By Douglas Nelson
[Table Lessons]

As I ended the phone call, I shook my head. The story my potential new client shared was similar to others I had heard many times, but hers was even longer and sadder.

Mrs. L. described the onset of gluteal pain that began about two years ago. Intermittent at first, the pain kept progressing in severity, frequency, and intensity. She was an active woman, playing tennis, going for long walks, and working with a personal trainer. As the pain intensified, it began to limit her activity, which negatively affected her quality of life. At first, the pain was an annoyance, but as time progressed, even her ability to walk for any distance was limited. When the pain hit, every step was difficult. More curiously, if she stopped the activity and sat for a few minutes, her pain dissipated.

The saddest part of the story was her journey through the health-care system. Her primary-care provider, a very conscientious doctor, had no idea what to do with her. Understandably, he referred Mrs. L. to a specialist, someone with a musculoskeletal background who could help her. Thinking it was an atypical version of sciatic pain, that specialist ordered an X-ray and MRI. When the images didn’t show anything conclusive, they were at a loss to explain the pain. A referral to another doctor came next, followed by two cortisone shots. With no results from the shots, more physical therapy was ordered and then more doctors of various disciplines. In the end, every practitioner told her they had no idea how to help and had nowhere to send her. No suggestions, nothing.

What strikes me most about her journey was the approach of the providers. Each health-care provider looked at her from the perspective of their own discipline. It’s like having a lock you cannot open, so you visit a locksmith. Each locksmith specialist tries their appointed key and, when it doesn’t work, pronounces “nope, not this one.” (And charges you for the visit). This isn’t an efficient way to go about the process.

Immediately following the conversation with Mrs. L., I had a training/mentoring session with several therapists. After I relayed the context of Mrs. L.’s difficult journey to them, one of the therapists made an insightful comment.

“It is amazing that this woman shared with you her deepest frustrations with her pain journey. She has never met you, yet she is willing to reveal the details of a very personal struggle. This trust is a gift that clients give to us, showing the soft underbelly of their lives in the deep struggles that bring them to the massage table. We often see clients when they are most vulnerable.”

She is quite correct. It is a privilege that, in more than 40 years of practice, I try never to take for granted. But there are two sides to that equation. 

“She’s not the only one who’s vulnerable,” I remarked. There was a silence in the room as they each looked at each other, processing what I just said.

“How is that?” one of them finally asked.

“As I listened to her list of symptoms, I found them to be extremely perplexing. Given what she told me, I think I understand why other practitioners failed. Her problem wasn’t solved previously because this is indeed difficult. In fact, I think this might be a fairly long process,” I admitted.

“But how are you vulnerable?” one of them asked.

“I am vulnerable because I have no idea how this process will go, yet she is trusting me to help her,” I responded. “She is looking for an answer, but right now all I have are questions that I find perplexing. If I commit to helping Mrs. L., it will become very apparent in the first session that I don’t have a magic answer. She and I will have to navigate these waters together and there will be many ups and downs. That process will take trust and commitment.” 

I would also posit that this partly explains her difficult journey through the health-care system. When a practitioner declares that the problem isn’t in their domain, they also abdicate any further responsibility. That’s fine for the practitioner, but the patient is still left with the original complaint, which they are left to figure out on their own.

The most amazing client outcomes I have experienced happen when both of us realize we are on this journey together; neither of us is sure about the result. We must work together and trust each other; that connection binds us and adds to the therapeutic relationship. That alone is powerful healing—that the client senses the therapist’s full commitment and dedication to the process.

While writing this last sentence, I just received a message from Mrs. L., updating me on her progress after our second session. “Marginal improvement”—she’s encouraged. The journey is underway.