Homeopathy Papers

The Threefold Approach to Therapeutic Intentions

Homeopath Jeroen Holtkamp presents an approach to case taking which aims at achieving self actualization for the patient. It demands of the homeopath a deep level of empathy, as well as an awareness of his/her own frame of reference.


First of all I would like to express my gratitude for being given the opportunity to expand on my threefold approach in Homeopathy for Everyone. In my previous three articles I introduced my threefold approach to the materia medica and case taking. As I will unfold my threefold approach a little bit more it is essential for the reader to have knowledge of my earlier writings. My third article on the threefold approach to anorexia nervosa also contains a broad abstract of my first and second article.i There is a resemblance between the miasm theory and the threefold approach, but for the many reasons that I dealt with in my previous articles they shouldn’t be confused. My approach to homeopathy based on the threefold principle is not another approach to miasms. In this article I will, with the help of a case, describe insights that shaped my intentions for ‘objective’ observations considerably. I also will present a meditative exercise that helped me to accept and affirm the life here and now. The therapeutic attitude in the threefold method of case taking is basically a scientific attitude which will be evident from its integrative characteristics.

A very brief refresher

In my opinion the materia medica is not primarily threefold because of the three spiritual enemies of life that pre-exist to any earthly manifestation of disease, namely Psora, Sycosis and Syphilis, as Samuel Hahnemann believed. Neither should the reason for the threefold appearance of the materia medica be sought in the physiological defence mechanisms.

The cause of the threefold appearance of the materia medica and so many other phenomena is the threefold nature of the psychological constitution of adult human beings. The threefold principle is a reality that each of us can investigate independently at any given moment or any given place and will always result in similar findings. In relation to the internal – and external signals that reach our consciousness via the senses and receptors we can discern three states of awareness which I call:

  1. Perceptive-psyche

  2. Reflective-psyche

  3. Awareness-psyche

Disease is but the downside to development, like falling is the downside to learning how to walk. The three levels of awareness signify the type of development the patient is going through.

If the patient is for example in a development of the perceptive-psyche he/she is inclined to express symptoms of over-sensitivity, changeability, strong likes and dislikes, etcetera. A person in a perceptive-awareness development depends for his satisfaction of life on what the senses have to offer and behaves in a more outgoing manner.

A development of the reflective-psyche is characterized by an exaggerated need for control, a desire for reflection and solitude, inclination to be dictatorial, etcetera. The essence of a development of the reflective-psyche, its activity, can be expressed in the words to-let-go-of. In my third article in which I describe the threefold approach to anorexia nervosa I explain how Natrum Muriaticum covers this essence of the downside to a reflective development.ii Many remedies share this essence with Natrum Muriaticum. I also explain why the Mother theme is a characteristic of Natrum Muriaticum.

The third and highest state of awareness in relation to our physical senses and receptors emerges when impressions and reflections lead to a development of self-awareness. It’s the conclusion of BEING here and now and is characterised by increased acceptance of life’s circumstances. The activity of the awareness-psyche is to be. The process leading up to awareness of what IS, is a learning process which I have extensively describe in my previous articles. The downside to this development is, amongst others, expressed in a fundamental distrust in life and an inability to surrender or make that leap of faith that is required to live here and now.

This threefold being of our awareness in relation to the world around us is not just a categorization that satisfies a need for theoretical structure. No, it is a constitutional reality of our conscious psyche. The fact that our awareness in relation to what comes to us via the senses and receptors is essentially threefold can be recognised in the phenomenon of being absorbed in thoughts. When a person is absorbed in thoughts he is less aware of what is going on in his environment. When you try to explain something he will not be able to listen to you sufficiently. Increased reflective-awareness development cannot take place simultaneously with an increased perceptive development; that is impossible. Likewise it is not possible to hold on to concepts derived from reflection, if a leap of faith is required for a development of the awareness-psyche.

As health and disease are the two sides of the one coin, namely development, one needs to focus the consultation not only on disease, but on the real totality of life. Keeping the focus on the patient’s development requires a balanced discernment between personally expressed negative, positive and neutral characteristics. In this way the homeopathic practitioner acknowledges to its full extent the on-going efforts in each patient to become a more wholesome person here and now. The ability to ‘catch’ the patient’s expressions that are characteristic for his/her struggle in self-actualisation increases the more the practitioner is able to observe ‘objectively’. Truthful observations are only possible when the BEING in the consultation is approached from a non-conceptual standpoint; an undefined therapeutic attitude that is aided by a complete openness which is characterised by the point of view of the patient. The practitioner meets many obstacles in his/her efforts to obtain this favourable therapeutic attitude, an attitude which is based on the homeopath’s intentions.

My learning curve

Looking back at my personal therapeutic development, I can trace back my first insights in the therapeutic intentions that I will described in this article with a case history that started in July 2006. The case I would like to present is an abstract of one of my peer reviewed case histories. I feel very reluctant to present a case history on the internet, so I have altered it to such an extent that it only serves the purpose of this article on therapeutic intentions.

Jill (46), diagnosed with Post Traumatic Disorder Syndrome and Crohn’s disease

Consultation 1:

It was a year after a life threatening incident at work when she made an appointment with me. Someone tried to choke her and ever since she had not been able to feel; as if nothing, including her body, was real. She felt very fearful and had the idea that this person could come any time again. She feared being alone and had the sensation that there was something behind her. She had sleepless nights. She felt that she had been treated very unfairly by her employer. She told me that she was very irritable and very, very angry.

The first signs of Jill’s Chrohn’s disease occurred during the legal separation process from her mentally and physically abusive husband. The stress in her was followed by attacks of abdominal pains and relieved by bouts of diarrhoea. Her husband was very powerful and staying in that foreign country would mean that she would have lost her children and that she would be homeless. To continue in Jill’s own words: I made a leap of faith. Without money or possessions I brought my children, back to Ireland, leaving everything behind.

As a child she has been sexually abused by her father. Four months after the traumatic incident she started to feel suicidal. To continue in Jill’s own words: Rather unexpectedly I realised that there was really nothing stopping me from doing it. Just say nothing and do it quick. At this I was alarmed and went for counselling. Jill has been offered help by her psychiatrist but she refused to take medicinal drugs.

My commentary:

I was struck by the severity of Jill’s traumatic experiences. Jill noticed that I could not suppress a few little tears. I am inclined to feel sympathy for people who suffer from injustice. I was deeply entangled in the patient’s story. Jill’s traumatic story kept me in a development of the reflective psyche which caused me to ask questions that only related to her reflective awareness. Because of that I made a little misjudgement of her situation. I myself was in an emergency state, although she has been able to survive for almost a year in this condition. Accordingly I gave her 1 globule of Arnica C200. I told her that she could become very emotional, that I had to analyse her case and that she would be able to collect her constitutional remedy tomorrow. Arnica had the expected effect and started the healing process. I prescribed the more constitutional remedy, 1 globule of Nat-s. 1M which, as we will see, had a more profound effect.

Consultation 2:

To me the most important of all Jill’s expressions this time was her intention to find a new purpose in life. In the mean time I gathered myself and was able to maintain a more therapeutic attitude. Jill opened the consultation with telling me about an important dream she had. As she was experienced in dream-work she was well able to give it a meaning for herself. This reflective process led her to a conclusion in relation to the frustrating relationship with her employer, who treated her very unfairly – on top of her crisis. She said: It’s either going back to the same situation or do something about it via a legal procedure. It’s not for my own sake that I am thinking of suing them, but it’s for the clients that I am working with. I have to sue them even though I know that if I don’t win, I might have to go to jail. She felt anger and expressed extensively a need for – and amelioration from solitude. Very remarkable were the shivers that she felt going down her spine as she was telling her story. It reminded her of giving birth and how perfect it was. She told me: I didn’t want any anaesthetic. I left the hospital of my own accord at 2 cm contraction. I was completely in charge. Space, time and all the pain came together that time. I felt the oneness of all going through me and I breathed it out. Spontaneously she relates giving birth to the current crisis: I’m going through a rough patch at the moment, but I know that I will come out of it. I know I have to go through the pain and I know it will be worthwhile. I have to start all over again. I’ve done that before. I know how to do that.

My commentary:

Although she still had a long way to go, to me and my patient these expressions of healing were enormous stimuli to her developmental process. It was her basic trust in life, her understanding that life has a purpose, that gave her the strength to make a leap of faith and flee to Ireland… and that revitalized her fighting spirit. Her story at the second consultation together with her heart palpitations at night made me decide to prescribe 1 globule of Aur-mur. C200. Looking back from a threefold point-a-view I clearly can see the characteristics of a reflective development as explained in this and my previous articles. Aur-mur. has the essence of a reflective-awareness development with a group of other remedies, of which Natrum mur. is the most representative. I felt overwhelmed by this case, which made me surrender to whatever might come up in the consultation. I realized that by my increasingly open therapeutic attitude I helped Jill to become freer in expressing herself.

Consultation 3:

At the third consultation I left the initiative completely to Jill and was not at all concerned with the subject. I started to feel free to also talk about the positive experiences in Jill’s life. Jill was qute detailed of her own accord in explaining her complaints. Her physical health problems started to become more prominent. Throughout the consultation my focus was not on particular remedies, and only at the end I recognized that Arsenicum was shining through. After a few confirming questions I felt that I had gathered enough indications for a prescription, namely: asthmatic affection, very chilly, desires: hot showers and hot drinks, asks for my qualifications, burning eyes, diarrhoea. I prescribed 1 globule of Arsenicum C200.

Consultation 4:

Very quickly her acute asthmatic complaints disappeared but there was no clear mental/emotional improvement. Jill’s general Arsenicum appearance became more explicit and the asthmatic complaints seemed to reoccur. The symptoms were:

  • The recurring asthma-like condition two weeks later = periodicity

  • Insecurity

  • Death. Now it occurs to her that she really could have died.

  • Asthma like condition

  • Wants to be in control all the time.

  • Still very chilly.

I prescribed 1 globule of Arsenicum 1M.

Although Jill still had a long way to go, it was thanks to the healing effect of Arsenicum that Jill felt that she could say: I have turned a corner. Jill was in a state of post-traumatic stress for almost a year. With the help of homeopathy it took her about nine weeks and 4 remedies to get the feeling that she was going up again. The self-knowledge that emerged from this crisis with the help of homeopathy was very useful in working independently on her new future. Something she wasn’t able to do for a year of her life. Thanks to this case I have learned that it really doesn’t matter what complaint or subject one uses as a starting point for working on the realization of a realistic attitude in the here and now. If the patient would be in agreement, I also could have used her digestive tract problems as an occasion for working towards her acceptance of her current circumstances. This acceptance; this increased ability through insight in one’s purpose, is what makes a speedy recovery possible.


I initially felt overwhelmed by this case, which made me learn to surrender and accept whatever might come up. As a result, in subsequent consultations the interview became more of a social talk, while I maintained my empathetic attitude. Looking back I feel that, unknowingly, I gave up the secure patient-therapist duality without getting personally involved.

My threefold approach to case taking requires stepping beyond the patient-practitioner duality. I understand that some colleagues feel a need to maintain a dualistic approach such as the miasm theory provides to a certain extent, because it appears to secure objectivity. The fear of losing yourself in the patient and to see him/her through coloured glasses is justified. It is justified as long as the individual practitioner does not want to acknowledge, or is not able to recognise his/her true self. Self-awareness decreases the chance of becoming entangled with the patient’s affairs. The homeopathic practitioner who recognizes the need for self-actualisation in the patient and wants to stimulate it, must make that step beyond the patient-practitioner duality and start active self-exploration. As homeopathic practitioners we all made that step to a certain degree, because most of us do accept that the strict dualistic approach to disease in conventional medicine is very limited in its effectiveness. A truly non-dualistic consultation through an undefined therapeutic attitude that is aided by a complete openness and is characterised by the point of view of the patient, requires us to be even more aware of our intentions. Justified therapeutic intentions are shaped through pondering one’s own existence and endure the tests of life experience.

Frame of reference

I feel I have pondered on the dilemmas of my own existence deeply and drawn the conclusion that we all refer to a frame of reference when communicating about our body and the world out there.

What constitutes a frame of reference can be made crystal-clear with the help of mathematics in physics. In conventional medicine all observations and measurements of the reality of disease are related to the framework of formalized pathological descriptions. But what standards do we homeopaths refer to when deciding what needs to be treated, or when determining the ‘weight’ of a symptom? What is our frame of reference?

We try to obtain ‘objectively’ individualising symptoms, and every homeopath seems to use different combinations of values to establish what symptoms are relevant. A group of homeopaths reason that pathology determines the symptoms to pick for repertorisation. To some this approach might be useful as pathology describes what a group of people have in common and therefore it indicates indirectly what symptoms not to take into consideration for repertorisation. Others take the culture or family in which the patient grew up, as a standard for what is normal. If a little boy of three years old for example loves to dance naked, one homeopath might not pick this symptom because it is normal in that family to walk around naked through the house. Another homeopath will pick this symptom because the child loves to dance and loves to do it naked. Both derive a different remedy. Yet, other homeopaths are picking their symptoms intuitively or emphasise synchronistic occurrences.

Most of us take a combination of standards in order to pick relevant symptoms. All standards are valid to a certain degree. I think that in homeopathy we generally apply the standards that are derived from who we think and feel we are. The individual homeopath applies the standards derived from who he/she is, which includes all his/her life experiences and professional training. Every strange, peculiar symptom that strikes us during case taking is an increase in the awareness of being different in a particular way. The homeopath, aware of his/her own individuality, is for the purpose of finding the most similar remedy, interested in nothing but differences between the patient and himself; tries to subdue his/her own personal reactions and allows the patient to express in an increasingly individual manner. My conclusion is that the homeopath’s frame of reference is simply his/her therapeutically trained ego.

Relativity of observations

The physicist Albert Einstein discovered that even hard objective measurements of macro-cosmic objects out there, like the mass of remote stars, are utterly dependent on the scientist’s frame of reference down here. What the astrophysicist accepts as his/her own norms, is what constitutes his/her mathematically coherent frame of reference.

This was a very significant step in the development of physics, because before Einstein physicists did ignore the fact that their measuring devices and his location were part of the reality they were observing. All measurements were regarded as absolute facts. The acceptance of Einstein’s theories of relativity led to the current relativistic concept of macroscopic reality.

In this universe there is no such thing as absolute rest. Everything is in motion with the consequence that one can only speak in terms of relative speed with respect to the observed system. In a train for example you might have the sensation that you are moving because the train beside you is leaving the station. In this universe without absolute rest however light, which is our medium of awareness, has an absolute speed of 300,000 km/sec. No matter the direction or the speed of your system of reference (imagine yourself in a little rocket) you will always have the same measurement results indicating the constant speed of light. If you travel, for example towards a star with a speed of 100,000 km/sec the speed of the light beams that fly in your direction remains 300,000 km/sec. instead of 100,000 + 300,000 km/sec. In the relativistic universe of astrophysicists the medium of awareness called light, and its properties, functions as sort of ideal medium. From that ideal physical medium other ideals are derived, such as the exact ideal measurement of the meter. In reality however one would not be able to make something with a length of exactly 1 meter or to measure it. The reality of a meter does not exist in the physical world, but functions among others as an ideal for scientific and technological perfection.

Ideals and relativity in the therapeutic setting

I was surprised to learn that there are homeopaths who doubt the purpose of life. First of all, one can see in my case history of Jill, how important the intention to look for one’s individual purpose can be for a speedy recovery. In the midst of her crisis Jill lost faith in her life, couldn’t see any purpose and became suicidal. The purpose of life can be compared with the physical concept of light and its properties. Light as a medium of awareness illuminates the ugly and beautiful aspects of life. It’s here and yet it is out of reach of physicists. The purpose of life is also an ideal, and striving for it is health enhancing and essential for survival. Jill’s search for purpose was a quest for who she really is.

Who we really are is what we refer to as “I”. “I” is the centre of my being. I only can call myself “I”. I have the final say in who I am. “I” is the final observer in each of us. All values in the world are relative with respect to the frame of reference that I make use of in order to function in daily life. My frame of reference or ego is my conscious of me, in relation to situations in life, and is driven by unconscious drives. Stepping beyond the secure patient-practitioner duality is aided by the acknowledgement of the universal triad of 1) observer 2) frame of reference and 3) reality.

A reply to Edward de Beukelaar’s article

I really appreciate Edward’s constructive contribution to the debate on miasms. I did not have time to integrate Edwards reply where he says: Disease can be defined as the result of a ‘wrong perception of reality’. iii With the inverted commas he expresses uncertainty about what a wrong perception really means…if it is wrong or not? He seems to refer to a convention that all homeopathic practitioners share. In the next sentence he attempts to define reality. Of course in this definition the ‘reality’ is not the interpretation of the patient, or the practitioner or anybody else, it is the circumstances in which the patient lives: the combination of outside and inside influences (known or unknown).

I fail to see the logic in Edward’s assertions, for he completely ignores the observers of that reality who are the patient and the practitioner. Correct me if I am wrong, but I gather from his other statements, that in his opinion it is undefined reality that dictates the correct interpretation. Wouldn’t that be contradictory to common sense? Is the reality of a traffic accident not relative to the point of view of the witnesses? To me it is obvious that disease is real and not a wrong perception; not even wrong’ as in Edward’s opinion. The experience of disease is a truthful observation, but relative with respect to the patient’s and practitioner’s point-of-view. At the start of the consultation, the patient has a perspective from within and the practitioner perceives it from the outside. The discrepancies in findings result solely from differences in the frames of reference that ‘I’ and the other make use of. Through the attitude of compassion the homeopath is, to a certain extent, able to adapt to the frame of reference of the patient leading to the acknowledgement that anyone in such a position would have a similar experience of disease or reality. I am sure that if my critic John Harveyiv and I had the opportunity to talk face to face about our conflicting perspectives on the multi layered reality of chronic disease, we certainly would have been able to find a solution.

While describing his/her disease, the patient is actually talking about his/her frame of reference, for this is generally the only way one can relate to his/her physical body and the outside world.

Physical symptoms versus mental/emotional symptoms

Here I have the opportunity to address one of Mr. Venkatesh’s comments in reply to Edward de Beukelaar’s article in the March issue. Thanks to people like Mr. Venkatesh and Edward de Beukelaar, I am able to sharpen my mind. Mr. Venkatesh distinguishes dualistically between reliable physical symptoms and mind symptoms. He concludes that physical symptoms are the only and sufficient indicator to the selection of the best curative agent.v

In my opinion, a dualistic approach to the nature of pain cannot be satisfactory for the homeopathic prescriber. In neuroscience they can describe objectively how tissue damage causes mechanoreceptors to generate signals, how these signals travel from the periphery to the central nervous system and what areas of the brain are involved, etcetera. Neuroscientists have been able to demonstrate the mechanisms underlying pain in extreme detail, but are not able to handle the descriptive subjective part which IS the expression of the pain. The tissue damage is objective, but they are not able to pinpoint the direct causal relation between the signals and the actual pain sensation. The pain sensation is subjective and very real. The pain is real with respect to the patient’s frame of reference. Homeopathic ‘energy’ remedies influence first of all the patient’s frame of reference, after that the healing of tissue damage will follow. A good homeopathic cure starts at the mental/emotional plane and progresses to the physical level. So, when describing the sensation of physical discomfort and pain, the patient speaks about his/her frame of reference and not as much about the tissue damage. The appearance of tissue damage can be helpful indeed, but a peculiar pain sensation is generally more decisive in case analysis.

Therapeutic intentions

The therapeutic intentions determine the type of questions we ask and the questions we ask have a big influence on the focus of the consultation. If our intention is to find the root of disease, the focus will be predominantly on the entire negative that occurred in the patient’s life. If on the other hand we complement the usual questions with questions about the positive aspects of one’s life, the focus is more balanced. The questions for memories of positive events trigger the patient to talk spontaneously about obstructions to their happiness. Like I have explained in Jill’s case history, a balanced focus creates an opportunity for patients to make sense of their lives and increases their ability to accept life for what it is. Acceptance of one’s burdens is the first step towards health. Besides that, and this is really important, a balanced interview will result in an indicated remedy that directly relates to the obstructed self-actualisation of the patient. In that way one treats the acute manifestation of chronic unwell BEING always first, which is completely in line with Hering’s principles.

A meditation exercise for acceptance and affirmation of the life here and now.

Writing the articles for Homeopathy for Everyone inspired me to do a meditation exercise which I developed myself. This meditation exercise is based on the threefold principle. Over the last 3 months or so I have done this exercise every morning for about 1 or 2 minutes diligently and I will continue to do so. After a while I noticed that it increased my ability to accept and affirm the moments as they come. This simple exercise goes as follows:

  • Recall a pleasant experience, hold on to it and relive it a little.

  • Recall an unpleasant experience, hold on to it and relive it a little.

  • Recall an experience in which you’ve accomplished something, hold on to it, relive it and feel what it felt like.

  • Use the feeling that accompanied that specific accomplishment to affirm all the things you intend to do that day.

I won’t spoil your meditation experience by telling about my experiences.


The threefold principle is based on our psychological constitution. If the homeopath has the intention to help the patient to self-actualise, he/she needs to step beyond the patient-practitioner duality. When doing so it is even more important to be self-aware, in order to avoid personal entanglement in the patient’s affairs. As homeopaths and patients we are gifted with a frame of reference. For the homeopath this frame of reference is the therapeutically trained ego, and is similar to the concept of a frame of reference in physics. The acceptance of the frame of reference affirms the clear therapeutic intention to take the patient 100% seriously, and urges the practitioner to do self-exploration. Even delusions are true and objective, but very relative with respect to the patient’s frame of reference. Acceptance of the frame of reference is also beneficial for each homeopath who wishes to step beyond the patient-practitioner duality. A truly non-dualistic consultation through an undefined therapeutic attitude that is aided by a complete openness and is characterised by the point of view of the patient, requires us to be even more aware of our intentions. Keeping the focus on both negative and positive aspects of life, will help the patient to independently give a sense of purpose to his/her life, and will result in remedies that stimulate self-actualisation.

About the author

Jeroen Holtkamp

Jeroen Holtkamp, I.S.Hom. studied homeopathy in the Netherlands and has been practising in Ireland since 2003. From his mid teens Jeroen has had a passionate interest in physics, philosophy, psychology and spirituality. Throughout his study and professional career he maintained and gradually developed, an independent but integrative vision on health, disease and homeopathy which benefitted his practice immensely.

1 Comment

  • To whom it may concern,

    A consistent implementation of the threefold principle in the therapeutic aspects of homeopathy, the case analysis, remedy selection and its philosophy raises, among others the following critical question: What is the placebo effect with regards to the homeopathic cure? I do not have an answer. What I know is that the placebo effect is very beneficial in both homeopathy and conventional medicine. Recently I heard a Doctor in Traditional Chinese Medicine on the radio, I can’t remember his name, who suggested that including the benefits of the placebo effect in medical trials would save a lot of money. I have many questions. Do we fully acknowledge the power of the mind? How does the dynamis fit in? What causes the inability to feel injuries, in some people with Autistic Spectrum Disorder Syndrome? Perhaps we have developed a negative attitude towards the placebo effect to please our deeply rooted materialistic nature?

    Author of the article: “The Threefold Approach to Therapeutic Intentions”,
    Jeroen Holtkamp, I.S.Hom.

Leave a Comment