Skepticism, Painfully Earned

By Douglas Nelson
[Table Lessons]

“Realistically, outcomes in complicated cases are not predictable. How can you be honest and still engender confidence in such cases?

“I have often emphasized to my students the importance of laying out a clear path forward for new clients. As audacious as it sounds, I don’t ever remember a new client choosing not to follow the plan. Until perhaps last week.”

This was a statement I was making to my friend Marc, an exceptional attorney and a person I deeply admire for his wisdom and thoughtfulness. I find many parallels in our work; we are both problem-solvers, just in different disciplines. We were talking about the importance of communication after he read one of my recent Table Lessons columns (“Vulnerability,” January/February 2019, page 28). 

“Why don’t you think this person will decide to pursue treatment?” Marc asked.

I’m sure there was a long break before my answer, as
I was completely lost in thought, reliving the meeting in my head.

The client in question was a young woman of high-school age, an intelligent young lady with penetrating eyes, a pleasant smile, and yet a deep sadness about her. Her mother accompanied her to the appointment, a woman who clearly loved her daughter, but whose face belied a parent who had experienced far too much pain and disappointment.

As the young woman, Ms. S., recounted her saga of orofacial pain, I could not help but glance at her mother from time to time. Her eyes would shift from her daughter to the floor, and occasionally, albeit briefly, to me. She seemed quite impatient, as if she would have rather been anywhere else but in my office.

Ms. S. chronicled the saga of her journey through the health-care system, and what a saga it was. Because of her debilitating pain about the face and head, the initial medical consultations took a very serious turn as the search began for tumors, disease processes, and dire reasons to explain her symptoms. Since there was no life-threatening reason for her pain, her doctors didn’t know what to do, and the immediacy for care seemed to wane.

Understandably, the family sought out multiple specialists in orofacial pain. Ms. S. recounted a long list of providers and the treatment approaches they espoused. At one point during this long list, I must have looked overwhelmed with the number of providers they had seen and what the family had been through.

Ms. S.’s mom locked eyes with me and finally spoke. “Each of these doctors and therapists proclaimed that all the prior approaches were misguided and incorrect,” she said. “Each doctor was confident that their approach would produce a positive outcome. One by one, they all failed, and when they did, there was a subtle insinuation that my daughter was somehow at fault.”

Now, it all made sense to me. The kind of skepticism I sensed in Ms. S.’s mom is skepticism that is painfully earned, and rightfully so. She was at her absolute tolerance point for practitioners who proclaimed to have the answer, only to disappoint yet again.

I explained to them how research insights might help create a model of understanding to explain what Ms. S. felt and how these symptoms might be interrelated.

I saw a significant glimmer of hope in the mother’s eyes.

“But,” I explained, “having a coherent and reasonable understanding of the possible mechanisms of pain does not necessarily clarify the most effective way to interact with it. While I have seen scores of clients with TMJ issues over my 40-plus years of practice, your daughter’s symptoms are different and more severe than anyone I have seen previously. I can’t guarantee an outcome, but I can promise you complete dedication and commitment to helping your daughter.”

Coming back to my conversation with Marc, I relayed my concern that this statement of uncertain outcome might be the reason Ms. S. might choose not to pursue treatment.

“Perhaps I was just too honest about the unsure outcome and the difficulty of the problem,” I admitted. “I didn’t want to be a source of false expectations, but I think they might have perceived that as a lack of confidence. I didn’t know another way to explain it, but I really would have liked the chance to help. I had hoped that sharing a deep knowledge of the science, while being honest about the difficulty, would reflect authenticity. I wonder if that was the best strategy?”


Just after this writing, Ms. S.’s mom contacted me and brought her daughter in for treatment. We had a great first session, filled with discovery and a developing understanding of how to proceed. The journey ahead may be long, but all three of us are fully committed to the process. I like our chances.

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 of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit, or email him at