed” (code 127.14) “It’s an adjunct to my armoury and of what I could use to treat the patient” (code 127.12)

B) Bach flower remedy criticisms Bach flower remedies were met with a few criticisms form participants. Despite the feelings of Bach flower remedy safety expressed by participants, it was noted that prescribing Bach flower remedies can, at times, be unclear due to limited prescribing guidelines (code 331).

“It’s just very blurry. It’s just not scientific” (code 331.14)

While the gentleness of Bach flower remedies was perceived as an advantage offered by this remedy selection, at times participants felt that Bach flower remedies were perhaps too gentle (code 91) and would not provide adequate support in cases with predominant symptoms or disease. It’s perceived as being far gentler than homeopathic remedies.

“…maybe it just doesn’t work as strong a medicine as I would like it to work” (code 91.2)

A participant also noted that some patients and members of the public alike may demonstrate reluctance to follow a Bach flower remedy treatment plan due to the view that the remedies are quackery (code 292). In this way, its use may then raise questions on the credibility of the profession of homeopathy (code 277).

“A lot of people see Bach flower remedies a little bit hippie, hippie-dippie. They don’t see it (as being based) on a very strong scientific background” (code 292.12)

“I found… we (homeopaths) try so hard to fit into a box that we have created for ourselves to prove that we are equally as good, if not try and be better, than the allopaths. And with that we can’t now do anything else weird because we are going to be seen in a worse light” (code 277.11)

Throughout the interview process, only one aggravation was reported by a participant. This occurred when recommending the use of Rescue Remedy to a friend (code 326). The participant, having been in practice for ten years, noted that in practice a similar aggravation had not ever been noticed.

“Except for Rescue Remedy. I have (seen an aggravation) with my best friend. She gets into a rage with Rescue Remedy and every single time… That’s in my entire practice. None of my patients have ever (shown aggravations)” (code 326.14) 52

Although unlikely, the practitioner did suggest that perhaps the aggravation was in fact a healing crisis rather than an aggravation (code 327).

“Sometimes they will cry. Like, they find they are taking their Bach’s and they will have an emotional release, but they don’t stay crying. They have a release and then they feel much better. So, it might have been a healing crisis but nothing that then shoves them into a state that they were never in before and it’s not ending. That was my friend” (code 327.14)

C) Patient considerations The patients play a significant role in determining the value that Bach flower remedies hold in homeopathic practice. Patients need to be considered and understood for their individualised views, feelings and opinions as well as for their willingness to share both time and information with the practitioner. In turn, the practitioner needs to respect each of the individualised traits belonging to their patients and walk alongside them through any given treatment plan.

Participants explained that upon hearing about Bach flower remedies, patients were happy to make use of them (code 310) and, at times, have even requested them (code 291).

“So, when you explain to them that there’s these Bach flowers and they treat emotions only… they actually get quite excited” (code 310.14)

“…some patients, quite frankly, request it. They go, ‘I have heard about Bach flower remedies, is it an option for us to look into?’” (code 291.12)

It is important to note that in order to provide the patient with the most appropriate Bach flower remedies, it is necessary to have some insight into their emotional state. However, some patients may be reluctant to share their emotions and provide the practitioner with some guidance regarding their inner health (code 321). This can make formulating an appropriate treatment plan difficult for the practitioner.

“…your patient doesn’t always give you all the information” (code 321.10)

“…it’s going to have to be your educated guess and intuition on some of this stuff because people are not outright going to tell you that, ‘I am feeling guilty because I drove over my dog in the car park,’ or whatever it is” (code 321.14)

In order to encourage that the patients share their emotional symptoms, it is very important that the practitioner spends sufficient time with the patient (code 316). With this in mind, it may take some time for the practitioner to be aware of the patient’s emotional struggles and therefore choose not to prescribe Bach flower remedies at the initial consultation.

“So, if I pick something (emotional) up, I always keep it for the second consult. So that I follow through with the case” (code 316.8)

“Bach flowers are not going to work unless you spend time with your patient… it’s not always the first consultation” (code 316.14)

Participants described that some patients will be better suited to a treatment plan comprised of Bach flower remedies than others. One practitioner explained that patients can be categorised into two groups, one represented as the rhinos, those which are stern and less likely to be aware of their emotions, while the other is represented by the grasshopper, a more sensitive and emotionally connected individual (code 330 and code 296). While discussing the suitability of these remedies for selected groups, it was mentioned that it is far more likely that Bach flower remedies be prescribed for the more sensitive adult (code 135.4), as some patients can be hypersensitive or overemotional, in particular females rather than males (code 297). Although a far-reaching generalisation, it might be said that most men tend to fall into the rhino category while more sensitive adults, mostly women, form part of the grasshopper category.

“I personally find there’s a very specific set of patients who are keen to follow a Bach flower route” (code 296.12)

“You’ve got rhinoceros patients and you’ve got grasshopper patients based on how they are constitutionally and how they react. So, I’d say your grasshoppery people are more your sensitive patients, more livened, a bit more aware. They can tell you about their health. The rhinos are the ones who don’t have a freaking clue... So, there’s obviously those type of patients and Bach flowers are not for your rhino patients. They just don’t touch sides” (code 300.14) 54

“I’m going to say those are your grasshoppery kind of ones. More women than men. But then again, women tend to go and sort things out naturally. Men just ignore it until something falls off or their wife complains” (code 297.14)

Because patients vary in temperament and circumstances, the patient may not always be made aware that the treatment they are using includes Bach flower remedies (code 319) and may also be unaware of the emotional purpose of said remedy. Often times this may occur because the practitioner has mixed Bach flower remedies in with the homeopathic remedies. While other practitioners will explain what Bach flower remedies are to their patients (code174) and ensure that they are aware that they are taking them (code 173).

“But then also, patients that seem really uptight, I don’t often tell them that I have put a Bach flower remedy in there. I just need them to get un-uptight. So, I actually just pop that into the mixture, often I don’t tell them” (code 319.14)

“I explain to them that it’s made from flowers and that it works a little bit differently” (code 173.13)

“I also explain to them that Bach flower remedies work very much on the mental and emotional” (code 174.4)

In some cases, some patients may be aware that they are taking Bach flower remedies but unaware of the specific remedies in their Bach complex (code 67).

“…when we label the bottle on our system or on our file notes, I write down the complex… But, when I label it for the patient I write ‘sleep drops’” (code 67.2)

The ultimate patient consideration would be that the patients’ care, treatment and progress are of upmost importance. For homeopaths and all health care practitioners, the patient is the priority. Throughout the interview process, participants noted that the priority of the patient remained constant amidst different treatment approaches that are used in practice, including Bach flower remedies (code 301). Participants acknowledged that patients must be considered holistically and prioritised in order to be adequately cared for and treated (code 335).

“I don’t believe that there is anything that should be ignored in practice. I think you need to do what the patient needs and not what you want to do” (code 301. 12)

“You can’t just heal the emotions and leave the physicals because it might not actually come right” (code 335.14)

Participants have stated that each patient needs to be understood as an individual. This could speak to the practitioner’s ability to prioritise the patient in ways that have already been discussed, such as noticing if the patient displays “rhino” qualities or “grasshopper” qualities and addressing or treating the patient holistically and in totality rather than locally. In all of these discussions, patient individualisation is evident. For these reasons patient treatment needs to be personalised, thus making each treatment plan case dependant (code 58 and code 9). Participants note that determining what the patient needs can be difficult at times. This reinforces the importance of spending time with the patient and the need for the practitioner to be perceptive to the needs of the patient.

“…(dependant) on what the patient is facing and where their energy is lying” (code 9.9)

“…(treatment) is based on the presentation” (code 58.12)

“There are no rules. You have got to read your patient and know what you are dealing with. It’s so case dependant, it’s tricky” (code 58.14)

While considering each patient’s need for a personally tailored treatment plan, many participants expressed the idea that not all forms of treatment will yield positive outcomes for all patients (code 107). This reiterates the need for an individualised treatment approach because as one participant explained, “not everything works for everyone” (code 107.4). Each patient needs to be treated in context of their specific needs at any given time.

“So, I have had some patients responding saying, ‘It’s amazing,’ and again it helps them to get through that traumatic or emotional time, and others where they’ve said they don’t really feel much of a difference” (code 107.3) “I do think that some patients have benefited more than others with it. Whether that’s the nature of their personalities, it’s created a shift” (code 107.10)

D) Use in Practice Practitioners may purchase all thirty-eight Bach flower remedies as a wooden box set from the South African suppliers. Some practitioners stated that because they so seldom dispense Bach flower remedies, it is unnecessary to purchase the entire box set (code 283). A few practitioners prefer to keep a small selection of the remedies in practice or even script the appropriate Bach flower remedies out for their patients to purchase at a Bach flower remedy retailer.

“…the frequency with which I dispensed them didn’t warrant me buying the whole box. So, there are a few that I keep that I had a particular patient on” (code 283.12)

However, almost half of those who took part in this study owned the practitioner set (code 48.2,5,6,8,10,14) while another practitioner admitted to slowly accumulating the Bach flower remedies as needed (code 155).

“…it’s nice to have the whole set of remedies” (code 48.13)

“I’m slowly, slowly building it up. Because as with everything, there are some in the kit that are super popular and others that I’ll probably never need…I have my main ones and I’m slowly collecting” (code 155.4)

The cost of the Bach flower remedies seemed to be a matter frequently mentioned by participants. This influences how and if the remedies are dispensed in homeopathic practice. One participant, who has only recently started in practice, declared that it is the initial cost of the Bach flower remedy kit that has limited her use of the remedies in practice (code 97.9). The significant initial financial outlay for the remedies was echoed by several other participants too, noting that Bach flower remedies are quite costly making them expensive to stock in practice (code 97).

“The kit is expensive… we buy the remedies quite often, but the kit, I think, is quite pricy” (code 97.2)

Two additional factors where noted with regard to the cost of Bach flower remedies. Despite the practitioner Bach flower remedy set being “pricy” (code 97.9), a remedy complex made up and dispensed by the practitioner remains more cost effective for the patient, if the alternative is purchasing all of the indicated remedies from a Bach flower remedy retailer. Therefore, it is more affordable for patients if practitioners dispense the remedies from their own dispensary rather than 57 scripting the remedies out for purchase elsewhere (code 207). The use of Bach flower remedies in practice are also affected by the budget of the patient. Although these remedies may be a positive tool to incorporate into a treatment plan, they may not be the primary form of treatment. In which case, should a patient have a tight budget, Bach flower remedies may fall to the wayside. It is still necessary to ensure that the patient’s budget allows for Bach flower remedies to be incorporated into the treatment plan prior to dispensing it (code 96).

“Often the patient will get 3 things: a homeopathic, a herbal and a supplement, and Bach flower remedies if I felt that I didn’t cover it and if they can afford it. But it’s not expensive. Bach flower remedies don’t work out to be too expensive” (code 96.2)

“So, often also it’s financial. Where is the patient? Because, I don’t want to prescribe too much because then they get too much that they then have to pay for” (code 96.6)

As to be expected in homeopathic practice, the use of Bach flower remedies is minimal when compared to the use of homeopathic remedies. Along with homeopathics being the basis on which a homeopathic practice is built, participants presented additional motivations. One participant mentioned that this is due to knowing homeopathic remedies better than Bach flower remedies (code 122). Participants noted that Bach flower remedies are not always memorised, and it is often necessary to refer to their resources (code 114), making homeopathy more convenient when there is limited time to dispense (code 126).

“I know my (homeopathic) remedies better than my Bach flower remedies so, those come to the fore quicker, so I think of them first. Which is once again, one of the reasons why that’s (Bach flower remedies) not used as often” (code122.3)

“I don’t know my Bach remedies well enough to just, give them off the cuff” (code 114.10)

“…if I have ten minutes to dispense, I don’t always have time to look them up, so it doesn’t get used as often” (code 126.3)

Participants acknowledge the minor role that Bach flower remedies have when discussing their use in practice. Participants recognise that this may result in the insufficient use of the remedies (code 90) and as a result, the practitioner’s experiences using Bach flower remedies may be limited (code 98). 58

“I am using them in my practice. Maybe not as much as I would like to, but I am using them… I forget about them to be honest… But I don’t use them as much as I would like to” (code 90.3)

“…my usage of Bach flower remedies is not as much as my other homeopathic remedies, or nutraceuticals, or botanicals, or mother tinctures… it’s not a huge part of my practice” (code 98.12)

E) Bach flower remedies and homeopathics As mentioned above, homeopathic practitioners prioritise the use of homeopathic remedies over Bach flower remedies in practice. Participants in this study emphasised that their training has made them most familiar and comfortable with using homeopathic remedies, making it a primary form of treatment in practice. For many practitioners, homeopathic remedies may be selected when the entire symptom picture, emotional and physical symptoms, need to be addressed (code 195). Bach flower remedy application is subordinate when treating patients (code 102), a sentiment affirmed by many participants who acknowledged that they would first turn to homeopathy before considering any other complementary medicine, such as Bach Flower remedies. Although all participants assure that Bach flower remedies are valuable in treating emotional symptoms, it is noted that in circumstances where an in-depth case is presented by the patient and more than emotional symptoms are displayed, practitioners will rely on homeopathy.

“… if they (patients) are giving me really good, homeopathic, specific things, not just mentals but also physicals, that would be a really good instance to use homeopathy because I feel more comfortable in my prescription in a holistic sense” (code 195.9)

“When I get a clear homeopathic picture, I will always use homeopathy first” (code 102.4)

Because Bach flower remedies address emotional symptoms at large, one participant remarked that Bach flower remedies could not be relied upon in clinical cases (code 290.12). It was also noted that even amongst homeopaths, Bach flower remedies are not very popular and are only used by a limited number of practitioners (code 157). One of the participants, a weekly clinician at the Homeopathy Clinic at UJ noted that, no one other than her seems to make use of Bach flower remedies in the clinic (code 157.4). This was confirmed during the recruitment phase of this study as several practitioners either declined participation or did not qualify for participation due to a lack of experience with the products. For those who do make use of the Bach flower remedies, 59 there is a sense of diminished support from fellow practitioners and colleagues (code 281). While respecting each practitioner’s individual treatment methods, one participant made it known that making use of Bach flower remedies is not for all practitioners (code 334).

“…I often feel, ‘Why aren’t people using them? Why haven’t people got them in their practice?’” (code 157.6)

“As a practitioner I have to be honest, I don’t think you get that much support if you say, ‘Bach flower remedies for homeopaths’… because like I said, some of them don’t really know about it… or they have an opinion like ‘Oh, that stuff doesn’t work’” (code 281.11)

“I must admit, it’s also that some homeopaths just really aren’t emotional practitioners… and there’s not anything wrong (with that)” (code 334.14)

F) Contributions of Bach flower remedies A central objective to this study is to determine the perception held by practitioners as they relate to the use of Bach flower remedies and their contribution to a homeopathic practice. As already discussed, practitioners perceive Bach flower remedies as a positive treatment tool that can be incorporated into their practice, all the while acknowledging their limited application of the remedies. As homeopathic treatment methods form the basis of their practice, practitioners reaffirm the position of Bach flower remedies as an auxiliary treatment in homeopathic practice (code 92) or as a contributing adjunct to the homeopathic dispensary (code 13)

“So, for me it’s a nice auxiliary therapy” (code 92.2)

“It’s such a nice adjunct to the homeopathic practice” (code 13.4)

Considering their limited experience with the remedies, practitioners expressing the perceived value for the remedy selection was apparent. Practitioners clearly stated the important role, albeit small in proportion, that Bach flower remedies have in their practice, with nine participants vouching for its value (code 142). When asked if it held any value in practice and if she would be keeping them in her dispensary, one particular participant replied, “Definitely!” (code 142.13). Other practitioners note that “…it works brilliantly” (code 142.4) and that “…they are so useful and beautiful to work with” (code 142.6). And for reasons such as these, participants understand their value and maintain the use of Bach flower remedies in practice. 60

“I definitely believe there is value in it” (code 142.5)

The noticeable positive reaction to Bach flower remedies was emphasised as some participants noted that in their opinion, Bach flower remedies are interchangeable with homeopathic remedies (code 152). When most participants mention that the basis of their practice is homeopathic remedies, this is a substantial statement. For those who had positive outcomes using the remedies, this translates into Bach flower remedies being respected on par with homeopathic remedies.

“To me homeopathy and Bach flower remedies are almost… interchangeable” (code 152.4)

“I almost equate them to my homeopathic remedies now” (code 152.10)

A few of the practitioners substantiate their high esteem for Bach flower remedies because their use usually results in two main outcomes. The first being, providing grounds for the practitioner to assist the patient through difficult emotional phases of life; and the second is the re- establishment of emotional harmony for the patient. Practitioners find value in Bach flower remedies because they assist in facilitating the patient’s own self-healing (code 256). Through using remedies like these, the practitioner is able to offer more emotional support and guidance. It is this guidance that allows the practitioner to help their patients help themselves.

“…without counselling or guidance…I do a lot of counselling with my patients, where they come in and we sit for two hours and I don’t give them a remedy… Because I can see that the remedy is still acting and it’s like, ‘Ok, that’s fine. It hasn’t worn off yet, keep going’. But I need to counsel them” (code 256.10)

“…I always feel that there will always be a need for a practitioner because it’s always more than just the remedies that they are getting. They are getting the interaction. They are getting someone who generally has that appearance, hopefully it’s more than an appearance, that kind of caring. And someone who will listen to them which is something that no remedy and nothing else can be because unfortunately we’re not being listened to these days” (code 256.11)

“…you are almost using self-healing… you have to play with the patients’ perception… it’s almost my responsibility to get them better and I need to get them out of their own way” (code 256.14) 61

A few of the practitioners substantiate their high esteem for Bach flower remedies because they both facilitate the emotional healing of the patient, but also assist in establishing a bond between patient and practitioner. By solidifying this relationship, a bond of trust between the practitioner and the patient can emerge (code 317) and channels for communication as well as grounds to explore the patients’ emotional health are created (code 250). These features positively guide the healing process.

“It’s a bonding thing… they’ve got to learn to trust you first. And, that’s why I say Bach flowers are a nice doorway to building trust” (code 317.14)

“I gave them that (the Bach questionnaire) and there were really strong emotional aspects that people were ticking and marking and rating that didn’t come out in the consultation” (code 250.10)

Establishing practitioner-patient bonds and healthy communication channels are fundamental when addressing the patient’s emotional state as part of the treatment. As noted by participants, patients can sometimes lack emotional awareness (code 108). As one participant stated, using the Bach flower remedy questionnaire provided emotional insights and indicated the areas where it was necessary to “scratch a bit more with the patient’s case” (code 250.10) in order to fully understand their emotional state. A sentiment shared by another participant was that some patients just can’t get to the crux of their emotions. For these individuals the idea of emotions is a foreign topic. Although some patients may not be able to describe their emotional state, either for lack of its understanding or for lack of articulation, one practitioner notes that their behaviour will always suggest it (code 108.14). Therefore, practitioners must remain perceptive to their patients.

“We know that with Bach flower remedies you have to work out what the problem is and sometimes it’s difficult to extrapolate that data, especially from men, to see what it is” (code 108.12)

By establishing more fluid and trusting communication channels between patients and practitioners, the use of Bach flower remedies in treatment may allow patients the opportunity to further understand the value of their emotions (code 318) as well as empower them to care more deeply for themselves (code 273). If the practitioner is able to show their patients how their negative emotions are causing physical dis-ease; such as in the case of extreme stress causing stomach reflux (code 318.14). Rather than feeling powerless, patients can be proactive about their 62 emotional and physical health (code 273.11) and feel “more in control of their situation” (code 273.14)

“They never saw it (their emotional state) as important either for their physical health…the Bach flowers, being a tame way of introducing that concept to them, literally work quite nicely” (code 318.14)

“I like that people can take their own health into their own hands… and with Bach flower remedies, it being so gentle, it is always nice that they have a bit of empowerment” (code 273.11)

By enhancing emotional awareness and creating the space for patients to share their feelings, Bach flower remedies may be adequately prescribed. In so doing, they assist in shifting the patients’ circumstance into a more positive emotional state (code 68). Once again, Bach flower remedies come up as positive practice tools as a few practitioners noted that it places a positive spin on the treatment and encourages the patient to feel more equipped to face their circumstances (code 68.8)

“I try to not use ‘fear’, because then every time they’re taking it they’re seeing the message, ‘fear’. So, it’s more about turning that word of fear around. I don’t want to say happy drops because that’s not right, but… putting a positive spin on it to say: ‘comfort drops’ or ‘energy drops’ or something that might be more uplifting than re-establishing the old or negative message” (code 68.2)

“…give that… little bit of optimism and that little bit of hope” (code 68.11)

One practitioner described this further by stating that by providing adequate emotional support for the patient, these remedies assist them because it “grounds” them (code 239.8). This was further explained with an analogy.

“So, it’s like you’ve got a (homeopathic) remedy that sorts out everything and aligns them into position, and then your Bach flower just grounds them because it deals with that underlying emotion that they can’t deal with. So yes, maybe Pulsatilla women are very tearful because they can never say, ‘No!’ to something. So, you know that you’ve got Clematis… that helps you to actually be assertive. Here you’re just giving the Pulsatilla so

that they can deal with the fact that they can’t say, ‘No’. But here you are giving them a spin off, being positive and saying, ‘I can do this!’” (code 239.8).

Practitioner objectivity is critical in caring for the emotional state of the patient (code 323). The practitioner can provide support from a non-judgmental and neutral perspective.

“I think that it is important that there is a practitioner who is impartial and objective to be able to break it down for those more overwhelmed (patients). I have actually had patients read the book, the Bach flower book and book an appointment with me to come and decide together, which is good” (code 323.14)

At large, Bach flower remedies are used for the treatment of emotional symptoms. Participants refer to the ‘onion layers’ of their patients (code 232). It relates to an idea that each individual is made up of several layers, determined by their personal attributes, circumstances and experiences. In their personal experiences with the remedies, participants revealed that Bach flower remedies can assist with gradually ‘peeling back’ an individual’s layers in order to release buried emotions that may exist at the core as well as act as a powerful emotional shifter (code 123). As one practitioner noted, when more than one matter comes to the surface the practitioner may choose to treat one matter at a time. That is, concentrating on ‘one onion layer’ for that moment so as to not overwhelm the patient (code 232.10). These therapeutic features of Bach flower remedies which were discussed by the participants, further suggest their contribution to the homeopathic dispensary.

“…adults obviously have many layers of life experiences, issues that maybe they aren’t going to let go of, say anger or resentment” (code 232.14)

“I think they can both (homeopathic and Bach flower remedies) be very powerful in shifting people in the right direction, if you choose the right remedies” (code 123.3)

G) Rescue Remedy in practice Rescue Remedy is the most commonly known Bach flower remedy complex. It is made up of five of the Bach flower remedies, indicated specifically for anxiety and shock (Vlamis, 1994). Rescue Remedy is frequently used by the public as it is easily accessible in the health retail environment. Although not all Bach flower remedies form part of the Rescue Remedy complex, all Rescue Remedy complexes contain Bach flower remedies. With this in mind, the practitioner’s 64 experiences with Rescue Remedy in homeopathic practice drew two opposing views from participants.

One of the participants noted that it was a frequent prescription in her practice (code 304.13), while another explained that this remedy complex was the only form of Bach flower remedies that were made use of in her practice (code 216.7). This participant finds its effects satisfactory and feels that it is unnecessary to incorporate any of the individual Bach flower remedies into the practice’s prescribing methods (code 224).

“I understand that they do have the box sets that you make up your own (remedies) but so far this (Rescue Remedy) has been working well. So, I haven’t found a problem. I’m just sticking to what works at the moment” (code 224.7)

A few practitioners noted that they do make use of Rescue Remedy in practice when it is well indicated (code 209). One practitioner dispenses a Rescue Remedy complex to women preparing for childbirth as it addresses emotions such as fear, anxiety and apprehension (code 209.6) On the contrary, another participant stated that Rescue Remedy is seldom used or recommended because her homeopathic practice does not encounter the circumstances or situations that might call for the use of this remedy complex, such as acute trauma and shock (code 328).

“So Rescue, I used across the board. But purely for the clinical picture of Rescue and what Rescue does as an individual product” (code 209.10)

“…but then I also know that I don’t see people who have just been in a car accident… I am actually not seeing those ones who are in shock and they have lost all reason and rhyme and they don’t know where they are, and they don’t know who they are…. Rescue Remedy would suit that, but I don’t see that” (code 328.14)

Because Rescue Remedy is very common and well known (code 117), patients may obtain it without the recommendation of the practitioner, from a convenient health retailer. For this reason, the general public may be better acquainted with Rescue Remedy than the individual Bach flower remedies.

“…lots of people are using Rescue and recommending it and taking it. That’s a very common one” (code 117.3) 65

As previously discussed, at times homeopathic practitioners find value in the Bach flower remedy set because they allow the practitioner to personally tailor patient appropriate remedies. Because many participants seek the specificity that the remedies can offer, Rescue Remedy may not be frequently prescribed or recommended (code 208).

“Rescue Remedy, I don’t usually dish out that often” (code 208.14)

Some participants revealed that patients may report a positive response to Rescue Remedy, a topic which will be discussed in more detail in Theme Three’s first category, Patient Response. Should patients provide positive feedback from making use of Rescue Remedy, a few practitioners suggested that they continue using it (code 268).

“But some people have found it on their own and they absolutely love it. Then I’m going to say, ‘That’s absolutely fantastic!’” (code 268.14)

Although it might not always be frequently dispensed, some participants noted the use of Rescue Remedy in the consultation room to calm patients and improve the value of the consultation time (code 105).

“…if people are coming in quite acute, with their stress and anxiety, and then I’d probably even give it to them just for the consultation, just so that they can relax a bit” (code 105.3)

Bach flower remedies are documented as being safe to use on plants and animals (Vennells, 2001). An interviewed participant also vouches for the positive experiences noted using Rescue Remedy on plants and animals (code 259).

“I use Rescue a lot… I dosed animals with it... I used to give it to the plants” (code 259.10)

There are several forms of Rescue Remedy on the market. Some complexes contain only the five Bach flower remedies, the Rescue Remedy formula put in place by Dr Edward Bach, while others may have these five remedies together with other ingredients such as homeopathic remedies. Some participants noted that those which contain only Bach flower remedies are preferable and show more favourable results (code 217). In the case of recommendation or prescription of Rescue Remedy, these practitioners would suggest that patients purchase pure Bach flower remedy Rescue complexes. 66

“I tell them to use the Rescue drops that’s made up of only the (Bach) flowers, not the homeopathic mix that you sometimes find… I find it works better if it’s just the flowers” (code 217.13)

3.5.1.2 Category 2: Grounds for Prescribing While uncovering the value that Bach flower remedies held for practitioners, participants shared their prescribing methods which indicated how they would decide on the Bach flower remedies that were most appropriate for the patient, and their prescribing techniques.

When looking to apply Bach flower remedies, some practitioners made use of a Bach flower remedy questionnaire (code 179). Through a series of questions that are answered by the patient, a selection of appropriate remedies would emerge. This provides the practitioners with some insight into the remedies that may be most appropriate for the patient. One participant explained the questionnaire as follows:

“It’s a questionnaire sheet on the Bach remedies… It goes alphabetically and then there’s three statements. The patient basically just reads it and then gives it a rating of one to five. And so, I thought, ‘Well, let me start with that’. So, I gave them that… you can pick up trends or themes” (code 179.10)

Of those interviewed, a few participants shared their remedy selection techniques. It was explained that the case would be reviewed to find similar emotional themes from which remedies could be selected (code 144). As already mentioned, the basis for prescription can sometimes appear “blurry” (code 332.14) and therefore some practitioners declare that they rely heavily on intuition to guide them when prescribing remedies for their patients (code 251).

“I would first sit with the case and go, ‘What themes do I see?’... Then I go back to the table (of remedies) and see which remedies then match” (code 144.4)

“…intuition I would probably say… it’s just going to have to be your educated guess and intuition” (code 251.14)

Value in Bach flower remedies were noted when participants perceived the remedies to illicit emotional shifts and assist in the individual’s ‘de-layering’, to facilitate the release of built-up emotions. When discussing grounds for prescription, it was suggested that Bach flower remedies 67 serve practitioners in practice because, in this manner, they may assist in reaching the root cause of a symptom picture (code 23).

“…you sort of have to de-layer something and try and get to the core as much as you possibly can” (code 23.14)

“And you can treat the physical until the cows come home and until you have actually addressed whatever the emotion is, even if it’s just talking about it. But sometimes they can’t talk about it and you know it’s just parking off there. You can give them the Bach flowers in their remedy… it actually helps release a lot of what they have been holding onto” (code 23.14)

3.5.2 Theme Two: Remedy Application in Practice In this theme, data that pertained to the physical prescription of Bach flower remedies in homeopathic practice was grouped together. This theme uncovers the symptoms that were treated with Bach flower remedies more specifically, the context under which they were prescribed, as well as how the remedies were prescribed and dispensed by the homeopath. Although not a primary objective for this study, the application of these remedies in practice directly influences the outcomes of treatment, and therefore ripples onto the value these remedies may hold for the practitioner.

3.5.2.1 Category 1: Symptoms and Context of Use While discussing their experiences, participants often referred to the emotional picture they would treat with Bach flower remedies and the unique setting that they felt would call for its incorporation into the prescription. These were coded and categorised as symptoms for which the Bach flower remedies were prescribed for and the contexts in which they were used.

Practitioners most commonly mentioned conditions such as anxiety (code 40.2,3,4,6,7,11), sleep disturbances (code 41.2,10) and stress (code 7.1,3,7,11) as symptoms which would be addressed using Bach flower remedies. Trauma (code 5.1,3,10), fears (code 39.2,4) and calming effects (code 219) were also brought up frequently.

“…fear of the unknown, fear of failure, fear of this or that” (code 39.4)

“Bach flower remedies tend to calm the patient down quite quickly and effectively” (code 219.8)

Symptoms which appeared less commonly during the data analysis were depression (code 230.8), mental blocks (code 320), life changes (code 136), worry (code 138.4), uncertainty (code 137), unusual emotions (code 38.2), grief (code 104.3), study stress (code 218.7) and emotional build ups (code 6.1). Some examples were provided of instances where such symptoms would be noticeable:

“I will use Bach flowers for when they are quite stuck in their mind set” (code 320.14)

“…facing changes in life like: moving, or changing jobs, or ‘I’m getting divorced’” (code 136.4)

The context in which practitioners might use Bach flower remedies was also considered during the interviews. It was found that practitioners mainly make use of Bach flower remedies as a means to complete the symptom picture (code 14). In this way, practitioners might rely on Bach flower remedies to treat the emotional symptoms being displayed by the patient while prescribing another remedy which addresses the physical symptoms displayed. One practitioner explained that Bach flower remedies may assist to “mop up” emotional symptoms that may persist despite using a well indicated homeopathic remedy (code 14.4). This demonstrates how the Bach flower remedies are used to complete the symptom picture displayed by the patient.

“…especially when you’re using an indicated homeopathic remedy, but you see it’s not covering the emotionals as well” (code 14.1)

“So along with the homeopathic remedies or whatever treatment I decide to do, as an addition I always add the Bach flower remedies… if the patient is already on their remedies and it’s working and I just need to add additional emotional support. I have had really good results” (code 14.11)

Bach flower remedies were also useful to practitioners when they were unsure if they had chosen the correct homeopathic remedy or to offer additional support in cases where the prescribed homeopathic remedy was less effective than expected (code 223). As discussed in Theme One, it is so important to establish good communication between the practitioner and the participant. 69

Participants noted that Bach flower remedies can also be particularly useful when the patient is reluctant to provide in-depth details about their symptoms or emotions and the presenting picture lacks details (code 139). It is difficult to select an appropriate homeopathic remedy for a case that does not have specific symptoms. Bach flower remedies however, could be selected more easily because there is a smaller selection and fewer indications for each. The safe and gentle nature of the Bach flower remedies allows the practitioner to address emotional symptoms even when the patient has been unwilling or unable to provide the details surrounding their feelings. Similarly, Bach flower remedies may assist when the homeopathic remedy is unclear (code 37).

“What if it’s the wrong remedy choice?... So where I could have maybe lacked on my side, the Bach flower remedies help it on that side” (code 223.7)

“Or, in those cases where the mom says, ‘My kid is anxious,’ and where there’s no real homeopathic picture, then Bach flower remedies become my first line treatment. Because at least the mom will say, ‘My kid gets very anxious when I drop them in the morning at school.’ But if they can’t tell me anything else about that anxiety, I can at least tie a Bach flower remedy to that, rather than trying to find a specific homeopathic” (code 139.4)

“It might be in the cases where the remedy doesn’t come out clearly for me, so I’m doing more support on the physiology side and doing the Bach flower remedy purely for the emotions that I can’t quite put my finger on” (code 37.2)

For a couple of practitioners, Bach flower remedies assist in providing more immediate support for the patient (code 270). At times the homeopathic remedy may take time to provide results. For this reason, the Bach flower remedies can be put in place as a more acute form of treatment while the homeopathic remedies’ action comes through. As one participant put it, the Bach flower remedy offers “support in the interim while the homeopathic remedies are working” (code 270.11). One of the participants found that Bach flower remedies are most useful in diminishing the intensity of the emotions being felt by the patient, again addressing the emotional symptoms more acutely (code 269). On the contrary, another participant suggested that Bach flower remedies could be used continuously, separated by the use of an intercurrent homeopathic remedy (code 10.1).

“So, it’s nice if you have a (homeopathic) remedy that is going to take its time to work, to use the Bach’s in between” (code 270.13) 70

“…just that immediate relief, I find that the Bach flower remedies just help release that intensity and give them a little bit of optimism” (code 269.11)

3.5.2.2 Category 2: Remedy Preparation and Dispensing Toward the end of his career, Dr Edward Bach prescribed only Bach flower remedies and clearly indicated how they should be prepared and dispensed (Ball, 2003). Although Bach flower remedies have become a common element in the homeopathic dispensary, remedy preparation and dispensing techniques vary widely, not only from Bach’s original instruction but from one practitioner to another as well as from case to case. Some practitioners admitted to prescribing and dispensing their Bach flower remedies in the same way they would their homeopathic remedies (code 146).

“I do it (prescribe Bach flower remedies) very homeopathically actually” (code 146.4)

“I work on homeopathic prescribing. The more severe the symptoms, the more frequently they are going to dose themselves” (code 146.12)

In order to better analyse this data, sub-categories were applied to this category. These will be discussed below.

A) Complex Versus Simplex While a classical homeopathic treatment approach would strongly advocate for the selection of a well indicated single remedy, Dr Bach opted to combine the remedies which best fit the case on condition that no more than six remedies be placed in the complex (Ball, 2003). Upon discussing the preparation of Bach flower remedies, it was seldom noted that practitioners would prescribe a single Bach flower remedy, or simplex, to a patient (code 175). For the few that reportedly prescribed single remedies, there was no remedy preparation required as they would dispense an original Bach flower remedy bottle, as one would find at a Bach flower remedy retailer (code 237).

“The chances that I use them (a Bach flower remedy) on their own is quite limited” (code 175.5)

“I will dispense the entire dropper container and then advise the patient on how many drops to take and how often” (code 237.12)

Dispensing an original Bach flower remedy as a simplex was preferable for one practitioner who was uncomfortable with the idea of tampering with the sealed Bach flower remedy container for fear of contamination or compromising the therapeutic effect of the remedy (code 284.12). The practitioners who opted for less complex prescribing would at most prescribe two Bach flower remedies at any given time (code 231). One participant felt that because Bach flower remedies are quite specific, no more than two remedies would be necessary to cover the presenting symptoms (code 231.12).

“So, I generally go on one remedy at a time. I prefer that. If I feel that they need a second remedy, I add that to the main bottle” (code 231.8)

Complex prescribing and dispensing was the more popular option amongst practitioners. Complex prescribing is carried out in one of two ways. The first being a collection of Bach flower remedies being combined in a single medicine bottle (code 95) and the second being a collection of Bach flower remedies in a medicine bottle that also contains homeopathic remedies (code 172). The first being the most popular of the two.

“I use Bach flower remedy in conjunction with the homeopathic or supplementation…but it’s separate. Completely separate” (code 95.8)

“I’m more a complex prescriber. So, I normally add it in with my other remedy… with the Bach remedy, so I’ll actually do it all together” (code 172.5)

In a few cases, participants mentioned that when prescribing Bach flower remedies, the name of each remedy was not always clearly noted on the dispensed container, instead a “complex” name was given (code 109). These participants admit that this is mainly due to insufficient label space to state all the components of the complex (code 110).

“When we label the bottle on our system or on our file notes, I write down the complex. So, I write ‘Larch’, ‘Willow’ …whatever. But when I label it for the patient, I write, ‘Sleep drops’” (code 109.2)

“…if they ever need to know the names, then I’ve got it there (in their file). Mostly just because of label space” (code 110.3)

B) Dosage In this sub-category, dosage refers to the amount of medicine number of remedy drops taken by the patient (Dicitonary.com, n.d.a). Dr Edward Bach’s dosage suggestion is either two drops of the individual Bach flower remedies into water to be sipped on throughout the day, or four drops of the Bach flower complex remedy to be taken daily (The Bach Flower Centre, n.d.b.). There were only two participants that followed Bach’s dosage instructions by recommending that patients take four drops of the remedy at any given time (code 112.3, 8).

The various practitioner dosages came through clearly during the interview process. Two participants recommended their patients take five to ten drops per dose (code 267.11,14) and for another two participants, their standard dose was ten drops (code 191.6,12).

A fifteen-drop dose was suggested by two other participants (code 222.7,13) while another participant suggested that a dose is between ten to twenty drops, depending on the patient’s age (code 55).

“To take twenty drops at a time and for kiddies less, probably ten drops” (code 55.2)

As suggested by a few participants, patients may place a few drops of their Bach flower remedy complex into their water and sip it throughout the day (code 8). It was suggested that this method may be preferable as it may become cumbersome for the patient to remember to take their Bach flower remedies so regularly (code 8.6)

“Usually a few drops in water and then drink it during the day” (code 8.1)

With so many various dosage suggestions, the diversity of each prescription among practitioners is clearly indicated. Not only does this demonstrate the personal dispensing techniques of Bach

73 flower remedies among homeopathic practitioners, but also demonstrates that Bach’s dosage instructions are seldom followed.

C) Frequency As dosage referred to the number of remedy drops taken by the patient, frequency refers to how often the practitioner will recommend that the remedy is taken, or the rate of occurrence (Dictionary.com, n.d.c). The participants of this study showed considerable variation on the frequency aspect of their prescription. Dr Bach suggested that a Bach flower remedy complex be taken four times daily as a standard frequency (The Bach Flower Centre, n.d.b).

For many participants, the emotional state of a patient was a leading reason for determining the frequency with which they made use of their Bach flower remedy treatment. Participants noted that with an increase in intensity or in an acute symptom presentation, it was advised that patients take their remedy more frequently than the standard recommended dosage (code 56). In acute cases, such as before a test, the remedy can be taken every five minutes (code 56.4). This could be every hour, every half an hour or even every few minutes, depending on the intensity of their emotional symptoms (code 221).

“For my very emotional patients, they have already accepted that they are very emotional and we are working on it. I’ll then give them a separate Bach flower and then they can take that six or seven or eight times a day. Every hour if they wanted to. If their situation is making them feel anxious or overwhelmed or like they can’t cope, then you take it every half an hour” (code 56.14)

“…sometimes if they are in a terrible space emotionally it might even be every hour for a day and then dropping down” (code 221.12)

In order to tackle acute emotional symptoms, one practitioner noted that when the patient first visits for a consult, it is recommended that they take their remedy every hour (code 177), which would decrease to one to four times daily after a follow-up consultation, at which point the emotional intensity is expectantly reduced. As noted by another participant, on subsequent visits the frequency would decrease to three to four times daily (code 286).

“I recommend people take it every hour for the first time when they come and see me. And then afterwards, it might be four times a day or as the patient needs it less, they use it once 74

a day. But I do tell patients that the first bottle will usually be used very quickly… they will find the second bottle will last longer because they need less of it” (code 286.5 and code 177.5)

A frequency of three to four times daily is the standard frequency advised by another practitioner (code 266.11). For others, a standard frequency of only three times a day is advised (code 113.3,8,14). For one practitioner, the Bach flower remedies are prescribed two to three times daily (code 309.13), for another it’s suggested one to two times daily. In the case of chronic treatment (code 285.12) and for three of the participants, Bach flower remedies are prescribed only once daily (code 57).

“…either daily or in acute cases… several times a day” (code 57.10)

“I do it once a day before sleep or once in the morning. It just depends on the case” (code 57.2)

One participant suggests a frequency of six times daily (code 191.6). However, this participant noted that it is necessary to be aware that this may be overwhelming to the patient with such a frequent prescription (code 192).

“…six times (a day) is a little bit cumbersome” (code 192.6)

Requiring that patients take their remedies very frequently may hinder patient compliance. Should practitioners wish to adjust and reduce the duration of which patients are on their Bach flower remedies, the frequency may be enhanced, together with the dose, to complete the treatment bottle faster (code 193).

“It also depends on how long I want them to be on it for. So, I don’t want them to have this bottle that is lingering six months after it’s been dispensed to them. So, then I will say, ‘put twenty drops in your water bottle’ because you don’t want them to sit with the medication for ever and ever either” (code 193.6)

Amidst the discussion of frequency, which can also refer to how often the practitioners prescribe Bach flower remedies, four participants declared that they do use the remedies frequently in their

75 practice (code 44), even noted to be used on a daily basis in practice by one participant (code 44.5). Another admittedly stated that Bach flower remedies were not frequently prescribed (code 306).

“But, my standard route is: I give one remedy, Bach flower remedies and a herbal” (code 44.6)

“It’s not a frequent prescription…a few times a month” (code 306.13)

One practitioner stated that in her view, the frequency with which a patient takes their remedies is more important than the dose that they take (code 337). Therefore, this practitioner finds that the amount of times the remedy is taken throughout the day holds more relevance than the number of drops taken each time the remedy is administered. For this reason, the recommended dose is seen to be irrelevant.

“For me it’s not about how much, it’s about how often” (code 337.12)

On the topic of frequency, the variation of prescriptions is very clearly depicted. Both frequency and dose are very loosely standardised in the way in which they are dispensed to patients. Perhaps this variation is important to note when considering how it may affect patient compliance, a point that was raised above by one participant, as well as patient response to a Bach flower remedy treatment, which will be discussed in Theme Three.

D) Complex Components The complexes are made up of a selection of Bach flower remedies which the practitioner feels are most suitable for the case. Dr Bach’s instructions stated that a complex could be made with a maximum of six remedies, by placing two drops of each selected remedy into pure mineral water (The Bach Flower Centre, n.d.b). Once again, there was a substantial deviation from these directions amongst practitioners, when prescribing Bach flower remedies.

When asked about how Bach flower remedies were prepared, one practitioner noted that Bach flower remedies are made from “Bach flower essences” (code 1.1). A few others noted how they frequently consult their books or resources to verify how Bach flower remedies are prepared and prescribed when dispensing them (code 111).

“I always look at the book in my kit, and how I should be dispensing them… I stand to be corrected but I basically use the instructions that I’ve been given” (code 111.3)

One participant stated that Bach flower remedy complexes should not exceed seven remedies per complex, that is according to how she was taught (code 265.11). A couple of participants noted that their complexes did not exceed six individual Bach flower remedies (code 176.5,13), while another two participants said their complexes were made up of five to six remedies (code 190.6,12) and another of only five remedies per complex (code 253.10). One practitioner stated that her remedy complexes do not exceed three Bach flower remedies (code 115.3) but for other practitioners, complexes ranged from three to four remedies per complex (code 50.2) or from three to five remedies per complex (code 171.4).

When creating Bach flower remedy complexes, the amount of each remedy placed into the complex also varied amongst practitioners. The participant response ranged between four to seven drops (code 264.11 and code 145.4) of each remedy being placed into the treatment bottle (code 308.13,14 and code 254.2,10).

E) Preparation Although Bach’s original instructions stated that Bach flower remedies be prepared in pure mineral water (The Bach Flower Centre, n.d.b), none of the practitioners who formed part of this study followed through with this. Five participants stated that their Bach flower remedies were prepared in an alcohol solution (code 53) ranging from five (code 307.13) to twenty percent (code 189.6 and 255.11,10), and three participants noted preparing their remedies in distilled water (code 52). Participants also mentioned that Bach flower remedy complexes were prepared in a 50mL bottle (code 51.2.4).

“Sometimes I use a bit of alcohol” (code 53.2)

“I probably don’t even use 20% alcohol, I think I just use distilled water” (code 52.3)

Two participants acknowledged that the original Bach flower remedies are prepared and preserved in brandy (code 54). It is a worthy awareness on the behalf of the practitioners. One practitioner kept this in mind when dispensing for paediatrics while another felt that this made it a more volatile preparation as it can “evaporate very quickly” (code 54.12).

“Sometimes I use a bit of alcohol, but mostly I don’t because I know the remedies are in brandy, especially for kiddies” (code 54.2)

This category which explored how Bach flower remedies are prepared and dispensed in homeopathic practice revealed the most incongruencies, not only from Dr Bach’s guidance but also from one practitioner to another. Despite the discrepancies, it is worth noting that participants acknowledged the value and benefit Bach flowers bring to their practices, which was discussed in Theme One.

3.5.2.3 Category 3: Bach Flower Remedies Used in Practice Some of the participants shared a list of the more popular Bach flower remedies that are used in their practice. As this was not shared by all participants, it does not portray a clear picture of which Bach flower remedies are most popular. Based on the limited information acquired, Elm (code 63.2,4,5,6,8) seemed to be the most popular, followed by Willow (code 60.2,4,5,6) and Oak (code 62.2,4,5,8). Larch (code 64.2,4,6), Aspen (code 59.2,4,5), Star of Bethlehem (code 103.3,4,14) and Olive (code 165.4,5,8) were the third most popular remedies mentioned. White Chestnut (code 169 4,5), Wild Oat (code 170.4,6), Sweet Chestnut (code 168.4,6), Mimulus (code 61.2,4) and Mustard (code 164.6) came in fourth. Honeysuckle (code 162.4), Hornbeam (code 163.4), Red Chestnut (code 166.4), Rock Rose (code 167.4), Gorse (code 178.5), Impatiens (code 196.6), Holly (code 197.6), Walnut (code 198.6), Pine (code 199.6), Gentian (code 200.6), Cerato (code 201.6) and Cherry Plum (code 238.8) were only mentioned once each.

3.5.3 Theme Three: Practitioner Perceptions The value of Bach flower remedies in homeopathic practice is at large a result of how the practitioner perceives it to work in practice. This is evident in the response that patients have to a treatment plan of Bach flower remedies, how practitioners relate to Bach flower remedies, practitioner options and the potential for similar additions to the homeopathic dispensary. The aforementioned aspects will be discussed in order to determine the perceptions that homeopathic practitioners have regarding Bach flower remedies.

3.5.3.1 Category 1: Patient Response Patient response is vital in determining the value of a form of treatment. In stating this, how patients respond to a treatment plan comprised of Bach flower remedies, directly influences the value practitioners place on these remedies. This category was divided into sub-categories in order to clearly see the nature of responses acquired from the patient. These are as follows: 78

A) 1Negative At times, participants noted that Bach flower remedies rendered underwhelming or disappointing results and attributed it to their possibly limited knowledge on applying the remedies (code 143). Several practitioners affirmed that Rescue Remedy had resulted in poor patient response (code 66), a sentiment which was already expressed in sub-category G of Theme One.

“Not every time but maybe it’s because I haven’t done any top up courses… So, maybe the fact that sometimes it doesn’t work is because of my own lack of knowledge and how to use it” (code 143.4)

“I haven’t actually had amazing results with Rescue Remedy... I haven’t seen anything drop dead amazing…I have had a large amount of people to whom I say, ‘Have you tried Rescue Remedy?’ and they say, ‘Yes, but the stuff doesn’t work’” (code 66.14)

B) Positive Positive patient responses were reported by nine participants (code 16). Participants reported that patients respond well to Bach flower remedies by showing improvements in their emotional states (code 16.8). A positive response in children was specifically noted by five of the participants (code 17). Bach flower remedies are seen as a gentle way to treat children, (code 17.7). One participant suggests that children are so responsive to this form of treatment because they have fewer ‘onion layers’ and are untainted (code 17.14).

“…I actually started getting some really nice feedback and… the type of feedback they were giving me and the change when I re-did the evaluation with them, was remarkable” (code 16.10)

The perception of a positive patient response is reinforced when patients return to the practitioner for a repeat of their Bach flower remedies (code 47). The patient’s request for repeated Bach flower remedies was noted by four participants. In terms of patient response, this is a “good sign” (code 47.2).

“That’s where the repeats come in, I mean the parents are like, ‘Oh my giddy-aunt, will you please just make sure you have got the recipe, number one written down. And, number two, I need more bottles!’” (code 47.14)

While two participants acknowledged that Bach flower remedies elicited a positive but gradual patient response (code 45), five participants remarked that the response to Bach flower remedies was relatively fast (code 141), even within minutes (code 141.13).

“It’s not as clear as a black and white response to, for example, GABA (Gamma- aminobutyric acid) or 5HTP (5-hydroxytryptophan), or serotonin, or anti-depressant. It’s far gentler. And I think that makes the response harder to read because I don’t often give them in isolation” (code 45.2)

“I’ve even had patients get through quite intense emotional feelings within less than an hour of taking the Bach flower remedies” (code 141.11)

C) Unclear For the most part, practitioners are prescribing Bach flower remedies in combination with homeopathics and perhaps other products as well, therefore it is difficult to determine if the positive patient response could be attributed to the Bach flower remedies (code 46). Emotional shifts can also be challenging and difficult to notice, for reasons that have already been discussed such as poor communication between the patient and the practitioner, and the patient’s limited emotional awareness. Under such circumstances, patient response may be difficult to determine (code 106). An unclear patient response may persuade practitioners to use the remedies less frequently (code 106.3)

“I can’t necessarily say 100% because I do tend to mix the homeopathic with the Bach flower remedy” (code 46.11)

“It’s not as clear as a black and white response” (code 106.2)

An unclear patient response could also be attributed to the practitioner not receiving any form of feedback from the patient. As one practitioner commented, at times patients who feel relief from treatment will not return, leaving the patient response to treatment unknown to the practitioner (code 294).

“Patient response, that’s a difficult one. Sometimes it may not necessarily be a Bach flower remedy, patients are inherently going to come back to you if there’s a problem and not necessarily come back to you if they are feeling better” (code 294.12) 80

Other variables that leave patient response to Bach flower remedies unclear is when practitioners do not dispense the remedies frequently enough. In such circumstances, the practitioner is permitted only limited, and possibly insufficient, opportunities to notice a response from patients treated with these remedies (code 305). Once again, questions of patient compliance are raised as this too can impact the patient response to treatment (code 295). Two participants noted that remedy choice is also very important. Therefore, the practitioners’ prescription can influence the patients’ therapeutic outcomes, affecting the patients’ response to the treatment (code 124). A poorly selected Bach flower remedy may not produce the desired outcomes, deeming the patient’s response to treatment unclear.

“I don’t think that I have done enough… I don’t think that I use it enough in practice” (code 305.13)

“So, you have to wonder, is their compliance ok?” (code 295.12)

“…very powerful in their shifting people in the right direction, if you choose the right remedies” (code 124.3)

3.5.3.2 Category 2: Bach Flower Remedies for Physical Symptoms Dr Edward Bach’s philosophy noted the use of Bach flower remedies in the treatment of physical symptoms as well as emotional ones. This was due to his understanding that all disease was rooted in emotional disharmony (Ball, 2013). Participants also shared their experiences and feelings toward this philosophy from the perspective of the homeopathic practitioner.

Several practitioners acknowledge that physical symptoms arise due to emotional distress (code 3). Participants provided examples such as: insomnia (code 3.7), a symptom which presents physically but is often rooted in mental or emotional imbalance and, anxiety which could cause physical symptoms such as nausea or indigestion (code 3.11). Two practitioners affirmed that indeed, physical symptoms are rooted in emotional imbalance (code 15.1,14). Similar concepts were already explored in Theme One as participants explained their perception of the emotional and physical connection. Although practitioners were familiar with Dr Bach’s views and his belief in the power of his remedies on the physical, they maintain that it remains a theory and is unheard of in practice (code 245).

“Absolutely… And usually when I’m getting frustrated with a physical case and we are hitting walls and we’re not going places with it, and you can try herbals and homeopathics and I’ll use the liver for example. I keep testing the patient and that liver is still sitting there coming up over and over again. And we have done flushes and we have done Milk Thistle, and we have done Dandelion Tea, and we have done Nux vomica and Lycopodium, and we’ve done Bryonia, and we have gone bananas! And then we start working with then say, anger, which is the energy that sits with the liver… and I cannot tell you that (physical symptoms arising from emotional distress) can be disputed. It literally comes down to looking at that” (code 3.14)

“In theory, I agree” (code 245.12)

For some participants, the theory could not be clearly confirmed or denied. It was felt that should Bach flower remedies have an effect on physicals, it would remain unknown to the practitioner due to prescribing Bach flower remedies in combination with other forms of treatment intended to clear physical symptoms (code 287).

“It’s not that it’s never been true. I have never allowed just for that because I have often backed it up. I follow a functional medicine approach... So now I can’t give you a proper answer there because it’s not just a pure Bach, I’m working on a biochemical level because I am looking at blood tests and then I’m backing it up with other things. In theory… our emotions are such a root to our pathology” (code 287.12)

Participants reported never having prescribed a Bach flower remedy for physical ailments, because the remedies are aimed at treating the emotional picture. On occasions where physical symptoms resolved, it would appear to occur completely by chance as an unexpected advantage (code 194).

“I usually tie my prescription to an emotional thing and if a physical thing disappears that’s great” (code 194.4)

According to Bach’s theory, all disease is rooted in emotional imbalance. By this theory, the presentation of physical symptoms and disease could be prevented. This outlook was shared by only one participant who suggested that treating with Bach flower remedies may act as a preventative for the manifestation of physical symptoms (code 24).

“If you can start treating somebody (with Bach flower remedies) long before you even start treating physical symptoms, that might be a preventative measure” (code 24.1)

3.5.3.3 Category 3: Relevance The relevance of Bach flower remedies in homeopathic practice, as perceived by the practitioner was also discussed as this too contributes to understanding the role that Bach flower remedies play in homeopathic practice. The discussion surrounding the relevance of Bach flower remedies to a homeopathic practitioner reveals why these remedies are frequently found in a homeopath’s dispensary. Participants shared multiple views and opinions to determine the connection that this healing modality has to homeopathy.

For the most part, practitioners felt that Bach flower remedies had found a home in the homeopathic dispensary because both modalities share similar philosophies and principals (code 22). Therefore, the two systems are closely connected (code 154), seen to be a “parallel medical treatment system” (code 154.12).

“I think it’s because within the field of homeopathy, we do have that similar view that emotions have more than just that short-term effect on the body” (code 22.11)

“…they are so closely linked, like brother and sister. They’re not the same thing. So, closely linked” (code 154.9)

Participants pointed out similarities that included the homeopathic background of Dr Bach (code 25), the shared Eurocentric roots that are shared by both Homeopathy, emerging from Germany, and the Bach flower remedies from the United Kingdom (code 260). As one participant said, they both “grew from a seed in Europe” (code 260.10).

“And because Bach flower remedies work on that level (emotional) as well, there’s kind of a kinship between the two. Maybe because you know Bach was a homeopath and understood that side of it as well” (code 25.11)

“…homeopathy being Eurocentric, I think Bach… kind of got attached to it. So, they almost form like a cluster or a group… because of our European influences in complementary medicine… So, the people that utilize the Bach remedies here are essentially of a European

origin and that’s what they know, and that’s what their family overseas knows and so forth” (code 260.10)

According to participants, it is their European roots that may have made them well known and accepted (code 213), and Bach flower remedies are long-standing because they have been used successfully in the past (code 213.6). These two treatment modalities, Bach flower remedies and homeopathy, are frequently met with the shared perception of being energy medicine (code 153).

“…you’re still talking ultra, ultra high dilutions. You’re talking energy rather than physical substance” (code 153.4)

One practitioner felt that for many, homeopathy has become synonymous with ‘natural’ and for that reason Bach flower remedies, which are categorised as ‘natural’, would be clustered with homeopathy (code 228).

“…it seems natural so the whole thing is natural, and then homeopathy is the next best thing…. You know, people hear that you are a homeopath and think… that you are completely natural, not understanding the full picture, and I think therefore it found a home there” (code 228.7)

As already discussed, many practitioners perceive Bach flower remedies to be a useful adjunct to their practice. Therefore, some participants noted that Bach flower remedies are relevant to homeopathy because of the complementary action that Bach flower remedies have on homeopathic treatment (code 225).

“That homeopathic remedy aligns them, but the Bach helps them on the emotional side… the Bach flower remedy grounds them” (code 225.8)

Practitioners expanded on the similarities between Bach flower remedies and homeopathic remedies by highlighting the intangibility of the active ingredient in both cases (code 293.12).

“…there is a kinship with how they are made because it is also, to some degree, an intangible. To a lot of people so is homeopathy” (code 293.12)

For these reasons, it would appear that Bach flower remedies and homeopathic remedies share preparation methods. One practitioner noted these similarities (code 293.8). However, when looked at closely, they do not. A common preparation feature may relate to how remedies from both modalities are sourced from plants.

“There’s an original plant” (code 293.12)

3.5.3.4 Category 4: Practitioner Opinions In discussion, practitioners shared various opinions that affect the use of Bach flower remedies in practice, to a greater or lesser degree. These were also unpacked to better understand the phenomena under investigation in this study.

Participants shared feelings toward the lack of research on Bach flower remedies and expressed the need and potential that this system of healing might have for further growth (code 249). One participant explains that should Bach flower remedies be a growing modality, the need for research and a better understanding of the remedies is greater (code 249.9). Presently, credible information sources on the topic are limited (code 249.12). One practitioner felt it worthy to note that natural substances are not always safe (code 302) which reinforces why further research in the field is important. If taken incorrectly, even natural medicines can result in undesired consequences (code 302.3).

“I actually think that if we were to do proper provings on the Bach’s we would get proper polychrest-type symptoms out of them. You could literally study it up to full-on remedies. I really think we could, I just don’t think the research has been done” (code 249.14)

“I strongly believe, and I say to most patients, that just because something is natural doesn’t mean that it is safe. So, when you are taking something that’s natural, you can’t just keep taking it because it’s natural” (code 302.12)

As in Theme Two, category two’s discussion on remedy preparation and dispensing, it was also apparent that not all practitioners treat and dispense in the same way. This too can influence what practitioners consider an important part of their practice. All practitioner’s treat patients in their own way. Some treat clinically (code 282.12) and may incorporate a functional medicine approach (code 288). It was also noted by one practitioner that she seldom dispenses what she can script out for a patient to purchase at a pharmacy (code 329). 85

“I am a very scientific kind of person, so I bring in a lot of functional medicine aspects into my practice… but I do hold a lot of value for the energy healing aspect” (code 288.14)

“I don’t often prescribe stuff in my practice that you can buy at Dischem. And I do, I recommend to patients to go and get it at Dischem” (code 329.14)

While one participant emphasised the need for emotional awareness and the important role that emotions play on one’s health (code 333), another considers health to be rooted in far more than one’s emotional state, as Dr Bach suggested, but that other factors such as genetics might play a key role as well (code 289).

“I didn’t realise the impact of emotions and it gets more entrenched in me every year of my practice” (code 333.14)

“I don’t know if I would say everything is due to our emotions. Genetics play a big role, and our epigenetics play a big role… I don’t think I, in my practice, would ever purely rely on a Bach to deal with a pure clinical picture based on emotion” (code 289.12)

When regarding the use of Bach flower remedies in practice, a few participants raised the point that homeopathy should be maintained. Regardless of additional and auxiliary therapies homeopaths are trained in homeopathy, and this essence should be preserved through the primary practice of homeopathy (code 278). By relying too heavily on auxiliary therapies, the essence of homeopathy can be lost (code 278.11). These practitioner opinions reiterate that although Bach flower remedies may prove themselves a useful means to treat emotional symptoms in practice, their main purpose is to support the homeopathic treatment modality, which should be the main focus of their practice.

“… I think it’s very important for practitioners or students going into practice to know that these things are available, but I think it’s even more important that they understand their basics first. When I refer to basics, I’m referring to the ability to diagnose, and their homeopathy first and then look at the extras” (code 278.12)

3.5.3.5 Category 5: The South African Flower Remedies In some cases, the interview discussions gave rise to the South African flower remedies, and their place in homeopathic practice. Although the South African flower remedies show little relevance 86 to the experiences of homeopathic practitioners making use of Bach flower remedies, it was an idea that emerged during the interview process and therefore warrants some attention.

South African flower remedies were only mentioned by three of the participants. Both South African flower remedies and Bach flower remedies are used to address emotional states, although the South African remedies seem to differ slightly (code 215). They are fairly new and relatively unknown (code 214).

“…there is something different about the South African flower remedies. You know, she’s also used gem remedies with the flower remedies. So, she has made complexes which are, some of them are really lovely” (code 215.6)

“(Bach flower remedies) are long standing and have been used successfully for a long time whereas the South African flower remedies are very new” (code 214.6)

While the collection of Bach flower remedies are made up of only 38 flower remedies, the South African flower remedy collection is far bigger (code 210) which makes them more difficult to use.

“…the whole set and it was millions of these things. I can’t remember, I think there was like eighty or ninety remedies” (code 210.14)

One practitioner said that despite the efforts made to incorporate the South African flower remedies into her practice, no results were found (code 336), while another has personal experience with the remedies (code 212) but has not yet made it a staple part of the practice.

“There were too many remedies and even if you do whatever combination, thinking you’d gotten it right, it’s just like you’d given them alcohol water” (code 336.14)

“I have used them on myself and my family but very little in practice because I also know the Bach flower remedies (better)” (code 212.6)

One participant posed the question: “Why are they not taught or used?” (code 211.6). In a South African context, it would appear applicable for South African flower remedies to form part of the homeopathic course material, as do Bach flower remedies, and thereafter provide the basic education necessary for these remedies to be used in homeopathic practice. 87

“I suppose if we were taught the South African flower remedies… and I think that is a lack in the course. Why aren’t we taught the South African flower remedies?” (code 211.6)

The potential value they may hold remains a mystery for many as some practitioners are not even aware of the South African flower remedies. Those who are aware feel that they could benefit from a more in-depth understanding of these, somewhat more relevant, remedies.

“I don’t really think we have seen the value of the South African remedies” (code 214.10)

3.5.4 Theme Four: Education The role of Bach flower remedies in homeopathic practice is also largely dependent on the amount of exposure to the remedies the practitioners had, either prior to starting their practices or while already in practice, as well as their feelings toward their education on the subject and the desire for further education.

3.5.4.1 Category 1: Bach Flower Remedies at University Bach flower remedies currently form part of the university course material for homeopathy. The weight of the education received during their studies and its effect on their use of the remedies in practice was discussed by participants. Figure 3.2, under heading 3.3 Demographics, visually depicts the exposure that participants reported to Bach flower remedies through the homeopathic course material. This question was addressed for demographic purposes and was discussed in more detail during the interview itself.

Many participants noted that although they could not clearly remember the nature of the training offered by the University of Johannesburg (code 80), there was the acknowledgement that some resources were given (code 79) such as notes (code 79.2) or a brochure on the remedies (code 79.3).

“…well, in the course… I can’t actually remember. We probably did it in like Aux-t or something. But unfortunately, at that time you are so bombarded with everything else, you can’t really give each section of Aux-t the credit it’s due” (code 80.11)

Of the participants, more than half of them noted that the training that was received on the topic of Bach flower remedies was not in-depth (code 81). Due to the limited time allocated to Bach flower remedies and a large workload, participants received only basic information on the 88 remedies (code 81.14). One participant felt that the knowledge received on Bach flower remedies was insufficient to fully understand them as a healing modality (code 81.12).

“I suppose I can say there was training but it wasn’t a formal module where I can honestly say I remember listening to a lecture… If there were notes there may have been a lecture. But I can’t remember dissecting the flower remedies like we did the Materia Medica” (code 81.2)

These general observations translated into the two opposing views. The first being the need for Bach flower remedies to be reinforced due to a perceived lack at the level of training and the other that the level of training is sufficient. These will be discussed below.

Some practitioners felt that the reiteration of Bach flower remedies at other stages of the course might be beneficial (code 156), such as at the start of 5th year as students begin their interaction with patients at the campus clinic. One suggested that this reiteration be made to overseeing clinicians at the campus clinic as well (code 280).

“Yes, even just to put a little poster up or even at orientation just to remind everyone of what’s available, to use them... I think that maybe we do need to be reminded that it’s ok to use other stuff” (code 156.9)

“I would like a little bit more information about them during that time (while studying) and maybe a little bit more exposure to the students… I think that if we were in the dispensary one afternoon or so… even the clinicians should be there, and get a bit more exposure on that side” (code 280.11)

Its availability in the clinic is seen to be positive (code 243) because it expands the students’ treatment options and increases awareness on what they can use. Therefore, its use in clinic should be supported and encouraged to allow for further learning (code 279).

“…it’s a really nice thing to have in the clinic because you have options” (code 243.9)

“…experiment on yourself and that kind of thing and even experiment on your patients because that’s what clinic is there for” (code 279.11)

Some participants stated that once homeopathic practitioners begin their practice, they make use of the tools they were exposed to at university (code 129). Participants note that students gain comfort and confidence using treatment tools that they were trained to use at university. If students are exposed to Bach flower remedies while under supervision, they will be more comfortable using them in practice (code 129.9) and, the greater the advantage for the patient (code 129.3). Four practitioners remarked the importance of student exposure to Bach flower remedies because they perceive these remedies to be valuable tools for practice (code 128). Without exposure at the student level, practitioners are less likely to incorporate Bach flower remedies into their dispensaries, leaving this useful tool undiscovered. Therefore, it is important that students and young practitioners know that tools such as these are available (128.12).

“I find that especially what you are exposed to in clinic is what you tend to hover on. That’s kind of where you normally go with your practice unless you get exposure to something else” (code 129.11)

“…if you have more of an awareness of it as a student, so learning it more and having it available in the clinics, I think then they would use it more in practice and probably find lots of advantages with it” (code 128.3)

Two participants didn’t recall having Bach flower remedies at their disposal while working in the campus health clinic (code 271.11,13). Another participant expressed her feelings toward a short falling in university training. As Bach flowers address mental and emotional symptoms, this practitioner felt the training offered by the university did not accommodate or train for the dealing of emotional cases, specifically addressing them from a counselling perspective (code 325). This short falling might be echoed by those who feel that the availability of these remedies in clinic was not made known to further assist in dealing with deep emotional cases.

“And so, the emphasis was not actually at varsity on how important emotions actually are. That is shocking. At varsity nobody mentioned how important emotional healing actually is and gave us any training on how to actually find out, talk to, communicate or council” (code 325.14)

Two practitioners reaffirmed that although the training on Bach flower remedies during the course material was not in depth, this is no reason for dissatisfaction (code 324). Bach flower remedies are viewed as an auxiliary therapy in homeopathy and therefore the primary focus of training is in 90 homeopathy and not in Bach flower remedies. The limited training served to create an awareness on the remedies. Should students or practitioners seek further education, then that would become their personal responsibility.

“…we studied a clinical course in homeopathy, so it should not have been a big part of it. It should have been what it was, a taster for you to say, ‘Oh yes, this is something I want to look into further.’ I don’t believe it should have been a big part of the course because we weren’t there to study a compendium of natural therapy, we were there to study homeopathy” (code 324.12)

“…it’s the simplified version of (Bach flower remedies), but I mean, even the simplified version is adequate” (code 324.14)

3.5.4.2 Category 2: Bach Flower Remedy Exposure The extent to which a practitioner may have been exposed to Bach flower remedies outside of their university training is also a contributing factor to the perceived value of Bach flower remedies. Here we explore experiences outside of the homeopathic training program which may have exposed practitioners to Bach flower remedies.

Of all the participants, three of them admitted that it was Rescue Remedy that introduced them to Bach flower remedies (code 134), and three others noted that their exposure came from a time when they worked in health stores which stocked the products (code 181).

“So, Rescue was often used there, but beyond Rescue I never actually used or worked with a single Bach flower remedy until probably about a year and half ago” (code 134.10)

“I used to work at Weleda Pharmacy, so I was exposed to Bach at that stage… I was still a student. So, that’s when I was introduced to it” (code 181.5)

For one participant, the exposure to these remedies came about once in homeopathic practice, and “definitely not campus” (code 227.7) and for another, Bach flower remedies were a part of her practice from the start, as she joined a practice that made regular use of the products (code 315).

“So, Bach flower remedies have been part of my practice since I started practicing (with a colleague) and there was an aromatherapist there who trained me in the Bach flower remedies” (code 315.14)

The 38 Bach flower remedies may be purchased as a set in a wooden box, which made the remedies more attractive to one of the participants (code 311). This was the exposure to Bach flower remedies, and the incentive to purchase the set and incorporate these remedies into the practice.

“It was actually the box. The beautiful wooden box. Honestly, it was a nice box” (code 311.13)

3.5.4.3 Category 3: Information Sources While on the discussion of education, participants were asked about where they acquire their information on Bach flower remedies. This would seem relevant as many participants indicated that they either do not recall learning these remedies, or that the learning they received lacked detail.

Some of the participants stated that their further learning was a result of self-study and personal reading on the topic of Bach flower remedies (code 203).

“I do a lot of reading…I had to go into more reading because that (university) was many years ago” (code 203.10)

“I picked up… one of the original Edward Bach books, and I picked that up because either I had an assignment? I can’t even remember the context. I picked it up to read it and it’s not a big book, so you can read it quite quickly and I thought, ‘Ok, this is quite interesting’…by that time (covering Bach flower remedies in course material) I would have done a lot of self-study” (code 203.11)

Acquiring information from suppliers was one of the leading sources of information, with almost half of the participants listing that as a source (code 84.2,3,4,7,12). One practitioner makes use of the Bach flower remedy chart that was provided by a supplier which demonstrates each remedy and its indications. Many practitioners mentioned that they have gathered information on Bach flower remedies from their colleagues (code 85) who are able to share their clinical experiences (code 85.12). 92

“I have come across a couple of people that have been very knowledgeable about it and it’s lovely but then I’d rather just go to them” (code 85.6)

“There was an aromatherapist (colleagues) there who trained in the Bach flowers and so she trained me more than what I did at varsity…We practiced it a lot and I learnt a lot and I could actually chat with her about how to use them more in-depth” (code 85.14)

Books were also a leading source of information (code 83.2,3,6,11), closely followed by online sources (code 21), such as The Bach Centre website (code 21.1,13).

“I do have a lot of books from years back, little booklets and things. And I think we even have some old reference books here” (code 83.10)

Some less popular sources of information are articles (code 82.2) and notes that were taken or received (code 202) either from university, through attending additional lectures or courses (code 180), or personally acquired.

“…notes that I have taken over the years, be it from varsity or other lectures I’ve gone to” (code 202.12)

“Part of it was, I did the Dr Collins course and he did Bach remedies… It was from the fertility course but part of that was the Bach remedies. So, that was included in that… It was probably after the course that I started using it more” (code 180.5)

Some of the practitioners had mentioned that they had done the Bach flower remedy course, which had provided them with a good source of information, through lectures and notes (Code 125). The Bach flower remedy course is discussed in more detail in Category 4: Additional Training and again in Theme Five. For another participant, information was gathered from the Bach flower remedy stand at the homeopathic conference held in Johannesburg in 2016 (code 226).

“…in the course that I did, they gave a lot more information on the different Bach flower remedies… I will go and look at those notes because they gave a lot more information” (code 125.3)

“I actually saw more of it during our conference, I think it was last year’s conference…when I went for the conference we got information on the Bach flower remedies” (code 226.7)

3.5.4.4 Category 4: Additional Training In 2015, a Bach flower remedy course became available to the public in South Africa. On completion of all three levels of the course, a registration as a Bach flower practitioner with the Bach Flower Centre in the United Kingdom may be acquired. The awareness for further education on Bach flower remedies was discussed with the participants. As previously mentioned, some participants noted that they have taken part in this course and, as seen in the above category, the resources gained served as an additional source of information. The willingness shown by participants to take part in this additional training as well as the experiences of those who did were noted.

While in discussion, only two practitioners were completely unaware of the Bach flower training course that was available in South Africa (code 74.2,14), while over seven practitioners were aware of it (code 28).

“Yes, I do know that they are available… I spoke to the Coyne Health people at the homeopathic congress” (code 28.4)

Four of the practitioners who were interviewed have received some form of training, either formal or informal (code 99 and code 322). Formal training would refer to taking part in the aforementioned Bach flower remedy course, while informal training may refer to training from colleagues or learning about the remedies in a casual working environment.

“And the one time the Bach flower remedies course was being reintroduced into South Africa, with the different levels. It was one of the starter courses mainly for health shops and tha,t and we got really wonderful notes and really good information. We could talk to this lady and that almost, not reignited, but also gave a little bit more understanding of each Bach flower remedy” (code 322.11)

“She was a reflexologist. She was trained. I think she was trained in England to be quite honest. And then she had all the books and the charts and everything. It wasn’t an actual

course that I took from her but she worked there, and we went through it and we worked with it and then I would consult with her when I had the cases” (code 322.14)

Participants shared their desires for further learning on the topic of Bach flower remedies. During the interviews there were five practitioners who noted their desire for further education (code 26). Their reasons for desiring further education varied from building on their formal training, such as completing the level 2 of the Bach flower remedy course (code 26.8) or simply wanting to be better equipped to assist patients (code 26.9). Practitioner interests in pursuing additional training on these remedies was also a question asked when collecting the demographics of the participants (Appendix C), where seven participants indicated a desire for further education. This is illustrated in Figure 3.3. A pair of practitioners noted that further education would serve to provide more insight into the application of the remedies and allow practitioners to prescribe the remedies more confidently (code 27).

“…like case taking type of scenarios where you would have a case and you’re not necessarily sure what the indicated Bach flower remedy will be” (code 27.1)

“…maybe there could be more boundaries. Because, at the moment it is very blurred, and I don’t know when it’s ok to recommend it to a patient” (code 27.9)

Some practitioners highlighted their desire to take part in the accredited Bach flower course (code 87). While another three participants stated that they had no interests in further education on Bach flower remedies and felt it was unnecessary (code 204).

“I wouldn’t actually put myself through a course and pay for it and have a certificate” (code 204.6)

Twenty-nine percent of participants noted that it was not a priority (code 86). The reasons varied from their interests lying elsewhere (code 88) to noting that the knowledge they have on Bach flower remedies was sufficient to confidently make use of them in practice without further learning (code 158).

“It’s not where I put in my time and that is because it’s not a big part of my practice. If it was, I would happily do it” (code 86.12)

“…not really at the top on my bucket list to do a Bach flower remedy course. But that’s because there are other things that interest me at the moment. It’s not because it’s not interesting, it’s just that my curiosity doesn’t sit there right now. I’m more curious about something else” (code 88.2)

“Right now, I am really quite happy because I have done a lot of self-study on it as well and with the other course I did with the health store it actually gave quite a nice in-depth section” (code 158.11)

Participants noted that the course should not be available to the public. Upon learning that it was, one participant sarcastically expressed her unawareness by saying, “I didn’t know that. Lovely” (code 33.5). Practitioners admitted that this dissuades them from taking part in the course (code 133 and code 131) and question its standards and suitability.

“I probably wouldn’t do it knowing anyone could do it” (code 131.3)

“I would be a little bit reluctant because again, I don’t know what level it is being pitched at and I feel like, is it professional enough? Is it for professional practice?” (code 131.9)

For these reasons, participants raised concerns regarding the medical credibility of such a course (code 132). If practitioners do not perceive the course to be of a high enough standard, they won’t see participation in the course as a means to benefit them professionally (code 132.3) or as a positive contribution to their practice (code 300). While many of the participants appeared unaware that the Bach flower course was open to the public, only one participant clearly stated knowing this (code 241.9).

“…there is still that little red flag that waves that’s like, ‘Lay-people can do this too’. It might lose its credibly in that way. Like, is it really a health care modality if lay people are able to do it? It feels less legitimate” (code 132.9)

“…it still comes back down to me that most people don’t see that as a proper qualification because, I come back to that, you can be a plumber and do the three levels and you don’t have any medical training whatsoever” (code 300.12)

Of those who received training, two participants completed the formal Bach flower courses’ level 1 (code 99). One of these participants noted gains from completing level 1 and expressed a desire to continue with level 2 (code 233), encouraging other practitioners to consider the course more seriously (code 240). The other participants’ reasons to take part were due to patient interests in the remedies (code 100.3) and to further assist patients (code 101).

“I need to do my level 2…Level 1, it expands the remedies more. How to mix, what labels you should be using, how to choose between the remedies and things like that” (code 233.8)

“…sometimes you just feel in practice, that there is a bit of a gap on an acute or chronic emotional level, to try and assist patients” (code 101.3)

There were some participants who showed interest in taking part in the Bach flower course and another who noted that participation could help fuel interest in the field (code 244).

“I think it would also be really good to peak your interests, so you would be able to study further and maybe understand those remedies in a bit more depth” (code 244.9)

One participant was undecided about taking part in the course (code 31.1) due to concerns regarding the level of information provided in comparison to what was received during their university training (code 29). According to three participants, the course required some evaluation so that practitioners may know the level at which it is being pitched (code 30). This would allow practitioners to better decide if they would like to take part, as well as determine if the content surpasses that which they already know and apply in practice.

“I never know if I should do such a course because I’m not sure if it’s just going to cover what we have already learnt…Is there more depth to it?” (code 29.9)

“I think that they must first have an evaluation criteria to be able to see at what level you fit in” (code 30.1)

Through discussion, participants shared some factors that might help encourage their participation. Should practitioners find that Bach flower remedies show an increase in patient response, discussed in Chapter Three, their desire to further learn would be increased (code 89). Should practitioners find patients who claim that a treatment of Bach flower remedies was life changing, 97 there would be a greater curiosity to learn more (code 98.2). Participants also shared that a CPD accreditation for the course would also encourage further learning (code 32), even if it were only two or three (code 32.4). Participants noted that the course was time consuming, which discouraged them from taking part (code 160), as level 1 is a two-day course. This could be amended, as one participant suggested, with an online course (code 159.4). The idea of an online course was very appealing to this practitioner. It was suggested that there could be an audio component, that served to teach each section of remedies in more detail, and case studies or exercises which could be submitted for both course and CPD accreditation. Online learning allows practitioners with limited time the opportunity to continue their professional learning at their own convenience. A shortage of time in combination with the expense of the course (code 229) resulted in the limited opportunity of practitioners to take part in the course (code 130).

“I don’t know that I would spend three days going to a Bach flower remedy seminar. I’m not convinced that I’m that committed to the process …we are all so stretched for time, that to find the time to go and sit in a lecture for two days is so hard” (code 160.4)

“…to be honest when I did see the course, it seemed to be quite expensive, at the conference… but I looked at it and said, ‘Oh my God, it’s just Bach flower remedies,’ and it seemed quite expensive” (code 229.7)

Noting that level 1 is a two day course, one practitioner stated that it was reasonably priced (code 234.8). Another who showed interest in the course acknowledged that although the course is open to the public, public education should always be seen in a positive light (code 313.13) and that a registration with the UK’s Bach Centre on completion of the course also increases its appeal (code 312.13).

3.5.5 Theme Five: Bach Flower Remedies Available Outside of the Homeopathic Practice Although Bach flower remedies outside of homeopathic practice may seem irrelevant to the aim and objectives of this study, the availability of Bach flower remedies at stores and the presence of Bach flower practitioners may influence the experiences and feelings that homeopathic practitioners may have toward making use of Bach flower remedies.

3.5.5.1 Category 1: Bach Flower Remedies in Stores Bach flower remedies can be found at certain health shops and pharmacies nationwide. Rescue Remedy, a formula of five of the Bach flower remedies, is commonly known for its noted 98 indications for shock and anxiety, and is found with ease in the retail setting (Vlamis, 1994). Rescue Remedy is made by various companies, either in its original formula or as a complex mixed together with several other homeopathic remedies. The individual Bach flower remedies are also available in the retail setting.

Through the interview process, practitioners expressed varying opinions regarding the availability of Bach flower remedies in the retail setting, which allows the general public to readily acquire the products. In this category, five of the participants expressed their personal conflicts on the issue, stating that it was a “two-edged sword” (code 183.10). These ideas were coded as Pros & Cons (code 183) because practitioners perceive there to be both advantages and disadvantages. Self-prescription and the threat that OTC medicines pose on the practitioner were two of the main disadvantages indicated. Alternatively, practitioners acknowledged that the availability of Bach flower remedies in the retail setting creates awareness and exposes the remedies, which is an advantage.

“…it has pros and cons. Pros because it is accessible to the patient and they have a better exposure to it so they feel more comfortable using something that they have been better exposed to but, self-prescription is never really a good thing because you might think you have one thing, and need that remedy or this remedy when actually you might need something else that is better suited to you” (code 183.9)

Concerns arose as participants often felt that the general public lacked an understanding of Bach flower remedies (code 20). Many participants agree that although the products are available and are used by many, members of the public lack the knowhow of their application or indication (code 20.9,12). As one practitioner notes, continuous use of a Bach flower remedy without guidance “might even create a proving if they use something for long enough” (code 20.14). This rippled out into a number of other concerns. Bach flower remedies each have precise indications for specific emotions. A lack in public knowledge would result in a reduced ability to select the most appropriate and best indicated remedy for oneself (code 275) and the misguided use of the products could result in unexpected emotional shifts for the consumer.

“The majority of people didn’t even know what Bach flower remedies were. They knew what Rescue was but not Bach flower remedies…They’ll be like, “Oh, Rescue! Fantastic! You have this one!” And then right next to it would be the Bach flower remedies and they

have no clue what it is. They don’t know anything about it. They don’t know which remedies to take” (code 20.11)

“…their whole environment might be affected and that’s what the patient needs to realise” (code 275.10)

“…if they know what it is, they don’t know how to find the remedy that they need and which Bach flower remedy they need” (code 275.11)

It was also noted by participants that self-treatment is never ideal and can even be difficult (code 185), and is even discouraged. A practitioner noted that despite her training in homeopathy, her deep understanding of the Bach flower remedies and her perceived awareness of her own emotions, she would not feel confident in selecting Bach flower remedies for herself (code 185.14). Often those seeking out remedies for personal symptoms may lack the objectivity to accurately select the best suited remedy (code 272), making the decision on which remedy to purchase very difficult. Diminished public knowledge combined with poor remedy choices can result in unwanted and disappointing outcomes for the consumer.

“… if you are emotional about something and you think you need help, you are not discerning” (code 185.14)

“…you are in that space where you can’t easily detect, ‘Ok, this is what I need for myself’” (code 272.11)

Participants felt that having products so easily available may perpetuate a culture of misuse of the remedies (code 19). One participant expressed that this is a potential danger to the public as misuse may result in aggravations (code 248.9). Although a worthwhile point to raise, an aggravation from Bach flower remedies was only recorded once throughout the interview process, noted under Theme One’s Practitioner Experiences. All practitioners expressed the convenience and ease with which they used the remedies due to its gentle and safe nature. For practitioners and public alike, an awareness surrounding remedy aggravations that occur due to the misuse of Bach flower remedies appear to be minor concerns.

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“I think people tend to over-use it when they realise what it’s for and then they don’t use it for the right amount of time and in the right dosage; so they tend to… misuse it” (code 19.1)

The practitioners who highly regard the remedies felt that it was unfavourable for the public to have access to substances which have a powerful effect on the emotions (code 120 and code 257). One participant went so far as to say that easy access of the remedies to the public was potentially dangerous because of the possible emotional shift that might follow (code 257.10). It would be ideal if members of the public who make use of the remedies and experienced emotional shifts as a result had the guidance and council of a practitioner.

“…it makes me a little bit more nervous to know that you can just buy them over the counter because of the potential imbalance that you can create or the significant shift that the patient can experience” (code 120.10)

“Well, if they don’t actually manage their lifestyle or their life properly or they don’t have a life coach or someone to guide them through significant changes in life, and I’m not talking about exam stress or something like that, but significant… So, you need the practitioner… the person themselves can’t necessarily see that. So, I think there is a potential danger…it can be a danger to the patient” (code 257.10)

Practitioner concerns were heightened when discussing that the possible misuse of the remedies would result in a poor or absent patient response, leaving the user feeling disillusioned and despondent (code 148). This was perceived as a major concern, because if a particular Bach flower remedy is selected without any knowledge and it doesn’t work, it will be their opinion that all Bach flower remedies do not work (code 148.4).When the user does not receive the effects that are desired, their despondency causes the remedy system to come into question. With outcomes like that, the field of homeopathy loses credibility for its association with Bach flower remedies. This may be interpreted as “All natural medicine is therefore rubbish” (code 148.4) heightening the public notion that all alternative medicines would provide fruitless outcomes much like the Bach flower remedies (code 149).

“They could get disillusioned with the product range and then think it doesn’t work…So, I think that could be the biggest failing of Bach flowers is that now the person has taken 12 of them and gone crazy, and they’re so in a flap about whatever they are in a flap about 101

that they actually then think, ‘Ah, it’s not working!’… probably going to get overwhelmed and it might make them disillusioned, and that’s probably the greatest risk” (code 148.14)

“I think that poor prescription, incorrect prescription, probably taints the perception of Bach flower remedies forever” (code 149.4)

The need to make use of the remedies responsibly was expressed by participants (code 303). As practitioners have discussed that remedies may be misused which result in disappointing outcomes, consumer responsibility becomes key, for both their own wellbeing and the preservation of the Bach flower remedies. As suggested by one participant, patients are not always discerning and for this reason the public should not be made to choose the most appropriate Bach flower remedy for themselves without a proper understanding or external guidance (code 119). Without proper training or understanding of this remedy system, the potentially powerful effects may not be attained (code 119.12) and in turn, the public might not be getting what they need.

“…you have to trust the patient to choose ethically as well… I actually say that the responsibility falls on the patients… I just wish patients were more discerning” (code 303.14)

“I think if it were available for people to have a look at and just say, ‘Oh that sounds great. I’ll take it’, I don’t think that would be the best thing” (code 119.3)

This validated the importance and place of the practitioner, who can offer guidance and objectively prescribe the most suitable remedy (code 247). Some participants noted that many retailers offering Bach flower remedies have staff which have been trained to some degree to offer guidance and product knowledge to the general public. The importance and need for these “trained middle- men” was expressed (code 72) in order to provide a safer retail environment and prevent the short fallings that practitioners identified with regard to the presence of Bach flower remedies in stores.

“…someone to hold accountable for something, someone has got your back and I think that is important to have. Your patients aren’t just treating themselves and wandering in the dark, but they have someone who’s there to help them” (code 247.9)

“So, the shops that I know it’s available in normally have someone pretty qualified, so a homeopath working there or someone who knows a lot about natural medicine. So, they 102

would know about how to advise on those remedies… so, normally there is a little bit of guidance when it comes to something like a Bach flower remedy. I can’t say for every place because I don’t know where they are selling it, but the places that I am aware of I know that there is normally someone pretty qualified that can actually help them choose and get the right one, which is nice” (code 72.3)

Having expressed the dangers of having Bach flower remedies available to the public, participants also noted that these remedies are not commonly used amongst patients (code 116), and that it being rare that the public know about the remedies and would request it in the retail setting (code 276). The risk is then somewhat diminished.

“…most people don’t even know enough about them. Most of the people who came in were like, ‘Oh, what is this?’” (code 116.11)

“There are people that know (about Bach flower remedies), but they are few and far between” (code 276.13)

Those who are familiar with the products may seek it out with full awareness of their purchase (code 70) while those who are unaware of Bach flower remedies will most likely not seek them out at all (code 69). Participants felt more comfortable with the idea that the Bach flower remedies are sought out by people who are well informed, with a keen understanding of how the remedies work and know what they are looking for, when they select a remedy for themselves. One participant noted that Bach flower remedies were not a popular sale while working at a health store. This was attributed to the idea that these remedies are commonly sought after by people who know what they need and why (code 70.11). Should this be the case, not many people would have become disillusioned with the products or experienced undesirable effects.

“Those that are knowledgeable, that are going out to the health shops, have obviously read up. There’s a reason why they’re searching for and taking that Bach flower remedy, and then I think I feel fine with that from a safety point of view. If they really invested their time in reading which one was suitable for them and they put more thought in it and more time than probably I’ve got in the short time that I’m in the dispensary, I have no problem with them taking it” (code 70.2)

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Another deterrent in the use of Bach flower remedies by the public can also be attributed to how expensive they are in the retail setting. Prior to dispensing, practitioners often prepare the indicated remedies in a complex. Oftentimes more than one Bach flower remedy is indicated. In this way, a Bach flower remedy complex from the practitioner is more affordable than purchasing all the indicated remedies from a retailer (code 206). When the consumer is new to using Bach flower remedies, purchasing a single, or multiple, remedy bottles from a retailer may be seen to be a very expensive trial experience for this treatment modality (code 206.11).

“I find that they are a bit expensive perhaps… I very often do find that people need more than just one. So then, what do I say? Please go and buy these five remedies? That’s quite an outlay” (code 206.6)

Some debate was had with regard to the regulation of Bach flower remedies. Some practitioners have noted that a regulation system may be the best way to ensure the safety of the public and that the good quality remedies are used appropriately while preserving the reputation of the profession (code 18). There is the sense that change in the form of regulation is welcomed and even anticipated.

“…if you’ve got the right price and you’ve got the right claims, big companies might buy it and then you’ve got a whole lot of people that have got access to something that might not be legitimate. So, I think registration and regulation are important” (code 18.9)

As some participants noted, regulation may assist in determining the value of the product (code 263). The ideal would be that the individual remedies be regulated but the shortcoming of implementing this type of regulation on this remedy selection would result in its reduced accessibility (code 261). One participant was concerned by the prospect of Bach flower remedies being available to practitioners only. As per her understanding, the limited number of practitioners making use of the remedies would only make it more challenging for practitioners to gain access to them (code 261.4). The nature of complementary medicine makes regulation challenging and it would need to be carried out in a specific way which accommodates their unique requirements (code 246). These requirements would include the verification of the manufacturing process with a full understanding that the remedies fall within a holistic treatment modality. One practitioner noted that Bach flowers in particular are difficult to regulate because there are not varying potencies which can be deemed either public safe or practitioner only. What was suggested was that Bach flower remedies be prepared in pre-made complexes available for retail with clear 104 indications of their purpose while the individual remedies remain a practitioner only range (code 246.10 and code 262).

“Because when you regulate you also basically have to put a stand point to it. So, how much value do you put into it. If you see something as highly valuable and an incredible asset to the profession, then it needs to fall into the level of regulation. If you are saying, ‘Well, we don’t want it to be regulated, we want it to be freely available’, then are we actually taking it seriously enough? Or, is it like, ‘Ah yeah, it’s just a little self-treatment thing’. Do we actually give it the value and the power that it actually does have by not regulating it?” (code 263.10)

“If they are going to be regulated it’s probably going to make it more difficult for them to actually be available” (code 151.10)

In having said that, almost half of the participants felt that the individual remedies should be exclusive to practitioners only (code 151) or at the very least not available over the counter (code 298). As previously mentioned, one participant suggested pre-made Bach flower complexes with clear indications. In this way, the public would benefit greatly from these remedies (code 262) and many of the concerns surrounding the availability of Bach flower remedies in stores could be addressed.

“…still have the single ones available for practitioners that are potentially, for much more deep-seated and much more hard-core emotions” (code 298.10)

“…if there was a way to almost pre-make them for the patient to use and then say, ‘Here’s a depression complex or… here’s a fear one.’ And then it gets made up with that indication and that basis. I think the public would benefit greatly” (code 262.10)

Many participants feel comfortable with Rescue Remedy, which offers clear indications and is well known, being available to retail (code 150). It is also unlikely that patients will see a homeopath to receive Rescue Remedy (code 15.13). Although practitioners appear to accept the retail of Rescue Remedy more so than the retail of the individual Bach flower remedies, the retailed Rescue Remedy complex was less frequently prescribed by practitioners (code 65).

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“I have no problem with Rescue for example, being on the shelf whether it’s the Bach Rescue or the Natura Rescue or whatever, because I think Rescue has a clear indication for shock and anxiety… it’s clearly stated, you know how to use it because it’s been formulated for a specific purpose” (code 150.4)

“I don’t use that (Rescue Remedy) often because they can get that over the counter. So, I kind of feel like, what’s the point of them coming to see me if they don’t need the specificity” (code 65.2)

For the practitioner, seeing the products they dispense becoming common in stores can be disappointing (code 236.8). Having products that are dispensed by the homeopath available in health stores and pharmacies was not always welcomed by practitioners. It was sensed that this poses a financial threat to the practitioners and undermines their training (code 121). For some practitioners, this made them feel as though the field of homeopathy as a whole loses value (code 73).

“…for the way I use it, it’s perfect but if it was something that I used more in my office in my daily practice then it wouldn’t be great. Because we do not earn sufficient income on the time that you are sitting with the patient. You actually earn more of it on your script. So, it’s available at the pharmacies and they can go purchase it themselves… it’s because it’s an infrequent part of my prescription, but if it was the majority of my script I would have a significant problem because how do I earn an income if I’m competing with 5 000 stores in my suburb” (code 121.12)

“I think the harm comes in, in the reputation of our industry. That’s the difficulty, it’s that it’s not seen to be a profession. It is not seen to be guarded. It’s not seen to have any kind of regularities or standards” (code 73.2)

Although it was felt that the “trained middle-man” offered value to the retail setting as it protected the public from misusing the products and in so doing might preserve the field of homeopathy, one practitioner shared strong feelings toward this. It was noted that this too threatened the practitioner as it essentially offered members of the public a “free consultation” (code 184.5) when frequenting a retailer with qualified personnel available to assist customers.

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Despite concerns regarding the effect that retailed Bach flower remedies might have on the public and on the profession of homeopathy, four practitioners reinforced the idea that Bach flowers are safe and pose no safety concerns to the public (code 147).

“I don’t think they cause themselves any harm. If something doesn’t work or it gets worse, usually people will stop. So, I don’t think it’s going to do any harm” (code 147.14)

For a small group of participants, the presence of Bach flower remedies in retail was welcomed and appreciated. The easy access of the remedies allows for patients to by-pass a consult when they are just seeking a remedy replenishment (code 235.8). In some cases, the public’s easy access to the remedies was supported (code 118). One practitioner thought it was wonderful and was glad that patients could easily get access to the remedies (code 118.6). It also boosts patient exposure to Bach flower remedies, in the eyes of some participants (code 182). This may translate into a greater willingness to use Bach flower remedies and encourage education and a new perspective on health and healing.

“…the ability for a patient to get a hold of them is fairly easy. It’s not like certain homeopathic remedies you can only get from specialised pharmacies and that. Bach flower remedies are available at Dischem, they are available at most chemists and I would far rather work out the right one for them and then tell them to go buy it” (code 118.12)

“At the same time, you do want to let people experience it or experiment with it, the public, because that’s how their knowledge grows and their buy-in to complementary medicine grows” (code 182.10)

Despite these various views on Bach flower remedies being available in the retail setting and the feelings it stirred amongst the participants, its presence in the retail setting is a reality. Although not all practitioners agreed on its place there, many did note that from a business perspective, their presence on the retail shelf is respected and even understood (code 71).

“So, I think everybody needs to make an income. So, the health shop wants to run a shop where they’ve got stock... Should all the profits of making medicines sit with the practitioner? I’m not really sure that that’s also fair. Or, should all the profits sit with the “Dischem’s” and the pharmacies and there’s no dispensary for the practitioner…? But,

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our industry is sort of left open because there aren’t homeopaths trained, working in the health shops, as a mandatory set up” (code 71.2)

“I do understand that as a commercial venture, you can’t only have Bach flower remedies just available to the practitioners” (code 71.4)

3.5.5.2 Category 2: Bach Flower Practitioners As of July 2016, there were four registered Bach flower practitioners listed in Gauteng (Olver, 2016). The qualification is awarded once all three levels of the Bach flower course have been completed, and registration with The Bach flower Centre is acquired. This course was not only open to practitioners but to the general public as well. During discussions with the participants, two distinct opinions emerged: one which welcomed Bach flower practitioners and one which criticised them.

Bach flower practitioners were welcomed for their contribution as listeners to a society that lacks emotional support (code 332.14). One particular participant stated her views, that half of the healing stems from the listening and caring environment that the practitioner offers and that any contribution made to the care of others should be embraced. Some practitioners felt that anyone who had shown enough interest in completing the course would have the best interests of those they treat and that with a qualification in Bach flower remedies they would be a valuable member of society (code 205).

“I think it’s great but then it’s back to what I said about 50% of the healing process is having somebody to tell your troubles to. And I think that even if that person isn’t wildly amazing at prescribing those Bach flower remedies in the right combination... I do think that if they are trained, they get that sense of responsibility toward the patient and they do have that intent to heal the patient. And it’s not just for financial gain I’m going to tell you, ‘I think that’s wonderful.’ Because I am going to tell you, the more ears and eyes and help and just support for us as a society out there is actually awesome. I think there’s too little of it. And too few avenues as well” (code 32.14)

“… because it’s not something that the general public, that might be my perception here, that are really interested in. And then to do a three level course, you know it takes a bit of commitment as well. I think there’s two ways to look at something, but I don’t have any issues with it, no” (code 205.11) 108

The idea of a Bach flower practitioner was not only just accepted (code 314.13) but warmly welcomed by five of the participants, who showed willingness to collaborate with Bach flower practitioners (code 161).

“If I had a wonderful Bach flower therapist in my area, I wouldn’t even mind taking that little bit of my practice out of my practice and referring… I wouldn’t even mind working with someone” (code 161.4)

“…even these practitioners who are studying Bach flowers, I still believe that in their heart they want to help. And I believe that that counts. These other charlatans are usually quite money-based. But I don’t think you are going to make a Rockefeller out of a Bach flower practitioner… they are in it for the right reasons” (code 161.14)

Alternatively, some practitioners were critical of the idea of a Bach flower practitioner. Their qualification came into question when a practitioner felt that it does not qualify them for any form of registration and, brought about concerns of accountability and quality of care that Bach flower practitioners can offer their patient (code 242).

“I think that it would be very beneficial if they did have some sort of registration process and in-depth training and make sure it is like a registered profession so that if anything does happen, people can be held accountable, and just to make sure that everyone is practicing on the same level” (Code 242.9)

The misuse of Bach flower remedies amongst Bach flower practitioners was raised once again. The concern is that these practitioners may feel themselves able to take on more than what falls within their scope (code 274) and this may result in incomplete treatment (code 76). As a result, participants were concerned that treatment offered by a Bach flower practitioner would be insufficient and that some aspects of the case would be left untreated. Bach flower remedies cannot serve as an “end to end treatment for all kinds of disorders” (code 76.2).

“…being only a Bach flower practitioner, I think that person will probably lose out a lot of aspects of medicine, of patient care…I would think it’s a little incomplete. An incomplete profession to say, ‘We’re Bach flower practitioners’” (code 76.10)

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A lack of deeper understanding or knowledge was questioned (code 34) and the possibility for negligence on behalf of the Bach flower practitioner could even result in harmful treatment (code 35), as important clinical signs could be missed (code 75) and potentially dangerous conditions could be completely overlooked.

“…being only a Bach practitioner, I think that person will probably lose out… I feel there has to be some sort of responsible medical background that can actually differentiate you from... and analyse the patient and say, ‘No, the patient needs different care’” (code 34.10)

“Because now you’ve got lay people who perhaps don’t have a deeper understanding of physiology or clinical cases, taking on patients that may be quite depressed or ill, and relying on a product range that may not be effective enough to deal with their symptoms” (code 35.2)

“Like with any practitioner who is not medically trained, is that there is a massive risk for misdiagnosis. Keeping that patient in your practice and treating them with Bach flower remedies when there might be another more significant pathology that they need to deal with. Because they are not medically trained, they are not doing a physical examination, they are not doing blood tests” (code 75.12)

That which raised significant concern was the access the general public had to this course. Three of the fourteen practitioners felt it inappropriate that lay people can become Bach flower practitioners (code 186). One even questioned the authority which has allowed for lay-people to access the training. As there is no need for any form of medical training, participants expressed frustration that someone unqualified, for example a plumber, could be treating with Bach flower remedies (code 186.12). One participant reported noticing the poor performance of a Bach flower practitioner with her own patients (code 186.14). Three others felt that the use of the term ‘practitioner’ is misleading (code 78) as it suggests that there is a profound medical understanding as well as an ability to diagnose. For these reasons it was felt that Bach flower practitioners too contribute to the discredit of the field of homeopathy (code 36). Some participants perceive Bach flower practitioners as poorly qualified dispensers of Bach flower remedies and without proper knowledge to use them. Some concerns arose that they may begin dispensing homeopathic remedies as well (code 36.5).

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“I have had a lot of hysterical patients that come here and have been to a Bach flower specialist, in inverted commas, because you get a lot of bored housewives becoming Bach flower prescribers” (code 186.14)

“I probably have a problem, if your wording is correct, calling someone a Bach flower practitioner because practitioner implies doctor. I wouldn’t mind them being called Bach flower therapists … By calling them a practitioner you’re kind of implying that you’re allowed to diagnose, which I assume you are not? By using the name therapist, you can treat feelings of anxiousness, rather than pre-diagnose or diagnose anxiety and treat it. My problem is actually with the wording or the title, more than the actual thing” (code 78.4)

“We study a long time. Medical doctors study a long time. We are health practitioners… I think anybody can start to do anything and then what’s the point of doing what we do? Why have this course at UJ? Why offer tertiary education in homeopathy if we can just learn it from a book? Same thing with the Bach flower remedies” (code 36.2)

One practitioner questioned the value of this qualification to both the Bach flower practitioner (code 258) and how it affects the ability of the homeopath to dispense Bach flower remedies, while being conscious of how easily these remedies can be accessed. Several participants agreed that it is essential that Bach flower practitioners have a keen and clear understanding of their scope of practice in order to work ethically (code 77). Bach flower practitioners do not diagnose, but use the remedies as a means to address and treat unpleasant emotions (code 77.8)

“I’m thinking, what does this registration give you? It lets you use it. Great. But what is stopping me from using it now without a registration? I mean, I can say, ‘Yes, I use Bach remedies in my practice.’ Great. So, my patient’s use them, great. ‘Ah yes, but are you a practitioner of Bach remedies?’ Well, I’m not but…” (code 258.10)

“So, as long as there is an understanding of the scope… As long as we keep in mind the scope of Bach flower remedies” (code 77.2)

3.6 RESEARCHER’S BRACKETING, REFLEXIVITY AND OBSERVATIONS Bracketing refers to the researcher’s objectivity during the process of data collection and data analysis so as to not influence the outcomes (Fischer, 2009). The researcher strived to implement 111 bracketing by beginning each interview with an open-ended question which were followed by follow up questions aimed to gather as much relevant information as possible, and each interview was concluded with the question: “Is there anything further you wish to add on the subject of Bach flower remedies in homeopathic practice?”. The researcher hoped to encourage openness and an honest exchange with each participant. Bracketing was practiced again during data analysis. During the first round of coding the researcher noticed that codes were applied under preconceived ideas of themes and categories which limited the ability to be objective. After two weeks the data was re-coded. The researcher approached the data with fresh eyes and applied more specific codes without the notion of category or theme to display a more accurate portrayal of information.

The researcher’s stance on the study’s outcomes were set aside through the process of reflexivity (Krefting, 1991). A consciousness with regard to the researcher’s bias was kept in check through all stages of the study. With subsequent interviews, the researcher became more aware of leading questions that were close-ended rather than open-ended. These were brought to the attention of the researcher once more during the transcription phase of interviews. With a growing awareness of this room to improve, the researcher strived to improve her interviewing skills. Memos were made in the margins of transcriptions during coding to draw attention to these potential biases and establish reflexivity throughout the study.

The researcher observed that all participants are different and engage to a lesser or greater degree, which had a direct influence on the flow of the interviews and the extent to which close-ended questions were used. In interviews where participants held back on discussion, the researcher found herself making use of close-ended questions rather than open-ended follow up questions.

The researcher also noticed that at times participants were unsure or were misinformed on the topic of Bach flower remedies, which was noted as a memo in the margins of the coded transcripts.

3.7 CHAPTER DESCRIPTION In Chapter 3, the data gathered through in-person interviews with homeopathic practitioners was discussed. The analysis of said data was allocated to a theme, category and in some cases sub- category. This served to consolidate the gathered data, asses its relevance and note its content in the context of this study. This chapter also discussed methods by which the researcher remained impartial throughout the duration of this study. In Chapter 4, the study’s conclusion is outlined with notes regarding researcher limitations and recommendations.

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CHAPTER 4: CONCLUSION AND RECOMMENDATIONS

4.1 INTODUCTION In Chapter 4, an outline of the study is presented together with the challenges and limitations faced by the researcher. Herein, the study’s conclusions will also be discussed accompanied by a list of recommendations for homeopathic practitioners, homeopathic educators, Bach flower retailers, trainers, and future researchers in the field of Bach flower remedies.

4.2 CONCLUSION This study’s central focus was to explore homeopathic practitioners’ experiences regarding their use of Bach flower remedies in homeopathic practice, as a means to determine the contribution of these remedies to homeopathic practice. A qualitative phenomenological method was applied to this study and data was analysed using Saldaña’s grammatical, elemental and affective coding methods (Saldaña, 2009). Data was collected by conducting in-person interviews with homeopathic practitioners who either make use of the remedies in practice or have some experience making use of the remedies. Interviews were built around one central question: Describe your experiences making use of Bach flower remedies in Homeopathic practice. This gave rise to many matters surrounding the use of Bach flower remedies and the effects it has on the practitioner as well as the patient. Through the process of data analysis, five themes emerged. Themes were made up of categories and in some cases, categories were made up of sub-categories to facilitate the organization of data as well as its analysis.

The study’s key outcomes revealed that Bach flower remedies are understood to hold value in the homeopathic practice. For the most part, practitioners receive a positive patient response when making use of the remedies, despite the diverse grounds and ways in which practitioners prescribe them. The remedies are also easy to make use of and are perceived as safe, making them a helpful asset in practice.

Practitioners agree that Bach flower remedies are used to treat emotional symptoms, and each practitioner will prepare and dispense Bach flower remedies using unique practitioner-specific prescribing techniques.

Bach flower remedies are incorporated into the homeopathic dispensary because the philosophy on which they were developed is similar to homeopathic doctrine. Although these remedies have

113 been successfully used in practice, many practitioners agree that further research into the remedies would be welcomed. A similar feeling is shared toward the South African flower remedies, of which very little is known.

Many practitioners acknowledge that their awareness of Bach flower remedies began while studying Homeopathy. Some practitioners felt that Bach flower remedies should be further reinforced during their studies.

The additional Bach flower remedy course was perceived as unprofessional by some practitioners, unnecessary by some, and interesting and welcomed by others. The course raised questions of credibility and relevance to homeopaths, and regulation was suggested. Similarly, mixed responses were received on the topic of Bach flower remedies in the retail environment. Concerns surrounding consumer safety and questionable professional credibility arose. However, it was noted that having Bach flower remedies available in the retail setting helped promote a greater awareness of these products, representing a positive view on its availability.

Theme one, value in practice was formed by two categories. The first category was practitioner experiences and, was further formed by seven sub-categories. These were basic uses and experiences, Bach flower remedy criticisms, patient considerations, use in practice, Bach flower remedies and homeopathy, contributions of Bach flower remedies and Rescue Remedy in practice. The second category was grounds of prescribing which explored how practitioners prepared and dispensed Bach flower remedies in practice.

Theme two, remedy application in practice was formed by three categories. The first category was symptoms and context of use. The second category was remedy preparation and dispensing. This category was made up of six sub-categories. These were complex versus simplex, dosage, frequency, complex components and preparations. The third category was Bach flower remedies used in practice.

Theme three, practitioner perceptions was made up of five categories. The first category was patient response and was made up of three sub-categories. These were negative, positive and unclear. The second category was Bach flower remedies for physical symptoms, the third was relevance, the forth was practitioner opinions and the fifth was South African Flower remedies.

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Theme four, education, was made up of four categories. These were Bach flower remedies at university, Bach flower remedy exposure, sources of information and additional training.

Theme five, Bach flower remedies outside of practice. This theme was made up of two categories which were Bach flower remedies in stores and Bach flower remedy practitioners.

This study explored the practitioners’ experiences making use of Bach flower remedies in homeopathic practice in an attempt to better understand this phenomenon. It was found that Bach flower remedies are a respected component of the homeopathic dispensary regardless of how prominent a component it may be for the practitioner. Bach flower remedies have shown promising patient response and a genuine approval of their use from the patients. Practitioners have made use of the remedies in various ways, all of which demonstrate their place in the treatment of mental and emotional symptoms displayed by the patient. Practitioners utilize the remedies as a means to enhance or add to their treatment plan, in that Bach flower remedies form a convenient and easy complementary adjunct to the practice, amplified by the ease with which Bach flower remedies can be used and added to a homeopathic prescription. Its value in practice was affirmed throughout this study.

It was apparent through the data gathered in this study that practitioners making use of Bach flower remedies in practice are not closely adhering to the preparation methods laid out by Dr Edward Bach. Most participating practitioners shared their unique methods of prescribing and dispensing the remedies. Prescribing the remedies in combination with homeopathic remedies at times made patient response to the treatment unclear, however positive outcomes were reported. Only one remedy aggravation was reported throughout all the interviews. The general consensus is that Bach flower remedies are safe and gentle for use.

While patient response was at times unclear, there was no negative outcome, but rather absent outcomes at times, indicating the gentleness of the product. Dr Bach’s teachings dictate that physical ailments manifest due to emotional dis-ease. Upon discussion with the participants this could not be confirmed or denied. Many practitioners resonate with this theory and articulate the connection between emotions and physical health that they might have witnessed. It was agreed upon that there is a physical and emotional connection that plays a significant role on health and wellbeing.

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The relevance of Bach flower remedies to the homeopathic practitioner was dismantled through the discussion. The leading cause for Bach flower remedies to be incorporated into the homeopathic dispensary was due to their shared philosophy and at times the view that they are of equal value and therefore should be incorporated.

Practitioners noted a need for further research into the field of Bach flower remedies and they shared how they practice and what approaches they may adopt in treatment protocols. The use of South African flower remedies was discussed with a minor group of participants. It was encouraged that these form part of the university curriculum for homeopathy.

On the topic of education, it was found that Bach flower remedies formed a small portion of their studies, together with other auxiliary therapies often associated with homeopathy. Many of them noted that their perceived value of Bach flower remedies was only established once in practice as it did not stand out as a prominent auxiliary modality during theoretical or practical learning. Many practitioners noted the bulk of their learning came from additional studies done outside of university and that emphasis on Bach flower remedies during their practical learning would have been beneficial.

While conducting the interviews, it was found by the researcher that practitioners were at times misinformed with regard to Bach flower remedies. As it is understood that Bach flower remedies form only a slight component of the homeopathic dispensary, it is reasonable to have noted this, however as many homeopaths have incorporated these remedies into their practices, it is essential that practitioners be well informed. This may speak to the need for further reiteration on Bach flower remedies throughout the homeopathic course and possible CPD accredited courses or workshops which practitioners could take part in.

There is a growing awareness on the available Bach flower training course. Some practitioners have already taken part while others show some interest. For the most part, practitioners felt that the course lacked professional status by being open to the public, and that their current knowledge on the topic was sufficient for them to confidently prescribe the Bach flower remedies.

The presence of Bach flower remedies in the retail setting received mixed responses. Practitioners expressed feelings of approval, indifference or disapproval. At large it was noted that practitioners wish to maintain the individual Bach flower remedies as practitioner only products and in so doing preserve the credibility of the homeopathic profession. Its accessibility also raised some concerns 116 regarding public safety and the potential for the misuse of the products. On the contrary, it was also noted that the retail setting allows for a greater awareness surrounding Bach flower remedies to be established.

The credibility of the field was also questioned with the presence of Bach flower practitioners emerging as a result of the certified Bach flower course. Practitioners felt that lay people dispensing Bach flower remedies posed many risks to the public for mistreatment and misdiagnosis, as well as for the homeopathic profession, negatively affecting its reputation.

It was suggested that should the Bach flower practitioners be accredited and registered, there may be a place for them. Although it was felt that the term ‘practitioner’ is inappropriate, some homeopathic practitioners noted their willingness to collaborate with them due to an understanding of the value of Bach flower remedies.

4.3 LIMITATIONS This study aimed to explore and describe the experiences of homeopathic practitioners in the Gauteng area who are making use of Bach flower remedies, by means of individual interviews. By conducting this study, the perceptions held by homeopathic practitioners as it relates to the use of Bach flower remedies were explored and described. These experiences were assessed in order to ascertain their value and the personal level of education held by homeopathic practitioners on Bach flower remedies and the desire for furthering their education on the remedies was evaluated. The researcher faced numerous limitations throughout this study. These limitations will be discussed below.

• This study was limited because one aspect of the proposed method of sampling could not be adhered to. The researcher had hoped to create awareness with regard to this study with the assistance of the Allied Health Professions Council of South Africa (AHPCSA). The council was unable to assist the researcher with a broad, provincial invitation to take part in this research study. For this reason, the researcher relied on snow-balling to recruit participants. As snowballing began with practitioners familiar to the researcher, this method of recruitment may have excluded many practitioners from taking part in the study, however insightful information was gathered by numerous willing participants. Although only snow-balling recruitment techniques were used, a diverse group of participants emerged, and data saturation was achieved

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• While snowballing, potential participants were contacted, either by email or telephonically. In both instances there were cases where potential participants would not follow-up with the researcher’s communications, limiting the pool from which data could be gathered.

• As a novel member to the field of research, the researcher may have shown deficiencies in her interviewing skills. Before initiating the interview process, the researcher conducted a mock interview. This served as an interview example in which important discussion points were highlighted and the volunteering interviewee was able to provide the researcher with constructive criticisms to improve her interview skills. Memo notes revealed that at times the researcher struggled to re-establish the main focus of the study when participants veered off topic. This resulted in a few missed opportunities in further exploring and clarifying some ambiguous responses from the participants. However, the memo notes made by the researcher during the interviews drew the researcher’s attention to possible improvements which could be applied in subsequent interviews. In this way, the researcher was able to improve her interviewing skills as the study progressed.

• When reviewing transcripts from the interviews conducted, the researcher noted her own short-comings. The researcher at times lacked bracketing and expressed personal feelings toward the subject of Bach flower remedies. In some cases, the researcher would ask close- ended questions rather than open-ended, follow up questions to further discuss the topic. In some cases, participants seemed less forthcoming with information and were less engaging with the researcher. Under such circumstances, the researcher used close-ended questions in order to gather sufficient data from the participant. However, wherever possible a conscious effort was made to prevent the reoccurrence of these limitations in subsequent interactions with participants.

• When capturing the demographics of the participants of this study, the researcher failed to note the ages, gender and ethnicity of the participants. In order to more accurately report on the study’s demographics, this information should have been gathered together with the consent form of Appendix C.

• As this research pertained to the use and value of Bach flower remedies, a tool to assist with emotional symptoms in homeopathic practice, the researcher noted one key failing. Amongst all the follow up questions that were asked to evaluate the worth of these

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remedies, the weight of emotional health on patient wellbeing was overlooked. The researcher should have included such a question.

• As a student of homeopathy embarking on a research endeavour for the first time, the researcher approached this study with limited skills in conducting a suitable interview. The researcher was both learning research skills and applying them simultaneously with no prior experience in data coding and analysis. Though the coding process, it became apparent to the researcher that keeping one’s personal perspectives separate from the study was challenging at times and that the way in which coding and theming was carried out, the outcomes and findings of the study could be persuaded. In an effort to remain impartial, the researcher aimed to be well read on both the topic of the study as well as the methods of investigation and analysis. The researcher also needed to continuously practice reflexivity to remain unbiased during the research process. This research study was validated by an independent qualitative analyst, which contributed to its trustworthiness.

4.4 RECOMMENDATIONS In this study, the value of Bach flower remedies in homeopathic practice was determined by exposing the practitioners’ experiences making use of the remedies. All the participants noted its use in the treatment of emotional symptoms, eleven of which advocate for its worth in practice. This principal finding lends itself to appointing recommendations that relate to homeopathic practitioners, homeopathic educators as well as Bach flower remedy retailers and trainers.

4.4.1 Recommendations for Homeopathic Practitioners Many of the practitioners who formed part of this investigation noted Bach flower remedies are not extensively used within the field. This was apparent as several practitioners who were approached could not take part due to their inexperience with the remedies. Participants did however, vouch for the positive contribution that Bach flower remedies made to their practice. With these outcomes in mind, it is recommended that Bach flower remedies be reconsidered for use by homeopathic practitioners.

4.4.2 Recommendations for Homeopathic Educators Although participants noted that training on Bach flower remedies at the level of university was vague and they reinforced that their training as homeopathic practitioners would result in their practice being built on homeopathic principals with additional therapies being only auxiliary, it

119 was suggested that the use and availability of Bach flower remedies be reiterated throughout the program. Some suggestions that arose during the interview process included increasing the awareness of Bach flower remedies to 5th year students working in the campus clinic, allowing students to blend their own mixtures and experiment in treating patients with the remedies. It was suggested that clinicians have a similar experience, as participants noted that homeopaths are more likely to make use of the tools they were exposed to as students once in practice. Should students not be exposed to the tools at university, they are less likely to make use of them in practice.

4.4.3 Recommendations for Bach Flower Remedy Trainers and Retailers When discussing additional training, one major deterrent in taking part in the UK accredited Bach flower remedy course was its acceptance of the general public in participating. Many practitioners felt that completing the course would not contribute significantly to their practice because they were already making use of the products. The additional training program allows lay people to become Bach flower practitioners, which raised several concerns in terms of patient safety and the possible misconception brought about by the use of the word ‘practitioner’. It was suggested that the course be evaluated to ensure that practitioners who take part are gaining new knowledge rather than repeat learning the knowledge and the skills that are already being applied in their practice. A course evaluation might also distinguish between a course that is open to the public and one which is aimed at practitioners. It was also recommended that the course allow for some form of local registration in order for Bach flower practitioners to be regulated.

For some practitioners, Bach flower remedies in retail were highly criticised, not necessarily for a lack of safety but rather to prevent their misuse. Other practitioners felt that this was a convenient way for the public and patients to acquire the remedies. At large, practitioners recommend that Bach flower remedies in a complex with clearly outlined indications, such as Rescue Remedy, are safe for retail while the individual remedies should remain practitioner exclusive. Regulation on the products was also suggested in order to further prevent their misuse.

The cost of both the certified course of Bach flower remedies as well as the remedies themselves was an issue that was raised by participants too. Some practitioners felt that despite their interests, the course seemed too expensive. Another participant noted the significant initial expense of stocking them in the dispensary.

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4.4.4 Recommendations for Future Researchers There is limited research currently available on Bach flower remedies. For this reason, a qualitative study was conducted to gain some form of understanding of the role of Bach flower remedies in homeopathic practice, in order to create a foundation on which further research could be done.

For further studies on Bach flower remedies, a qualitative, general survey study regarding the use of auxiliary therapies amongst homeopathic practitioners could be considered. A sample group from another area could better suggest the use and value of these remedies in practice. Laboratory studies, clinical trials or placebo controlled, double-blind studies could also be considered as a means to better understand Bach flower remedies.

4.5 CHAPTER DESCRIPTION In Chapter 4, the discussion on the homeopathic practitioners’ experiences of making use of Bach flower remedies in homeopathic practice draws to a close having completed the literature control, followed through with the methodology and the analysis. The study’s conclusions are clearly outlined and the study was reinforced with recommendations, and limitations were also delineated.

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APPENDIX A Permission Letter to the Registrar of the Allied Health Professions Council of South Africa

Dear Dr. Mullinder

I am a Homeopathy student at the University of Johannesburg currently working on my research in completion of my Master’s Degree. This study is to explore and describe the experiences of homeopathic practitioners in the Gauteng area making use of Bach flower remedies. The study is to be conducted by gathering qualitative data by means of individual interviews with consenting practitioners.

It would be greatly appreciated if you could please forward an invitation to practitioners who are registered with the Allied Health Professions Council of South Africa and who are practicing in the Gauteng area to take part in this study. Practitioners are invited to discuss the relevance and use of Bach flower remedies in their practice. Participation is voluntary and may be withdrawn at any stage. This study ensures that the identity of participants will be kept completely anonymous.

UJ ethical clearance has been granted for this study (Ethics Number: REC-01-9-2017). For further information you may contact Dr. Chris Stein, the Chairperson of the Faculty of Health Sciences Research Ethics Committee at the University of Johannesburg on (011) 559-6686 or [email protected].

Please sign in the allocated area below should permission be granted for homeopathic practitioners to be recruited as participants for this study through the Allied Health Professions Council.

Thank you in advance for your assistance. Sincerely, Cecilia Dos Santos Dr. J. Pellow Homeopathic Researcher Research Supervisor [email protected] [email protected]

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APPENDIX B Information Sheet

DEPARTMENT OF HOMEOPATHY RESEARCH STUDY INFORMATION SHEET

April 2017

Good Day

My name is Cecilia Dos Santos. I WOULD LIKE TO INVITE YOU TO PARTICIPATE in a research study to explore homeopathic practitioners’ experiences regarding their use of Bach flower remedies in practice.

Before you decide on whether to participate, I would like to explain to you why the research is being done and what it will involve for you. I will go through the information sheet with you and answer any questions you have. This should take about 10 to 20 minutes. The study is part of a research project being completed as a requirement for a Masters, Degree in Homeopathy through the University of Johannesburg.

THE PURPOSE OF THIS STUDY is to determine the value of Bach flower remedies to Homoeopaths as noted by practitioners through their experience with patients as well as establish any gaps in the education system as it relates to this collection of remedies.

Below, I have compiled a set of questions and answers that I believe will assist you in understanding the relevant details of participation in this research study. Please read through these. If you have any further questions I will be happy to answer them for you.

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DO I HAVE TO TAKE PART? No, you don’t have to. It is up to you to decide to participate in the study. I will describe the study and go through this information sheet. If you agree to take part, I will then ask you to sign a consent form.

WHAT EXACTLY WILL I BE EXPECTED TO DO IF I AGREE TO PARTICIPATE? As a participant in this study, you will be expected to take part in an interview of approximately 20- 30 minutes, during which your experiences and opinions about Bach flower remedies will be discussed. Interviews will be audio recorded to maintain accuracy. After the interview, the audio recordings will be transcribed, then destroyed. The interviews will take place at a time and location most convenient to you, in a private room. None of your personal information will be disclosed in this study. You will need to agree to take part in the study by signing a consent form as well as consent for the interview to be audio recorded in order to accurately capture the data.

WHAT WILL HAPPEN IF I WANT TO WITHDRAW FROM THE STUDY? If you decide to participate, you are free to withdraw your consent at any time without giving a reason and without any consequences. If you wish to withdraw your consent, you must inform me as soon as possible.

IF I CHOOSE TO PARTICIPATE, WILL THERE BE ANY EXPENSES FOR ME, OR PAYMENT DUE TO ME: You will not be paid to participate in this study and you will not bear any expenses.

RISKS INVOLVED IN PARTICIPATION: There are no risks anticipated for this study.

BENEFITS INVOLVED IN PARTICIPATION: You will create insight into the use and value of Bach flower remedies through your participation by shedding light on the matter with practitioner experience. You will also assist in guiding tertiary education on the topic of Bach flower remedies.

WILL MY PARTICIPATION IN THIS STUDY BE KEPT CONFIDENTIAL? Yes. No names will be associated with the transcription of data from the audio recording into writing. Once transcriptions have been made, the original recordings will be destroyed. In this way anonymity will also be preserved. All data and back-ups thereof will be kept in password protected folders or at the Department of Homeopathy, on the university grounds, under lock and key. Only I or my research supervisor will have access to your personal information. 133

WHAT WILL HAPPEN TO THE RESULTS OF THE RESEARCH STUDY? The results will be written into a research report that will be assessed. In some cases, results may also be published in a scientific journal. In either case, you will not be identifiable in any documents, reports or publications. You will be given access to the study results if you would like to see them, by contacting me.

WHO IS ORGANISING AND FUNDING THE STUDY? The study is being organized by me, under the guidance of my research supervisor at the Department of Homeopathy in the University of Johannesburg. The University has provided limited funding for this study.

WHO HAS REVIEWED AND APPROVED THIS STUDY? Before this study was allowed to start, it was reviewed in order to protect your interests. This review was done first by the Department of Homeopathy, and then secondly by the Faculty of Health Sciences Research Ethics Committee at the University of Johannesburg. In both cases, the study was approved.

WHAT IF THERE IS A PROBLEM? If you have any concerns or complaints about this research study, its procedures or risks and benefits, you should ask me. You should contact me at any time if you feel you have any concerns about being a part of this study. My contact details are:

Cecilia Dos Santos 0713537632 [email protected]

You may also contact my research supervisor: Dr. Janice Pellow [email protected]

If you feel that any questions or complaints regarding your participation in this study have not been dealt with adequately, you may contact the Chairperson of the Faculty of Health Sciences Research Ethics Committee at the University of Johannesburg:

Dr Chris Stein Tel: 011 559-6686 Email: [email protected]

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FURTHER INFORMATION AND CONTACT DETAILS: Should you wish to have more specific information about this research project information, have any questions, concerns or complaints about this research study, its procedures, risks and benefits, you should communicate with me using any of the contact details given above.

Researcher:

______Cecilia Dos Santos

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APPENDIX C Participant Consent Form

DEPARTMENT OF HOMOEOPATHY

RESEARCH CONSENT FORM

Homeopathic practitioners’ experiences regarding their use of Bach flower remedies in practice

Please initial each box below:

I confirm that I have read and understand the information sheet dated May 2017 for the above study. I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily.

I understand that my participation is voluntary and that I am free to withdraw from this study at any time without giving any reason and without any consequences to me.

I agree to take part in the above study.

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Please fill in the table below:

How long have you been in practice as a homoeopath?

What tertiary institution did you graduate from, and in what year?

Did Bach flower remedies form part of your course material during your studies? Have you had any additional training on Bach Flower Remedies?

How long have you been making use of or did you make use of Bach flower remedies in your practice?

______Name of Participant Signature of Participant Date

______Name of Researcher Signature of Researcher Date

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APPENDIX D

Consent for Audio Recoding

DEPARTMENT OF HOMOEOPATHY

RESEARCH CONSENT FORM OR INTERVIEWS TO BE AUDIO-TAPED

Homeopathic practitioners’ experiences regarding their use of Bach flower remedies in practice.

Please initial each box below:

I hereby give consent for my interview, conducted as part of the above study, to be audio-taped.

I understand that my personal details and identifying data will be changed in order to protect my identity. The audio tapes used for recording my interview will be destroyed immediately after transcription. Transcriptions will be destroyed five years after the publication of the research.

I have read this consent form and have been given the opportunity to ask questions.

______Name of Participant Signature of Participant Date

______Name of Researcher Signature of Researcher Date

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APPENDIX E Confidentiality Agreement - Editor

CONFIDENTIALITY AGREEMENT

I, Fatima da Silva, hereby declare that I understand and agree to the following conditions with regards to the editing of the transcriptions of this study.

1. I understand that the content on of these interviews was received for the purpose of editing the transcriptions of audio recordings transcribed by the researcher and shared by participants of the research study. 2. I understand that the identity of the participants and any individual or company discussed as well as the content of the interview transcriptions are confidential and may not be revealed. 3. I accept to treat all transcribed information as confidential content to which only I have access. I will keep all digital and hard copy transcriptions securely. 4. I will return all transcriptions back to the researcher on completion of their editing and will delete any digital transcriptions in my possession thereafter.

Name (Editor): Fatima da Silva

Signature: ______

Date: ______

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APPENDIX F Confidentiality Agreement and Research Validation from the Qualitative Analyst

CONFIDENTIALITY AGREEMENT

BETWEEN

Owen Manda

IPSOS

AND

Cecilia Gorete Dos Santos

Research Title: Homeopathic practitioners’ experiences regarding their use of Bach flower remedies in practice

As per the research code of ethics, confidentiality should and will be maintained throughout data analysis.

The qualitative research inspector commits to maintain confidentiality when reviewing the data for this study.

I, ______, commit myself to keep all information confidential during and after the research validation process pertaining to the qualitative research study stated above. Through consultation and oversight, I hereby affirm that the content of this study has been validated.

Qualitative Research Validator:

______

Date: ______

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APPENDIX G Higher Degrees Committee Letter

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APPENDIX H Academic Ethics Committee Letter

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APPENDIX I Transcript Example

R: Describe your experiences using Bach flower remedies in homeopathic practice.

P: So, it started with using Natura Rescue, which obviously has Bach flower remedy in it and then going from there to trying to figure out what other mental or emotional stuff you can treat with it. And then, because my practice is very paediatric, and I do deal with, like: anxiety, separation anxiety, nightmares, problems going to sleep and that type of thing. Using them in my practice is mainly for those types of things.

R: Ok, so that mental and emotional picture in kids.

P: Mainly in children, occasionally in more sensitive type patients. I’ll use them in grown-ups as well, but in adults it’s not standard practice.

R: You mentioned it was mostly the Natura that got you into it.

P: Just the Rescue Remedy.

R: Just the Rescue Remedy, and then you started it apart. Would you say that of all your Bach flower remedies it’s mostly your “anxiety”, that are your most popular?

P: It’s usually ones to do with fears of the unknown, fear of failure, fear of this or that. Also, actually in adults, lots to do with facing changes in life like: moving, or changing jobs or, “I’m getting divorced and I don’t know what’s going to happen next.” It’s a lot of fear, anxiety, worry, that type of thing.

R: If you read case studies on Bach flower remedies you’ll find that there was a physiological kind of picture, but you understand that there is a lot of emotional background that’s propelling that physical picture, and they might use Bach flower remedies to clear up the physical as well as the emotional that’s causing it. Have you ever used Bach flower remedies in a physical picture as well?

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P: No, I have never. I only use it when mentals are the leading symptom. Sometimes a physical symptom will actually disappear. For example, the kid’s tummy ache will disappear once the anxiety about going to school disappears, or whatever. But I usually tie my prescription to an emotional thing and if a physical thing disappears that’s great.

R: It’s a bonus.

P: Yes, it’s a bonus. But I would never go, “Oh, you’ve got tummy ache so…”. I mean, it’s difficult to actually separate it out because now that I’m saying it, even if I know that you’re coming for tummy ache, but I know that the underlying thing is anxiety because of…. You are treating both actually at the same time.

R: But, I think as homeopaths we are always looking at the big picture, right? So, you would, in that way, be looking at both. So, you say you’re using your Bach flower remedies for the kids and their anxiety. Where do your homeopathics end and Bach flower remedies start? How do Bach flower remedies fall into a homeopathic practice?

P: So, when I’ve got a clear homeopathic picture, I will always go for homeopathy first. If that kind of helps but there are still other little bits and bobs, I will use the Bach flower remedies to almost mop up the last little symptoms. Or, in those cases where the mom says, “My kid is anxious,” and you go where there’s no real homeopathic picture, then Bach flower remedies become my first line of treatment. Because, at least the mom will say, “My kid gets very anxious when I drop them in the morning at school.” But if they can’t tell me anything else about that anxiety, I can at least tie a Bach flower remedy to that, rather than trying to find a specific homeopathic.

R: So, it’s a good filler in that way?

P: It is a good filler. So sometimes, homeopathy comes first and the Bach flower is used to mop up. Other times Bach flower remedy is the primary thing because I can’t get more about the case out of the patient.

R: Yes, perfect. That makes a lot of sense. How would you describe your patient response to the remedies?

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P: Well, my daughter takes it. She was one of my first…. test subjects. She used to cry every day when I dropped her at school and cry when she had to do stuff, and everything was just crying and crying and crying and… it was amazing! It literally changed within a few days. Within a few days things started to change.

R: A few days? Wow, that’s fast.

P: No, very, very quickly. I think it works brilliantly. Not every time but maybe it’s because I haven’t done any top up courses, so I’m literally just going on the table indications and going: “I’m going to use this one and this one and this one.” So, maybe the fact that sometimes it doesn’t work is because of my own lack of knowledge and how to use it. But also, not everything works for everybody.

R: True. When you do prescribe Bach flower remedies, how do you prepare them? How do you prescribe them and how do you tell your patients to take them?

P: Ok, I literally use that little booklet, the instant little one, and I work from the case. I would first sit with the case and go, “What themes do I see? Is it anxiety associated with fear of the unknown, or is it…? Whatever. Or, fear of known things or unknown things, separation?” So, I kind of try to find the theme. Then I go back to the table to see which remedies then match. And then, I always look back at the book. But I think I literally take a 50ml bottle and put, I think it is, seven drops of each remedy into distilled water. Done.

R: And how frequently would you tell your patient to take it?

P: I do it very homeopathically actually. So, if they are very, very anxious, they may take it every 5 minutes before they write a test, or something like that. Otherwise, once a day at night before they go to bed, if it’s kind of because of nightmares. Or, they will take it once a day in the morning if it’s more, sort of, school related.

R: So, you just adjust it to your case and what you are dealing with. What is your opinion on Bach flower remedies being quite available to the public in a retail situation?

P: I do think they are 100% safe. So, I don’t think there are any safety concerns around it. I think there is a problem, the same with homeopathy, in that, because there is too little knowledge, 145 sometimes the prescription doesn’t work. And then it gets said, “Oh well, if Bach flower remedy X didn’t work for me, then therefore Bach flower remedies don’t work.” And that sometimes is extrapolated into, “All natural medicine is therefore rubbish.” I think that poor prescription, incorrect prescription, probably taints the perception of Bach flower remedies forever.

R: And sometimes it’s not even the case of there being no prescription. Customers are walking into a store and they…

P: Oh yes! They’ve googled it! And have said, “Well, I need….” I have no problem with Rescue, for example, being on the shelf, whether it’s the Bach rescue or the Natura Rescue or whatever, because I think Rescue has a clear indication for shock and anxiety and…

R: Yes, and I think it is clearly stated on the product.

P: Yes, it’s clearly stated. You know when to use it, how to use it, because it’s been formulated for a specific purpose. But, I don’t think people should be necessarily able to go and say, ‘Oh, I want some Horse Chestnut and some Mimulus and…’

R: And just compile their own?

P: And just compile their own.

R: Mostly because their effect might not be the desired effect?

P: Yes. Not because of a safety concern at all.

R: Because of the reputation?

P: Yes, from a tainted reputation.

R: Ok. So, we have discussed how homeopathy and Bach flower remedies complement each other or work together.

P: Yes. To me homeopathy and Bach flower remedies are almost… interchangeable.

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R: Do you feel that that is particularly because homeopathy was in the background, in the rooting of Bach flower remedies, because its founder was a homeopath?

P: I think so. And also because, my understanding, you’re still talking even in ultra, ultra, high dilutions. You’re talking energy rather than physical substance. Many of the things are rooted in the same sort of philosophy. To me they are very tightly interlinked.

R: I think that is true. And because of that, it forms part of the course material as you study, and the remedies are available in the dispensary and we get exposed to it. So, you said you haven’t had any formal training on the products, you’re just using the little insert. I’m assuming that you have the little kit?

P: So, I’m slowly, slowly building it up. Because as with everything, there are some in the kit that are not super popular and I’ll probably never need. And if I do, then I’ll probably get them here. And for the rest, I have my main ones and I’m slowly collecting.

R: Is that little booklet that you’ve got your only source of information? Or do you have other sources?

P: Google. Because while I tell my patients they are not allowed to google everything, obviously as a doctor, I google.

R: Is it any particular site that you are using?

P: I wouldn’t know. I’ve got a few bookmarks in my practice folder and I just sort of go back to the same ones.

R: As long as it’s a good source that’s getting the information that you need.

P: Yes, not Wikipedia.

R: When you were a student, did you do Bach flower remedies? Did you cover it?

P: We did it in Aux-t. but it was like, a blimp…

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R: Do you think it has value to be in the course material for homeopathy students, like we discussed the link between the two?

P: I think so. I think it should probably be done in Aux-t and then probably done again at the beginning of clinic year, or whatever, because from what I understand, I’m basically the only person here who used the Bach flower remedies.

R: Some of the clinicians weren’t even aware that there were Bach flower remedies in the dispensary.

P: I think it can probably be reiterated, especially because we treat so much mental stuff. It’s such a nice adjunct to the homeopathic practice.

R: A nice adjunct. If the opportunity arose, would you want to study further, know more about Bach flower remedies? Would you like more formal training on it?

P: I get by with what I know. I would like more, kind of, training. But truth be told… I would probably like an online course. Like a whole bunch of audio things that you need to listen to…

R: Like a little lecture?

P: Yes, like a lecture on the fear remedies and the uncertainty remedies and whatever. And you complete little questions and a little case study. And you submit it and at the end of it you get a little diploma. I don’t know that I would spend 3 days going to a Bach flower remedy seminar. I’m not convinced that I’m that committed to the process. At the moment, I find that between practice and varsity and Natura, that we are all so stretched for time, that to find the time to go and sit in a lecture for 2 days is so hard and I would much rather be able to do it between the hours of eight and ten at night or I can listen to it in my car or….

R: It’s more convenient that way?

P: It’s far more convenient.

R: That’s actually such a lovely idea.

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P: All my courses that I do are online courses with an audio component. I put it on in my car and listen to all of it while I’m driving.

R: That’s brilliant.

P: Please recommend it.

R: I think that so many practitioners have personal responsibilities as well as multiple professional responsibilities. It’s so important to be able to expand your professional scope at your convenience.

P: At my convenience. Exactly! Yes, and give me a few CPD points for it. It doesn’t even need to be that much… I’m not looking for ten CPD point but two or three points.

R: So, you are aware that there are currently the Bach flower remedy courses available?

P: Yes, I do know that they are available.

R: Have you had any feedback about them? Do you know much about them?

P: ...

R: It’s a 3 level course. Level 1 and 2 are two day seminars and then level 3 is a four day seminar with a six month correspondence…

P: Yes! I do know about it. I spoke with the Coyne Health people at the homeopathy congress.

R: Are you aware that that course is available for the public and anyone is welcome to do it?

P: No, I did not.

R: So as far as I have been informed, it’s open to anyone. You don’t have to have had any kind of qualification. If you finish all 3 levels you become what is known as a Bach flower practitioner and register with the Bach Flower Centre in the UK and then you can prescribe. Obviously, your scope would be just Bach flower remedies. As a homeopathic practitioner who uses Bach flower remedies, what is your feeling about that? 149

P: I do understand that as a commercial venture, you can’t only have Bach flower remedies just available just to practitioners, because as a practitioner, I’m not going to be able to get them because there aren’t enough practitioners that use them. I probably have a problem, if your wording is correct, calling someone a “Bach flower practitioner” because practitioner implies doctor. I wouldn’t mind them being called Bach flower therapists because you get aromatherapists and all that sort of thing. By calling them a practitioner you’re kind of implying that you’re allowed to diagnose, which I assume you are not? By using the name therapist, you can treat feelings of anxiousness, rather than pre-diagnosed or diagnosed anxiety and then treat it. My problem is actually with the wording, or the title, more than with the actual thing. I don’t know what the courses entail but I would be a bit weary of someone who may potentially even be kind of semi- suicidal or anxious or whatever, going to a Bach flower therapist or practitioner and then missing an important diagnosis or something.

R: Or perhaps not receiving the care they needed in that moment?

P: And who knows what happens.

R: Yes, and it’s important that people are being cared for and that they’re getting the correct care when they need it.

P: Like I say, I just dabble in Bach flowers. If I had a wonderful Bach flower therapist in my area, I wouldn’t even mind taking that little bit of my practice, out of my practice and referring. And saying, “I’ve got this kid, this kid has x, y, z. Please will you assist…”. I wouldn’t even mind working with someone. But it’s the same with everything, people with scio machines and other things. I’m always a little bit worried about misdiagnosis and mismanagement of patients.

R: I think that’s a fair enough feeling. Do you believe that there is a place for Bach flower therapists or practitioners within…?

P: The scope of complementary medicine?

R: Yes.

P: Yeah, sure. I don’t have a problem with it. Look, people go to reflexologists, and they go to whatever and they get beautiful results with it. 150

R: It’s all quite a synergistic system where everything works well with each other? P: Exactly. And as long as they, on some level, know the boundaries of what I can treat with this, and when do I need to refer, I have no problem.

R: Is there anything else on Bach flower remedies that you feel you’d like to express or share?

P: Nope. Do you want to know which ones I use?

R: Yes, sure. Tell me.

P: I use Aspen a lot. Chestnut, Elm, Honeysuckle, Lach, Mimulus, Hornbeam, Mustard. Some of them I use more for adults. So, the Mustard is an adult kind of remedy, and Honeysuckle I use more for adults. Oak as well. Olive as well. Red Chestnut, Rock Rose, Star of Bethlehem, Sweet Chestnut, White Chestnut. Wild Oat I also use in high school kids who are like, “What am I going to do with my life?” And that’s it. I do use some of the others, but those are the main ones.

R: How many do you use in a complex.

P: Usually between three and five, and I sometimes will add a homeopathic remedy into it as well.

R: Into it? That’s interesting. So, in that case is it into distilled water?

P: I generally first make my remedy. So I’ll succuss and whatever, and then I’ll just add my…

R: Do your patients know that it’s a Bach flower remedy?

P: Yes, always. I always let them know. Always.

R: Are they aware that it is different to homeopathy?

P: Probably not, but I also explain to them that Bach flower remedies work very much on the mental and emotional stuff.

R: I know that in the box set, Rescue Remedy has already, as a complex, has already been prepared and is in the box, do you ever use Rescue? 151

P: No, I don’t actually have it. I haven’t bought the whole kit. So, I always use the ones from here and now I’ve slowly started the…. They are actually out of stock of a few. I think I ordered about 10 but only got 7 of them so far. So, I don’t actually have the Rescue Remedy.

R: Would you ever recommend that they get a Rescue to use in conjunction with whatever you’ve just blended for them?

P: No, I rely on my own little….

R: Alright, super. Thank you so much.

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APPENDIX J Table of Codes

Codes can be found in chronological order, colour coded according to the theme under which they fall. Below each code, the excerpts from the transcripts which fall under each code may be found. Exerts which are included are those which were not listed as verbatim in text, but in some cases may provide additional support for Chapter Three’s Data Analysis.

Code Code names &Substantiations no. 1 Source: flower essence “Bach flower remedies is made from flower essence” (code 1.1) 2 Emotional and physical connection “…it is supposed to work on the emotional that is linked to the physical. Anything physical will flow from it (the emotions)” (code 2.1) “… it’s difficult to actually separate it out because now that I’m saying it, even if I know that you’re coming for tummy ache, but I know that the underlying thing is anxiety… You are treating both actually at the same time” (code 2.4) “Always” (code 2.8) “I think especially when it comes to depression, it’s emotional. But maybe, they have body aches and pains because maybe their body is tired and exhausted. So, once the emotional side cleared up the physical clears up… if you are less depressed, you are thinking less about the pains, but you are also treating the pain symptoms” (code 2.8) “…actually, doing the mental and emotional treatment… that can start to affect the physical and start to help the physical” (code 2.10) “…I do believe that a lot of our illnesses and diseases do come from an emotional base” (code2.11) “In theory I agree, because our emotions are such a root cause to our pathology” (code 2.12) “…most of the time there is some kind of emotional link” (code 2.13) “So, if we are treating a physical we are usually trying to treat an emotional” (code 2.14)

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“And they are intricately linked, and I don’t think you can separate it out” (code 2.14) 3 Physical symptoms because of emotional symptoms “Anything physical will flow from it if you start using it and you treat the emotional first” (code 3.1) “I think all symptoms just about come from the mental and emotional” (code 3.5) “So, insomnia is more physical… So, although it is a physical symptom it’s more mentally developed anyway” (code 3.7) “There has been your anxiety related... So, like nausea and indigestion where you can definitely see that there is a strong emotional root cause” (code 3.11) “…my focus for patients is a lot on emotions because I really have a strong belief in the fact that…emotions cause physical ailments. And you can treat the physical until the cows come home but until you have actually addressed whatever emotion… they have been holding onto…” (code 3.14) 4 Treatment of emotions “Only by emotional symptoms” (code 4.1) “At this point I’m using them for mental-emotional only” (code 4.2) “I know they work on the emotional level very strongly… Bach remedies cover those emotional concepts very nicely” (code 4.2) “…from there trying to figure out what other mental or emotional stuff you can treat with it (Bach flower remedies)” (code 4.4) “I only use it when mentals are the leading symptom” (code 4.4) “And definitely as mental and emotional remedies, it works quite well” (code 4.5) “So, I’m just using it at the moment for stress and anxiety, insomnia and that kind of thing there” (code 4.7) “...or emotional modality to it, or a more emotional case, then I use the Bach flower remedy” (code 4.8) “With the Bach it’s more emotional” (code 4.8) “…it really works on that mental sphere” (code 4.9) “…the effects have always been on a mental-emotional level” (code 4.10) “…more on an emotional level that on a physical level” (code 4.12) 5 Trauma

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“trauma” (code 5. 1,3,10, 14) 6 Emotional build up “emotional baggage type of symptoms, or build up” (code 6.1) “going through very difficult emotional things in their life” (code 6.11) 7 Stress “stress” (code 7. 1,3,7,11) 8 Preparation: Into water and sip throughout the day “Or drop them in their water bottle and sip on them throughout the day because six times (daily) is a little bit cumbersome” (code 8.6) 9 Treatment plan dependant on patient progress and/or response “It depends on the follow up consultation, how they feel” (code 9.1) “We focus our treatment in a different direction then” (code 9.3) “…depending on how they feel” (code 9.8) “(dependant on) what the patient is giving you and where their energy is lying” (code 9.9) “So, it really depends on the state of the patient and where they are emotionally” (code 9.10) “To see if they need a follow-up remedy or not” (code 9.10) “I always explain to the patient that we will obviously readjust” (code 9.14) “Bach flowers do actually work quite nicely as chronic ones but then you do need to reassess and go from there” (code 9.14). 10 Continuous use separated by intercurrent “But with some of them you can keep them on it continuously. Maybe use an intercurrent remedy” (code 10.1) 11 Specificity of Bach flower remedies “…every now and then, when a patient says something and I think, ‘Ah! That’s a Bach flower remedy’. And then I will go for it” (code 11.3) “…the remedies are quite specific with what they are used for” (code 11.12) 12 Large homeopathic range versus small Bach flower remedy range “…a lot of other homeopathics, if I can put it like that, has a wider range. And there’s a lot of them that can be used for the same symptoms” (code 12.1) “I can’t mix and match the homeopathic remedies as quickly and effectively as I can the Bach flower remedies” (code 12.2) 13 Adjunct to Homeopathy

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“I think it’s an add on” (code 13.1) “I find them a nice add on” (code 13.2) “We are using it as a little bit, so it’s just a piece with us, being practitioners. It’s just a tiny little piece with the whole entire, everything else” (code 13.7) “…using Bach flower remedies as an add-on together with my regular homeopathic remedies” (code 13.10) “I think it’s a great adjunct to my practice” (code 13.12) “…it will often be an add on” (code 13.12) 14 Used to complete the treatment for the presenting picture “I am wanting to use it for the emotional side of the patient” (code 14.2) “…homeopathy comes first, and the 1Bach flower is used to mop up” (code 14.4) “If that (homeopathic remedy) helps but there are still other little bits and bobs, I will use the Bach flower remedies to almost mop up the last little symptoms” (code 14.4) “…if the homeopathic remedy doesn’t cover the mental and emotional remedy of what the Bach flower is covering…” (code 14.5) “…if it’s a physical symptom and they come for this physical symptom, but you can see in their behaviour, sometimes people need to calm down. So, I still give them the homeopathic” (code 14.7) “You not just treating on the emotional only. That would be wrong to do” (code 14.8) “Sometimes the homeopathy might not take it to that level whereas the Bach remedies will just hit the nail on the head” (code 14.9) “I didn’t want to necessarily give more than my indicated remedy from a physiological point… ideally we want to give the one remedy that is going to sort everything out but in practice it doesn’t really work that way” (code 14.10) “I’ll actually let the case unfold a bit with the homeopathics and if I find that they need a little bit extra support or if the patient is extremely exhausted, they just need that little extra boost. I will always put in, like your Olive for energy, you Oak to just help with stability, along with the homeopathics” (code 14.11)

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“I would definitely add Bach’s with the mental and emotional pictures of Pulsatilla…I must admit, I take the mental and emotional of our homeopathic and mimic it with the Bach flower and put it together” (code 14.14) 15 Bach flower remedies are indicated for physicals rooted in emotions “Yes, most definitely” (code 15.1) “Yes, absolutely!” (code 15.14) 16 Patient response: Good/ positive “Well, actually good” (code 16.1) “…they have shown improvements in areas in which I was questioning them about” (code 16.6) “I have had good results” (code 16.7) “Good results, all of them love it… Good feedback” (code16.7) “I found that they really did work” (code 16.9) “Now that I have re-looked at it (Bach flower remedies) because of feedback from others” (code 16.10) “Some really interesting cases that have cleared up just with Bach flower remedies” (code 16.11) No, I believe they work…they (the patients) are like, ‘No, I’m fine. I’m good. I can handle it. The emotions aren’t as intense’” (code 16.11) “I tell you, the results are all there” (code 16.14) “I find that with products that if people do ask for repeats without me telling them to carry on it’s usually working very nicely” (code 16.14) “...if you’ve got an angry child because they’ve got a new sibling… 95% of the time that will work with Bach flowers. You clear that whole thing up” (code 16.14) “It really works quite nicely” (code 16.14) 17 Patient Response: Positive in children “…especially… children” (code 17.1) “…especially for children” (code 17.2) “…my practice is very paediatric” (code 17.4) “…it’s an alternative to help kids” (code 17.7) “Like with my kids, I can physically see how it’s helping them” (code 17.7) “…children respond like bombs because they don’t seem to have as many layered stuck emotions to work with” (code 17.14)

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“…children will be quick” (code 17.14) “…and especially children… they still present a very pure picture” (code 17.14) 18 Need for regulation “I think it should be better regulated” (code 18.1) “I think things are starting to change on the regulation side where people don’t have such easy access. So, we’ll see where that goes” (code 18.3) “…I would like it to be monitored better” (code 18.9) “It probably should be regulated… So, what should be available to the public and what shouldn’t” (code 18.10) “So, I think it shouldn’t be over the counter. I don’t think it should be displayed on a shelf like it is” (code 18.12) 19 Culture of misuse “…those same patients just never seem to (successfully use the remedies) …they think they need the whole box” (code 19.14) 20 Public lacks understanding “…it’s natural but it can still have consequences to taking it, if you take something incorrectly” (code 20.3) “I think there is a problem, the same with homeopathy, in that because there is too little knowledge sometimes the prescription doesn’t work” (code 20.4) “You know what, to be honest, most people don’t even know enough about them” (code 20.11) “…that’s something they can pick up in the pharmacies because they can. They don’t realise that it can be very potent” (code 20.12) “No, I don’t think they have a clue” (code 20.12) “… if you have this accessibility on the shelf, people have no idea what they are doing” (code 20.9) “So, they don’t know how long to take something for, they don’t know how to identify if it is shifting or not shifting, whether it is working for them or not. They might even create a proving if they use something for long enough. How many do they use together?” (code 20.14) 21 Information sources: Online “From the website, The Bach Centre website” (code 21.1)

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“Google… I’ve got a few bookmarks in my practice folder and I just sort of go back to the same ones” (code 21.4) “…with the internet it’s just so freely available” (code 21.5) “So, I look at a lot of websites” (code 21.12) “The internet…The Bach Flower Centre site” (code 21.13) 22 Relevance: Shares homeopathic principals and philosophy “Because it (Bach flowers) fits so well with the essence of homeopathy, trying to get to the source of something” (code 22.1) “Many of the things are rooted in the same sort of philosophy” (code 22.4) “Because it works on the same basis” (code 22.8) “…it’s the same concepts and he does say it in his book that the methods were similar in that sense” (code 22.8) “They both work in a gentle, holistic way and restore health in the same kind of way” (code 22.9) “…it’s a similar concept to homeopathy” (code 22.10) “And also, the gentleness of it which is also in homeopathy (code 22.11) “Take this for these particular symptoms and it’s going to undo it” (code 22.11) “It’s not a completely strange mindset for us” (code 22.12) “It’s a similar mindset that we’ve been brought up with as homeopaths... Take this for these particular symptoms and it’s going to undo it” (code 22.12) “I think it’s the emotional link to disease” (code 22.13) 23 Finding the root cause “…trying to get to the source of something” (code 23.1) “…and also getting them educated about the fact that their constant anxiety about failing exams is causing the acid reflux in their stomach. So needless to say, you can give them alkalizing powder, you can give them their Nux and whatever else you like and yeah… It sometimes does the trick but a lot of the time it doesn’t because they are sitting there stressing like crazy. And if you can get to that and show them that their stressing like crazy is causing the acid stomach, then they don’t feel so crazy as well. They start to feel like, ‘Oh, that makes sense. Because I noticed it from that time to that time’” (code 23.14) 24 Preventative treatment to physical manifestations 25 Relevance: Dr Bach’s homeopathic background

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“Yes, I think so. Yes” (code 25.1) 26 Desires further education “Yes, I think so” (code 26.1) “I would like more… training” (code 26.4) “I need to do my level 2… yes, definitely because someone said it is a good step to do” (code 26.8) I think I would because I enjoy learning new things that are going to help patients” (code 26.9) “I would love to go next year sometime” (code 26.13) 27 Desires more insight “I honestly don’t know how in-depth it goes to be honest. With the training that I’ve got, I know it’s skimming the water but I kind of feel like I would be able to implement it when needed” (code 27.9) “Maybe it needs to be demarcated better in terms of who does what and where and how, explore deeper and probably people need to be reminded of it” (code 27.9) “I don’t know how in-depth or how well they cover a case so I wouldn’t know” (code 27.9) 28 Awareness of Bach flower course: Yes “Yes” (code 28.1,5) “Yes, there is a lady that does them” (code 28.6) “…they offer courses on it” (code 28.7) “I know there is a course that they run” (code 28.9) “I am, through Coyne” (code 28.12) “I know it’s there” (code 28.13) 29 Course: Repeated (UJ) information “I’ve heard from sources that some of the lower level entries are very similar to what we do at UJ” (code 29.1) 30 Course: Evaluation required “I would be a little bit reluctant because again, I don’t know what level it is being pitched at and I feel like, is it professional enough? Is it for professional practice?” (code 30.9) “It all depends on what you can do with it because I am looking at equivalent fields… it all depends on what you can do with it” (code 30.10)

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31 Course: Undecided about taking part “I’m still unsure if I’ll be doing the course or not” (code 31.1) 32 Course: Increased interest with CPD accreditation “Yes” (code 32.1) “…and give me a few CPD points for it. It doesn’t even need to be that much… I’m not looking for a ten CPD point but two or three points” (code 32.4) “I think if the course was CPD approved, it would be much better especially with the homeopaths and things” (code 32.8) “…it would definitely call a lot more to people because they could do it and it could go toward their CPD status. Whereas at the moment it’s not quite there yet” (code 32.8) “…if it was a full day workshop or two day workshop that’s almost like ten points or even fifteen” (code 32.8) 33 Course: Should not be available to the public “I don’t agree with that” (code 33.1) “No, I did not know that. Lovely.” (code 33.5) 34 Bach flower practitioner: Lacks full understanding /knowledge “I also feel that if you don’t know the philosophy behind something and now you’re prescribing something that you don’t have a broad knowledge of, and you’re just a part of the picture, that you probably cause harm” (code 34.1) “…and as we know, someone who has a scio machine, who’s a housewife, is suddenly a practitioner” (code 34.5) “…something pathological that maybe someone that’s not having a healthcare background is dealing with, that could potentially be quite dangerous” (code 34.8) “...you can be a plumber and do the three levels and you don’t have any medical training whatsoever” (code 34.12) 35 Bach flower practitioner: May cause harmful treatment “…you probably create more harm than you would create good” (code 35.1) “But what if it’s something that needs to be dealt with on a more urgent level?” (code 35.12)

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“But, there’s a lot of people doing a lot of ‘healing work’ out there. They have never set foot in a university, they don’t do much training of any sort” (code 35.14) 36 Bach Flower Practitioner: Discredits homeopathy “…that imparts on homeopathy as a whole because then they might as well do a short course on homeopathy and be called homeopathic practitioners” (code 36.1) “…it opens us up even more to seemingly being less professional” (code 36.2) “It totally discredits what we do” (code 36.5) “And now they’re dispensing Bach and next they’ll be dispensing homeopathic remedies and so on and so on. So, again, we lose total credibility” (code 36.5) “For someone who studies for six years and is seen the same way as someone who had a weekend course. It doesn’t gel” (code 36.5) 37 Homeopathic remedy is unclear “I often use Bach flower remedies when a homeopathic remedy isn’t perhaps clear” (code 37.2) “Often the patient will get three things… and Bach flower remedies if I felt that I didn’t cover it” (code 37.2) 38 Unusual emotions “I use it a lot with strange emotions that come up” (code 38.2) 39 Fears “…fear of going to work” (code 39.2) 40 Anxiety “anxiety” (code 40.2,3,4,6,7,11) “separation anxiety (code 40.4) 41 Sleep disturbances “…sleep disturbances (code 41.2) “…nightmares, problems going to sleep and that type of thing” (code 41.4) “…insomnia” (code 41.7, 10) 42 Safe and gentle “I find them very safe” (code 42.2) “… it’s far gentler” (code 42.2)

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“if… they take the wrong one, what’s the harm? They’re not going to feel any effect. It’s not like it’s going to cause any side effect” (code 42.2) “I think there are far worse products out there that aren’t regulated… far more dangerous products” (code 42.2) “…our medicines are not dangerous. So, it’s not like you are taking a scheduled substance and overdosing on a hectic drug. So, there doesn’t need to be that control” (code 42.2) “So, is it safe for the public to use them? Yes. Is it safe for anyone to prescribe them? Yes. Is it safe for anyone to just take them over the counter? I believe it is safe” (Code 42.2) “Not because of safety concerns at all” (code 42.4) “…it’s an alternative to help kids because it’s a gentler form, which is more beautiful” (code 42.7) “It’s quite mild and I don’t think it can do any harm” (code 42.7) “And Bach flower remedies, it being so gentle” (code 42.11) “(make use of it) knowing that we can’t really do any harm” (code42.12) “It’s very safe and gentle” (code 42.12) “They are so gentle” (code 42.14) 43 Tailored prescription “…you can make a mix and make a personalised complex” (code 43.2) “Things work beautifully when they are prescribed specifically for that person” (code 43.6) “You’ve got to make your own remedies” (code 43.8) “…I maybe put in another remedy because I feel they need that extra remedy (code 43.8) “…if I do, I add two more (remedies) and I tell them, ‘If you’re going to come back, you need to come back, so I can add the other two remedies to it” (code 43.8) “…if I find the case still kind of suits the Rescue Remedy kind of picture and then that’s five Bach flower remedies, then I’ll add another two just to complete whatever picture there is… something that is a bit more tailor made for that person” (code 43.11) 44 Use: Frequently “I actually use them quite often in that way” (code 44.2)

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“Well, every day I would use it” (code 44.5) “…in the majority of the time they do walk out with a Bach flower remedy” (code 44.8) 45 Patient Response: Gradual “…it’s not an instantaneous thing but it happened slowly” (code 45.9) “…I noticed maybe a month later, it had stopped. It sort of phased out slowly” (code 45.9) 46 Patient Response: Difficult, given in conjunction with other products “I wouldn’t be able to say that I could only put it down only to the Bach remedies because I normally use that combination…I have seen, at the same time while I’m treating the patient, physical relief but I wouldn’t be able to attribute it purely to the Bach remedies” (code 46.10) 47 Patient Response: Asks for repeat “…patients ask for more of those drops, so that’s a good sign” (code 47.2) “…patients come back and get repeats from me” (code 47.3) “…they come back and they purchase again” (code 47.8) “I have standard patients that order Bach flowers all the time…So, when it’s time for their Bach flowers to finish and they need a new set, they actually reorder Bach flowers, more than any other medicine” (code 47.14) “Still, lots of patients will come back and get repeats from me… and some don’t” (code 47.3) 48 Owns practitioner Bach flower remedy kit “…we have the Bach flower remedy practitioner kit with all the different range” (code 48.2) “Yes” (code 48.5) “…someone gave me the whole set. So that was very nice” (code 48.6) “Yes, I do. I think it’s very fun and it looks neat on your table or wherever you are” (code 48.8) “Yes, we’ve got the whole set” (code 48.10) 49 Remedies are easy to use “…it’s very user friendly because there is a picture of where to find each flower and the little booklet is handy” (code 49.2) “…very user friendly “(code 49.3) “Yes, I find that very easy” (code 49.3)

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“It’s easier to just have these thirty-eight in a box” (code 49.6) “With the Bach remedies I feel there’s a little bit more leeway, it’s a little easier to use” (code 49.10) 50 Complex components: Three to four remedies “…take three or four and mix them” (code 50.2) 51 Bottle size: 50ml “…then mix them in a 50ml amber bottle” (code 51.2) “…in a 50ml bottle” (code 51.14) 52 Solution: Distilled Water “I mix them into a 50ml amber bottle with distilled water. Sometimes I use a bit of alcohol, but mostly I don’t” (code 52.2) “…into distilled water” (code 52.4) 53 Solution: Alcohol 54 Awareness of Bach Flower Remedy preparation in Brandy “…my opinion is that sometimes the Bach flower remedies are a lot more susceptible to being contaminated or their effectiveness being damaged once being opened. And certainly being in a brandy base, that alcohol, it can evaporate very quickly” (code 54.12) 55 Dosage: Ten to twenty drops 56 Acute cases, increase frequency “And it just depends, if they need something more often, we can repeat that dose. Otherwise, I do it once a day before sleep or once in the morning” (code 56.2) “…if they are very, very anxious, then they may take it every five minutes before they write a test or something like that” (code 56.4) “…absolutely everything stresses her out… so I tell her to take it every hour” (code 56.7) “If it’s something like shock, or a panic attack, yes… you take it more frequently” (code 56.8) “…in acute case, if they really feel they are struggling, several times a day. Even in acute cases up to every fifteen minutes” (code 56.10) “Rescue for example, I will bombard them every ten minutes, every ten to fifteen minutes” (code 56.10)

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“…if they are going through quite a bit in their life at that point… then I will say even every half an hour if there is something quite stressful in their life…if they are experiencing anxiety and stress relating to this then they can take it up to every hour even” (code 56.11) “The more severe the symptoms, the more frequently they are going to dose themselves” (code 56.12) 57 Frequency: Once daily “…once a day at night before they go to bed if it’s kind of because of nightmares. Or, they will take it once a day in the morning if its more, sort of, school-related” (code 57.4) 58 Treatment plan is case dependant “…it depends on the patient, how I want to prescribe also” (code 58.7) “…with patients it’s definitely that (Bach flower remedies) with a combination of homeopathics, depending on what they are coming for as well” (code 58.7) “I use Bach flower remedies in conjunction with homeopathy or supplementation. It just depends” (code 58.8) “…it just depends how I want to attack the case because if I see its just emotional then I’ll make a separate bottle of Bach flowers just for emotions, that they know also that that gets used when and as needed” (code 58.14) “Where others, if you tell them they are taking something for their emotions, they just shut down straight away. Some of them are even offended” (code 58.14) 59 “Aspen” “Aspen” (code 59. 2,4,5) 60 “Willow” “Willow” (code 60. 2,4,5,6) 61 “Mimmulus” “Mimulus” (code 61. 2,4,5) 62 “Oak” “Oak” (code 62. 2,4,5,8) 63 “Elm” “Elm” (code 63. 2,4,5,6,8) 64 “Larch” “Larch” (code 64. 2,4,6)

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65 Rescue Remedy: Easily accessible, is a deterrent “I hardly ever dispense it for people because they can get it from the health shop” (code 65.3) “I don’t actually have the Rescue Remedy… I rely on my own little (complex)…” (code 65.4) 66 Rescue Remedy: Patient response poor “I’ve used it (Rescue Remedy) on myself… I haven’t noticed a sudden change…I haven’t used it in a long time” (code 66.2) “It doesn’t work for everyone, obviously. It’s a bit of a broad sweeping thing” (code 66.6) 67 Patients are unaware of the specific Bach Flower Remedy they are prescribed “So, the patient doesn’t necessarily know what Bach remedies are in their complex or even that it is Bach flower remedies” (code 67.2) “…I’d probably give it a complex name and then just jot it down in the file so that if they ever want to know…” (code 67.3) 68 Positive suggestion “We try use it as a positive thing” (code 68.2) “It’s like changing into a more positive aspect” (code 68.8) “…it’s taking something negative and giving it a positive” (code 68.8) “…how they have changed from a negative side to a more neutral or more positive side” (code 68.11) 69 Public who are unaware of it won’t pursue it “I’m not sure that my patients would go out to a health shop and seek Bach flower remedies because they don’t know that it’s a Bach flower remedy” (code 69.2) 70 Safe for people who know about it and seek it out “…it will be an educated decision” (code 70.2) “But there are still quite a few patients out there that are familiar with the remedies, know what works for them, will go and find it and keep bottles of it and things like that” (code 70.3) “In general, they’ve got some guideline otherwise they wouldn’t just be purchasing it, you know” (code 70.6) “It’s definitely for people who know what they are doing” (code 70.10)

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“…general people who are interested in it, they can go the extra length” (code 70.11) “So, I actually found retail-wise they didn’t actually do that well. Occasionally you’d have someone who was like, ‘Oh, I really need to top up. I need some Olive and I need some this and this’…but that was rare” (code 70.11) “It’s informed people that take the remedies. It’s not people that just decided they feel like taking Wild Chestnut today. I think its informed people, so it’s fine. I don’t have a problem with it” (code 70.13) “The only people who are going to be shopping for Bach flowers are probably the only ones that have read and researched” (code 70.14) “…you get others that aren’t going to even bother (with purchasing Bach flower remedies) so, I’m assuming you haven’t lost an audience there and you haven’t done any harm, because they are not going to go there” (70.14) 71 Business is business “You can’t fight the system as far as I’m concerned. It’s always going to be a thing. I don’t mind. If I give it to patients and they find that it works, and they want to go and get it somewhere then that’s their own choice” (code 71.3) “…I’m not going to spend time worrying about fighting the system” (code 71.3) “Yes, practitioners are using it but they can’t get upset… In any situation in a health store, a pharmacy… A product is sold in the health store then in the pharmacy and then it goes big retail. It can become disappointing” (code 71.8) “So, I think in terms of things being available on the shelf, from my perspective, I wouldn’t mind it financially, you know. If you’re going to get it, you’re going to get it. Some people prefer getting it from their doctor, some people prefer to get it from the pharmacy” (code 71.9) 72 Need for “middle man” training at store level “Maybe training needs to be involved in that “middle man” kind of situation between the practitioner and the patient, and where they are going to buy the supplements from” (code 72.2) “Maybe having an alternative medicine pharmacist or someone who you could have a brief consultation with at least could guide you toward the right thing” (code 72.9) 73 At Stores: Discredits homeopathy

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“We (homeopaths) lose credibility” (code 73.5) 74 Awareness of Bach flower course: No “In this country? Ok, I didn’t know” (code 74.14) “No, I was not aware of that” (code 74.2) 75 Bach flower practitioner: Severe pathology may be overlooked “…I would be a bit weary of someone who may potentially even be kind of semi-suicidal or anxious or whatever, going to a Bach flower therapist or practitioner and then missing an important diagnosis” (code 75.4) “I’m always a little bit worried about misdiagnosis and mismanagement of patients” (code 75.4) “…because if there is something deeper going on, if there is some sort of psychological issue or something pathological that maybe someone that’s not having the healthcare background is dealing with, that could potentially be quite dangerous. So, I’m weary about it” (code 75.9) 76 Bach flower practitioner: Remedies might be an insufficient form of treatment “But where it becomes problematic for me, is that it might not be enough… So much will be untreated if the patient is only relying on Bach flower remedies” (code 76.2) “…and not use them as an end, to end treatment for all kinds of disorders” (code 76.2) “…where are you coming from and how much can you actually take care of them?” (code 76.9) “They’re just treating an emotional and then possibly a physical complaint because they are dealing with it from the emotion with Bach flower remedies” (code 76.12) 77 Bach flower practitioner: Awareness of scope “And as long as they, on some level, know the boundaries of what I can treat with this, and when do I need to refer, I have no problem” (code 77.4) “The Bach remedies do not diagnose anything, you are just speaking about the emotions. It’s a general form of actually treating the emotions, without diagnosing” (code 77.8)

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“I feel there has to be some sort of responsible medical background that can actually differentiate you from... and analyse the patient and say, ‘No, the patient needs different care’” (code 77.10) “…as long as it’s done ethically” (code 77.14) 78 Bach flower practitioner: “Practitioner” is misleading “I’m worried about having the word ‘practitioner’” (code 78.2) “If you are a lay person and you are using that term, I think it may be misconstrued. So, if you are saying you are a practitioner, people might think that you have a deeper medical background than maybe you do. So it could be giving a false impression” (code 78.9) 79 University training: Some materials given “I recall there being notes” (code 79.2) “I don’t know if we just maybe got the little brochure that told you what was in different categories and that kind of thing” (code 79.3) “Yes, it was covered in my course material” (code 79.6) “…we learnt about it in 3rd year, in Aux-t, and then I think in 4th year too. We went through it in Mat Med” (code 79.9) 80 University training: Can’t clearly recall “I don’t know if we were examined on it… it was such a long time ago. I may be mistaken” (code 80.2) “…that (university) was a while ago, so…” (code 80.3) “I can’t really remember 100%” (code 80.7) “…we covered so much just as like additional modalities that I will be lying to you… what it was that we learnt” (code 80.14) “I don’t actually remember what I did at varsity” (code 80.14) 81 University Training: Not in depth “I was aware of them as a student… I don’t know if we were actually taught it in any of our subjects” (code 81.3) “It was very brief… when I was studying at UJ it was a very brief, short thing, maybe an hour lecture, maybe an hour and a half. Not more than that” (code 81.7) “…when we were in 5th year we only got a small page and that was it… I remember it being in the last stages” (code 81.8)

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“…the information then was introductory. It was good, I know about it” (code 81.10) “I don’t feel that the information we received while studying was sufficient” (code 81.12) “They might have touched on it, but it was definitely not main knowledge” (code 81.13) “I know we covered it, but I actually can’t imagine that we did a hell of a lot” (code 81.14) “You get an introduction about it…I think at varsity we had so much on our plate that it was like, ‘Ok, these are the Bach flowers that does that, that, that and that’… we probably did get taught all the basics of it” (code 81.14) “We did it in Aux-t but it was a blimp…” (code 81.4) 82 Information sources: Articles “articles” (code 82.2) 83 Information sources: Books “Books” (83.2) “I have a book, just a small little book that I got somewhere on Bach flower remedies” (code 83.3) “…if I find a book on it I will read a book on it. I have quite a few books on it” (code 83.6) “…so I have a couple of books on it, but just to jar my memory” (code 83.6) “I’d kind of read up and kind of get to know the remedies” (code 83.11) 84 Information sources: Supplier information “…the Bach Coyne Health’s little (booklet)” (code 84.2) “…the brochure” (code 84.3) “I literally use that little booklet, the instant little one” (code 84.4) “Yes, that kind of thing” (code 84.7) “…the typical Bach flower chart with all the levels of pathology and what it’s for” (code 84.12) 85 Information sources: Colleagues “…colleagues” (code 85.2) “And other people were saying that they had such great results with it, so I started playing around with them” (code 85.10) “…because of the feedback from others” (code 85.10)

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“…you are always going to be able to ask your colleagues… from the clinical experience of your colleagues” (code 85.12) “…it (the Bach flower remedies) came alive because of the reflexologist. Because she was very much into her emotional aspect… and felt strongly about it and her strong feelings about healing and the emotions” (code 85.14) 86 Course: Not a priority “…it’s not a priority for me in my practice” (code 86.2) “The reason why I haven’t, is because I’m not in full-time practice so I see a couple of patients a week or sometimes I don’t see anybody for three weeks” (code 86.10) “Perhaps later but not at this point” (code 86.11) 87 Course: Interested “… but, I certainly would be interested” (code 87.2) “I have been interested in it” (code 87.3) “I would be interested” (code 87.7) “I would love to attend it” (code 87.7) “I probably should” (code 87.10) 88 Course: Interests lie elsewhere “…perhaps later on in life. But for the next couple of years probably not. I’ve got to get settled in practice first” (code 88.11) “I mean, there are others remedies that have come into play that I just heard about, the sound and light remedies… So, in comes some more tools but thanks to Bach flowers I am very interested to know what the sound and light remedies are about” (code 88.14) 89 Course: Increased interest with increased patient response “I think if something would have really struck me to make me go and do Bach flower remedies. Like, a patient says, “Wow, this really changed my life!” And then I’d be really curious. It hasn’t gotten me that curious yet” (code 89.2) 90 Insufficient use of Bach flower remedies “…maybe it means that I don’t use it (Bach flower remedies) enough. Maybe I don’t use it in isolation” (code 90.2) “…I must admit that I don’t use them very often” (code 90.3) 91 Bach flower remedies too gentle a medicine

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“…it’s very mild in treatment so it’s not going to be treating huge symptoms and disease” (code 91.9) “…it’s a bit more gentle (than a homeopathic remedy). I see it a little bit more gentle” (code 91.10) 92 Auxiliary treatment “…it’s definitely more an auxiliary treatment” (code 92.2) “At no point is it not an option for the patient. It is just not going to be my first option” (code 92.12) 93 Bach flower remedies: No aggravation “…I don’t think you can overdose on it either” (code 93.7) “…I am not expecting an aggravation or the possibility of an aggravation when it comes to a Bach flower remedy” (code 93.10) “And it’s a lot gentler, the Bach’s, so I worry less about aggravations of remedies” (code 93.12) “I must admit, I have actually never seen a proving or aggravation (with Bach flower remedies)” (code 93.14) 95 Complex prescribing in separate bottles “… often the patient will get 3 things: a homeopathic, a herbal and a supplement, and Bach flower remedies if I felt that I didn’t cover it” (code 95.2) “I am a complex prescriber, so I don’t do one remedy unless it’s a real clear case” (code 95.2) “I use both. I very often use both…if they would benefit, really benefit and it’s important that they have Bach flower remedies then I’d include them with the remedies” (code 95.6) “…it’s that (Rescue Remedy) with many other things… a combination of homeopathics…” (code 95.7) “…it’s always a single remedy. With the Bach remedies, often I combined” (code 95.10) “I always add the Bach flower remedies either into the simplex or by themselves” (code 95.11) “So, for me I often find that two is sufficient because I might give something homeopathic as well and then it’s enough” (code 95.12) “It’s on their own” (code 95.13)

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“I will always do them in combination with each other” (code 95.14) 96 Patients’ budget allows for Bach flower remedies 97 Expensive to stock “…the kit is expensive” (code 97.3) “…it’s just a bit expensive” (code 97.9) 98 Experience: Limited “My experience is very limited… It’s still quite limited” (code 98.3) “I don’t know how in-depth or how well they cover a case” (code 98.9) “I don’t think I have done enough” (code 98.13) “Well firstly, it’s not a frequent part of my prescribing” (code 98.12) 99 Course: Attended “I have been on one Bach flower course” (code 99.3) “After doing the courses, it really opened up the remedies more” (code 99.8) “…it was aimed at the health store people and staff so that they know a little bit more about Bach flower remedies…we did a full afternoon. It was going through each remedy a bit more in depth and then we did case studies thereafter… a little bit more condensed. It wasn’t like an official course” (code 99.11) 100 Patients’ use of Bach flower remedies encouraged further learning “Because, sometimes patients will talk about using Bach flower remedies” (code 100.3) 101 Cause: To further assist patients 102 Bach flowers remedies secondary to homeopathy “If I am doing mental (symptoms) and emotions with homeopathics, then I don’t think I’d do a Bach flower remedy mix” (code 102.2) “I forget about them to be honest. I’ve got a big dispensary, so I’m always thinking of my homeopathics and herbals and things like that, first” (code 102.3) “I would obviously do homeopathy first, but I would use it as a complementary medicine” (code 102.9) “… I suppose it’s just a different way of thinking because it’s just not what I do” (code 102.9) “I would still lean more toward a homeopathic because it’s still led me to a better remedy” (code 102.9)

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“…when I have a homeopathic remedy that kind of stares me in the face, I’m going to go the homeopathic remedy way” (code 102.10) “…but for me it wouldn’t be a massive part of my practice” (code 102.12) “…if I did away with it I probably wouldn’t miss it as much because there’s so many other parts to my practice. The other being predominantly the homeopathy and the diagnostic side of things” (code 102.12) “…at no point is it not an option with a patient. It’s just not going to be my first option” (code 102.12) 103 “Star of Bethlehem” “Star of Bethlehem” (code 103. 3,4,8,14) 104 Grief “…big grief remedies” (code 104.3) 105 Bach flower remedies in use in practice “So, if they need it just to relax and be able to talk to me, then I use it more often” (code105.3) “…unless there’s a child throwing a tantrum in my office, and then it’s Cherry Plum, or whatever they need. So, we will do that” (code 105.14) “If it is acute I might even dose them in my office” (code 105.14) 106 Patient response: Hard to determine “It’s hard to say. It might also be one of the reasons I don’t use it as often” (code 106.3) “You find, not everyone says that Rescue works beautifully” (code 106.6) “Yes, it’s hard to tell” (code 106.12) 107 Not all things work for all people “…in some patients they say, ‘When I take those drops it helps a lot,’ and others say they don’t really feel a difference” (code 107.3) “I think it’s like everything else, everyone is an individual. So, I don’t know if I would bet on just giving Bach and they are just going to be good” (code 107.5) “…it (Rescue Remedy) doesn’t work for everyone, obviously. It’s a bit of a broad sweeping thing to just sort of say ‘here you go’” (code 107.6) “But then sometimes Bach flowers don’t always release the emotion. So, I am going to say that’s not fool-proof” (code 107.14)

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“…you are going to get people that love it (Bach flower remedies) and some people that don’t” (code 107.14) 108 Limited emotional awareness “Some people are also not aware of subtle changes in their bodies” (code 108.3) “We know that with Bach flower remedies, you have to work out what the problem is and sometimes it’s difficult to extrapolate that data, especially from men, to see what it is” (code 108.12) “The word ‘emotion’ is foreign” (code 108.14) “I think people are so out of touch with their emotional states, they really are! And that’s probably usually the biggest challenge in healing in the first place… but their behaviour will suggest it. Their behaviour will definitely suggest it. And they will tell you all about their behaviour and what happened and why…But then you have to deduce it (their emotions) from them” (code 108.14) 109 Complex name given “Yes, I’d probably give it a complex name and then just jot it down in the file so that if they ever want to know…” (code 109.3) 110 Complex name given due to label size “…because I am a very complex prescriber… but obviously it’s noted in their notes what did they get” (code 110.5) 111 Preparation: Follows resources “So, I do use the little booklet that they have, guiding you as to what to use when” (code 111.3) “I always look back at the book” (code 111.4) 112 Dosage: Four drops “…four drops three times a day” (code 112.3) “…four drops three times a day” (code 122.8) 113 Frequency: Three times daily “...three times a day” (code 113.3) “…three times a day” (code 113.8) “I usually prescribe a formula that they are going to use for quite a while, so it will be a maximum of three times a day” (code 113.14) 114 Bach flower remedies are not memorised, refer to resources

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“I haven’t memorised all of them, so I don’t know them off by heart” (code 114.3) 115 Complex components: Maximum of three remedies “…it would normally be about three” (code115.3) 116 Not commonly used amongst patients “It’s not the most common thing patients are using” (code 116.3) “The majority of people didn’t even know what Bach flower remedies were” (code 116.11) 117 Rescue Remedy: very common and well known “They knew what Rescue was but not Bach flower remedies” (code 117.11) “I think they just end up buying Rescue. It’s a select few people that would buy a single Bach flower remedy (code 117.13) 118 Happy for patients to purchase their prescribed remedies in stores “If I give it to a patient and they find that it works and they want to go and get it somewhere, then that that’s their own choice” (code 118.3) “…they will be getting their own stuff, that’s fine. I don’t mind. People have a choice and they must just get from where they want to get from” (code 118.3) “Totally ok with that. Wonderful! At least people can get them” (code 118.6) “Yes, I script it out and they can go purchase it for themselves” (code 118.12) “So, obviously for the way I use it, it’s perfect” (code 118.12) “I don’t have a problem with it” (code 118.8) 119 Not preferable that patients can choose a remedy without guidance or knowledge “I think like anything, you need to be trained in it properly… I still believe it’s a powerful treatment, but you’ve got to know what you are doing” (code 119.12) “…maybe having… someone you could have a brief consultation with, who at least could guide you toward the right thing as opposed to you just going to select one yourself” (code 119.9) “…I don’t know about being able to access things off the shelves, especially homeopathics and even Bach flower remedies. Like, how do you know this is exactly what you need?” (code 119.9)

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“…the biggest concern is that people might not be getting what they need… with accessibility on the shelf, people have no idea what they are doing” (code 119.9) “It’s better to ask a practitioner or somebody who knows a little more” (code 119.13) 120 Not ideal for patients to have access due to powerful emotional effects “…it would be lovely if people or patients didn’t have access to things that were in potency and can have big emotional changes” (code 120.3) “Now having worked with them and seeing their results it makes me a little bit nervous that it’s just over the counter. Just that the public has access to it” (code 120.10) 121 Unfair on homeopaths for products to be available to untrained people “…because of our training, we have studied a lot for them to just be able to go and get it” (code 121.3) 122 Homeopathy recalled faster than Bach flower remedies “I haven’t memorised all of them, so I don’t know them off by heart” (code 122.3) 123 Powerful emotional shifter “…I gave her the remedy, it was about a month later, she came back for a follow up and she had turned 180 degrees in her life… it was a significant emotional change… she had a different energy, a different drive, a motivation” (code 123.10) “Their whole environment might be affected and that’s what the patient needs to realize” (code 123.10) “I believe it’s still a powerful treatment, but you’ve got to know what you are doing” (code 123.12) 124 Patient Response: Remedy choice is important “if they think that doesn’t work then it’s your remedies” (code 124.8) 125 Information Sources: Bach flower course material “After doing the course, it really opened up the remedies, so it made it easier to use the Bach flower remedies” (code 125.8) “I think it was more with the level 1” (code 125.8) “it was one of the starter courses mainly for health shops and that, and we got really wonderful notes and really good information” (code 125.11)

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126 Limited time in the dispensary “…the short time that I’m in the dispensary” (code 126.2) 127 Helpful tool to have in practice “…when I use them, I feel like the patient that is there is needing them at that moment so I’m not going to not give them something that I feel that they need” (code 127.3) “I think to any practitioner that’s dealing with patients, the Bach flower remedies are good ones to use” (code 127.8) “…if someone is presenting with a certain mental complaint or emotional compliant and I know that that Bach flower remedy would suit them 100% and help them, I don’t know why I wouldn’t just give that” (code 127.9) “Yes, it’s a fantastic modality to incorporate” (code 127.10) “I find them actually very useful” (code 127.11) “I think it really does benefit health practitioners well, especially on your complementary side, just as another aspect to look at” (code 127.11) “It’s always there and while I am dispensing I turn around and think, ‘Ah! Why don’t I add in or mention it (Bach flower remedies) to the patient because it can help but it’s certainly going to be the outer ring of my priorities” (code 127.12) “It’s one of the tools we can use” (code 127.13) “I see it as a nice big tool there” (code 127.14) “And it is a very invaluable tool” (code 127.14) 128 Exposure at university (powerful practice tool) “It might be a little overwhelming because when you’re starting out in clinic all you are thinking is, ‘Oh! Which remedies?’. You are trying to focus on homeopathy and you’re not really looking at the complementary aspects of homeopathy. I definitely think it has a place” (code 128.9) “I think it’s very important for practitioners or students going into practice to know that these things are available” (code 128.12) “It’s one of the tools we can use so it’s nice to have it in the course” (code 128.13) 129 Practitioners use what they are exposed to as students “I just used it (Bach flower remedies) in practice” (code 129.6)

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“…use them a bit more (in clinic), to explore and try them out, because if you have never done it under supervision you are more reluctant to do it on your own” (code 129.9) “I think a good awareness at an earlier stage is probably going to benefit the practitioner and the patients more” (code 129.3) 130 Limited opportunities for additional training “… but I really just haven’t had the opportunity to do it” (code 130.3) “For me, it’s just a case of the time that I have, the finances I have available to study” (code 130.12) “I just haven’t had the time to go” (code 130.13) “…financially it’s always difficult to do a course, in terms of time as well” (code 130.3) 131 Course: Deterrent due to being open to the public 132 Course: Medical credibility compromised “…if I’m going to be sitting with people that aren’t trained in something medical, then I’m probably thinking I could be studying something that is going to benefit me in my profession” (code 132.3) 133 Course: Dissuaded by the nature of the course “It probably dissuades me from actually doing the course” (code 133.3) 134 Interest from Rescue Remedy “It started with using Natura Rescue (Remedy), which obviously has Bach flower remedies in it” (code 134.4) “Yes, Rescue I have used in the past” (code 134.10) “I used Rescue a lot” (code 134.10) “So, Rescue Remedy was actually the first main introduction for me” (code 134.11) 135 Sensitive adults “…more sensitive type adults” (code 135.4) “There are also certain patients that are hypersensitive reactors” (code 135.12) “For my very emotional patients, they have already accepted that they are very emotional and we are working on it, I’ll then give them a separate Bach flower and then they can take that six or seven or eight times a day” (code 135.14) 136 Life changes 137 Uncertainty

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“I don’t know what’s going to happen next” (code 137.4) 138 Worry “worry” (code 138.4) 139 Useful when patient information lacks the details “…if a patient’s not giving me a lot of information, I’d probably use the Bach” (code 139.9) “…your patient doesn’t always give you all the information” (code 139.10) 140 Personal/family experience “I use it with my kids and patients as well” (code 140.7) “Even myself as well, when I can’t sleep at night I actually take a few drops and find it works beautifully” (code 140.7) “I have seen it personally with my husband” (code 140.8) “I have used them before… for myself” (code 140.9) “…I started experimenting either on myself or on family members” (code 140.9) “No, I believed it worked. I would take rescue ‘till it was coming out of my ears at exam time” (code 140.11) 141 Patient Response: Quickly “…very, very quickly” (code 141.4) “So that turn around in just a month from such a significant situation where, she had been in that situation for a couple of years already” (code 141.10) “Rescue works quickly… you see a difference within minutes” (code 141.10) “…I have seen fast results” (code 141.10) “It kicks in quickly, within minutes” (code 141.13) “very quick. No, very quick” (code 141.14) 142 Practitioner vouches for its value “I think it works brilliantly” (code 142.4) “It’s been very successful” (code 142.6) “…they are so useful and so beautiful to work with. It’s really great” (code 142.6) “…if it is working beautifully I think I will stick to it” (code 142.7) “I see it working beautifully” (code 142.7) “…that also did help” (code 142.9) “I definitely think that it has value in practice” (code 142.9)

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“I’m actually saying, ‘Hang on! With the results that I have seen they been as powerful as what my homeopathic remedies would have been’” (code 142.10) “I actually only now see the value it has in practice” (code 142.10) “It’s (Bach flower remedies) always there. And if you go into my dispensary you’ll see there’s a massive poster up of all the Bach flower remedies” (code 142.12) “…definitely!” (code 142.13) “This is the tool for me!” (code 142.14) “…if you took my Bach flowers away I would be quite upset, quite upset” (code 142.14) “Bach flowers are properly proven, legit. They work” (code 142.14) “Bach flower remedies, they work. They are awesome!” (code 142.14) 143 Patient Response: Sometimes underwhelming due to limited experience 144 Search for the emotional themes of the case “I would pick up the theme and see, ok there are relationship issues here and from what I knew about the Bach remedies it was more about… I know they work on the emotional level very strongly” (code 144.10) 145 Complex components: Seven drops of each individual remedy “…seven drops of each remedy into distilled water” (code 145.4) 146 Bach flower remedies are homeopathically prescribed 147 At Stores: Safe, no safety concerns “if… they take the wrong one, what’s the harm? They’re not going to feel any effect. It’s not like it’s going to cause any side effects” (code 147.2) “I don’t think there are any safety concerns around it” (code 147.4) “In terms of safety, I don’t think so, because we know that these compounds don’t necessarily have a toxic effect on the body” (code 147.9) 148 Misuse results in disillusionment “…because there is so little knowledge, sometimes the prescription doesn’t work and then it gets said that ‘Oh well, Bach flower remedy X didn’t work for me therefore Bach flower remedies don’t work’. And that is sometimes extrapolated into, ‘All natural medicine is therefore rubbish’” (code 148.4) “…you’ve got the basic knowledge, lay-person knowledge about it and you just pick something and it doesn’t work and then you become despondent. You

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don’t get the help that you need and then all natural medicine doesn’t work” (code 148.9) “…how do you know that this is exactly what you need? Because at the end of the day if it’s not what you need as a patient, you are not benefiting. And the patient should benefit from treatment” (code 148.9) “If all patients were benefiting from OTC, I don’t think that would be a problem, but I don’t think that’s what’s happening” (code 148.9) “My concern is with the patient and are they getting what they need and are they getting the attention that they need” (code 148.9) “…because it’s there, they will try it. It doesn’t work for them because it’s not the specific remedy for their symptoms and they go, ‘Ag, this is rubbish. It doesn’t work’” (code 148.12) 149 Field loses credibility due to product misuse 150 Rescue Remedy: Safe due to clear indications “…if I’m just making up Recue to give out to something common, like birthing moms, and I want them to have Rescue Remedy on them” (code 150.6) “I don’t think that people will come to us to buy Rescue Remedy, so it makes sense to have it on the shelf” (code 150.13) 151 Public shouldn’t be able to access individual remedies “I don’t think people should be necessarily able to go and say, ‘Oh, I want some Horse Chestnut and some Mimulus” (code 151.4) “…it’s obviously a problem for our profession because… We lose credibility” (code 151.5) “…still have the single ones available for practitioners that are potentially, for much more deep seated and much more hardcore emotions” (code 151.10) “I think that’s more practitioner only” (code 2151.13) 152 Bach flowers and homeopathy are interchangeable “The Bach’s are homeopathic. They just fit right into the whole arena” (code 152.14) “There is no beginning and there is no end” (code 152.8) 153 Relevance: Energy Medicine “The vibration and the philosophy behind it” (code 153.8) “So, it is energy healing, you see” (code 153.14)

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154 Relevance: Closely connected “To me they are very tightly linked” (code 154.4) “I see Bach flower remedies as a branch of homeopathy. It’s someone who took a concept and maybe just explored more and changed it up a little bit” (code 154.9) “I think the homeopaths would utilize it because of its similarity to homeopathy” (code 154.10) “…it’s a parallel medical treatment system” (code 154.12) “…they still work to a degree, on not necessarily a proving but we know that when you take that remedy over a period of time, the same with a homeopathic remedy, it’s going to treat a specific symptom and it’s one particular flower” (code 154.12) 155 Building up kit slowly 156 University training: should be reiterated after 3rd year “I think it should probably be done in Aux-t and then probably done again at the beginning of clinic year” (code 156.4) “…even if it’s for three months only or something that goes a little bit deeper… in-depth in the course” (code 156.8) “So, if it’s coming up in our course we mustn’t just look at it as an auxiliary therapy but… go a bit more in-depth about it and not just skim over it” (code 156.9) “…maybe someone more specialised, like a Bach flower practitioner to come in and do that topic, and to come in in forth year and fifth year and remind you of it” (code 156.9) “It would be nice to have it more extensively covered in the course to inform us more” (code 156.13) 157 Limited practitioners use it “… from what I understand, I’m basically the only person here (UJ’s Homeopathy Health Clinic) who uses the Bach flower remedies” (code 157.4) “I must say, I think that they are underused” (code 157.6) “…but at the same time a lot of homeopaths don’t really use a lot of Bach flower remedies… I think it has died down a bit” (code 157.8)

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“I’ve even convinced a few other practitioners, ‘No, you must try it.’ And they try it and they like, ‘Ok, actually it does work.’ You know, they are a little bit shocked” (code 157.11) 158 Current knowledge is sufficient for prescriptions “I get by with what I know” (code 158.4) “No, I don’t feel I need to do further education” (code 158.5) “They’re adequate. I don’t think I would go on any course” (code 158.6) “…I have an understanding of each one. So therefore, it shouldn’t be a train smash if I don’t attend the course because we have an understanding of the individual remedies” (code 158.7) “No, I would feel like I could probably do it on my own” (code 158.9) “…I wouldn’t necessarily go on a course that will then qualify me as a Bach practitioner. I don’t think there’s a necessity for that” (code 158.10) 159 Course: Online is more convenience “I would probably like an online course. Like a whole bunch of audio things that you need to listen to… Yes, like a lecture on the fear remedies and the uncertainty remedies and whatever. And you complete little questions and a little case study. And you submit it and at the end of it you get a little diploma… I would much rather be able to do it between the hours of eight and ten at night or listen to it in my car” (code 159.4) 160 Course: Time consuming “…my days are very limited. So, I have to sort of see, is it worth it for me to do a course like that?” (code 160.10) 161 Bach flower practitioners: Willing to collaborate “Great. Lovely. You know, they are so useful and so beautiful to work with, it’s really great…Absolutely. If people know how to use them and are prescribing well. Lovely” (code 161.6) “…people don’t really know much about Bach flower practitioners as compared to homeopaths, so I think that the two would actually work quite nicely together and probably better together. It’s probably easier to monitor and do all the training” (code 161.9) “I have had one or two (Bach flower practitioners) that do actually get it quite right which is lovely” (code 161.14) 162 “Honeysuckle”

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“Honeysuckle” (code 162.4) 163 “Hornbeam” “Hornbeam” (code 163.4) 164 “Mustard” “Mustard” (code 164.4,6) 165 “Olive” “Olive” (code 165. 4,5,6,8) 166 “Red Chestnut” “Red Chestnut” (code 166.4) 167 “Rock Rose” “Rock Rose” (code 167.4) 168 “Sweet Chestnut” “Sweet Chestnut (code 168.4,6) 169 “White Chestnut” “White Chestnut” (code 169.4) 170 “Wild oat” “Wild Oat” (code 170.4,6) 171 Complex components: Three to five remedies “…usually between three and five” (code 171.4) 172 Bach flower complex with homeopathics (same bottle) “Usually between three and five (Bach flower remedies) and I sometimes will add a homeopathic remedy into it as well” (code 172.4) “…I use them (Bach flower remedies) in conjunction with homeopathic remedies” (code 172.5) “… add Bach flower remedies either into their simplex” (code 172.5) “I use both. I very often use both…if…it’s important that they have Bach flower remedies then I’d include them with the remedies. And once in a while I’ll say, ‘I can’t find a homeopathy remedy’… and I’ll say ‘ok, I’m just giving them Bach flower remedies’” (code 172.6) “I always add the Bach flower remedies either into the simplex or by themselves” (code 172.11) “I tend to prescribe more than one homeopathic remedy in the formula as well” (code 172.14)

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“…they (the Bach flower remedies) usually get thrown in with some of my other homeopathics…I’m not scared to mix them with other homeopathics. I don’t know if I’m not supposed to? But, they work, they work. So, if you put them with other homeopathics then they tend to go quite well anyway” (code 172.14) 173 Patients aware that they are taking Bach flower remedies “I always let them know. Always” (code 173.4) “But I will tell them that there’s Bach remedies in them so they will be aware of it” (code 173.5) 174 Explain to patient that Bach flower Remedies work on mental and emotional symptoms 175 Prescription in isolation is limited “I don’t think I have ever prescribed one by itself, unless it’s Star of Bethlehem” (code 175.14) 176 Complex components: Maximum of six remedies A maximum of five” (code176.5) “…a maximum of six remedies (code 176.13) 177 Frequency: Every hour on patient’s first visits, follow up 1-4x daily “I recommend people take it every hour for the first time when they come and see me. And then afterwards it might be four times a day or as the patient needs it less, they use it maybe once a day. But I do tell patients the first bottle they will usually use very quickly… they will find the second bottle will go much slower because it is as if they need less of it” (code 177.5) “…if it’s quite severe, in the beginning I do it every hour, at least six doses on the first day and thereafter go down to three times a day” (code 177.8) 178 “Gorse” “Gorse” (code 178.5) 179 Bach flower questionnaire “I looked at a questionnaire of the Bach” (code 179.5) “So, fortunately this questionnaire, it gives me a good indication and narrows it down and then I read up on the remedies” (code 179.10) “…we had a questionnaire where the patient sat in front and filled in a questionnaire and we mixed the remedies for them” (code 179.13) 180 Information Sources: Dr Collins course

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181 Exposure working at a health shop “…fortunately at that time I was working at Weleda already, so I had that side” (code 181.10) “I used to work at Weleda Pharmacy… they had the whole set there” (code 181.10) “I was working part-time for a health shop… and they did a lot of product education” (code 181.11) 182 Increased exposure with retail “…people are more exposed to it so they become more aware of it” (code 182.5) “…I think it’s good if everyone does it. We’d have calmer, happier children” (code 182.7) “…because it is accessible to the patient and they have better exposure to it, so they feel more comfortable using something that they’re better exposed to” (code 182.9) “I don’t mind it because it’s just bringing out that kind of awareness, bringing out more information that maybe there’s another way to look at health, to look at healing” (code 182.11) 183 Pros and cons “I think it’s like a two-way street. It’s like Natura, the homeopathic remedies are put in a bottle and they say, ‘I want that for bed wetting.’… Whereas if they come for a consult we would probably just give them Causticum and maybe something else. But, it saves them from actually going to a consult. It’s a win-win situation… if they don’t know and they still have to come back to you to mix and sort out, then it’s fine. So, I think it’s a two-way street” (code 183.8) “At the same time, you do want to let people experience it or experiment with it, the public, because that’s how their knowledge grows and their buy-in to complementary medicine grows. So, it’s a bit of a two-edged sword” (code 183.10) “I think there’s always two ways of looking at things. On the one side, I like that people can take their own health into their own hands and with their families as well…On the other side, I suppose it’s what people do with it

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actually. It’s down to the individual. You get people who can really misuse it” (code 183.11) 184 Trained middle men offer “free consults” “And because there are homeopaths working at Weleda, they (the patient) essentially gets a free consult” (code 184.5) 185 Self-treatment is discouraged “…people start to treat themselves because now they think they have got the know how” (code 185.5) “…self-prescription is never really a good thing” (code 185.9) “No, no! I don’t prescribe for myself. I don’t because it’s dreadful” (code 185.14) “But if they hit “Dischem”, they would have been in a tangle because it’s very difficult to self-prescribe” (code 185.14) “…people get all wonky with where they are at… I think they just think, ‘Well, let’s take all of them’” (code 185.14) “I wouldn’t want to have to choose for myself. I have to be honest. And I am studied and I know and I also think I am quite aware of my emotional sate” (code 185.14) 186 Practitioner unhappy with lay people becoming Bach flower practitioners “Who has given them the ok with this?” (code 186.5) “My frustration with a lot of the auxiliary therapies, and I’ll put Bach in there, is that you can be a plumber and dispense Bach flower remedies and become a person diagnosing and treating” (code 186.12) 187 Enjoy using Bach flower remedies “I enjoy using Bach flower remedies” (code 187.6) “I think it’s been a very good experience overall” (code 187.8) 189 Preparation: 10% alcohol “I put them into 10% (alcohol)” (code 189.6) 190 Complex components: Five to six remedies “I usually get up to five or six in one combination” (code 190.14) “…I’d generally add about five or six remedies” (code 190.6) 191 Dosage & Frequency: Ten drops six times daily “I recommend that they take ten drops” (code 191.6) “…ten drops” (code 191.12)

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192 Increased frequency becomes cumbersome 193 Dosage dependant on desired duration of treatment 194 Bach flower remedies clear physical symptoms by chance “Yes, I have to a certain extent, especially when there’s anxiety and anxiety then starts presenting physically in the body. So yes, to that extent but I don’t use it like that” (code 194.6) “…emotionally they do get better. Physically they do get better but I think it’s just in time” (code 194.8) 195 Homeopathics preferred for full treatment picture (mental/emotional & physical) “I have to a certain extent, especially when there is anxiety and then anxiety starts presenting physically in the body… Then, I’d turn to homeopathy the moment it goes that deep” (code 195.6) 196 “Impatiens” “Impatiens (code 196.6) 197 “Holly” “Holly” (code 197.6) 198 “Walnut” “Walnut” (code 198.6) 199 “Pine” “Pine” (code 199.6) 200 “Gentian” “Gentian” (code 200.6) 201 “Cerato” “Cerato” (code 201.6) 202 Information Sources: Summary notes “little cheat sheet” (code 202.6) “Maybe it was from campus” (code 202.7) “…it was Dr Solomon (lecturer) that did a bit on it… every single flower and how it worked… that’s the leaflet I have” (code 202.7) 203 Self-study “I have done my own reading” (code 203.6) “I am happy with my books and I am happy with my own reading” (code 203.6)

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204 Course: Unnecessary/uninterested “No, I know it sounds terrible, but I must admit that I don’t have a desire for further studies” (code 204.14) “No, not really. It’s December now, maybe my desire will increase in January” (code 204.13) 205 Bach flower practitioners: Positive “Lovely, great! Lovely! They are so useful and so beautiful to work with, it’s really great” (code 205.6) “I think its fine because I’d assume it’s very mild in treatment so it’ s not going to be treating huge symptoms and diseases. So, I think if people do the course and are able to do it at home and help their families, it’s good” (code 205.7) “I do think that if they are trained, they get that sense of responsibility toward the patient and they do have that intent to heal the patient, and it’s not just for financial gain then I’m going to tell you, I think that’s wonderful” (code 205.14) “…if there are more hands-on deck out there, fantastic! And I think if someone has actually put the effort in and the investment into actually training and they are interested and they are enthusiastic, they are providing a set of ears and a kind heart and just support” (code 205.14) 206 At Stores: Expensive “And they are quite expensive if you are just going to buy one and you’re not sure of what this is actually going to do. And even if you give them the questionnaire then they are like ‘Oh, now I need four!’ And they are these expensive little bottles” (code 206.11) “I might give something homeopathic as well and then it’s enough. And from a cost perspective, it is enough” (code 206.12) 207 More affordable to dispense from practice “That’s why I just keep them (the Bach flower remedies) myself and just dispense myself” (code 207.6) 208 Rescue Remedy used less frequently “I do use it (Rescue Remedy) on the odd occasion” (code 208.6) 209 Rescue Remedy when indicated

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“And it covers quite a nice array of emotions like anxiety and apprehension and fear of taking it on (childbirth). So, it’s nice. It doesn’t work for everyone obviously. It’s a bit of a broad sweeping thing to just sort of say, ‘Here you go’” (code 209.6) “…Rescue for example, I will bombard them every ten minutes, every ten to fifteen minutes. The person keeps it with them and when they feel they are getting edgy or fidgety then they take the Rescue and it works quickly” (code 209.10) 210 South African flowers: So many “There are so many of them that I have no idea” (code 210.6) 211 South African flowers: Should be taught/ used 212 South African flowers: Personal experience 213 Relevance: Widely used and known “Bach, because they are so widely used…they are long-standing and have been used successfully” (code 213.6) 214 South African flowers: Very new “It’s unique and it’s unknown” (code 214.10) 215 South African flowers: Emotional too 216 Only use Rescue Remedy “I have only used the Rescue Remedy” (code 216.7) 217 Original Bach flower remedies are preferred “I find it (the original Bach flower remedies) absolutely beautiful. I have had better results using that” (code 217.7) “I find that the (original) Bach flower works much, much, better… that works beautifully” (code 217.7) “…you can keep yours and I’m now sticking to the original Bach remedies” (code 217.10) 218 Student stress/ anxiety “kids going through exams” (code 218.7) 219 Calming “…just to calm down, I think its excellent” (code 219.7) 220 Family and friend honesty on treatment

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"Sometimes, with your patients they feel they need to tell you that it is working to make you feel better, but with your kids there is no line” (code 220.7) 221 Frequency: Acute cases once hourly “…fifteen drops… and take it every hour” (code 221.7) 222 Dosage: Fifteen drops “…fifteen drops” (code 222.7) “…fifteen drops” (code 222.13) 223 Cover incorrect homeopathic remedy “…probably lack of effort with regard to reportorising and finding the right case… it was more from a change of prescription and a lack of reportorising, and finding the correct homeopathic remedy” (code 223.10) “…maybe I have given them a remedy and it hasn’t given me the results I wanted” (code 223.12) “…when the indicated (homeopathic) remedy didn’t make a difference” (code 223.13) 224 Rescue Remedy is sufficient “At the moment I am getting my results, so I am just sticking to it!” (code 224.7) 225 Bach flower remedies are complementary to Homeopathy “It (homeopathy and Bach flower remedies) works well together” (code 225.7) “… I would use it (Bach flower remedies) as a complementary medicine” (code 225.9) “…it complements” (code 225.14) “I take the mental and emotional of our homeopathics and mimic it with the Bach flowers” (code 225.14) 226 Information sources: Homeopathy conference 227 Exposure: Once in practice “Yes, definitely not campus” (code 227.7) 228 Relevance: “Natural” “I’m going to use the word ‘natural’, although it is a terrible word to use” (code 228.7) 229 Course: Expensive

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“…financially it’s always difficult to do a course, in terms of time as well” (code 229.9) “I would love to attend it but I think it will be too pricy” (code 229.7) 230 Depression “depression” (code 230.8) 231 One to two Bach flower remedies at time “So, I generally go on one remedy at a time. I prefer that. If I feel that they need a second remedy, I add that to the main bottle” (code 231.8) “there is one specific one (emotion) that they (the patient) need to deal with first so that’s what I go with first” (code 231.8) “I don’t usually do more than two… Because usually the remedies are quite specific with what they are used for” (code 231.12) 232 Peel the onion a layer at a time “So, there might be two concepts that come through strongly but then I’ll say, ‘Well, let’s not tackle both of them because it’s going to give you emotional turmoil. So, let’s do one at a time.’…When the patient has reached a certain level, then I’ll go with the next one” (code 232.10) “But also like with homeopathy, there is always a peeling back of the layers” (code 232.11) “…you sort of have to de-layer something and try and get something to the core as much as you possibly can” (code 232.8) 233 Course: Beneficial “That’s why with the course it teaches you how to do your own bottles and put your own label. It gives you an advantage” (code 233.8) 234 Course: Reasonably priced “…it’s quite reasonably priced” (code 234.8) 235 At stores: Saves them from a consult “…it saves them from actually going for a consult” (code 235.8) 236 At stores: Disappointing “In any situation in a health store, a pharmacy, a product is sold in the health store then in the pharmacy and then it goes big retail, it can become disappointing” (code 236.8) 237 Dispense original Bach flower remedy bottle

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“…what I do is I take the whole bottle (and give it to the patient)” (code 237.8) 238 “Cherry Plum” “Cherry Plum” (code 238.8) 239 Bach flower remedies: Grounding “It assists them but it’s almost like the Bach flower remedy grounds them” (code 239.8) “…grounding is the best word I can use” (code 239.8) 240 Course: Should be considered by more practitioners “If it’s not in varsity at least an access to homeopaths to actually do the course. I think it was at one stage. I think it was and then it just died down (code 240.8) 241 Bach flower practitioner: Aware that it is open to the public “I know that you don’t necessarily have to be a qualified health practitioner to do it, or as far as I understood from that conversation. But you could do it if you were a health care practitioner. So, it was open to anyone if they wanted to go” (code 241.9) 242 Bach flower practitioners: Should be registered for accountability 243 Available in UJ clinic is positive 244 Course: May increase interest 245 Physicals resolving with Bach flower remedies is unheard of/ theoretical “No, I don’t know that side of the Bach flower remedies at all, so I haven’t gone into that at all” (code 245.3) “I have actually never experienced or never heard of anyone treating physical ailments with a Bach flower remedy” (code 245.9) 246 Regulations would need to be specific “So, if it were to be regulated it would have to be in a specific way... It would have to be done in a holistic way. Make sure that it is manufactured correctly, that whatever is in it is actually what’s in it, and maybe, that it’s registered under a homeopathic or a Bach flower remedy with the understanding of what it is and how it is used” (code 246.9) “…it would have to be in its own scope because you want the best for your patients. you don’t want them to take something that’s not going to help them, or it might be to their detriment” (code 246.9)

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“If they are going to be regulated it’s probably going to make it more difficult for them to be actually available. But, I think there needs to be education on it, almost like a split on what is safe for the public and what is not and what should be practitioner only. Which is difficult with Bach because you don’t have different potencies, and anybody can prescribe it anyway… Arnica D6 for bruising or sprained ankles, sure. But Arnica 200, not so much. So, you can’t really do that split with Bach and if there was a way, to almost actually pre-make them for the patient to use” (code 246.10) 247 Importance of the homeopathic consultation- vital role/ offers guidance and treatment overview “…you definitely need someone to be there for them” (code 247.9) “So, with the consultation you are giving someone an individualised treatment and hopefully it is tailored towards exactly what would help them” (code 247.9) “and if there is a deeper problem like a pathology that is not getting addressed… you definitely need someone to be there for them” (code 247.9) “…someone who is educated and knows various steps which could be taken in an emergency, or if something emergent comes up, or what to do and when to do it” (code 247.9) 248 Misuse may cause aggravations “They go in there and it doesn’t work, or they get an aggravation” (code 248.9) 249 More research required “Maybe that (more attention in the course material) could stimulate interest and stimulate research into the area which would then help us understand where and when it’s appropriate to give it to patients” (code 249.9) “I feel that we need to do more research into them. If it is going to be a growing modality, they should be better understood” (code 249.9) “So, we are limited because there are fewer res earch projects available, or abstracts, because I spend a lot of time on Google Scholar and there’s not as many available on the Bach flowers as we might like” (code 249.12) “…there isn’t much data that is clinical around Bach flower remedies” (code 249.12)

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250 Bach flower remedies: Grounds to explore emotions and communication “…it actually pointed us in a direction, with regard to the consultation, of where I need to scratch a bit more with my patient’s case, which was nice” (code 250.10) “And then between myself and the patient, we then go through the questions and we’ll decide on which ones she should take” (code 250.10) “I normally talk through it with the patient, of what we want to achieve” (code 250.10) “…they get more emotional and they are happy to talk about their emotions” (code 250.12) “…chatting about the Bach flowers gives them a chance to air how they feel or how they think they feel” (code 250.14) “And, it actually helps to open the door to actually having a discussion later… the Bach flowers are a lovely gateway without the patient feeling like… they can’t trust you” (code 250.14) “…that’s why I say it’s actually more a tool for opening channels of communication and healing through communication” (code 250.14) “A nice clever way to make them feel non-threatened about sharing with you how they feel” (code 250.14) 251 Intuition based prescriptions “I work a lot with intuition as well” (code 251.10) “…but you will know just instinctively” (code 251.14) “You instinctively know when you are dealing with who and what and why and how” (code 251.14) 252 Gentle enough not to cause radical shifts “…it’s really based on how gentle do I want to actually introduce an emotional level with the patient. Do I feel that the patient can handle a homeopathic remedy that might push them over the edge and that I really have to monitor closely, or is it something that I feel that can actually just go in the background?” (code 252.10) “so, I have to worry less about aggravations of remedies” (code 252.10) “…also, if you don’t get the right one… you won’t really do any damage per say” (code252.11) 253 Complex components: Maximum of five remedies

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“I go to a maximum of five” (code 253.10) 254 Complex components: Five drops of each individual remedy “I take five drops of each Bach flower remedy and put it in” (code 254.2) “I take five drops of each of the individual ones” (code 254.10) 255 Solution: 20% alcohol “…into 20% alcohol” (code 255.10) “…20% alcohol” (code 355.11) 256 Practitioner value: Facilitate self-healing, counselling and coach “…I say to them (my patients), ‘I am your coach. I am not going to help you. You are going to help you. I am your coach. I can give you guidance’” (code 256.10) “I think it helps them (the patient) feel like there’s a bit more of a personal relationship” (code 256.14) “Some people just naming how they feel is actually all the healing” (code 256.14) “And most of the times you are just entertaining the patients whilst they get themselves better” (code 256.14) 257 Public access potentially dangerous “…I think it can have danger to the patient” (code 257.10) 258 Bach flower practitioner registration- what does this really mean? 259 Rescue Remedy: Animals and plants 260 Relevance: Eurocentric “…homeopathy and everything, it kind of grew from a seed in Europe” (code 260.10) 261 Regulation decreases accessibility “…you can’t have Bach flower remedies available just to practitioners, because as a practitioner, I’m not going to be able to get them because there aren’t enough practitioners that use them” (code 261.4) 262 Available as complexes 263 Regulation or availability determines product value “...because they can self-medicate according to their own dosage, they quite like that… But, in the same breath, they don’t like that because they find it quite wishy-washy” (code 263.12) 264 Complex components: Four to five drops of each individual remedy

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“I use about four to five drops” (code 264.11) 265 Complex components: Maximum of seven remedies “I know the limit I was taught was seven, maximum” (code 265.11) 266 Frequency: Three to four times daily “…three to four times daily” (code 266.11) 267 Dosage: Five to ten drops “…about five drops, sometimes I do ten if they’re not going to do it as often” (code 267.11) “I’m usually doing five to ten drops” (code 267.14) 268 Patients who state that Rescue Remedy works- continue “I find that the patients who have come and said, ‘I use Rescue, it helps but not quite enough,’ then what I normally do is if they don’t have any extra Rescue Remedy in their kit then I’ll do Rescue Remedy” (code 268.11) “I tell them to keep going with it. Because often they are like, “Oh, can you give me something else” and I’m like “No! Is it working for you? Then… use it!” (code 268.14) 269 Bach flower remedies for emotional intensity “Normally for me, it depends on the intensity of the emotions that they are feeling” (code 269.11) “…the emotions aren’t affecting them as intensely” (code 269.11) 270 Used as an intercurrent to boost while the homeopathic works “…just almost for those moments and for that instant relief and support in the interim while the homeopathic remedies are working through, then sometimes I’ll come in with just the Bach flower remedies, just as that intermediate support” (code 270.11) “…I would only prescribe Bach flower remedies to give the relief immediately, not to cure the case or to treat them long-term” (code 270.13) 271 Bach flower remedies- not readily available in clinic “I think I tried but we didn’t really have a lot of Bach flower remedies at that point in clinic” (code 271.11) “I can’t remember. That was too long ago… I would have known (if Bach flower remedies were available in the campus clinic)” (code 271.13) 272 Difficult to be objective

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“I wouldn’t want to have to choose for me. I have to be honest and I am studied” (code 272.14) 273 Empower patient “Instead of doing the blame game and feeling like, ‘The poor sorry me,’ have something positive to do with your emotions” (code 273.11) “I think because they can self-medicate according to their own dosage, they quite like it. If they are feeling worse, they can take it more often” (code 273.12) “…sometimes patients need to know what is in their stuff, not because they think they need to know. Sometimes I think they need to know because there’s also this idea that I am doing myself some good. I am taking something for my emotions” (code 273.14) “You know why (I script out)? It’s because then patient compliance is great because now they know where to get it and know why they are taking it and how they can help themselves. So, they don’t always have to rely on me” (code 273.14) “And then (after they understand the connection between the mental and the physical) they feel more in control of their situation” (code 273.14) 274 Course may result in grandiose attitude “You get people who can really misuse it and sort of have a grandiose thing like, ‘Listen, I know what I’m doing, I have my Level 3 and it’s registered, recognized by the institute and everything’” (code 274.11) 275 Patients don’t know how to select the right remedy “Occasionally you’d have someone who was like ‘oh, I really need to top up. I need some Olive and I need some this and this…but that was rare” (code 275.11) 276 Rare that people will seek them out “…that (customers requesting Bach flower remedies) was rare” (code 276.11) “It’s a select few people that would buy a single Bach flower remedy” (code 276.13) “…people that don’t know how to do that, probably wouldn’t even look at Bach flowers in the first place” (code 276.14) 277 Use questions credibility 278 Homeopathy must be retained

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“…we also sort of loose a part of the essence of homeopathy” (code 278.11) “…you will probably find that the homeopathy declines dramatically on their prescribing as well… functional medicine does start really eliminating energy healing in the arrangement because we are so nit picking and breaking it down into the physiology” (code 278.14) 279 Increase clinic use 280 Increase clinician exposure 281 Limited support from fellow practitioners on Bach flower remedies 282 Treats clinically “…my practice is a very clinical practice” (code 282.12) 283 Limited use therefore no kit 284 Dispense a sealed bottle “So, usually I am not in favour of messing with the sealed container. I don’t know if it’s just where it comes from but my opinion is that sometimes the Bach flower remedies are a lot more susceptible to being contaminated or their effectiveness being damaged once being opened” (code 284.12) 285 Frequency: One to two times daily “Usually it will be once or twice a day as a chronic dose” (code 285.12) 286 Frequency: Follow up cases three to four times daily “…it might even be every hour for a day and them dropping it down to three or four times a day there after” (code 286.12) 287 Treatment of physical symptoms- hard to determine “Because I use homeopathics with it, I wouldn’t be able to tell you if it’s the remedies or the flower remedies that did it” (code 287.13) 288 Functional medicine approach “I follow a functional medicine approach” (code 288.12) 289 Genetics on health 290 Wouldn’t rely on Bach flower remedies for clinical case “I don’t think I, in my practice, would ever purely rely on a Bach to deal with a pure clinical picture” (code 290.12) 291 Patients request it 292 “Hippie”/ Quackery 293 Relevance: preparation

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“The time Hahnemann had done the potentising, it was the same method that Bach used as well. So, the methods are exactly the same. So why shouldn’t they work together” (code 293.8) 294 Patient response: Don’t give feedback if better 295 Patient response: Compliance? “…some patients aren’t as compliant as others” (code 295.11) “It’s because patient compliance is great when they know where to get it (their medicine) and know why they are taking it and how they can help themselves” (code 295.14) “(too many remedies) is not really great for patient compliance” (code 295.14) 296 Bach flower remedies for specific patients “I do think that some patients benefit more than others with it. Whether that’s because of the nature of their personalities, it’s created that shift” (code 296.12) 297 More common in females “Definitely more female than male” (code 297.12) 298 Individual remedies shouldn’t be an OTC “So, I don’t think it (individual Bach flower remedies) should be over the counter” (code 298.12) 300 Course: Proper qualification 301 Patient care and progress is priority “…when I use them I feel like the patient that is there is needing them at that moment so I’m not going to not give them something that I feel that they need just because someone else is prescribing it down the road” (code 301.3) “…the important thing is that your patient is getting better” (code 301.11) “For some reason when you tell them, ‘There are these Bach flower remedies, and this is what they can do, shall we look at them?’ They actually feel like you are helping them because they don’t have to sit and be poked, prodded or judged, or have to share the gory story” (code 301.14) “So, your whole heartedness in their benefit and their health actually is half the healing” (code 301.14) 302 Natural doesn’t mean safe “…it’s natural but it can still have consequences from taking it, if you take something incorrectly” (code 302.3)

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“It’s safer than a straight herb, but still you can have a reaction” (code 302.12) 303 Must use responsibly “…just because something is natural doesn’t mean that it is safe…, for me I don’t feel like that factor is often told to the patient” (code 303.12) “it’s better to ask a practitioner or somebody that knows a little bit more” (code 303.13) 304 Rescue Remedy used quite often in practice “Rescue Remedy is used quite often in practice” (code 304.13) 305 Patient Response: Difficult due to limited frequency 306 Frequency: Infrequent 307 Solution: 5% alcohol “…5% alcohol” (code 307.13) 308 Complex components: Six drops of each induvial remedy “…six drops, I think, of each remedy” (308.13) “I put 6 drops of each remedy” (code 308.14) 309 Frequency: Two to three times daily “It’s usually twice or three times a day” (code 309.13) 310 Patients happy to use it “I explain to them that it’s made from flowers and that it works a little bit differently. So, I do explain to them and they are happy to use it” (code 310.13) 311 Interest: The box 312 Practitioner was unaware of registration with the UK “Oh, I didn’t know that. I thought it (the Bach flower course) was information only… yes definitely (more appealing with the possible UK registration” (code 312.13) 313 Course: Good! Offers education “I think it’s good to inform people. It’s better to inform people” (code 313.13) 314 Bach flower practitioners- no problem “No, I don’t think so (that Bach flower practitioners will impact homeopathic practitioners)” (code 314.13) 315 Bach flower remedies: Part of practice since the start 316 Time with the patient is important (Not always 1st consult)

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“…then come back to the emotions once I’ve gotten to know the patient much better” (code 316.14) 317 Increases bonding and trust “For some reason it really bonds the patient to the practitioner as well. I think it helps them to feel like there’s a bit more of a personal relationship. And those things are important” (code 317.14) “…then they trust you as the practitioner more and then usually the story comes out. It’s good” (code 316.14) 318 Come to value emotions “Bach flowers are the doorway to working on it, showing them why you are trying to go the emotional route” (code 318.14) “…people accepting that now they are getting, ‘physical medicine’, that’s going to help from the emotional point of view” (code 318.14) “…and also getting them educated about the fact that their failing exams is causing the reflux in their stomach” (code 318.14) 319 Patient not aware of Bach flower treatment when getting it “…most of my patients don’t even know they are getting Bach flower remedies because it’s with the homeopathics as well” (code 319.11) 320 In a mind rut “I have had patients that struggle with emotions like, they are emotionally stuck in the way that they needed to make life decisions, but they weren’t personally strong enough to make that choice. To actually go through with it” (code 320.10) “…in a mind rut that they are in and those emotions that come from that rut” (code 320.11) “I usually like to add in my own version of the other Bach flowers as to why that person is in that shock or trauma (code 320.14) 321 Case lacks details due to patient reluctance or inability to share “As with adults, its blurred and they can’t even tell you half the stuff you need to know” (code 321.14) 322 Informal training 323 Practitioners objectivity “…you do need someone fairly impartial to help you…just to voice how they feel without trying to self-calculate what it is they need. Just get it out and then

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the calculations can begin, and probably better if someone else does the calculating” (code 323.14) “…people can read, and people can research and all that stuff but when it comes to Bach flowers of all things, I would say that’s probably a bit sketchy” (code 323.14) 324 University training: Adequate 325 University training: Lacks emotional training 326 Rescue Remedy: One aggravation reported 327 Bach flower remedy- Healing crisis suspected 328 Doesn’t see Rescue Remedy cases 329 Don’t dispense what I can script out 330 Grasshoppers Vs Rhinos 331 Very blurry to prescribe (no rules) 332 Role of the Bach flower practitioner-Listening and for the right reasons “Like I say 50% of the healing is actually just having someone to listen, or you actually saying out loud... You’ve just had your own epiphany moment because you have just said it out loud to someone who is impartial and that’s where I think that’s a great role for other people to train in Bach flowers. I don’t think there’s a threat at all… I appreciate back up… If there are more people out there who put more time and energy into people no matter what, it makes me happy because our society needs it” (code 332.14) 333 Emotions are important 334 Not for all practitioners 335 Consider the person as a whole “I usually try to get to the similimum” (code 335.13) 336 South African flowers: No result “I did actually have no results with them” (code 336.14) 337 Frequency over dose

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