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90 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 1 Putting Client Expectations to Work The Conversation Continues with MT Researcher Mark Bishop, PhD BY TIL LUCHAU AND WHITNEY LOWE In our last column, we spoke with researcher Mark Bishop, PhD, about how client expectation triggers neurophysiological (that is, physical) reactions in the brain, how pre-treatment expectation predisposes clients to get more (or less) benefit from their work with you, and the jaw-dropping finding that client expectation (before treatment) is an even bigger predictor of benefit than the modality or technique used. (If you missed the first article, see "How Client Expectations Shape Results," in the January/February 2021 issue of Massage & Bodywork, page 88). So, as practitioners, how can we use this information? In this article, we go deeper into the implications of Bishop's research, and we think about ways to apply what we are learning about client expectation—specifically, how it shapes results in massage and manual therapy. LETTING CLIENTS CHOOSE Til Luchau: If I'm remembering right from the San Diego Pain Conference, you had some thoughts about matching clients or patients with a therapeutic modality based on their expectations. You were saying there is a good research rationale for giving the client a choice of modalities—a menu of options that work— and letting them vote on which modality or method you're going to use. Am I remembering correctly? Mark Bishop: You are. For me personally, if there is no difference between me doing mobilization for your neck or manipulation for your neck or muscle energy technique for your neck—if I think the outcomes will probably be similar—then it's no harm for you to say, "You know what? As the patient, what I want is this one." TL: Then, why don't we just ask our clients what they want, and just do that? Is there any downside to that approach? MB: If in my opinion there is a best way to treat you, then part of the [patient] education would be to say, "OK, the people who get this treatment program seem to recover the fastest and have the best outcomes. So, this is what I recommend we do today." But then, what if the patient doesn't want to do anything suggested? They might say, "Well you know what, the only thing that I expect to help this is . . . a hot technique | THE SOMATIC EDGE Editor's note: Til Luchau and Whitney Lowe recently spoke with manual therapist, physiotherapist, and researcher Mark Bishop about his fascinating research into how clients' expectations influence treatment results. His research shows that clients who think treatment will help often benefit far more than those who don't expect much relief. Key excerpts from their longer conversation (which took place on Whitney and Til's The Thinking Practitioner podcast) have been edited here for clarity and context.

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