Who's Assessing Whom?

By Douglas Nelson
[Table Lessons]

“You could certainly tell who was the most experienced,” my client said. “It was interesting to perceive the distinct differences in abilities between the therapists.”
I’m sure my eyes widened a bit at her statement. I was immediately lost in thought, thinking about the impact and gravity of her statement. Allow me to explain the context.
Ms. J. was a previous client participant in an advanced-level course I was teaching. She had returned for a follow-up session after her initial participation. In these courses, six therapists and I see clients who have predefined, specific issues. In almost all cases, I have never met the clients; my only contact with them is a phone interview to make reasonably sure their problem is relevant to our training. This makes the context of the session as real as possible.
Many of these clients have never had massage therapy, and I have no idea where the direction of the session might go. As a group, we interview, create assessment strategies, and problem-solve our way to a viable strategy, which is then executed. In its simplest form, we gather information, interpret the meaning of that information, and then respond. If the response is positive and what we expect, we are on the correct path. If not, we redirect. This is the hallmark of great problem-solving, no matter what the discipline.
How do we gather information? In our field, there are three primary avenues. First, we ask questions. Voltaire said you should judge a person by their questions rather than their answers. In medicine, it is often stated that 90 percent of diagnoses can be done with only a detailed case history. In the field of massage therapy, asking pertinent questions can immensely influence treatment outcomes. Second, what we observe is an essential aspect of gathering information. We observe the client’s posture, movement patterns, and body language. These observations are then combined with the case history for possible connections. Third, we palpate. What is the quality of the tissue? How does the tissue respond to intervention? From our first training in massage school to advanced approaches in the field, the value of accurate and thorough assessment is stressed as essential to producing desired outcomes.
That is what makes Ms. J.’s statement so powerful. Who’s assessing whom? While we therapists are concentrating on our listening, observational, and palpatory skills, our clients are doing the same to us. The assessment highway has two lanes. When she articulated her ability to discern differences in therapists, my brain flashed back to her session during the training. Let’s take each of the three avenues of information gathering, but from her perspective.

I remember watching Ms. J. as she listened to the questions from my group of therapists. Watching her micro- and macrofacial expressions, she was reacting to the question and the questioner. If the question seemed irrelevant or too vague, her expression revealed the disconnect. Questions that surprised and intrigued her were revealed in her body language and showed a connection with the therapist who asked such an insightful question.

I paid close attention to Ms J.’s reaction to the group; she was observing us (including me) closely. In fact, following her comment about the varying level of experience and abilities between therapists in the group, she also commented on how fully engaged some therapists were. How did she determine full engagement? I thought back to watching her eyes when she was lying supine on the table while one therapist was treating her. She was glancing around the room, observing the other attending therapists who were not presently treating her. If those therapists were distracted or not paying attention to what the treating therapist was doing, she registered that as lack of engagement.

This aspect of her experience at the training was absolutely intriguing.
I had to ask: “How is it that you determined one therapist was more experienced or competent than another?”
“The quality of their touch,” she replied. “Some therapists, from the initial contact, put their hands on me with complete authority; I felt a clarity about what they were feeling and why. It just put me at ease, like they knew what they were doing and were fully in charge. Other therapists seemed tentative, which might be a lack of confidence. The difference was quite noticeable.”
I processed Ms. J.’s statements as we shared a moment of silence. So much of the focus of training in the field of massage therapy is centered around the therapist’s assessment and subsequent response. Far less discussed is the reality that as we are assessing the people who grace our treatment table, they are assessing us as well. In our speech, in our body language, in our touch—what impressions are we giving them? Who’s assessing whom?

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