Trust Me … I’m a Massage Therapist

By Tim Clark

I’ve always known that what we do as massage therapists is so much more than ‘hands on bodies’ but the past couple of weeks have really drilled home the importance of one central idea.

On at least three occasions in my first week back after lockdown, clients told me that they had considered going elsewhere for a massage while I was closed but decided to wait to see me.

What did they say it was that made them wait?

It wasn’t that I offered rebates. Or that my fees were lower. (In fact, I put my fees up to cover my extra COVID-19 measures.) Or even necessarily that my massage was the best.

It’s simpler than that.

They said they trusted me.

It was a huge vindication of the time I had taken away from work to help prevent the spread of the virus, and of the measures I had put in place to protect against it during my return to work. More than that, it was a vindication of the work I had done over years cultivating and sustaining relationships with my clients that offered them an experience of safety.

You might be thinking, ‘We know trust is important, Tim. Tell us something we don’t know.

I get it. I’m right there with you. I’ve always known that trust is central to every single aspect of what we do, not only as a foundation for safety but as an aid to healing. But to hear it from my own clients’ mouths, especially after the destabilising events of the last few months, brought it home in a way that was vivid and real. Trust was right there in the room with us, out in the open – not just an abstract concept but something that we could both feel in the moment.

I got to thinking about what I can do to make sure that my clients continue to feel this sense of trust, and how I can make trust a focal point of my work. There are some really practical things we can do and some things that we can develop in ourselves, based on theory.

The Practical Stuff

In his book The Placebo Effect in Manual Therapy (2015), Brian Fulton offers a great, evidence-informed overview of how we can help our clients to trust us. Some of the “obvious and not so obvious things” (pp115-6) he mentions are:

  • “Keep your appointments and all other agreements with your patients.”
    • Breaking agreements breaks trust.
  • “Create realistic expectations.”
    • Positive: yes. Unrealistic: no.
  • “Help your patient to understand the healing process.”
    • Knowing that healing doesn’t always happen on a straight upward trajectory can reduce the frustration people feel when things aren’t going well.
  • “Explain your plan and strategy.”
    • Don’t leave them wondering if they’ve gotten involved with a treatment plan that might be a financial burden.
  • “Carefully explain the patient’s role.”
    • Foster autonomy and ownership of the healing process.
  • “Avoid making the patient feel diminished in any way.”
    • Even if you’re not overtly patronising or critical, your judgements can still be communicated unconsciously, so check them.
  • “Don’t allow interruptions during treatments.”
    • Undivided attention communicates care.
  • “Don’t be afraid to admit that you don’t know something.”
    • Acknowledging your limits reassures the client you’re not afraid to be human.

PD reflection idea: What do you do to foster your clients’ trust in you? What could you add to this list? Have there been times when you felt like you might have broken trust? What did you do to repair it?

The Theoretical Stuff

Fulton notes that people, depending on their history, will have different capacities for trust. He uses attachment theory as a lens for thinking about how easy or difficult it is for people to trust (p114).

Some people find it natural to trust others because their formative relationships (especially with their parents) have left them with the deeply held belief that people are generally trustworthy. In attachment theory, these people are deemed to possess a ‘secure’ attachment style. A majority of people exist somewhere on the spectrum of secure attachment.

People whose caregivers were unreliable, especially when they were very young, may struggle to warm to you or to relax during treatments. With these people, any breach of trust can register as reconfirmation that others can’t be trusted, which means they feel a need to remain constantly alert to external threats and are more likely to withdraw when their needs aren’t met. Attachment theory names this attachment style ‘avoidant’.

Conversely, some people with inconsistent caregivers respond by crying out or clutching in an attempt to have their needs met. As adults, they can come across as boundary-pushers or overly dependent, both of which can really test our ability to keep relationships appropriately professional. In attachment theory, this way of relating to others is referred to as ‘ambivalent’ or ‘anxious’.

With anyone, though, the principal of trustworthiness is a guiding light. An experience of a safe, trusting relationship can help to chip away, even a tiny bit, at deeply held beliefs around distrust, and even provide a model for how to relate to others in a way that is about authentic connection above all else.

PD reflection idea: Think about what you learned about trust growing up. It can even be helpful, if you can, to ask your parents or caregivers about what you were like as a baby. Then learn more about attachment styles here or here. What might your attachment style be? How might your attachment style impact on how you work with clients? Do you sometimes find it difficult to trust them? Are there clients you think might have struggled to trust you?

It was a gift for me to learn a few years back that I have a predominantly avoidant attachment style. I tend to keep a distance between myself and others because I expect them to respond negatively. It’s easy to see how this has crept into my work with clients. Sometimes, especially when a client is new, I expect that I will inevitably disappoint them, which can lead me to overcompensate by trying to be all things to them. It has taken time to learn to be more myself with people, to acknowledge my strengths and accept my limitations, and to let my guard down a little. Of course, this has extended into all my relationships. (I think I’m even doing it a little bit right now!) It has become more about my ‘way of being’ than about affecting any particular ‘professional approach’.

Which leads me to…

The Even-More-Theoretical Stuff

Feelings of trust are held in our bodies, and neuroscience is helping to bring us closer to understanding how we hold and process those feelings. In particular, the work of Stephen Porges on Polyvagal Theory, which goes back as far as the late 1980s, has done much to unravel the science of human connection.

In Polyvagal Theory, the term ‘neuroception’ is used to describe the signals we receive from our environment and from our own bodies that tell us we’re safe or in danger. It’s not only about what’s happening inside our bodies but about what happens between our bodies when we’re in contact with others. The neuroceptive feedback we get when we’re in relationship with other people is constantly updating and shifting. Those shifts in turn affect the other person’s shifts and on it goes.

Furthermore, the way we receive those signals depends upon our past experiences, especially traumatic ones.

For example, if I raise my hand and you’ve never been hurt by another person before, you may interpret this to mean that I’ll be asking a question or hailing a cab. On the other hand, if you’ve been traumatized earlier in your life, you may interpret the intention of my raising a hand with a sense that I’m about to strike you.

(Siegel, 2010, p21)

One of our tasks as massage therapists is to “track the nuances of neuroception” (Dana, 2018, p38) in ourselves and remain open to them in our clients. This is how we attune to our clients, and how we can monitor the waves of safety and threat that occur when we’re in contact, and thereby manage trust.

And when it feels like a client has reacted in a way that we find hard to explain – or indeed that we have had an inexplicable reaction – recognise it not as a reflection on either of you but as one of the inevitable mis-attunements of neuroception that can happen when two people are in contact, each one with their own in-built safety-seeking system activated. We can’t really explore these mis-attunements with our clients the way a psychotherapist might, but knowing that they occur can help take the sting out of experiences when we feel like we’re not being trusted or, indeed, if we’re struggling to trust a client.

PD reflection idea: I’ve barely touched on this massively complex and illuminating theory here. If you’re neuroscientifically minded, consider reading some of Porges’ own work. There’s a ton of remarkable writing here. What else can you take from Polyvagal Theory into your massage work? What questions does it raise for you that you could explore further?

I hope this has offered some fresh perspectives on trust. There’s a lot more to be said on both the theories I’ve mentioned here and a lot of potential applications for us in massage therapy that have yet to be explored, but it’s exciting territory.

References

Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. Norton: New York

Fulton, B. (2015). The Placebo Effect in Manual Therapy. Handspring: Edinburgh

Siegel, D. (2010). The Mindful Therapist. Norton: New York

About the Author

Tim Clark is a Melbourne-based massage therapist and psychotherapist. Tim has offered a free massage to anyone who will write his next bio for him.

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Comments

  1. Thanks Tim, great post!

  2. Thanks so much Pavel! I really appreciate it.

  3. Insightful and informative as usual, Tim, speaking to the essence of what we do. Thank you.

  4. Thank you Ronna! I’m glad it’s useful.

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