AMT Chairperson Spring 2021 Message

By Subhadra Gerard

I first came across the term ‘felt sense’ many years ago when reading an interesting book called Focusing by Eugene Gendlin. Focusing is a body-oriented process of self-awareness and emotional healing developed by Gendlin (a psychotherapist). Simply put, it is a process of “noticing how you feel – and then having a conversation with your feelings in which you do most of the listening. Focusing starts with the familiar experience of feeling something in your body that is about what is going on in your life. (For example) when you feel jittery in your stomach as you stand up to speak, or when you feel tightness in your chest as you anticipate making a crucial phone call, you are experiencing what we call a ‘felt sense’ – a body sensation that is meaningful”[1].

Over time, Gendlin’s focusing process has helped somatic psychotherapists illuminate the somatic dimension of emotional healing and change. In this regard, the work of Ron Kurtz (see Body Centered Psychotherapy: The Hakomi Method) and Peter Levine (see Waking the Tiger: Healing Trauma) come to mind.

However, I am not here to talk about focusing per se. What I want to do here is beg your indulgence and appropriate the term ‘felt sense’ for another purpose. I was struck by the term when I first read it, and I have since had the view that it could equally be used to describe the ‘feeling’ mechanism we massage therapists use as we ply our trade.

Recently, I had occasion to look up the medical definition of ‘palpation’ and found two meanings[2]. There was the readily recognisable: physical examination in medical assessment by pressure of the hand/fingers to the surface of the body, especially to determine the condition of an underlying part or organ. The second meaning was: an act of touching or feeling. We are talking here about touch as the sensing or perceiving of what is being touched, not just a simplistic touching. This involves interpreting the body sensations as meaningful.

Massage therapy is one of the manual therapies. It’s hands-on and, as such, involves touch. A lot of touch. When we touch (palpate) a client’s body, we are feeling their body, their skin and the underlying structures. In so doing, we are using what I would like to call our ‘felt sense’.

Palpation = touch (sense) = feeling (felt sense)

I’ve long thought that we massage therapists, having been well trained and with a decent amount of experience, possess a felt sense that is second to none in the world of manual therapy. It seems that I am not alone.

The popular educator, Joe Muscolino, shares a similar view: “muscle palpation is so integral to the field of massage therapy that it’s likely that massage therapists lead all other health professionals (my emphasis) in muscle palpation skills”. In contrast to that sentiment, though, Muscolino goes on to state that “unfortunately muscle palpation is often not well learned by students and therapists alike because of the manner in which it is presented in textbooks and the classroom – as protocols to be memorised”[3].

He believes that a much more effective approach would be to teach a set of guidelines on how to palpate; and then reinforce that with lots of hands-on practice. (Muscolino is talking about muscles but his comments can equally be directed to the whole range of structures that we are feeling as we work).

Palpation is part science: you need to have a knowledge of anatomy, physiology, kinesiology and pathology. However, palpation, well executed, is also an art form with the requisite high level of skill. The professor of osteopathy, Robert Kappler, has summed it up this way: “The art of palpation requires discipline, time, patience and practice … Palpation with fingers and hands provides sensory information that the brain interprets as: temperature, texture, surface humidity, elasticity, turgor, tissue tension, thickness, shape, irritability, motion. To accomplish this task, it is necessary to teach the fingers to feel, think, see and know. One feels through the palpating fingers on the patient; one sees the structures under the palpating fingers through a visual image based on knowledge of anatomy; one thinks what is normal and abnormal, and one knows with confidence acquired with practice that what is felt is real and accurate”[4].

Palpation lies at the heart of how all manual therapists work. Therapeutic interventions are commonly determined by prior palpation and the meaning/interpretation given to what has been palpated. This palpation involves the felt sense, but the intervention often involves another kind of contact, be it a high velocity adjustment, some other mode of manipulation or mobilisation, an exercise, or the application of a TENS machine etc.

Generally speaking, massage therapy goes further than other manual therapies because the use of the felt sense is more or less continuous: the assessment becomes the intervention/treatment itself, which becomes (hopefully) the reassessment. To quote Muscolino again: “Treatment should be a two-way street that involves not just motor pressure out to the tissues of the client, but also continued sensory information in from the tissues of the client’s body… (W)hile we work, we continue to assess, gathering information that guides the pace, depth, or direction of the next strokes”[5].

The bodywork guru, Leon Chaitow, takes this view a little bit further: “Palpation and treatment are synchronous with decisions over how (the therapist) should respond by varying the degree, duration and direction of forces. These decisions are determined by what is being assessed/felt by the (therapist’s hands), and how this is interpreted in real time, moment by moment. What is done therapeutically in a (massage) setting is directly related to what is being palpated and assessed at that moment, rather than having been planned ahead… For experienced therapists, much of the instant decision making that results in modifications of application of forces (compression/stretch, etc) happens without due deliberation. The hands do the thinking – intuitively, so to speak”[6].

Bodywork teacher, Edward Maupin, agrees, but he has a slightly different take on how the process can unfold: “Even though you know procedures, you are always inventing them anew in response to this experience in the present moment of what you are touching. Your technique becomes an improvisation in response to what you are touching. All the techniques, all the experience, all the practice, are in the here and now as original, creative responses”[7]. I love that way of working!

What I’ve been endeavouring to do in this conversation today is remind you all of what an important, highly developed felt sense you have – and that you should embrace it, treasure it, and continue to nurture it.

Let me finish by picking up on points made earlier by Joe Muscolino. There was a disconnect between him saying that we massage therapists were ‘best practice’ with our felt sense, and then informing us that many(?) students/therapists are not well trained to begin with. The sad reality is that a number of AMT members have shared with me that they do not have a great felt sense, and that they would love to ‘retrain’ in how to do it proper-like!

There is something that AMT can do about that. We are (hopefully) not too far away from being able to run face-to-face workshops again, so there will be the opportunity to meet your needs in that regard. Stay tuned.

I’ll leave you with some final questions to reflect on: how finely tuned is your felt sense? Right up there with the best of them? Or is it, perhaps, in need of a little tweaking to help you be the best possible massage therapist you can be? Either way, there’s work to be done.

About the Author

Subhadra Gerard is a massage therapist and occupational therapist in Perth, WA. In May this year he took on the role of Chairperson of the AMT Board of Directors.

References

1. Cornell, A. (1996). The power of focusing: A practical guide to emotional self-healing. New Harbinger.

2. “Palpation.” Merriam-Webster.com Medical Dictionary, Merriam-Webster, https://www.merriam-webster.com/medical/palpation

3. Muscolino, J. (2010). Effective palpation. Massage Therapy Journal, Winter 2010, American Massage Therapy Association.

4. Kappler, R. Palpatory Skills in: Ward, R., (Ed), Foundations for osteopathic medicine (1997), Williams and Wilkins.

5. Muscolino, J. (2009). The muscle and bone palpation manual. Mosby, Elsevier.

6. Chaitow, L. (2009). The essence of palpation: How do you feel? Massage Today, Vol 09, Issue 3. 7. Maupin, E. (2005). A dynamic relation to gravity: Volume 1 – the elements of structural integration. Dawn Eve Press

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