In my imagination, nothing eclipses my fear of the sea at night.

The same waters I enjoy and swim in comfortably by day transform into a formidable force containing the unknown at night. The dark tides leave me helpless to the forces that lurk beneath.

As massage therapists, we find ourselves navigating through the light and dark waters of our profession—the riptides of ethical dilemmas, psychological projections and the occasional fear that our practice, the very vessel that carries us forward, may capsize.

Oh sure, we’ve role-played client-therapist scenarios in school and maybe even in supervision sessions—but have they prepared us for the reality of being out in the open water?

Undoubtedly, these exercises were met with the nervous giggling of students while most wondered, “I’ll never really find myself in this situation; right?”

The truth is, most days the course is smooth. The sky is blue and the sun glistens. We excel in our practices while the ship seems to sail itself. Our clients are thankful their captain is competent, compassionate and resilient.

But even the most experienced of seafarers will occasionally read the signals incorrectly, sailing right into the middle of unfamiliar territory.

The Therapeutic Bubble

Ideally, our treatment rooms are a sanctuary, a safe haven from the cares of the world. Ironically, it is here the demands of the world can sometimes become the most apparent.

Taking the time to slow down and breathe, clients have the opportunity to listen to their body’s inner wisdom once again, if only for an hour. The awareness they garner can change their relationships, possibly even their lives.

The road to facilitating change requires a delicate blend of compassion, skill and, at times, restraint. With the right mix, therapists create a therapeutic bubble of comfort and safety, allowing clients to blossom.

Still, the path of healing is seldom a consistent, upward trajectory. There are times when the process breaks down, appears to retreat or moves sideways. At these times, it is important to remain patient and not force the desired outcome.

When we assume we know what is best for others, what they should or should not do, there is the potential to do harm and lose trust.

Whether a client is working with an issue as complex as abuse or simply learning how to relax enough on the table to receive a massage, using force against a living system is asking for resistance.

How do we ensure good client service to make sure that the healing relationship starts on the right path?

Maintaining Safety

To begin, we create a safe environment. A safe environment is predictable, consistent and focused on our clients. It begins with a solid foundation built on trust and an attitude paraphrased from the Hippocratic Oath, “I will keep clients from harm and injustice.”

Safety takes on many subtle forms in the treatment room and beyond:

  • The session starts and ends on time.
  • The therapist actively listens to a client’s needs and delivers a session focused on those needs.
  • The therapist has the courage to state the obvious when boundaries get crossed and she falls into the dark spaces with a client. Sometimes, it even requires courage to admit when an error in judgment has been made, which is often accompanied by awkwardness and humility.

Errors Help Get On Course

Oddly enough, it is satisfying to review the times in my career when I struggled, fumbled—just plain made mistakes. Yes, these experiences have been the hidden gems. In a mysterious way, while at first painful, they became the most vital lessons for growth, leading to a healthier practice.

There is a teaching from the Christian tradition that poses the paradox: “I delight in weaknesses, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.”

The same concept is immortalized in pop culture by Star Wars: “Darth, if you strike me down, I should become more powerful than you could possibly imagine.”

Along the theme of paradox, one of my worst experiences as a massage therapist turned out to be one of the best.

I was a few years out of massage school and working part time at a chiropractic office.

This particular day I was standing with a cup of water in the hallway waiting for my client to exit the treatment room.

His first words flew straight as an arrow down the hall, puncturing my heart with a direct hit. “Where did you go to school?” he asked seemingly annoyed, “I feel worse now than I did when I came in!”

My heart sank through my chest. I struggled to respond to his pointed—actually jagged—remarks. “Can you tell me what you are noticing,” I asked with obvious trepidation. After a long and painstaking silence, all he offered was an ambiguous, “I feel worse now.”

The ensuing moments were extremely uncomfortable. Looking back, perhaps his vagueness should have been a tip-off right then that I shouldn’t jump to conclusions; but, nevertheless, I would spend months reflecting on his words and the dynamics of the session.

Finally, a year later, it became clearer what might have transpired that day.

While attending a Tom Myers Anatomy Trains workshop, Myers introduced the difference between pain that is imposed and pain that is exposed when working with a client.

Light bulbs lit up inside my head: Imposed pain comes from a stimulus outside the body; exposed pain comes from inside the body. The intent in bodywork must be to expose any stored pain, not impose more pain.

“If we come into the body with the intention of inviting the tissues to take up information they might be missing, our work is very different from when we come in with the intention of fixing it— breaking up that fascial adhesion, stretching that spasmodic muscle, annihilating that trigger point, whatever,” Myers said. His words provided the insight to a new level of awareness.

When I reflected back to the session I couldn’t forget, I realized I had been checking in about pressure, comfort and tracking the client’s experience on the table.

Pain that was living in his tissues and had possibly been there for years, latently residing underneath his awareness, had finally been exposed. It was now in his conscious awareness, and he believed it was the result of my incompetence.

But was it? Expanding upon this concept, I began to wonder in what ways massage therapists contribute to imposing/exposing pain not only in the physical, but the mental, emotional and spiritual realms of clients as well.

By viewing our clients from this perspective, it is possible we, as practitioners, impose/expose pain regularly.

With mindfulness and reflection, we can refrain from transferring uninvited pain or discomfort of any nature into our clients’ systems and conversely, expose the inherent power of their bodies’ healing mechanisms.

Much has been written about the obvious ways we safeguard a client’s well-being within the framework of a massage session. Apart from complex psychological and sexual issues, there are basic details we therapists often overlook.

Where Did My Voice Go?

Some discomfort is a result of small details.

Not long ago, I received a massage from an experienced therapist who is also a friend.

At one point during the session as I lay prone, I noticed the entire left side of my body was undraped, leaving me feeling exposed through my perineum.

As I lay there internally conflicted, my inner dialogue went something like this: “It probably just feels like I’m exposed; I can’t be. I should be comfortable with this; I know this person. They are going to be offended if I bring attention to this and it will impact the rest of the session. Relax, why are you so uptight?”

Now keep in mind, I am an experienced therapist, teacher and advocate for safety in draping. Yet, I struggled to find my voice to speak.

I laid there and never said a word. I had a direct experience of the inherent power differential between therapist and client; my inability to communicate was a bitter pill to swallow.

The truth was, I felt completely unsafe lying on the massage table.

I was once again in touch with how difficult it might be for clients who are uneducated in the realm of boundaries to find their voice. Besides being a humbling experience, it provided sobering insight into a small detail imposing discomfort in a profound way.

Too Deep

One of the most obvious culprits of imposed pain is applied therapeutic pressure.

“How many of you have had an experience receiving a massage where the therapist crossed your tolerance for pressure?” Inevitably, when I ask a group of massage students or therapists this question, roughly 40 percent will raise their hands.

The ensuing feedback recalls days if not weeks of resulting soreness, bruising, even anger that the therapist did not heed the verbal or nonverbal signals of discomfort.

One can conclude there is a significant portion of clientele that has been harmed by the very therapy they sought for wellness. Sadly, some of these people will never give massage another chance.

Safety First

It may serve us well to take a look at the ways we structure our practices.

Are we ensuring our clients’ safety is foremost and not an afterthought? Have we created a therapeutic bubble for our clients’ well-being? How will we know if we have drifted off course and our intent is focused on our own agenda to the detriment of healing for another?

By asking ourselves if our interactions are imposing or exposing pain with our clientele, we have a guidepost to bring our ship back on course when the water gets choppy and unpredictable.

As the late Nina McIntosh so eloquently suggested in her book, The Educated Heart, “Confusion is bred in silence—if we can begin to talk more frankly, we will learn from one another rather than each of us learning alone through painful experience.”

Paradoxically, by admitting we are human and embracing our mistakes, we come into our true power as therapists and can set sail for a greater life and practice.


Eric Stephenson, L.M.T., N.C.T.M.B., is director of education for imassage Inc. and teaches continuing education workshops on a national level. In 2009, he presented at the American Massage Therapy Association Convention, the International Spa Association Conference and the World Massage Conference.