It’s Not Just About the Massage – A Closer Look at the Psychology of the Treatment Room

“If the patient comes in thinking that you’re not going to help them, you’re not going to unless you can convince them that you can.” – Joseph Brence

I recently watched a fantastic webinar by physiotherapist Joseph Brence, where he talked about his M.I.P (Motivation, Input, Plan) model for motor control. Joseph is a prominent physical therapist with a special interest in the neuromatrix and pain. Although coming from a physiotherapist’s perspective, a lot of what Joseph talks about can very easily be transferred to what we do as massage therapists. Although the webinar touched on a great many interesting topics, one of the things that really stuck in my head is the idea that no matter how fantastic your massage skills, if your client doesn’t have confidence in you, you’re not going to give an effective treatment – pure and simple. Your hands on skills are only part of it.

Clients are complicated creatures, and touch is a subjective experience. As a massage therapist, I have taken many workshops with prominent leaders in the field on bodywork, who can sometimes appear to completely eliminate years worth of pain with just a five minute demonstration, and have legions of adoring fans who will quite literally cross continents to get just a few hours worth of bodywork from their chosen guru. Of course these ‘experts’ usually have pretty finely-tuned hands on skills, but could there be more going on here than simply good bodywork?

The simple answer is – absolutely. With any subjective experience, such as moods, emotions and indeed pain, a lot of what we’re feeling is produced by our heads rather than our bodies. The pain you’re experiencing is absolutely real, but will vary depending on your attitude towards it, what you think it means, and the outside world. If you play guitar for a living and you cut your finger, that pain is going to feel a whole lot worse than it would to someone who sings for a living, because it could potentially mean so much more – you could lose your livelihood, your creative outlet and your passion. Likewise if you cut your hand trying to flee from an angry bear, you most likely won’t even feel it until much later on. Why? Because for you to be stopped in your tracks with pain isn’t the most useful course of action for you at that moment – and so your brain deliberately dampens down the sensation so that you can get away and live to tell the tale.

The point is that the brain interprets sensation depending on what else is going on. If someone works out of a dirty, cluttered treatment room with harsh lighting, where the massage table seems rickety and is covered in cheap and scratchy linens, where the temperature is too cold or uncomfortably hot, where you can hear a lot of outside noise or perhaps the music they’re playing is a type you despise… then even if the massage itself is fantastic, that is going to be weighted against the rest of the more unpleasant stimuli to produce a negative end result. And all this interpreting is deeply subjective and personal to the person being treated (the horrible treatment room might not matter so much if you have an unshakable confidence in your therapist… or perhaps you’re used to getting massaged with lots of noise in the background and it doesn’t bother you) – the best we can do is to try to find out their biases and work with them as much as we can.

Is someone is in pain and has an unwavering belief in acupuncture – then acupuncture is probably going to reduce their pain. If someone received some over-enthusiatic stretching techniques at one point in their lives which resulted in them not being able to get out of bed for a week, then stretching is probably going to cause more harm than good with that client, regardless of how well intentioned and expertly executed. The hands on treatment they receive is important of course, but it’s only a factor, and not as big a factor as what’s going on in their head.

So how can we as massage therapists attempt to work, not only on our clients bodies, but also on their brains? The first option is to find out before they even walk into you office. I have a form that I ask all clients to fill out and email to me before their first appointment, which includes music and temperature preferences, if there are any parts of their body that they would rather me not work on, and whether they would prefer scented or unscented oil, amongst other things. In that way I can accommodate at least some of their biases before they even walk through the door. The second is by stating very clearly before the start of the treatment that if there is anything that can be adjusted to make them more comfortable, whether it be the outside environment or the massage itself, that I would really appreciate them speaking up. Creating an environment where the client feels confident that requests are not only responded to, but welcomed, means that the massage suddenly becomes a team effort – and those make for the very best treatments. The third is by paying close, careful attention – not only to the words they say but also to their body language, both on and off the table, and being mindful or any changes in muscle tone, breathing, facial expression or movement, and using them as clues to act accordingly.

It’s not easy interacting with such a complicated nervous system, but we have to try if we want clients who feel supported, respected and valued – and that’s half the battle won before we even lay our hands on them.

How to you gain your client’s confidence before they even lie on the massage table? Let me know in the comments below.

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