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CLIENT ENCOUNTERS This disconnect between our perceptions and that of our clients always proves exasperating and frequently we are left confused and wondering what we did wrong. Inevitably, this confusion leads to conflicts, many of which we cannot resolve. THE CLIENT'S TALE From day one, she was highly resistant, yet oddly tenacious, in her resolve to trudge forward. The explanation for this inconsistency puzzled me and despite our continuing efforts, remained obstructed. As our sessions progressed, each one began with a nearly verbatim reaffirmation that she noticed no change either during the previous session or in the intervening time. She reported consistently no decrease in her discomfort, no noticeable improvement in movement, balance, ease, or range of motion (ROM). Each cueing, somatic exploration, visualization exercise, or suggestion for lifestyle modification was met with a passive acceptance that felt more defeatist than participatory. An oddly sincere desire to try whatever was suggested coexisted inexplicably with her stoic fatalism; the reasons for her overriding belief that change was in fact not viable lurking just beyond my grasp. This kind of somatic schizophrenia (a metaphor only and not a suggestion that the client was actually psychotic) proved a source of considerable emotional confusion for me. As you might expect, I asked her why she continued to come back each week when she stated unrelentingly that nothing had changed. Her answer only deepened my confusion. She simply repeated that she needed the work and kept hoping that she would get better. Such bracing in structure and affect, the stubborn determination are at this point more interested in the progress of our story than specific theory or technique, we will look at the emotional aspects of this work. In my experience, this area more to "tough it out" while at the same time arguing at every stage should perhaps have told me I was out of my depth. Yet, I was young and doggedly determined to meet her head-on. Every week she flashed me that same defiant look, that same prideful tone. "I feel nothing," she reiterated triumphantly, her manner evoking a certain smugness, a red badge of discouragement, if you will. An odd metaphor, but, since I never could fathom the exact nature of what we were playing out, all I have is metaphor and speculation. Things really heated up as soon as we began doing more direct neck work. Many of my readers are perhaps familiar with the type of deep neck and intra-oral work taught by many neuromuscular therapists or variations of that work done in various structural integration protocols. Such individuals may well anticipate what occurred. For those whose neck and head work are less intensely specific, there may be some confusion as to the intense response we describe below. However, since we 78 massage & bodywork march/april 2009 than any other, including the pelvic floor, deep abdominal regions, and the tissue around the breast, is the most potentially charged of any territory. Here is where we meet the world, where we take in sustenance and air, where we speak our heart and express ourselves. Work in the anterior neck region, for instance, can trigger respiratory anxiety if the client has a history of asthma, has ever choked on food or any other foreign substance, or been choked. Consequently, an individual may interpret even the gentlest entry into the oral or nasal passages as a violation, even when he has readily agreed to the work and processed its ramifications with his practitioner. Therefore, manipulation in this region generates the highest likelihood of triggering fear and anger responses. Not unexpectedly, even when we remain hypervigilant in our work in this territory, the possibilities of trauma activation may sneak up on us. This short, but I think necessary, discussion leads us back to the client under consideration. I proceeded patiently through the surface and deeper lateral and posterior neck structures of this client. Highly rigid and not overly responsive, there were no real surprises at this point. Some delicately executed anterior neck work nothing new. The client remained still and quiet. Then came the first internal exploration of the mouth. It proceeded slowly, but soon it became clear something was very wrong. It started as a slight tremor of the jaw, one that would not go away. Slowly, the tremor intensified. Soon the client realized she was both reacting and unable to restrain the trembling of her mandible. Suddenly, she became extremely agitated. She sat straight