Issue link: https://www.massageandbodyworkdigital.com/i/68005
QUESTIONS ABOUT PROFESSIONAL BOUNDARIES AND ETHICS? CONTACT NINA MCINTOSH AT 877-327-0600 OR VISIT WWW.EDUCATEDHEART.COM. with clients, it's not like hanging out with friends—as you remind us. Our professional responsibilities should still be uppermost. I know you've said, "Don't ask questions or talk in such a way that clients have to think to respond to you." I think that's appropriate if a client is there to receive a relaxation massage. However, for those massage therapists who provide clinical or medical massage (neuromuscular massage, muscle therapy, or deep- tissue work), it is imperative that they communicate often with the client regarding trigger-point locations, pain levels, sensations, and tissue responses. As part of my treatments, I ask clients to rate their pain, describe it, and provide immediate feedback as I am working in their problem areas. I tell them, "Although I can feel the shape and consistency of your muscles, I cannot feel what you feel inside." I suggest, "On a scale of 1 to 10, with 10 being excruciating pain, what number am I on when I press here?" I'm not trying to interfere with their relaxation, but in order to address the tissues without causing damage (or making the muscle tighten or guard), I need them to share that information with me." BOB L., AUSTIN, TEXAS Dear Bob, Thank you for your comments. I agree that techniques with specific pain relief in mind require more communication with some clients than with others. Even with a massage that has pure relaxation as the goal, we may want to check in occasionally with clients. One issue that I need to clarify is what thinking means—when we say that a client shouldn't have to think to respond to our questions. The concepts of right brain and left brain are useful here. The left brain is the side that deals with the logical, analytical, and rational aspects of our lives; the right brain is more intuitive, creative, and subjective. Left brain is what we want less of when clients are on the table—we don't want them planning what to have for dinner or worrying about how to solve their work problems. That will not help them be in a relaxed state. And even for the more they are deeply relaxed, may have to think to remember which is which. It can be helpful just to tap lightly on the appropriate side and say, "Would you turn over on this side, please?" I've collected a variety of feedback technical kinds of work, we want the client relaxed, open, and receptive. During a session, we don't want to engage clients' left brain, for instance, to make them focus on a complicated explanation of how the body works or to answer a detailed question. Harmless as it seems, asking, "How many times have you hurt this foot?" requires a client to go too much into his thinking and analyzing left brain, as he tries to remember and count all the times the foot had been hurt. However, clients can easily answer questions about how they feel or describe a pain level without revving up the left brain. One way to help clients stay calm and peaceful is to be conscious of how you use your voice. Rather than talking in your everyday speaking voice while you're working, use a lighter tone and softer volume than you would in normal conversation. Also keep instructions simple. For example, some people have trouble distinguishing between right and left, and even people who don't, when from other bodyworkers on useful ways to get information about how the client is doing. Some find the 1 to 10 pain scale effective, others think that even that much calculating can be confusing. They prefer making sure that the client knows to tell them to ease up with painful touch. Still others say they mostly gauge a client's pain by noticing physical cues from the client—tensing up, frowning, and so forth. And some suggest varying what you say in accordance with how much body awareness a client has, checking in more with those who aren't as tuned into their physical sensations. No matter how and what we decide to communicate with our clients—and ask that they communicate with us— the bottom line is always client comfort and satisfaction. Keeping professional boundaries in mind, whatever the form of communication with clients— whether a little bit of contact-making chatting or inquiries into physical response—our goal is always to attend to their health and well-being. Author's note: special thanks to my online forum for their contributions. years of experience as a bodyworker with her previous years as a psychiatric social worker. She is the author of The Educated Heart: Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers (Lippincott Williams & Wilkins, 2005). To learn more about professional boundaries and ethics, visit www. educatedheart.com. Nina McIntosh combines more than 20 Gayatri Stein, visit www.gypsydogpress.com. To learn more about illustrator Mari visit massageandbodywork.com to access your digital magazine 119