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Ep 278 - Imposter Syndrome?:"I Have a Client Who . . ."Pathology Conversations with Ruth Werner

A double-exposure image of a woman looking sad and happy.

A new massage therapist has a client who presents some special challenges: she has chronic pain, uses a lot of medications to manage it, wants deep work, and no matter what the MT does, seems to want more. The MT feels out of their depth and at a loss for how to help this client improve.

In this special episode, we talk about those feelings of inadequacy with our clients who seem to be especially demanding, and what we can do to help ourselves stay present and positively engaged.

Do you have advice for this therapist? I’d love to hear it. Contact me at


Pocket Pathology: /abmp-pocket-pathology-app

Author Images
Ruth Werner, author of A Massage Therapist's Guide to Pathology.
Ruth Werner's logo, blue R and W interlinked.
Author Bio

Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist’s Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP’s partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner’s books are available at More information about her is available at   



About Til Luchau and  

As a Certified Advanced Rolfer™, Til was on the faculty of the Dr. Ida Rolf Institute® for 20 years, where he served as Coordinator and Faculty Chair of the Foundations of Rolfing Structural Integration program. The author of the Advanced Myofascial Techniques textbook series (which has been translated into 6 languages), his regular Myofascial Techniques and Somatic Edge columns have been featured in Massage & Bodywork magazine since 2009, and (along with Whitney Lowe) he co-hosts the popular Thinking Practitioner Podcast. He is the Director of which since 1985 has offered short, credit-approved professional trainings and certification for manual therapists of all types, in person and online.






Full Transcript

0:00:00.1 S?: Join Til Luchau, September 28th through November 16th for an in-depth interactive online training in advanced myofascial techniques for the ILIA and SI joints. Earn NCBTMB approved credits toward becoming CAMT certified in as little as 90 minutes per week. Want even more join Til's monthly subscription, giving you unlimited access to more than 35 curated classes including advanced myofascial, Feldenkrais, and Zoga movement. It's affordable and you can cancel at any time. Sign up now at 




0:00:44.9 Ruth Werner: Hey, I Have A Client Who listeners, did you know I have a growing library of NCB approved one-hour online self-paced continuing education courses that you can do any time, anywhere. Well, now you know. Current classes include What's Next COVID-19 Updates For Massage Therapists and, A Massage Therapist's Introduction to Pharmacology Pt 1. And brand new, A Massage Therapist's Introduction to Pharmacology Pt 2. Classes are at $20 each and they confer one hour of continuing education credit. Wanna know more? Visit my website at and check it out. Be sure to sign up for my mailing list so you'll never miss a new class. 




0:01:39.3 RW: Hi, and welcome to I Have A Client Who, pathology conversations with Ruth Werner, the podcast where I will discuss your real life stories about clients with conditions that are perplexing or confusing. I'm Ruth Warner, author of A Massage Therapist's Guide to Pathology, and I have spent decades studying, writing about and teaching about where massage therapy intersects with diseases and conditions that might limit our client's health. We almost always have something good to offer even with our most challenged clients, but we need to figure out a way to do that safely, effectively and within our scope of practice, and sometimes as we have all learned, that is harder than it looks. 


0:02:25.9 RW: Today's episode comes from a lot of stories I've gotten over the last two years of doing this podcast. It's not so much about a disorder that a client might experience, instead it's about what massage therapists go through when they feel out of their depth and overwhelmed and simply not equipped to be the person their client needs them to be. This is especially true in the context of clients who live with chronic and painful conditions. I hear about it more from people at the beginning part of their career paths than from those of us who are closer to the end of this part of our professional life. And that's especially heartbreaking, because these feelings left unaddressed can shorten a career. I know that when the time came for me to leave my practice, this issue of impostor syndrome was definitely a contributing factor. I recently had one especially compelling letter, but it was in the context of a client who was quite unique, and the contributor felt there was too much identifiable information for me to post a podcast episode with the details they had provided. So I didn't. Because I will always respect your concerns about confidentiality, I promise. 


0:03:42.6 RW: But I and the team here at I Have A Client Who felt that the other issues about the therapist's feelings and ways to cope with them were also valuable and worth sharing. So what follows is a slight fictionalized of the conversation I had with one contributor, but it could apply to many conversations, including some that I wish I had been able to have near the start of my career as a body work practitioner, and the letter, again, fictionalized goes like this, "Hi, Ruth, I'm a new massage therapist. I just got my license about a year ago, I work in a clinic where many people with health problems come, I'm the newest massage therapist, and most of the older ones have retired or moved to other jobs. I have a client who has, and you can fill in the blank here could be fibro or chronic low back pain, or migraines or whatever, and she's been getting massage once a week for many years, but all the people who worked with her in the past aren't here anymore. Her massages are paid for with a settlement from her accident, and that's why she keeps coming every week. If she had to pay out of pocket herself, I'm pretty sure she would not attend for massage therapy. In the beginning, I understand from her that massage therapy helped a lot with recovery from her accident." 


0:05:02.3 RW: "Now, her session goals are different every time, sometimes it's for spasms or a tightness, sometimes it's for headache or for foot pain or whatever. It varies a lot. I honestly believe my role has been to aid in just general relaxation more than anything else. I just don't see her getting any better, she uses pain killers and muscle relaxants, and she wants me to go really deep. I wonder if her meds are having some kind of secondary effect on me. I have to admit that I have to guard my energy with this client, and I've noticed a definite decrease in my mood when I work with her. I'm really out of ideas, no amount of pressure is enough. She doesn't like to be involved with any movement, passive or active, it's definitely hard on my body." Oh, this kind of breaks my heart because I know exactly what this contributor is talking about, the meds are not the cause of distress here, but keeping appropriate boundaries and expectations is, and it's not as simple as they made it sound in massage school. So picture this, you're a new practitioner, you have a job, a great job in a busy, active medically-based clinic. 


0:06:21.6 RW: Your client is a massage veteran, but all her previous massage therapists have moved on, so you are on your own, and all you wanna do is help her, and nothing you do seems to please her, you can't work deeply enough for her, you're concerned because of your own limitations. You're concerned because of her meds and the whole experience leaves you drained and exhausted. Okay, let's take a breath. 


0:06:49.7 RW: I'll let you know how I replied in a moment, but first I'd like to invite you dear listener to consider if this has ever happened to you, especially back at the beginning of your career, or if you happen to be a relative newbie, please understand that this happens. We get clients who through no particular fault of their own, make us feel inadequate or unprepared or not up to the task, and that can make us question a lot of our fundamental life choices like, whatever made us think we could do this to begin with. Maybe I'm overstating this a little bit, maybe I'm catastrophizing just a little. Yeah, probably because this happened to me when I was new and the memory still stings, but I did not have the self-awareness to ask for help. It's just one client here who's having some difficult issues and this massage therapist needs some extra support, and the fact that they're even asking for guidance, tells me they're on the right track. 


0:07:55.0 RW: And here's what I sent back, "I understand what you mean about feeling depleted after a session, it can be a special challenge to work with people who are in chronic pain, that transference is real and you're not alone, and you can take some steps to stop it. Here are a few ideas, even though her sessions are paid for, she probably wouldn't get massage if she didn't think it was worth her time, so bear that in mind. Remember that you are not responsible for this client's choices or attitudes or even her healing, you are not going to fix her disorder. You are responsible for creating a safe and comforting space for her and for you, your well-being is as important as hers during your time together, and the more clearly you can hold your boundaries, the easier it will be for you to let her be her and not take that on as your responsibility." 


0:09:00.3 RW: "You say that all you're doing is relaxation, but relaxation is a great thing, revel in it, you may be the best thing that happens to her all week. Consider carving out time for a five-minute pre and post meditation of your own to prepare yourself to welcome her into your awareness and then to reset after your session. And lastly, chat with your peers, not so much about this client, but about their self-care routines for when may feel drained by certain people in their practice." And that's what I sent back to our contributor who felt that that could be helpful. But I'd like to invite you to share your encouraging words or thoughts or advice about what this massage therapist and others like them could be doing to feel better about their work when they feel overwhelmed like this. 


0:09:58.2 RW: If I get enough of your input, I'd love to put together a whole episode based on that. You have so much wisdom, and I'm delighted to be an avenue through which you can share it. You can do that through my Facebook page and Messenger, or through my website at, or through my email address at abmp, that's; ihaveaclientwho, all one word, all lowercase at Truly, I wish I had known more about these strategies at the beginning of my career, I might have lasted longer as a practitioner, but then maybe I wouldn't have become an educator and a writer and a podcaster, and I love every bit of my work. 


0:10:49.7 RW: Hey everybody, thanks for listening to, I Have A Client Who, pathology conversations with Ruth Werner. Remember, you can send me your, I Have A Client Who stories to,, that's ihaveaclientwho, all one word, all lowercase at I can't wait to see what you send me and I'll see you next time.