Issue link: https://www.massageandbodyworkdigital.com/i/1128556
FOSTERING EMOTIONAL AMBIENCE Chronic symptoms—especially those that haven't responded well to other interventions—can be laden with difficult feelings (depression, hopelessness, etc.), self-perpetuating fears and limitations (such as the fear of movement), or fixed attitudes and belief structures. Our scope of practice as manual therapists doesn't typically include direct psychological work per se, which requires a different kind of training, sensitivity, and therapeutic paradigm. But we can have enormous influence on our client's perspective and mind-set about their symptoms through our own approach and attitude. In this realm, preparation can mean fostering an emotional ambience that makes the desired change more likely, largely by cultivating those attitudes in ourselves and in our client interactions. Some of these states include curiosity, respect, warmth, patience, gentleness, and humor. HANDS-ON WORK The psychological aspect of preparation could be defined within hands-on work as fostering the internal conditions necessary for change to occur. This would, of course, include readying oneself as a practitioner by becoming mentally, physically, and emotionally present, available, and primed for the work. Once we are ready for the hands-on portion of the work, preparation takes on a more biological or physical meaning. Often, using the metaphor of body-as-onion, we start working with superficial layers of the body in preparation for deeper work, such as in the Superficial Cervical Fascia (or "Mother Cat") technique. 6 Another preparatory strategy we use is influenced by the work of Jan Sultan, one of the teachers Ida Rolf originally chose to teach her work. This preparatory strategy is to address the periphery of the body (the appendicular extremities and girdles) before working with axial issues. Autonomic Nervous System Arousal A related aspect of preparation has to do with the client's state of autonomic nervous system (ANS) arousal (above). Sympathetic "fight-or-flight" states, like those accompanying anxiety, fear, unresolved trauma, or pain, can be aggravated by hands-on work that is too direct, too fast, or too deep. "Preparation" may involve calming and modulating these responses before proceeding with any direct or pressure-based work. When there is a high level of sympathetic (fight-or-flight) activation, addressing this state itself often takes precedence over structural goals. Whether this ANS arousal is related to unresolved traumatic responses, chronic pain, anxiety, or the stresses of daily life, an on- alert, hyperaroused, and hypersensitive state precludes learning and change, and, as stated above, can be aggravated by aggressive hands-on work. Fortunately, there are very effective hands-on and proprioceptive approaches to ANS arousal. 1 Note 1. To see examples of these approaches, refer to the Massage & Bodywork articles "Working with The Vestibular System" (March/April 2014, page 114) and "Working with Whiplash" (March/April 2010, page 108). French neurologist Guillaume Duchenne de Boulogne (1801–1875) is famous for his investigations into electrical stimulation of facial muscles and the expression of emotions, including fear (seen here with a patient suffering from an anesthetic condition of the face). Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 91 THE SOMATIC EDGE