Assumptions & Outcomes

By Douglas Nelson
[Table Lessons]

“Would you mind giving this person a call? She wants to speak to the owner.” As the owner of a massage therapy clinic with many therapists, requests like this ramp up my heart rate.

Seldom do people want to speak to me because they want to share what a fabulous experience they had with one of my staff. More often, as you might imagine, something has gone wrong and the client wants to be heard.

When I picked up the phone, on the other end of the line was a pleasant voice belonging to a person who had visited my clinic a few days earlier. After I introduced myself, Miss R. explained her frustration: “It’s not that I am complaining or that I want to get the therapist in trouble, but the session wasn’t at all what I expected. I have never had a massage before, and I was really looking forward to it. After all that expectation, I was disappointed with the session. I don’t mean to be a complainer; I just want you to know I am very disappointed.”

“First, you shouldn’t apologize at all for expressing what you feel. If we, as an organization, failed you, I need to know. I cannot correct a problem that I don’t know about. Tell me what was disappointing with the session.”

“It is not so much that the massage itself was a problem, just that the session was really incomplete.”

“Incomplete? How do you mean?”

“I mean that the therapist spent all her time working with my neck, shoulders, and upper body. The massage there was great and really needed. The problem is those are the only areas she worked. She did not massage my legs at all—just a little work on my back and hips. I’d say that 90 percent of the session was on my upper body.”

“Oh, I see. You were hoping for something quite different from what you got, so of course you were disappointed.”

At this point, I couldn’t help but wonder how the goals for the session could be so far from what the client wanted. This is very uncharacteristic for my staff, but everyone can have a bad day or make an occasional bad choice.

“Did the therapist sit down with you and discuss what your goals for the session were? Did she take the time to ask you what, if any, areas were of concern?”

“Yes, she did sit down with me at the beginning and asked me where I was feeling tension and stress. I told her about the headaches I was having and how they have been an almost daily occurrence for the last two weeks. I think they are coming from my shoulders, both of which are extremely tense. Also, the area between my shoulder blades has been driving me nuts. If I sit for any length of time, I get this burning pain, and my job requires me to sit most of the time. Between the aching in my shoulders and the headaches, life has been pretty miserable. That is why I was looking forward to the massage so much.”

Before I could respond, Miss R. interjected, “Uh oh. I just realized that everything I complained to the therapist about was right where she worked. I didn’t think about it, but she did exactly what I asked. I just never thought about it until I heard myself tell you what I told her.”

“Did the massage help those areas she addressed? Are your shoulders better and have you had a headache in the last two days?”

“My shoulders are less tense and come to think about it, I haven’t had the headache either. I am feeling really embarrassed right now, because it seems I got exactly what I asked for, even though I expected something different. It’s just that my image of massage was a whole-body session, with maybe just a tad more emphasis on an area of tension. I am not really even sure where I got that idea, maybe from the movies or something. I just didn’t think massage could be focused like that.”

“The practice of massage is wide-ranging, from more general relaxation to highly specific problem-solving. While my therapists can do both, our specialty is in problem-solving, which is what the therapist did, based on your description. We could do a better job of clarification of goals and I’d like you to come in again for a free session just to relax. Make sure you tell the therapist that you want a relaxing, full-body session.”

As I hung up the phone, I kept thinking about assumptions. I have had clients complain that the session wasn’t focused enough; in this case, the session was too focused. Before dealing with tissue restriction, we therapists must clarify not only the client’s goals, but also the unstated preconceptions or assumptions that could affect the outcome. Sometimes, that’s the most difficult work of all.


Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit or email him at