To complement the MASSAGE Magazine article, “Educate Clients: The Ethics of Talking to Clients About Their Health, by Ruth Werner, in the December 2013 issue.
Imagine you are in the middle of a massage session. The music is soft, the light is low, your client is breathing peacefully, and suddenly she says, “My doctor says I have blood clots in my legs, but it’s OK—he says I should get massage to improve my circulation”; or, “Oh yeah, I have a new rash I meant to ask you about. What do you think it is?”; or, “Oh I forgot to tell you, I just tested positive for hepatitis C.” Each one of these interesting conversation starters is based on a real comment from a client. My guess is many readers of this article have similar conversations in their history. These types of comments reflect the fact massage isn’t just for healthy people anymore.
A sample communication might go like this one, which is based on an observed interaction in one of my classes. The role-players made this up as they went along.
Scenario: Your client makes an appointment to help with his back pain. While you are working together, he mentions that since his injury, one of his feet occasionally goes numb and he’d like you to work it deeply to “get the feeling back in it.”
Client (as his foot is touched): “Oh, I’ve been looking forward to this. This will help my foot, right?”
Therapist: “What’s going on with your foot?”
Client: “Since my accident, sometimes I have no feeling in my right toes. This’ll help, right?”
Therapist: “Are you feeling numb now?”
Client: “Maybe a little.”
Therapist: “Have you talked to your doctor about it?”
Client: “Hmm. I don’t remember; maybe. I don’t remember what he said, though. You do more for me than he does, anyway.”
Therapist: “Do you have any idea why your foot goes numb?”
Client: “Not really, it’s just since my car accident. Work it deeper, OK? I really want to get the feeling back into my toes. Yeah, like that—only deeper.”
Therapist: “Without more information, I shouldn’t apply deep pressure to your foot.”
Client (interrupting) “More pressure! I want you to just really work it out so I can feel it again!”
This is the point where the three-step conversation really begins.
The therapist suspends the massage, comes toward the head of the table to make eye contact and:
1. States the observation
“Since your accident, you have some numbness in your foot. You don’t remember if your doctor has given you any information about this.”
2. States concern
“I am concerned about this, because massaging a numb area could cause damage you wouldn’t even know about until later. And without knowing what’s causing the numbness, it’s just not safe for me to work deeply here.”
3. States the choices
“For this session, I’m going to very gently include your foot in the massage, and before you come see me again, please get some information from your doctor about what’s going on. Then, next time, I can give you a massage that might make some real differences for you.”
Client: “But I really want a good, deep foot massage.”
Therapist: “I know. I love that too. But until we know more, I don’t want to take the risk of doing any damage here. I know some great work for the back of your leg that might help, though.”
Client: “How is working on my leg going to give me feeling in my foot?”
Therapist: “If part of your nerve is compressed, it can feel like numbness. I can work safely on your leg and see if we can relieve any nerve compression. I think you’re going to love it. Then, next time, when we have more information, we can look at your foot some more.”
Client (reluctantly): “Well, OK.”
Ruth Werner is a retired massage therapist and author of A Massage Therapist’s Guide to Pathology and Disease Handbook for Massage Therapists. She is a massage therapy educator and National Certification Board for Therapeutic Massage & Bodywork-approved continuing education provider, a volunteer on multiple committees and workgroups for the profession, and president of the Massage Therapy Foundation (www.massagetherapyfoundation.org).