In 1948, William Sutherland had an "Aha" moment that expanded his perspective on cranial osteopathy, a field he created that eventually gave birth to three bodies of CranioSacral Therapy: Upledger, Biodynamic and Visionary. Years earlier he noticed the beveled sutures of a disarticulated skull and realized the cranium must be built for motion. Now he had another inspiration that would once again alter the shape of Western manual therapy.

"He had his hands on a patient and spaced out just enough to get out of the way," says Michael Shea, PhD, author of Biodynamic Craniosacral Therapy. "Suddenly he observed a force in the body that was making corrections without his having to add any force to the system. He began writing about the need to have reverence in our hands for this self-correcting power."

That reverence for the power of the human body lies at the heart of each model of CranioSacral Therapy (CST). Yet each one has its own personality. Here for the first time, three CST instructors discuss their shared history, what unites them, what distinguishes them, and what the future holds.

The Membrane Model: Upledger CST

There's one fact all three instructors agree on: The man responsible for delivering CranioSacral Therapy into the hands of manual therapists is John E. Upledger, DO. "He had the courage to take what, until 1985, had been called cranial osteopathy and encourage people who weren't osteopaths to study it," says Hugh Milne, DO, author of The Heart of Listening: A Visionary Approach to Craniosacral Work.

Upledger's journey began with his own "Aha" moment in 1971, when he was assisting in a neurosurgery, explains Don Ash, PT, author of The CST Handbook. "They were opening up the patient's spine to remove a piece of calcified plaque from the dural tube." Upledger's job was to hold the dura still, but he couldn't stop it from pulsing in and out of the incision site, and no one in the surgical suite understood what was causing it.

Intrigued, Upledger set out to resolve the mystery. His path led him to Sutherland's theories and he went on to become a skilled cranial osteopath. Then in 1975 he received a research grant from Michigan State University that would mark another turning point in the evolution of cranial work. "He gathered 22 scientists and researchers who were charged with proving or disproving Sutherland's theories," Ash says. "They came up with compelling studies demonstrating that cranial sutures aren't fused as everyone had believed. Finally, they had scientific evidence supporting Sutherland's theories on cranial motion."

Upledger also studied the effects of CST on autistic children. "When he liberated their cranial sutures using gentle techniques focused on the craniosacral system membranes, their behavior improved," Ash says. "They became more social, more engaged in the world." Upledger noticed some kids had emotional outbursts in session and became more interactive and responsive afterwards, leading him to expand his CST model to encompass SomatoEmotional Release.

"John was so inspired, he wanted to gather up all the cranial osteopaths he could find, put them on a bus and travel to different schools to work with these kids," Ash says. As the story goes, he could only find three cranial osteopaths, and none of them wanted to get on a bus. That motivated Upledger to dedicate his life to teaching CST to as many people as possible.

"Upledger said CranioSacral Therapy belonged to the world, and it's not the exclusive domain of any medical specialty. He began teaching osteopathic students, PTs, OTs, MTs, teachers, nurses, parents of special-needs kids, anyone with knowledge of basic anatomy, good intention and a gentle touch."

The Core Intention: Blend and Trust

In Healers on Healing, Benjamin Shield, PhD, dedicated the book to "Dr. John Upledger, who taught me that the shortest distance between two points is an intention." That focus on the intention of touch is another trait at the heart of each body of CranioSacral Therapy. The core intention of Upledger CST is to blend and trust, Ash says. "We use all our senses to feel the innate movement of the central nervous system. We blend and listen as the cranial rhythm guides us to tissue restrictions. Then by way of gentle techniques and good intention, we invite the body to change."

"Andrew Still, the father of osteopathy, said anyone can find disease, but how do we find health?" said Ash. "We can't cure anything with CST. We simply facilitate the patient's self-healing. It's virtually risk-free. In 25 years, I've never seen an adverse reaction."

A Modality by Any Other Name

As Upledger refined his body of work, other osteopaths and manual therapists were evolving Sutherland's insights to create their own models of CST. Yet Ash believes what distinguishes them comes down to semantics. "We all agree there's a rhythmic movement of the central nervous system and healing potential of the cerebrospinal fluid. We agree with the osteopathic principles that the body is an interrelated unit, function follows structure, and the body has all the pharmacopeia it needs to heal itself. Allopathic interventions may be helpful at times, but the body has self-healing capability. And we all agree with using as little manual force as possible."

Finally, Ash says they all appreciate the potency of cerebrospinal fluid and recognize that it has consciousness, "although I'm grateful that Biodynamic and Visionary expand on this. I think there's a lot to be learned about the nature of fluid in the system."

The Fluid Model: Biodynamic CST

When Michael Shea heard the words "cranial work" as a massage student in 1976, a light bulb went off in his head. "I had to learn it, so I rushed to every course I could find. But it was all underground, taught only by osteopaths in weekend workshops." One of those osteopaths was John Upledger.

Shea went on to teach at The Rolf Institute, but by 1981 he felt burned out using so much pressure every day. "Craniosacral has such a light touch. I knew it would save my neck, my spine, my joints, my whole body. So I threw myself at it again." Five years later, Upledger invited Shea to become one of his first CST instructors. He accepted the invitation and taught for about a year before opening his own school so he could also teach Myofascial Release.

Along the way Shea heard about James Jealous, DO, who had continued developing Sutherland's cranial osteopathy along the lines of the Biodynamic approach. "I wanted to find out if Biodynamic was the next evolution of cranial work," Shea says. "Jim gave me a year-long series of phone interviews and it quickly became clear that this was a different orientation to cranial work. It came from Sutherland so it was part of the cranial lineage, but it came from what he'd been developing before he died when he had the inspiration that the body has self-healing power associated with a tempo much slower than the cranial rhythm."

The Biodynamic model is based on synchronizing yourself with that slow body tempo, called the "long tide," rather than faster rhythms like the cranial rhythm, Shea says. "There was something Sutherland noticed about this deeper tempo that's systemic and three-dimensional. It has a potency to make changes in the body, and it has its own ability to direct the therapeutic process. I tell my students, 'Most of us learned to work on 8 percent of the human body. But because Biodynamic work extends to all the fluid sub-compartments as one entity called the 'fluid body,' we get to work on 92 percent of the human body.'"

The Biodynamic Dance

The central focus of a Biodynamic session is self-awareness. Shea says, "When you're learning, you've got to spend 80 percent of a session tracking your own three-dimensional wholeness. Then you bring that attunement to your client. Later it becomes more like 50/50, but first you learn to get grounded and embodied so you can trust your own sensory process, because when you're with a client you read them with your whole body."

It's a practitioner-patient dance, he says. "We can't keep our attention on a client for 45 minutes. It'll send the autonomic nervous system off the charts. So we learn to dance in cycles of slow attunement. The practitioner brings his attention to the client, then back to his own body to monitor himself. Then he may move his attention out the window to look at a cloud, then back to the client again. Ultimately, the practitioner is looking for whether the client's fluid body can breathe as a three-dimensional whole with the long tide. This rhythmic cycle rebuilds the nervous system."

A Distinction of Timing

After Sutherland developed the cranial concept, Shea says several decades were spent refining the mechanical model. "But after a while, working on the parts wasn't enough. Osteopaths noticed that the parts had a relationship to the whole systemic physiology of the body. That's when the functional model began. Now the spirit of Biodynamic work, which starts with the whole and moves toward the parts, is becoming embodied in the different models."

According to Shea, Upledger CST is a highly effective functional model. "It's got wholeness in terms of its focus on neurophysiology and fascia." And Visionary brings a spiritual dynamic and a welcome emphasis on the heart. "The main difference is that Biodynamic focuses on the long tide as a perceptual process in a two-person biology between the therapist and client. Then we wait for the stillness. In stillness is the renewal."

The Mystical Model: Visionary CST

The Visionary branch of CST goes back to 1899 when Sutherland was studying under Andrew Still, says Hugh Milne, DO. "In Contributions of Thought, Sutherland said, 'You might say Dr. Still was like an X-ray. He could look right through you and see things without putting his hands upon the body. Time and again, Still walks in the door, points to the model and says, 'Look, that's what's wrong.' He didn't touch the model, but he could see it.'"

"I began having similar experiences at osteopathic school," Milne explains. "A patient would walk in and I instantly knew what was wrong with him. Frankly, I doubted my sanity." His quest to understand led him to India where he lived in an ashram and worked at a multidisciplinary clinic. He was finally free to practice osteopathy any way he wanted. "I learned Shiatsu and deepened my meditation practice," Milne says. "All that evolved into Visionary Craniosacral work."

Angeles Arrien, a shaman and teacher, said a visionary can perceive four things at once - the physiological parts, the physiological whole, the client's spiritual journey and his own process -- and treat all four equally. "That's one of the foundations of the four-fold understanding of Visionary Craniosacral," Milne says. "But the genius of the work is simply the magic of what happens between two people."

Milne has a special appreciation for CST as a spiritual practice. "The honoring of stillness is a spiritual practice to me, so meditation is my preparation for Visionary work. Rumi said, 'There is a way between speech and presence where information flows. In disciplined silence, it opens. In wandering talk, it closes.' When I get silent, the channel opens. On a good day I'm picking up information with my inner ear. I'm sensing the client's soul journey with my own heart and soul. And I'm doing my best through tactile and verbal means to help my client regain their inner path."

Visionary work also encompasses tools of classic shamanism, such as soul-retrieval, ritual, and the healing power of nature. Ultimately, the intention is simply to set someone right. "The ancient salutation on arriving at the shaman's doorstep is, 'I come to you in order to see,'" Milne says. "That is, I'm having a difficult time. I'm sick. I've lost my bearing and can't manage on my own. The intention is to set this person right, to bring them back to their true self. With Visionary work, I see a radiant human being standing in his own power and beauty, in touch with his gifts, his genius. The practitioner's job is to help someone be in their radiance, not simply let go of a symptom. We help create an open heart, a clear head and a free body."

The Modality That Shouldn't Be Named

"I have great respect for other styles of cranial work," Milne says. "Upledger seems to follow Sutherland's classic teaching. Biodynamic has evolved Sutherland's work in the realm he was most fascinated with the last few years of his life, the wisdom in fluids. It also honors stillness and the Taoist understanding that what needs to happen will happen if we create an open, non-directive field. When given an open space, the human body and the soul's wisdom will rise to the highest good for body and soul."

Visionary comes in with a focus on the human being as a soul on a journey. But in the end, Milne says, distinctions don't matter. "The client is oriented to a therapist, not a therapy. I once had a dream that Sutherland walked into my room, looked at me kindly and said, "You shouldn't try to name it. None of the names are right." I woke with a start. Was it a visitation? A fantasy? I don't know, but the words ring true. Whether it's Upledger or Biodynamic or Visionary, you shouldn't try to name it. None of the names are right."

From Inspiration to Evolution

Today, all three bodies of CranioSacral Therapy inspired by Sutherland continue to evolve. "When I began teaching in 1984, I thought this was a fad," Milne says. "Instead it's grown every year. Ida Rolf once told her students, 'If any one of you is only practicing what I've taught you five years from now, I will have failed as a teacher.' That's a good teacher. Every practitioner needs to find and follow their own genius."

Author's Note: Spelling alternates between "CranioSacral" and "Craniosacral" based on each instructor's preference.