More people than ever are experiencing massage, research is validating its benefits and it is slowly being integrated into our health-care system. Simultaneously, with the economy limping along, people are finding it increasingly difficult to pay out of pocket for preventive health care.
This conundrum has many therapists searching for ways to attract and retain clients in an effort to stay in practice. Treatment planning is one such way.
Treatment planning is a win-win arrangement for client and therapist.
In practical terms, the goal is to keep clients healthy and our practices thriving. By engaging and empowering clients within a structured format, therapists have the potential to increase therapeutic results while simultaneously building a sustainable practice.
The concept of a multi-session treatment-plan approach is nothing new in the medical field. However, from my observations, it is not widely practiced in the massage profession.
Almost without exception, mainstream and complementary health-care providers give clients specific instructions about rebooking and treatment options. Clients want to know when and why they should return.
We will explore an approach for massage therapists that provides simple guidelines for our profession.
My intent is to provide a template for:
- Working with a new or existing client for three sessions within a three-week period
- Establishing a monthly maintenance schedule thereafter.
This is not an exploration of the various techniques that are part of assessment. Also note, a treatment plan is not a substitute for, but rather is used in conjunction with, a full client health-history form with SOAP noting.
The two biggest reasons clients give for not receiving regular massage are time and money.
The three-session series educates a client about the positive cumulative health effects of scheduling massages closely together and then following an ensuing maintenance plan.
The theory is if properly educated, many clients are willing to invest the time and cost for three sessions, especially if the investment results in a noticeable improvement in their presenting condition.
This approach may be applied with any modality.
In my practice, it works especially well with a subacute or chronic problem using various deep-tissue methods. Applying heat and pressure to connective tissue activates the thixotropic and piezoelectric qualities of fascia.
More frequent sessions increase the range, ease and quality of motion, hydration of muscle tissue and fascia, as well as overall parasympathetic tone. By agitating tissue continually within a short period, habitual distortion patterns have less chance of setting in between sessions.
A three-session treatment plan has many advantages over a one-session “wait and see how you feel before you book another” approach. In a three-session series:
- Clients can see cumulative results due to a realistic timeline and strategy.
- Client and therapist have a proper window of time to establish the safety and trust (rapport) that are paramount in any healing relationship.
- When client sessions and simple homework are reinforced within a three-week period, it is much more likely to become a habit. Establishing a new habit requires approximately 21 days.
- Clients stay focused on the expectation of feeling better, increasing a potential placebo effect.
- Studies have shown written goals have a tremendous rate of success.
This all sounds good in theory—but how do we confidently integrate this approach into our practice?
Selling vs. Sharing
Many therapists are uncomfortable with the idea of proactively selling their services.
In conversations with therapists across the country, a common question is how to recommend regular visits without feeling like a salesperson. I believe a large part of the answer is a paradigm shift away from the idea of selling toward one of sharing our gifts with a world in need.
When working with a team of therapists to refine this skill, I invite them to recognize their gifts, offer them in good faith and detach emotionally from the client’s choice.
As humans, relatively few of us do well with rejection. However, when therapists view a treatment plan as a preventive measure that will benefit clients, rather than a service being sold, then they feel empowered. We offer our gifts to the world, and the world decides if it needs what we have to offer.
“When we come from a place of love, of service, people will never have the impression we are selling them a bill of goods they don’t want,” explains Creating an Abundant Practice author Andrea Adler.
The basic components of creating a treatment plan with your clients are: engage and empower; determine strengths and resources; uncover complaints; set short- and long-term goals; and determine therapeutic objectives.
Belief inspires hope.
Hope begins with the therapist’s attitude and beliefs about the efficacy of massage therapy. Do your verbal and nonverbal communications express hope?
Clients are looking for inspiration and the chance they may find relief through massage therapy.
“If we can skillfully do this, I believe we can change the world, really,” says Tracey Moon, the massage program director at Duke Integrative Medicine. “Clients come in all the time with limiting beliefs due to their DNA, an old injury they will have to live with, a knee the doctor said would not be able to run again.
“How can we honor their beliefs and offer hope [and] inspiration to a new way of thinking with ease and kindness?” Moon adds.
After communicating a hopeful message to clients, we then seek to educate them.
Information is empowering and involves the client in his healing process. Asking permission to take 10 minutes of the first session to speak about the approach of your particular modality and the structure of the three-session format establishes your expertise.
Remember to keep it simple, though.
Find simple terminology to explain complicated anatomical and physiological concepts, and reinforce the concepts with visual aids, such as reference books and wall charts.
In a therapeutic model, it is all too easy to continually focus on what is wrong.
While most people are looking for some kind of relief from a presenting condition, don’t let that be your immediate focus. Instead, step back and ask your client, “What is working well with your overall health, and where do you feel strong in your body?”
At first, most clients may find this surprising and possibly irrelevant.
But by always looking for the next positive answer, you reframe the focus and offer a unique perspective, one the client has possibly never experienced in a health-care setting.
A resource might be an at-home yoga practice, a daily meditation practice or walking on the treadmill for a few minutes each night after putting the kids to bed. Simply, it is a proactive step toward health.
Where is the primary complaint? How might you distill the information into one or two common themes within a three-session format?
Refrain from taking on too much.
By keeping the focus simple, you make the best use of time.
Short and Long-Term Goals
Ultimately, all goals are subjective and individual.
Treatment plans offer a way to achieve client-centered goals.
Encourage clients to think about realistic goals they want to come out of the first three sessions, usually as they relate to their immediate complaint. Goals must be quantifiable and tracked throughout ensuing sessions.
Reducing the level and duration of pain might be an example of a measurable short-term goal. Playing 18 holes of golf comfortably could be the ultimate aim.
Beyond the initial complaint, what improvements is the client seeking to make in his or her overall sense of well-being? How would the client imagine massage therapy as part of his or her long-term preventative health care? Why might this approach be worth the investment?
As a therapist, it is important to remember treatment plans need to work toward addressing the client’s goals.
Therapists understand the body’s distortions and how to work with them. By education and invitation, we may seek permission to proceed with a certain approach.
However, the client’s informed consent is of utmost importance.
Any sort of imposed force in a therapeutic setting will be met with resistance, usually to the detriment of the healing relationship, and possibly harm both therapist and client.
Because each person has a unique set of presenting conditions and outcome goals, a routine approach to every situation is often limited.
Approach the idea of treatment planning with playful curiosity, staying flexible to the changing needs of the client. Begin with the simple format outlined here, and over time customize the approach to fit your practice.
Finally, remember: The gifts you bring to this profession are unique and needed by a part of your community. There are clients waiting for you.
Eric Stephenson, L.M.T., is director of education for imassage Inc. and teaches continuing-education workshops on a national level. He has presented at the American Massage Therapy Association Convention, the International Spa Association Conference and the World Massage Conference.