In Reiki First Degree (Level-1) course, the students are taught a certain set of hand positions that might vary from teacher to teacher. It is quite simple without any complications, yet, at times students from other Reiki lineages ask me for clarifications, which should not be required if they are trained properly. The count of hand positions differs with different teachers but is generally between 14 and 18. Whatever be the count of those positions (also called points), it does not really matter much because those are taught as guidelines NOT to be taken as final, binding and unchangeable. You do not have to restrict yourself only to those positions.
In Reiki healing session, you can place hands wherever needed, on as many positions as required. Basic requirement and important part is to treat all the vital organs and important areas of the body. As long as this is done, count or sequence of hand positions is immaterial. A set sequence is taught so that as beginner, you get used to treating all the important organs. In the beginning you may go by the sequence taught during the course but as you practice, you can follow your own sequence that you think might be more useful. The hand positions may vary on case to case basis depending on which areas require the healing or more attention. For example, if your recipient has pain in the elbow but your training manual does not show a hand position on elbow, that does not mean that you cannot or should not treat the elbow. Do it wherever and on as many positions as required.
You need not worry about direction of hands either. It would change with change in your or recipient’s position. Whichever way you place the hands according to the situation, is fine. Remember that Reiki energy flows by intention. As long as your intention is right and positive, there are no mistakes and complications. Simply place your hands where necessary and that is it, nothing more. Go by your intuition, practice and enjoy.