Quality of Touch
The Core Synergy between the Art and Science of Bodywork
By Clint Chandler and Christopher Quinn, D.C.
Originally published in Massage Bodywork magazine, February/March 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
Among the plethora of specific techniques in the manual therapies, there is a single concept on which they all crystallize: Quality of Touch (QOT). While it is possible to perceive QOT as a product of the therapist's innate ability to attune herself to her clientele, it is much more realistic to see it as an integral skill which can be taught, learned and constantly improved.
QOT is a keystone to therapeutic effectiveness and client satisfaction. The synergy between excellence in technique and QOT leads to great therapeutic trust, rapport and receptivity by the client.
Our focus on QOT begins with the assumption that a practitioner has specific technique competency, anatomical knowledge and fundamental manual skills. Development and enhancement of QOT begin with defining the concept. There are three fundamental components: communication, kinesthetic differentiation and sequencing.
Communication is inherently complex, involving two individuals giving, receiving and interpreting messages. The interplay of focus, intention and the emotion of both defines the therapeutic environment. Professional manual therapists are acutely aware of the importance of basic verbal interactions with each client.
We would all agree asking the client for feedback on your touch is routine. How we ask for this feedback is an important consideration. We have all heard or used the phrase "Let me know if the pressure is too deep." But what do these words potentially mean to the newcomer to bodywork? When should they "let you know"? The words "too deep" and "feedback" are judgmental -- our clients want us to feel good and, thus, often refrain from informing us. Does the client have permission to let you know if they would like more pressure? Explore alternative directions. An example might be: "I want to adapt this session for you. At any time please tell me if you think more pressure or less pressure would be more effective."
While these specific statements are essential, more time should be devoted to bridging verbal and non-verbal communication. Not only should our intent flow from the oral message we proffer, but our listening skills should be honed toward each of our client's individualized needs. Complete presence is at the core of connecting and will determine how both the client and you respond.
No matter which techniques we prefer, our common goal is to help each person improve in some way. It is the therapist's professional responsibility to be genuinely positive, encouraging, accurate and confident working in unison with the client to achieve the established goals for each session.
Beyond purely verbal communication elements, the concept of kinesthetic communication is essential to the effectiveness of the manual therapies. Reading the client's body is the essence of kinesthetic differentiation by the therapist. The skilled practitioner is constantly receiving kinesthetic information through his/her hands, instantly adapting the movements, pressure, hand placement and direction to optimize effectiveness, and asking appropriate questions such as "Is this point tender?" The skilled therapist's hands know where to go, so much so that the client feels as though they are having their mind read. This is achieved through silent kinesthetic differentiation. The therapist must consciously distinguish between tissue types, fibrosis, hypertonicity, adhesions, scar tissue, and hypertrophy -- in a nutshell, normal vs. abnormal variants.
Much of this kinesthetic communication is experienced by the client in the sequencing of each session. Sequencing begins with the appropriate initiation of touch -- making contact and preparing the area with warming and confident initial strokes. This initial impression will set the stage for the specific technique the practitioner will then apply to the area. As the work in the region concludes, the next important element of sequencing is that of transition. Seamless transitions from one area of work to another are essential to a truly holistic, full-body session which concurrently addresses specific areas of concern. Effective transitions are dependent on maintaining contact and the intentional connection of areas through long sweeping strokes where appropriate. During the transition, one hand should be on each area before the focus is completely given to the new region. Overlapping of strokes is beneficial both in the transition of connecting two areas and defining the flow and pace of the session.
The timing of transitions, effective positioning, and draping of the client determine the overall flow of the session. The goal is to complete a full-body session without rushing through certain areas. Setting and maintaining a pace through to an unhurried closure will be optimal to your client's experience. The signature of the closure should parallel and highlight the goal of the session, whether it be relaxation or activation in a pre-event sports massage or invigorating chair massage in the workplace.
Regardless of the client's concern or the therapist's chosen technique, the quality of the client's session is directly linked to the therapist's Quality of Touch. Each client is a new opportunity to learn and enhance this essential skill.
Christopher Quinn, D.C., is president of the Boulder College of Massage Therapy (BCMT) and faculty member of the Human Sciences Department. Quinn has extensive graduate training in the sports sciences, with a background in chiropractic medicine. For information regarding BCMT's 1,000-hour massage therapy program, Associate of Occupational Studies degree or advanced bodywork programs and courses, call 800/442-5131.
Clint Chandler, B.S., L.M.P., has been a massage therapist and educator for more than 16 years. He has a deep understanding of anatomical structure and function and is a lead instructor in BCMT's Normalization of Soft Tissue Department and a nationally recognized presenter of Whiplash Assessment and Treatment of Acceleration Injuries.