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VERBAL
SKILLS FOR MASSAGE THERAPISTS
Note:
These guidelines are not meant to imply that you need to talk a lot
during a massage session. Often,
very little needs to be said. Verbal intervention should be used minimally
and subtlely to keep some contact and check on the client's well-being.
If the answers are congruent with the client's body language e.g the
client says "I'm fine" and the breathing appears flowing
and you have a sense of ease and peace, no more needs to be said. If
the client's response to a question is not congruent, e.g the client
says "I'm really enjoying this" but you notice that the
breathing is very shallow and the client's eyes are wide open and
'on guard', you need to sharpen your observations and begin to ask
yourself what is happening. Don't rush in to asking questions or commenting.
Its important to give the client space. Verbal
interventions include instructions, questions, reflections, suggestions. Instructions.
These are especially important with new clients who may be very anxious
about what the're supposed to do. e.g "I'm just going to wash
my hands. You can get undressed - leaving on your underwear - and
get on to the table in between the sheets." Questions. Ask
open-ended questions - eg. "how does this feel?" - unless
you have a reason for wanting more specific information e.g "does
this muscle on your arm here feel very tender?" Its
often best to start with an open-ended question but if your client
answers in a very general neutral way, you may want to follow up with
something more specific. On the other hand if you ask a lot of very
specific questions, your client may feel they're being interrogated!
It may be best to just ask one question which can be answered in various
ways. Content of questions The
broad categories of interest, in approximate order of intensity or
charge are: thoughts,sensations, images, memories, feelings, relationship.
You may ask a general question eg. what's happening? and the answers
can contain one or a combination of the following. Thoughts.
"I'm thinking about work". Thoughts may be on the road to
the feeling e.g the client may continue, "I had a row with my
boss and I still feel angry.." Thoughts may be an avoidance of
feelings, "I was just admiring the wallpaper", or revealing
general anxiety. Sensations.
These are particularly important to encourage, and perhaps explore,
when working with massage. For the client, noticing and describing
sensations is vital in building embodied self- awareness. It can be
a fresh way to get in touch with experience without going down familiar
thought pathways. It can be a very subtle and safe way for the client
to expand their vocabulary for their sense of themselves. E.g.'s
"how does this leg feel?", "is this painful?",
"are you aware of how cold your feet are?" "does this
pressure feel okay?" "is this comfortable?" "can
you feel this muscle?" "does it feel tight?" etc It
can be helpful to bring the client's awareness to areas that are numb,
or cut off - but be careful: you don't want to increase anxiety, or
make the client feel judged. Remember,
particularly in British rather repressed and 'body-shy' society, people
are not used to talking about body feelings and sensations. They may
find your questions very strange! You may need to start with simple
practical questions, "are you warm enough" so that they
begin to feel that its okay to listen to their body, and that you
care about their well-being. When
people do become aware of a sensation that is not numbness or pain,
they may find this frightening, particularly if it is a feeling of
aliveness, inner movement, etc such as tingling. As with any subject,
your tone of voice can help convey gentle interest, acceptance and
understanding. Images. For
the more sophisticated client, when there is a sense of something
stirring which they can't easily put into words, you can ask if they
have an image. A certain proportion of people thrive on visual imagery,
but again, its important that the client doesn't feel they have failed
if they don't have an image. Sometimes visual imagery is a way of
splitting off from what's happening in the body and it is a sign that
the client is quite frightened. (There will be other signs of fear
too, in the breathing etc) You have to consider, does the image resonate?
can you find a connection between what is going on in the client's
body and the imagery they are using? E.g "there is a bubble of
tears around my heart" - this is an embodied image that is concrete
and suggests feeling. Memories
There
may be an overlap between images and memories. The client may see
a picture of themselves somewhere or they may be seeing from the perspective
of then, e.g feeling small and looking up at an adult. Being in the
observer position is slightly more detached and may be necessary to
keep the feelings manageable. Some
memories are pleasant, some stir up conflicting feelings. Sometimes
the client knows quite clearly that they are remembering. Sometimes
its more like a dream - there is uncertainty - did this happen? It
is important not to assume immediately that it is a memory. It is
much more important to support the client in recognising the feeling
content and giving that space. Memories
of Abuse Sometimes
people are frightened that memories of abuse are surfacing and they
will ask, "do you believe me?" If the client's memory is
very specific and has a context - you can indicate your acceptance
of the client and your willingness to listen and try to understand.
If the details are vague, it may be wiser just to confirm your trust
in the client's feelings, eg. "I can see you are very frightened.
I don't know what happened to you but I will support you in finding
out". The
massage table is not the place to explore this kind of trauma unless
you are very experienced. When a client is overwhelmed by fear, it
is helpful to (a) get them upright - sitting on the table or on a
chair (b) keep eye contact - this helps bring the client back into
the present (c) keep them warm, covered and supported with blankets
and cushions. Recovering
memories is not the objective of biodynamic massage - it is something
that can happen in the process as the client becomes alive to their
history as it has been preserved in their body. If the client has
suffered major trauma, you need to consider whether massage is appropriate.
Is the client in therapy? Has the therapist given permission for massage
? (You always need to obtain the therapist's consent before starting
massage) What is the client's life situation? Will they be able to
get enough support to hold them during an intense process? When
a body memory is emerging there may be strong internal conflict between
the part that has kept it suppressed and the feeling which wants
release and completion. It is at this point that verbal intervention
is most valuable to support the client in making sense of what is
going on. Clients can quickly re-bury feelings and memories without
very clear external support and encouragement. You need to strike
a balance between asking questions to gain information, perhaps feeding
back what you see, and giving the client space to actually experience
what's going on. Don't press for resolution and insight - remain open
to all sources of information especially your own and the client's
intutitions. Feelings You
may become aware of the client's feelings rising by changes in their
breathing, changes in colour (particularly the face), increased restlessness
or increased stiffness. They may not be aware of these feelings -
keep the questions open, and be aware of your tone.If the client is
regressed, if there is a lot of sadness or fear, you will probably
instinctively soften your voice. This may be reassuring for the client.
However, it is still important to remain separate: if you find yourself
too drawn in and involved, you will not be maintaing safety. It is
possible to be gentle and matter of fact. If
the clients can allow and make sense of their feelings - ie. understand
what they are connected to, the feelings may only need acknowledgement
and space. If you are not sure what's going on, you can ask questions
to help clarify. e.g if the client says "I'm remembering how
unhappy I was a few years ago", you might ask, "are you
feeling unhappy now?" , or you might ask them where the feeling
is in the body. Notice whether your questions or comments are followed
by signs of opening (more breath, more feeling, more contact) or closing
down.(holding the breath, tightening muscles). (1)
Sometimes
the best thing you can do is wait, stay present to what's going on
in you, keep a contact with your hands. You can place your hands where
you feel/see the conflict or charge, or in a place of support such
as the lower back, or on the diaphragm (at the back), or, if the client
is on their back, you might hold their feet (if there is fear and
the client needs grounding), hold their hand, or place a hand behind
the neck to create a bridge between head and body. It
is not possible to give a comprehensive guide to how to meet, contain,
and support a feeling process here. It is something you learn throughout
the training. In biodynamic terms there are considered to be two channels
for feeling: the expressive route, which means encouraging the feeling
to come out through tears, movement, kicking, making sounds, putting
things into words; and 'melting', which is grounding the emotional
charge by supporting the downward flow of energy and abdominal discharge
through peristalsis. Clover Southwell explores the indications and
contraindications for these approaches in depth in her article on
equilibrium. (2) In working with clients where there
is not a psychotherapy contract, it is best to aim for melting and
relaxation. (3) There
is a third more psychodynamic option, particularly appropriate for
working in a psychotherapy process, which can include both the above
but which focuses more on containment through finding words, making
connections, exploring the relationship. In this approach sessions
might include more verbal work before and/or after getting on the
table. The
therapeutic relationship In
biodynamic massage, the relationship between client and therapist
is of paramount importance. The relationship always reveals something
about the client's process and the therapist's process. It is never
neutral. Everything that happens in the client's body is, at least
partly, is a manifestation of that relationship. If the client is
breathing shallowly, this is in relationship to you as the therapist.
If you feel protective of, irritated by, uninterest in, the client,
this is a reflection of the relationship between you. Hence the importance
of the massage therapist being able to own their feelings, and recognize
their typical patterns. As
a beginner, it may be difficult to take into account all the aspects
of what is going on, especially when you are learning new techniques
and just starting to find your way around a body. But it can be reassuring
to know that everything that the client does or feels is not neccessarily
a reflection of your skill, but has at least as much to do with their
history and your presence. It
is not neccessary to do anything with this information or any information.
Initially you just need to notice things, feel things, observe and
ask yourself a few questions. If the relationship does not seem to
be getting in the way of a process -e.g you are doing a membrane massage
and the client is gradually relaxing - you do not need to do any more. When
the relationship appears to be affecting the client's ability to relax,
express, or surrender to the process (sometimes described as "resistance"),
then you need to reflect on what is happening. This is often the aspect
of experience that the client is least aware of. It is not always
appropriate to follow this up on a verbal level - it really depends
on the nature of your contract with the client, their readiness or
'ripeness' to explore the relationship, their capacity to respond
to and understand the nature of your questions or comments.It can
be very intimidating if the client feels that the therapist is trying
to "get at" something. Softly, softly may be the best approach,
eg. do you feel you're getting what you need/want from me today?"
However a client who is more therapeutically experienced might prefer
a more direct question, e.g "how are you feeling with me right
now?" Reflections These
can cover any of the above categories, and make an alternative to
asking questions. They need to give the client some information that
can be usefully assimilated which they might not quite have noticed
for themselves yet. eg. "your breathing has changed since I started
working on your legs. How are you feeling as I work here?" By
reflecting and then asking a question you are educating the client
as to possible links between breathing and feeling etc. One or two
such reflections in a session is plenty unless there is a strong process
going on otherwise the client may feel judged, analysed, examined. Suggestions The
occasional postive suggestion which gives the client permission to
let go and be themselves can be valuable, especially with clients
new to a process.. These should be simple, "feel your belly (or
legs, or hands etc)", "notice what's happening...",
"let yourself breathe", "allow yourself some space
to let go". Such suggestions belong in the session when the client
is very close to opening, relaxing etc and these offer the extra support
needed. They are not appropriate when they go against the prevailing
tone of the session, eg. if you sense hostility, you don't want to
try and infer safety. Resonant
moments: when it all comes together. The
separating of experience into components, eg. focussing on the sensation,
or on a past memory, or on a detail can be, ultimately, from a psychotherapeutic
point of view, a way of managing overwhelming feeling. We have all
developed strong protection from being fully open and conscious. When,
as massage therapists, we work on the body, we work directly with
that protection in its energetic and physiological form., |If we are
connected to our feelings, and in addition we have the verbal skills
to evoke and trace a process, we have very powerful tools. The bringing
to awareness of all dimensions - feelings, memories, thoughts, sensations
- in the context of a relationship in the present constitutes an intense
experience which touches and changes both the client and the therapist. There
is a parallel between the connections the massage therapist makes
on a body level - between limbs and trunk, between layers of tissue,
between an awareness from inside and a sense of being contacted from
outside - and the connection made in any theraeutic context, between
client and therapist, past and present, words and meanings, feelings
and thoughts etc. Connections are relationships and the more complete
our relationships the more alive we are. In
using words as massage therapists the aim is to invite the client
to be present with as much as is right and ripe for them in that moment,
and no more. Massage is process oriented and not goal oriented. For
one client, allowing a single deep sigh or a feeling more warmth in
their feet can be a huge stride. Notes (1)
In Body-centred Psychotherapy: The Hakomi Method (Liferhythm, Mendocino,
1990) Ron Kurtz gives lots
of examples of phrases and indications of process when working with
the body. (2)
Clover Southwell, "Biodynamic Massage as a Therapeutic Tool -
the Concept of Equilibrium" (3)
In order to working professionally with clients you need: a Certificate
in Biodynamic Massage from Chiron or CPD; to belong to a professional
association such as AHBMT (Association of Holistic Biodynamic Massagr
Therapists) or AMP (Association of Massage Practitioners); insurance;
and supervision. Supervision supports you in making and maintaining
suitable contracts with clients, appropriate to their needs, wants
and your qualification and level of experience. |
email roz@thinkbody.co.uk |