Issue link: https://www.massageandbodyworkdigital.com/i/1128556
WHAT IS PREPARATION? Preparation is defined as "the action or process of making ready." 1 Although preparation for hands-on work needs to include the physical aspects of "making ready" (such as relaxing excessive muscle tone, "warming up," or mobilizing superficial layers before working deeper structures, etc.), these physical considerations are only part of the picture. "Making ready" as a preparation begs the question: Ready for what? As practitioners, we need to know our context and aim to know how to prepare. In fact, one of the most important (and most overlooked) parts of the preparation phase is gaining clarity about the purpose and goals of the work itself—the client's reasons for seeking work, and their hoped-for results; one's own goals, priorities, and aims as a practitioner; and, most importantly, how these two areas (the client's and the practitioner's priorities) intersect (or diverge). ASK, LISTEN, AND CLARIFY Many manual therapists are most comfortable working nonverbally at what Dr. Rolf called "the silent level of the flesh" 2 (Image 1), and are often keen to get to work with their hands. Taking time to ask, listen, and clarify what the client wants from the work, and then exploring and discussing how this matches what you think you can deliver, is indispensable verbal preparation for your hands-on work together (Image 2). These considerations are small examples of a "biopsychosocial" approach, which describes a whole- person, body-mind, context-dependent perspective on pain and symptoms. 3 FROM BIOPSYCHOSOCIAL TO SOCIO-PSYCHO-BIO Many conditions that were previously thought of as primarily physical complaints (such as temporomandibular joint dysfunction or TMJD) are now more accurately seen as being biopsychosocial phenomena, where the physical symptoms are only the most obvious aspects of a more complex, interdependent interplay of structure and function, and also of emotions, perceptions, beliefs, lifestyle, habits, social factors, and more. 4 In the preparation phase of our Advanced Myofascial Techniques approach, we reverse the ordering of "biopsychosocial" so that it becomes "socio-psycho-bio." Before we can be maximally effectual in our biological or physical goals, the social aspects of the working relationship need to be established. This "social" level incudes all the interpersonal interactions that enable the physical work to be effective: building rapport and trust, and establishing the tone, boundaries, and style of the therapeutic coalition. Therapeutic effectiveness— in both physical medicine and in other fields—has been shown to correlate with the strength of the practitioner-patient alliance. 5 Patient compliance, or the client's willingness to adhere to the practitioner's suggestions between sessions, is strongly influenced by this social rapport as well. These interpersonal, social-level aspects dovetail with the inner, intrapersonal, psychological considerations of our "socio-psycho-bio" progression. These intrapersonal aspects include the client's mood, receptivity, optimism, or pessimism; their largely unconscious assessment of the situation's safety or risk; and their conceptualizations, stories, expectations, and ideas about their presenting issues. 90 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 9 The late Dr. Ida P. Rolf, the originator of Rolfing structural integration. Image: Ron Thompson, used by permission. Taking time to ask, listen, and clarify what the client wants is indispensable verbal preparation for hands-on work. Image: Advanced-Trainings.com, used by permission. 1 2