Originally published in Massage & Bodywork magazine, October/November 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

If you are a professional dedicated and committed to growth and you are truly invested in helping your clients heal, then you are continually looking for ways to support your process. That process necessitates increasing self-awareness, lowering resistance to change, eliminating self-defeating behaviors, committing to exemplary attitudes and beliefs, and creating a greater degree of maturity, energy and the feeling of being wholly alive.

However, in order to preserve the momentum of growth, we need to take a self-assessment every once in awhile to ensure our own behaviors, feelings and thoughts are not so influenced by the past that we unwittingly come to the table with unfinished business which may impact our clients.

That is what the term "wounded healer" means. It comes from the field of psychotherapy and was derived from the concept of counter-transference. In essence being "wounded" is like having an injury that did not heal. For example, the wound may be a need that was not met in our childhood or some way we were mistreated or neglected. Yet we may walk around not knowing it or not wanting others to know. This is a form of denial that can lead to unclear motives and communication with our clients. An example of counter-transference is when you unconsciously see in a client one of your parents who was ill or who died prematurely. You now have a vested interest in healing the client, not only for the client's sake, but to heal your wound derived from not being able to save your parent. Sound far-fetched? Not at all. Many examples of this theory abound in the annals of psychology.

According to human behavior and personality theories, we know we are a unique combination of body, mind, emotions and spirit, as well as the memories of our past experiences. In addition, many factors from our childhood (upbringing, school interactions, extended family, etc.) are responsible for the development of our adult functioning. These factors also influence our responses, reactions, choices and decisions.

We all have some chink in our personality because our wounds affect the way we interact with others. It may manifest by not being able to function in a rational manner. Instead of responding logically to a situation, we put up defenses we developed during childhood. For example, if we learned it wasn't safe to express our needs and feelings, we will hide the wound from others. These maneuvers, however, limit our objectivity. It can restrict our ability to hear and understand vital information a client brings us. This can lead to indecisiveness and can limit our ability to make wise treatment plans.

To come to terms with your wounds means understanding human behavior and the self-defeating patterns that crop up in various interactions with clients. To have a successful practice you need to maintain constructive adult-to-adult communication without the past impinging on the present. Having the knowledge of your past psychological traumas and how they still may be impacting you professionally will allow that to happen.

To best understand if you have wounds from the past and how they are manifesting themselves with your clients, I will turn to Gestalt theory to illustrate. Gestalt theory views defenses as mechanisms to hide our wounds from others and ourselves. Gestalt focuses on present experiences to bring into awareness the childhood traumas. These defenses can be physical, such as muscle tensions and restricted breathing, or verbal in the way we interact with our clients.

The greater your "knowing" of your wounds, the easier it is to understand on a deeper level how you erected defenses as a child to cope with any danger to your survival. We then understand we no longer need these defenses because the old danger doesn't exist anymore. What was frightening to a child is no longer valid for an adult. By releasing the held emotions and tensions and allowing energy to flow, we can experience a fuller sense of our being, resulting in more effective coping skills.

The reason many of us keep our wounds hidden is we believe re-experiencing the wound will be too much to bear. However, if you are ready to see how your wounds show up in your practice, I have defined each of the Gestalt theory of defenses below, what you can do to heal the wound, and how you can respond to your clients in a healthier manner.


Projection
This defense works to keep unpleasant information about us out of our conscious awareness by seeing the unacceptable trait in others.

Kevin has a client who is demanding and overbearing. Kevin is contemptuous about how his client behaves, plus he takes it personally and feels hurt. Kevin's contempt is a clue to how he feels about himself, as he has been known to be domineering with his friends. His feeling hurt is a projection of acting hurtful to others.

Healing the Wound: Kevin needs to focus on accepting himself, warts and all, and own his projections.

Communication Skill: Attuned listening. To neutralize this client, first know they are taking their anger at themselves out on you. You can defuse an outraged client when you know it is easier for them to be upset with you, than to be angry with themselves. Show you understand their feelings and their distress. Another technique to end anger is to find one thing in their diatribe on which to agree.


Denial
This defense is quite effective in keeping unacceptable emotions out of awareness.

Each time Audrey has a client who will not give up control to her ministrations, she tells herself it is not a problem. But she often gets a headache when it happens. She is not consciously aware the client's need to "win" is touching off a childhood pattern of her mother trying to control her. However, the reality would be too painful for her to acknowledge.

Healing the Wound: If you had a controlling parent and you learned to hide your rage or helplessness from them, it is time to bring your emotions to the surface and support whatever feelings come up.

Communication Skill: Before having a dialogue with the client it is essential to center yourself with deep breathing and grounding. Understand that your client's fear of being vulnerable and having an emotional release may be causing them to keep the control. If they have not verbalized this, it is not your role to bring this to their attention. What you can do as a massage therapist is to ask them what kind of massage they would prefer.
Scapegoating
Scapegoating is another form of denial. It is a "kicking the cat" reaction to frustration and inner conflict.

Jane was working with a client who stopped her treatment prematurely. A week later she heard the client had gone to another therapist. Jane felt rejected, but instead of sorting out her feelings, she went home and started a fight with her husband.

Healing the Wound: First, an examination of any problems you may have with rejection are in order. For example, a parent who rejects a child, even in a small way, gives the child a message they are either not loved or not good enough. To heal this wound let yourself know the present is no longer a reflection of the past. You are an adult now and can handle clients leaving, for whatever reason.

Communication Skill: Without being invasive it is perfectly okay to call a client and ask why they decided not to return. If you phrase it in a way in which it would be helpful to know if there was anything you missed so you can better serve your other clients, most people don't have a problem responding. However, if they can't (or won't) tell you, the best thing is to refocus your efforts and energy on getting new clients. It is not uncommon for clients to "play the field," looking for the perfect therapist and the perfect cure.


Rationalization
This is a complex defense, because at first glance there is a belief in being right.

Every time a client said they couldn't pay the entire fee, Eric would justify to himself that because he was a healer, it was okay to see them for a lower fee. However, some place inside him, Eric did so because he believed he wasn't worth getting a normal fee.

Healing the Wound: Low self-worth is the foundation for rationalization. If you are ready to examine how you feel about yourself, and in the process find an undeserving self, you will need to do some hard work to raise your esteem. Start with challenging your belief system and see if what you believe about yourself is today's reality or a holdover from the past. Then work on affirmations to strengthen your current self-image.

Communication Skill: Shifting gears. First empathize with them and show you understand their difficulty. When they see they will not lose face they are more apt to be open to your next statement. Then you say you would be willing to work with them. However, the lowest fee you charge is $XX. This way you have decided what you are worth. If the client declines, let them go cordially. That is the difference between a poverty mentality and one of abundance.


Suppression
This is a defense most people are somewhat aware they are employing. The reason it is a defense is that it is not honest.

Janet demonstrated to a new client several different types of massage she was proficient in and each one was rejected. She thought two of them were more than suitable for this particular client and was angry, but did not want to show it. However, her body knew how she felt and she got a severe headache.

Healing the Wound: Anger is a volatile emotion most people are not comfortable exhibiting. Yet when we don't have another option for our anger, we either explode or implode. More than likely when Janet showed her anger as a child she got punished. She quickly learned to suppress it. However, her mother was constantly taking her to the doctor for hives. Learning how to express all our feelings in a healthy and appropriate way can heal the wound. Here are some suggestions for Janet: beat a pillow with a tennis racket, go to a place where no one can hear you and scream as loudly as you can or talk to a trusted associate or a supervisor who can hear and acknowledge your emotions.

Communication Skill: Show the client you don't have a need to know what is right for them. It may be that in their childhood no one understood what they needed and now they themselves don't know either. Demonstrate a sincere desire to give them what they want and if you find out you don't have the necessary skill they are looking for, refer them to another therapist you know does.


Symbiosis
This defense is a boundary issue. It is as if you and the client are one. You know what they need, but it is really your need.

Joe was usually an effective communicator, yet with this client he felt at a loss for words when she started crying during a treatment. Some clients may try to make you a part of their problem. If you get "hooked" or, in psychotherapy language, you have a counter-transference reaction, you will find yourself on the defensive. If you show your helplessness, like Joe did, you will only end up alienating the client and feeling guilty or angry with yourself for letting your emotional buttons get pushed. It was not part of Joe's work ethic to make the client's feelings go away. It was his "job" to be calm and understanding.

Healing the Wound: It is not an overstatement to say many of our wounds stem from our childhood. This particular wound has to do with a parent keeping his or her distance from their child so that the child never feels totally wanted. This creates a never-ending need to connect and can sometimes exhibit itself in the treatment room with a client. Remedies include: maintaining strict boundaries with clients, checking your intentions before every session, and analyzing how you treat yourself. For example, Joe should ask: Do I like myself? Am I kind to myself? Do I see that my needs are met? Are my personal relationships satisfying? Answering these questions honestly will give you information about the nature of your wound.

Communication Skill: Empathy is the most effective communication approach to use when the client has an emotional reaction during a massage. You need to put yourself into your client's shoes, not into their emotions. This "stepping back" keeps your reactions in the proper perspective. You can acknowledge they're upset. Then simply let them know you have felt what they have felt and gradually bring the focus back to their massage.


Introjection
The defense of introjection gets put into motion when it is not safe as a child to have our own opinions or even, our own identity.

We swallow whole, so to speak, whatever we hear. In other words, we take in information without questioning. Simon found himself doing that with a particular client who talked without end about his physical problems. Rather than ask for medical records or a conference with his doctor, he took at face value his client's self-diagnosis.

Healing the Wound: Simon needs to trust his intuition, his common sense and his experience as a professional. To do that, he needs to reinforce his gut reaction something is not right, rather than just adopt someone else's words without checking out the reality.

Communication Skill: In working with a client who may be a hypochondriac, assertiveness skills are vital. The use of "I" rather than "it," "one," "we," "you" or "they" keeps the context in the present. Having a detailed intake form with a place for the client to agree to have a conference with a physician they are seeing, when necessary, and to know any drugs they may be taking is vital to staying ethical and legal.

In closing I would say the defenses profiled here tell a story. The tale they tell is one of self-limiting professional behaviors based on mostly unconscious needs. Fritz Perls, the creator of Gestalt Therapy, embraced the concept that each of us seeks to be whole. This does not mean being defense-free, it means being aware of when we are using defenses to our detriment. It may be impossible to obliterate the past, it may be difficult to give up outdated ways of thinking, feeling and behaving. All we can do is be committed to doing and being our best. In the last analysis, that is all we can realistically hope for.

Arlene Alpert, MS, LMHC is president/CEO of Jupiter Consulting & Training Institute, a business relationships and communication specialist, educator and author with more than 23 years of education, experience and expertise. She is a NCTMB continuing education provider with her course, "Client-Centered Communication." She has presented workshops and retreats in the United States and abroad, and offers her successful TellTalkTM -- Telephone Consulting. Her latest book is Traveling Beyond Life's Roadblocks: Creating A Life Of Choice and a manual, Helping Clients To Heal. For more information about her services, call 561/744-4988, e-mail ALPERT10@aol.com or visit www.arlenealpert.com.