The Importance of Self-Awareness

By Tim Clark

I had some achy shoulders recently and decided to treat them with massage. The therapist was highly experienced and professional but by the time he’d finished treating me, I knew I would not see him again. During the pre-treatment assessment, I explained that my shoulders were sore, mostly from a sudden uptick in my exercise regimen. I also explained that I was a student, which seemed to ring alarm bells for him. He told me my shoulder pain might be due to too much hunching over a desk while studying, probably exacerbated by my height (I’m 6’6”). I told him I really hadn’t been doing much desk work lately, as I was on a break from uni, but he didn’t seem convinced. The massage itself was fine, but on my way out he made the throwaway comment: “Keep an eye on that desk work”. It was hardly the gravest error any massage therapist ever made, but was enough to alienate me and leave me feeling unheard.

It suggested to me that, as well as not being a great listener, he wasn’t aware of his own tendency to blame symptoms on a stock-standard cause, presumably based on his own experience of people with shoulder pain, rather than meeting me with an attitude of curiosity and openness. It was a simple moment that illustrated to me just how important it is for us to keep as close an eye on ourselves as we do on our clients.

Under “Professional Boundaries – Principles” in the AMT Code of Practice, self-awareness is named as a guiding principle in maintaining professional boundaries and it colours many other aspects of the work we do. Of course, we all like to think we’re pretty self-aware, but the problem is that often we don’t know what we don’t know. Unfortunately, just because I am me doesn’t mean I necessarily know me.

So what can we do to get to know ourselves better?

An article by Knapp, Gottlieb and Handelsman (2017) identifies five questions that psychotherapists might ask themselves to increase their self-awareness, but they are just as useful for massage therapists to help us identify our blind spots. We might not like the answers, but we can’t afford to ignore them.

1. Do I recognise my immediate emotional reactions?

We respond quite instinctively to our clients, sometimes positively, sometimes not. If we remain unaware of our reactions, they can colour our interactions in unintended ways. Bringing emotions out of instinct and into consciousness allows us to determine whether they are helpful or not.

The “big six” – happiness, sadness, fear, disgust, anger and surprise – can all serve valuable purposes but might also cause ruptures in our relationships with clients, or even harm our clients.

Example: Expressing anger by applying excessive pressure, or turning disgust into avoidance.

Even feelings of happiness can be counterproductive if they’re out of sync with the client’s mood.

Remaining curious about our emotional reactions, without judging them, can help us stop them from negatively impacting our work.

2. Do I judge my competencies accurately?

When a client tells me that I’ve fixed their problem in a single treatment, I like to think that it’s because I am either blessed with magical powers or am just so good at what I do that I can’t help making people feel better.

Of course, this is the hubris of a fool. Usually I can only partly account for what I have done to help, and sometimes I have no reasonable explanation at all.

Like so many professionals, we massage therapists are susceptible to overestimating our abilities.

Example(s): We attempt to treat problems beyond our scope of practice. Or, we might overclaim the range of our expertise, suggesting that we are specialists in twenty different bodywork modalities, when really we are simply proficient across a range of methods.

3. Do I recognise that I might harbour implicit prejudices?

It is easy for people who consciously and vocally support social equality to harbour unconscious prejudices that may influence the way they treat others.

Example: We might say that we don’t treat people differently because of their ethnicity yet unconsciously lower our standard of service to someone from a particular ethnic group.

Only when we have identified our prejudices can we look for ways to compensate for them and keep them from harming our clients. We might not like admitting these things to ourselves but we need to accept that we are capable of prejudice, then foster compassion for ourselves, flaws and all.

4. Am I aware that I might succumb to cognitive biases or unhelpful heuristics?

There are more than 180 named cognitive biases to which we are all capable of falling victim. (This infographic distils them into twenty simple reminders about the traps we’re prone to falling into.)

My massage therapist tripped over a fundamental (or ultimate) attribution error in diagnosing my problem, rather than remaining open to the contributing factors I was describing.

There are many reasons we might rush to an easy diagnosis but it’s important to keep in mind that even well-informed assumptions can be disproved at any time and, therefore, we should remain open to alternative explanations until we’re confident of having every base covered.

Clients might find our uncertainty frustrating, or judge us as incompetent, but they might also value our honesty and even learn to develop the same kind of curiosity and open-mindedness about their own health.

5. Am I fully aware of my values?

Sometimes we need to deal with ethical dilemmas on the spot, which is tough if we’re not sure what is most important to us.

Having your Code of Ethics on display in your treatment room can help to reinforce positive professional values so that they become automatic.

It might also be helpful to distil your values into a few ‘catch-all’ words you can fall back on in difficult situations. Words like ‘respect’ or ‘care’ might feel too broad or abstract. Think about more specific, practicable terms like:

  • Beneficence – acting in clients’ best interests
  • Non-maleficence – doing no harm
  • Fidelity – honouring trust
  • Autonomy – helping people help themselves
  • Fairness
  • Self-respect.

(These are among the guiding principles of the Psychotherapy and Counselling Federation of Australia’s Code of Ethics.)


Clearly, there is plenty that we can do to improve our self-awareness. As well as making us better practitioners, it can help to make us more secure, differentiated individuals, better able to determine where our problems end and someone else’s begin. This can only be good news.


Knapp, S., Gottlieb, M. & Handelsman, M. (2017). Self-Awareness Questions for Effective Psychotherapists: Helping Good Psychotherapists Become Even Better. Practice Innovations, 2(4), 163-172. DOI:10.1037/pri0000051.

About the author

Five years ago, if you’d told Tim Clark he would be a massage therapist and psychotherapist in five years’ time he would have laughed in your face. That said, he completed his massage training last year and has just finished the Master of Counselling and Psychotherapy. Tim’s Master’s thesis examines the relationship between a massage therapist and her client through the lens of psychotherapy.

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  1. This is such a helpful article, just in time… for me to reflect on my connection to my beautiful and sensitive clients!
    As massage therapists we can possess the most proficient techniques but if we lack ability to fall in tune with our clients, we might loose them for good.

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