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How Much Is Too Much?
heart of bodywork

By Nina McIntosh

Originally published in Massage Bodywork magazine, January/February 2009. Copyright 2009. Associated Bodywork and Massage Professionals. All rights reserved.

Because we want to create a relaxing atmosphere for clients, I've often cautioned against talking too much while working. But how much is too much? Two recent letters from readers challenge the idea of needing total quiet and offer examples of times when being more verbal can be helpful.

Although I agree with you in general about not conversing with clients while we work, my current work setting has, more or less, made chatting a necessity. I work with a chiropractor who is warm, friendly, and very informal with his patients (whom he often refers to me). He has known many of these people for a very long time, and during his treatments he talks with these patients as you or I might talk with a coworker--sharing stories, information, or opinions about family, vacations, politics, etc.

When I began working in his office, I tried to maintain a firmer professional and personal boundary, keeping my conversation with clients focused strictly on the work. This confused and baffled many of them, as they were accustomed to a more chatty level of interaction, and some of them misinterpreted my behavior as emotional distance, personal coldness, or a rejection of their desire to get to know me.

In the end, I have chosen to adapt my style so that it more closely matches the doctor's. I still maintain a professional demeanor, honor patient confidentiality, and uphold ethics and standards of practice. At the same time, I have come to realize that every clinic or group practice has its own distinct dynamic, and there are myriad ways to express professionalism and maintain good boundaries.

Carl K., Boise, Idaho


Dear Carl,
Thank you for your thoughtful comments. This is a great example of adjusting your style for the sake of your clients' comfort. The key here is that you haven't lost sight of your professional role and your focus on clients' well-being. You're choosing to chat in order to gain clients' trust, not because of your own social needs.

Although it sounds as though you've worked out an appropriate and useful way to engage your clients, there are still some things to watch out for. For instance, you say the chiropractor has "known many of these people for a very long time." In that time, he's probably learned what topics work and don't work with particular clients. Unless we know a client, it's best to stay away from hot button or controversial issues such as politics or religion. Even if your views seem to be the same as the client's, some topics just aren't relaxing. If the client brings up a controversial subject and your views are in fact different, it's best to keep them to yourself, keeping in mind that the client isn't paying you for your opinions on public matters.

Nor is it appropriate--at any time--to share your personal problems with clients or anything more than light-hearted comments or complaints about your family life. Saying that your husband (or wife) snores also isn't the same as burdening a client with details of your latest marital spat.

No matter what the situation, let the client take the lead in talking and respond as little as you can (without being rude). Some clients may appreciate a little small talk and others may be yearning for quiet.

The lesson your letter teaches us is to be flexible about rules and bend them when they interfere with our clients' sense of security. Don't forget your professional role. Even though we may act friendly with clients, it's not like hanging out with friends--as you remind us. Our professional responsibilities should still be uppermost.

I know you've said, "Don't ask questions or talk in such a way that clients have to think to respond to you." I think that's appropriate if a client is there to receive a relaxation massage. However, for those massage therapists who provide clinical or medical massage (neuromuscular massage, muscle therapy, or deep-tissue work), it is imperative that they communicate often with the client regarding trigger-point locations, pain levels, sensations, and tissue responses.

As part of my treatments, I ask clients to rate their pain, describe it, and provide immediate feedback as I am working in their problem areas. I tell them, "Although I can feel the shape and consistency of your muscles, I cannot feel what you feel inside." I suggest, "On a scale of 1 to 10, with 10 being excruciating pain, what number am I on when I press here?" I'm not trying to interfere with their relaxation, but in order to address the tissues without causing damage (or making the muscle tighten or guard), I need them to share that information with me."

Bob L., Austin, Texas


Dear Bob,
Thank you for your comments. I agree that techniques with specific pain relief in mind require more communication with some clients than with others. Even with a massage that has pure relaxation as the goal, we may want to check in occasionally with clients.

One issue that I need to clarify is what thinking means--when we say that a client shouldn't have to think to respond to our questions. The concepts of right brain and left brain are useful here. The left brain is the side that deals with the logical, analytical, and rational aspects of our lives; the right brain is more intuitive, creative, and subjective.

Left brain is what we want less of when clients are on the table--we don't want them planning what to have for dinner or worrying about how to solve their work problems. That will not help them be in a relaxed state. And even for the more technical kinds of work, we want the client relaxed, open, and receptive.

During a session, we don't want to engage clients' left brain, for instance, to make them focus on a complicated explanation of how the body works or to answer a detailed question. Harmless as it seems, asking, "How many times have you hurt this foot?" requires a client to go too much into his thinking and analyzing left brain, as he tries to remember and count all the times the foot had been hurt. However, clients can easily answer questions about how they feel or describe a pain level without revving up the left brain.

One way to help clients stay calm and peaceful is to be conscious of how you use your voice. Rather than talking in your everyday speaking voice while you're working, use a lighter tone and softer volume than you would in normal conversation.

Also keep instructions simple. For example, some people have trouble distinguishing between right and left, and even people who don't, when they are deeply relaxed, may have to think to remember which is which. It can be helpful just to tap lightly on the appropriate side and say, "Would you turn over on this side, please?"

I've collected a variety of feedback from other bodyworkers on useful ways to get information about how the client is doing. Some find the 1 to 10 pain scale effective, others think that even that much calculating can be confusing. They prefer making sure that the client knows to tell them to ease up with painful touch. Still others say they mostly gauge a client's pain by noticing physical cues from the client--tensing up, frowning, and so forth. And some suggest varying what you say in accordance with how much body awareness a client has, checking in more with those who aren't as tuned into their physical sensations.

No matter how and what we decide to communicate with our clients--and ask that they communicate with us--the bottom line is always client comfort and satisfaction. Keeping professional boundaries in mind, whatever the form of communication with clients--whether a little bit of contact-making chatting or inquiries into physical response--our goal is always to attend to their health and well-being.

Author's note: special thanks to my online forum for their contributions.

Nina McIntosh combines more than 20 years of experience as a bodyworker with her previous years as a psychiatric social worker. She is the author of The Educated Heart: Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers (Lippincott Williams Wilkins, 2005). To learn more about professional boundaries and ethics, visit www.educatedheart.com.

To learn more about illustrator Mari Gayatri Stein, visit www.gypsydogpress.com.




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