Telling Your Therapist Like It Is

A new client told me that she had recently gotten a deep tissue massage that had left her sore for 10 days without improving her symptoms. A friend had recommended the therapist to her; the friend had been going to this therapist many years. The massage itself had been very painful, but my client didn't want to say anything because she figured it was the treatment. Judging from the other massage therapists I know, I can guess the therapist would be very upset to hear she had left the client so sore. The therapist may not have asked clearly (or at all), but she needed to know the client had hurt, so that she could analyze her process.

I encouraged this client to tell the therapist. We don't have any other way of getting feedback, and it helps so many.

So I wanted to talk a little about honesty and direct communication in massage, starting with some examples of clients who have a knack for honesty, and were very honest with me from the get-go. 

1. Get a better massage.  

A while back, a man with chronic pain who was new to town came in. He had gotten many, many different kinds of care, and told me that the only thing he had ever found that worked for him was a technique he knew I didn't do. He had been referred by his old therapist and was willing to give my work a try. 

I knew the principles behind the technique he liked, so I tried to use them, even though they weren't natural or instinctive for me. As I worked on him, he did not seem to be relaxing, and my movements felt awkward and hesitant. The session did not seem to be going well. 

Afterward, I asked, "How do you feel?" 

"Well, it's always nice to get a massage," he said, looking a little miffed. 

Oof.  

I didn't like hearing his response, but I sort of loved it. How often can you be sure you know exactly what someone's thinking?

For many people, the worst part of that experience would have been telling the truth after someone has just spent a lot of energy trying to help you. But he braved the waters and answered honestly. I said, "Well, I hope you'll come back. There's more I can do and more ways I can approach this. If it doesn't work for you, I can help you find someone who might be a better match."

He rescheduled, and in the second massage, I just did what I was comfortable with. He came out looking elated, and said promptly:

"That was much better than the first one." 

Haaa. Okay, chalk one up for a super honest exchange between a client and their therapist. This person became a regular, and turned out to be equally expressive in his gratitude. For me, he set a new standard for the kind of exchange you could have in the massage room. 

2. Maximize relaxation. 

Historically, in the West, we've been taught to farm out our health. "You go to the doctor, and you get your health," I once heard someone say. Though we've come a long way from that, many of us still hesitate to ask too many questions of our health care provider. But not feeling comfortable expressing one's self can be a source of stress and muscle tension. If you can't express yourself to your massage therapist, some of that tension may be reinforced even when you're getting care. Whereas if you can find a way to speak up, you can change the care you get.

Example. A client who had seemed to really like her first massage/NKT session startled me when she asked, before her second session, "Could you have a smoother transition between working different areas?"

Wooow. Yes, I can do that! Muscle testing often directs me to go back and forth between different parts, and sometimes it can be easy (for me) to lose the transitions, which are more important to some clients than others. It's completely fixable. Most people who feel a massage was too choppy would probably skip the next one, but she just decided to ask me to fix it. She also wanted quite a bit more oil than I'm used to using, because it felt better to her. Using so much oil was so unintuitive to me that a little further in she had to ask for more oil again, but twice was enough. She too became a regular. 

(By the way, I became a little defensive on the oil suggestion. We may not always respond with our best selves. But don't worry about us--this is your money and your time. I did get a chance to explain why I don't use so much oil, and she was interested, but she didn't like how it felt.)

3. Only you know what you're feeling. 

This brings us to the truism that only you know what your body is feeling. This is unfortunately true no matter how experienced or skilled your massage therapist is. An informal study by Douglas Nelson (author of The Mystery of Pain) concluded that, if we are not looking at or speaking with the client, therapists really only know exactly what a client is feeling (specifically, whether an area feels sore when we touch it) about 50% of the time. You may not mind us getting it right only some of the time, but if you want us to know for sure, just let us know.

4. If you can't tell your massage therapist you're hurting, who can you tell? 

This may sound simple (a lot of my clients say, "you don't need to ask---I'll tell you if it hurts"), but boundaries in our daily lives are often mimicked in the massage room. For instance, if in general you often don't feel comfortable expressing yourself, you may not say anything when a therapist hits a sore area in a too painful way.  Many clients don't want too much talking on the massage table, so if the therapist doesn't feel comfortable interrupting, they may not check in to confirm that the pressure is fine.   

Here's an example: A client I have would, once or twice a session, brace her body, furrow her brow. and maybe screw her eyes tightly shut. It meant I was in an area that was uncomfortable. I don't want to press to the point where you're doing that, and everyone's body is different (really, everyone's!). But if I didn't check in at the right moment, her body got tense. She clearly thought she had to endure it. Discomfort doesn't always correspond to the amount of pressure we're using; depending on what you have going on in an area, it can be sensitive to very light touch, and the pressure may even feel deeper than it is.

I explained to my client that I didn't want her to feel she had to brace, and to please tell me if an area was sensitive. But it was her default mode. After a while I said, "I'd rather you not have to store all that tension in your body in response to the soreness. But I don't always know when I'm going past your comfort zone. Maybe you could just say, "Ow," and I'll back off?" She told me later that she had thought about this a lot, how and when to "just say ow"---not just in massage, but in life. 

A friend of mine simply says to her therapists in a little voice, like a little bird, "Too much pressure."  It's very pleasant, like a little cuckoo clock. "Too much pressure." 

5. Talk out your symptoms. 

Another reason I think developing honesty and communication in the massage room is so important is that, when it comes to the body, it's easy to ignore symptoms or sort of "think around them", especially if you don't like to complain. If you get the chance to speak freely about them, you may be able to think through symptoms more fully.    

A while back a client I had gotten to know well said she had been having her first bout of back pain for several weeks after a fall, and nothing had been making it better. She wanted her usual relaxation massage.  I asked her if she knew why she craved relaxation massage, and she said that she was stressed for a few reasons, including the stress of the pain. I said that I didn't want to override her instinct for relaxation massage, but I have some new techniques to help treat the pain, and could I use them? She said okay, but not enthusiastically---she wanted to be relaxed, not "worked on".

As I went through a few initial assessments with her, I caught myself. I stopped and studied her face. "I know this is a tendency of mine, to want to do 'therapy' over 'relaxation' when someone's hurting---am I being pushy?"

She paused and said, "Well, a little." I said, "Okay, we'll do relaxation massage." "Okay!" she said brightly. 

Not everyone would find that much communication particularly relaxing. But it immediately turned funny when she started shaking her head. "I've never had someone ask me whether they're being pushy. Because pushy people are just pushy, they don't ask if they're being pushy....I know because I'm pushy."

Halfway through the massage, my client changed her mind and said I could incorporate the new work. I didn't want to override her initial instinct, so I folded in just a smidgeon of P-DTR. Who knows what the magic ingredient was---in our work or her life---but three days later she reported that her back pain was gone. 

I can think of several examples in which poor communication got in the way of a session or massage relationship.  But I can't think of any cases in which open communication mucked up the works. 

As you get to know your therapist, communication will either get easier, or you'll stop needing much at all. But I just wanted to give examples of the kinds of dialogue that can help you get the most out of your session.