Issue link: https://www.massageandbodyworkdigital.com/i/1338685
education and high level of credentials, or it could also be administered by an individual with just a very basic level of massage training who has very little formal academic training. Might you see expectations from the client or patient change when they see you don't have a lot of significant training? Could that change the outcomes of the client's perception of effectiveness of your treatment? MB: It may indirectly. One of the things you're talking about is within the therapeutic alliance. One of the elements people have identified as building therapeutic alliance is the trust in the provider and the perceived, as you said, skill level of the provider. So potentially, yes. If you walk into a place, and the person has their academic training, their clinical certifications, and the pictures of the happy people on the wall who've signed with the "Thank you for a great job!" and all that type of stuff, that helps build the kind of confidence that our client has in you as a provider. I don't know enough about it to give you an answer about the degree qualification. I think that whether you're someone from the physical therapy background or massage therapy or osteopathy, for example, it's potentially the same environment setup, and that would be the healing context, the therapeutic environment around this. One of the things is the first person with whom the client interacts is [the] expectation ambassador. Whoever interacts [with the client] the first time has great potential to help set this context in motion. Like, "Whitney, yes, we've got an appointment at the time that works. You are going to see Til. You'll love Til. He is such a funny guy. He does great work. Everyone loves seeing him." Even just those sorts of comments can begin the person on the other end of the phone saying, "Good, good. I got to see Til. He's the best in the clinic. This is going to be great." Same with [other] people giving the good reports; these all help build that pre-contact expectation. Then, once you 92 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 get there, that therapeutic context has been shown to really influence alliance, client confidence, and that type of thing—the trust and confidence that the patient and client [have] in the provider. Author's note: What the client hears about you early on sets the tone of the therapeutic encounter. This applies whether you have someone else as an official "expectation ambassador" or you do your own client orientation and scheduling. Clients can see evidence that others received benefit and are appreciative of your work through client comments on your website or scheduler, positive reviews on your social profile, or information in your "client welcome" materials. Though we can be shy about blowing our own horn, we could also argue that if we don't help the client understand that others have benefited from working with us, their perception of their treatment results they get from their investment ( fees) may be less. COVID EXPECTATIONS? TL: What about COVID? How might that influence the contextual factors or the client expectations? MB: I would think that being very reassuring . . . and saying, "Do you have any concerns about coming to see us? Anything about COVID? Let me tell you about the protocol." Just interacting with people before they get there [is helpful] . . . setting the stage . . . so people's expectations of what [treatment] is going to look like matches what they experience when they get there. CLOSING THOUGHTS WL: Mark, thank you so much for sharing your research and your perspective on this with us here. TL: Absolutely. Is there anything you want to leave us with? Any key thoughts or key points that you think we should be keeping in mind? About Mark Bishop, PT, PhD, FAPTA Mark Bishop is a physiotherapist with more than 30 years of clinical and research experience in the area of rehabilitation of musculoskeletal pain disorders, and is a faculty member in the Department of Physical Therapy, with affiliations in the Center for Pain Research and Behavioral Health and the Pain Research and Intervention Center of Excellence, at the University of Florida. His work has focused predominantly on the mechanisms underpinning the effectiveness of conservative interventions for pain—especially manual therapy and exercise. Learn more about Bishop and his work at https://pt.phhp.ufl.edu/ about-us/faculty/mark- bishop.