The client centered approach to massage therapy is a method of client care that attempts to change the traditional relationship developed between a caregiver and a client. In the traditional American view of this relationship the care giver (as in a Doctor) is held in extremely high regard and is given almost total power over a plan of care developed for the patient, thus greatly increasing the power differential.
This can lead to many problems including:
-Alienation of the client both mentally and emotionally from the process of healing.
-A sense of fear because of unknowns and lack of control.
-Greater potential for abuse of power
The client-centered approach seeks to significantly lessen the power differential and provide a healthy groundwork for healing to take place. There are two fundamental aspects to this new approach one involves the structure and outcomes of the relationship, the other encompasses the intention of the practitioner.
Structural and Outcome based concepts in the client centered approach:
1 – Two Way: There should always be two-way information flows between client and therapist. This means that the therapist receives information from a client (like “my upper back is sore”), the therapist then takes this information, does some hands-on assessment (and then responds with “yes, In my professional opinion we should do …”), at which point the client can accept, refuse, and or give more feedback.
2 – Participatory: The therapist should always be encouraging participation in the process of healing, even if that participation is at the level of going into deep relaxation it is still an important, if inactive, type of participation that can be recognized.
3 – Clear Boundaries: As discussed above, clear boundaries will help to facilitate a trusting relationship where the client can feel very comfortable.
4 – Decision Making: The client must be given all possible opportunities to make decisions and choices about the direction of their plan of care and even specific treatments. Keep in mind that this happens within the context of therapy and you are welcome and moreover expected to give your expert opinion on all treatment matters.
Intention of the therapist in the client centered approach:
1. Highest Good: The therapist should always hold the highest good of the client as their highest goal. If at anytime the therapist begins to question whether or not they are pursuing the highest good for their client, then the therapist needs to seriously consider why this feeling is coming up and what they can do to correct matters. If they cannot find a reasonable solution to whatever problem is presenting itself then it is of great importance to refer the client to another therapist.
2. Redirecting Power: As one of the major goals of the client-centered approach is to lessen the power differential it becomes important to redirect power to the client (see section below on transference and side-stepping).
3. Don’t Hold Power: In keeping with redirecting power, we must also keep in mind that we are not trying to hold onto power or develop a feeling of power over the client in the therapeutic relationship or as a therapist in general.
One important case to note is that of the client who refuses to give feedback. It can be frustrating at times to work with such clients, but remember that they are struggling with life as we all are. In these cases it is advisable to continue to seek feedback and attempt to keep lines of communication open and free.
The less open or communicative patient forces you to make more independent decisions. In the end, with communication channels open, this can be a beneficial growth opportunity for both practitioner and client.
Health care providers of all types struggle with these issues. Chair massage and full-body massage providers are often more acutely aware of challenges around how power is balanced in the therapeutic relationship because of the particularly intimate nature of massage and the alternative approach to medicine and healing that is commonplace within the profession.
This gives the massage therapist, whether working in a chair or table massage setting, a unique opportunity to engage clients and get them involved in their own process of healing and renewal. Following the steps and concepts outlined above will help you, as a bodyworker, to practice a client-centered approach that provides your clients the best possible therapeutic experience.