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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 . 27 For the rest of the day, I kept thinking about that statement and the power therein. For so many of my clients over the decades, hope was probably at the center of why they experienced continued improvement. This kind of hope was made possible by results—making a difference in the frequency, severity, or intensity of the presenting symptom. The person now realizes that change is possible and that they have some sense of agency in the process. So many people in chronic pain feel powerless in the process, believing there is very little they can do to affect their state. Often, our health-care system perpetuates this feeling with the idea that health is a commodity, something you can purchase or obtain. Mrs. H., like so many thousands of people with musculoskeletal pain, was diagnosed with a condition her providers did not know how to treat with the tools and knowledge available to them. We, as massage therapists, know that soft-tissue therapies can play a significant, and often overlooked, role in these cases. Hope that surfaces in the presence of change is very different than wishing for something to be true. When Mrs. H. first came to see me, results were not immediate. The first two sessions yielded very few tangible results. Given the characteristics of neural sensitivity, this was not surprising. I took the time to explain the dynamics of neural irritation, bidirectional feedback loops, and how precise soft-tissue therapy might be of benefit. I also shared my previous experience with this condition and the research underpinnings of what I was doing and why. No promises were made as to outcomes, just a realistic overview of possible explanations and treatment approaches to her pain. Should our initial approach fail, I also outlined two other possible treatment approaches we could pursue. It is my strong belief that laying out these options for her proposed not only a possible treatment solution, but also a process. If one avenue didn't work, there were others to pursue. This gave way to a second factor, which has been present in almost all the successful therapeutic encounters I have had—trust. Trust is generally earned, not given. Earning the trust of a client is a multifactorial process, one that spans many dimensions of the therapeutic encounter. There are many ways to earn it, and even more ways to lose it. Additionally, trust can give rise to faith. Faith keeps one committed, even when there is little immediate feedback that the treatment/process is working. (If I didn't have faith, I'd have never made it past my first few cello lessons three years ago.) Very few of the difficult cases I have seen over the years have had significant immediate results. Most of these clients come for two or three sessions before our work begins to pay dividends. What keeps them coming back? Faith in the process. Trust in each other. Hope that springs from the sense that improvement is actually possible, even if at first elusive. Hope. Trust. Faith. It is a powerful progression for making a difference. Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois, and president of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit, or email him at Earning the trust of a client is a multifactorial process, one that spans many dimensions of the therapeutic encounter. There are many ways to earn it, and even more ways to lose it.

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