Tell Me More ...

Curiosity and Real Listening are the Gateways to Deep Inquiry and Discovery with Clients

By Lauren Cates and Kerry Jordan
[Feature ]

When you sign up for a class called “Oncology Massage 101” or “Massage Therapy for Transgendered Clients” or “NMT for Pelvic Dysfunction,” your true inspiration may be somewhat about people affected by cancer, transgendered people, or people with hip pain, but I want to talk about how a large part of what leads us to learn is our desire to lessen the number of times we “get it wrong.”

We want to learn so we can feel “expert.” We want to learn so we can use lingo and cite statistics that will make us more effective, put our clients at ease, and maybe even make them sit back, impressed, and say, “Wow! How did you know that?”

This is really, really normal and human. If this is how you go about things, you’re in very good company.

Humans are hardwired to want to know more stuff. When we know more stuff, we feel in control. Massage therapists clamber after continuing education (CE) hours that promise “certification” after eight hours or 16 hours, unfazed by the absence of clinical, supervised practice or the other hallmarks of true competency. We invest in courses that will give us permission to add capital letters after our names and that will empower us to tell clients what’s wrong with them and that the days of it being wrong are over!

Lest you be convinced that I hate learning or even CE hours specifically, let me tell you that I am a big fan of learning, of experiences, of anything that creates the opportunity for me to be more “useful” and to live a more meaningful and connected life. Like so many things in this human life, it boils down to expectations and intent.

It’s a venerable thing to pursue knowledge and skill, but most of us are really pursuing certainty. What most of us want is to be sure we finally know enough to never get it wrong again. If we learn enough, see enough, and get enough skills and techniques and perspectives in our bag, we’ll always know the right thing to say and the right thing to do.

Let’s step back from the hardwired, expertise-seeking, totally reasonable and human goals of “knowing more.” Is there room for genuine “Surprise me!” curiosity in that space? Curiosity not for mastery, but for discovery and deeper inquiry? What if our desire to learn was about getting really honest about how very little we truly know or will ever know? The choice to learn more about anything could be its very own open-ended question: What don’t I know?

No matter how much we learn about anything, we are always at the threshold of ignorance. The truth of this can feel like a raw deal or an exciting invitation to keep exploring.


Confronting the Mystery

Carl Jung, the founder of analytical psychology, invited us to “Learn your theories well, but put them aside when you confront the mystery of the living soul.” Many of us imagine our brand of massage therapy or the setting we provide it in keeps us safe from having to confront the mystery of the living soul. Maybe one day we’ll be providing massage to cyborgs and robots. Until then, every single person who makes their living interacting with humans would do well to remember that our bodies are not machines, but containers for something much more intimate, complicated, and unknowable.

There are things we can and even do know about the body. And there are countless other things about the body and how it interacts with the mind and spirit that are just not knowable. (And honestly? The number of “facts” I learned in massage school that science has since disproven or shifted is staggering, so I wouldn’t hold on too tightly to what we think is knowable about the body.)

Massage therapy works. Plain and simple. A skilled person who applies and adapts techniques they have learned to address a client’s complaints will be basically effective and likely even make a good living. And that’s fine. It does matter that your hands do smart things based on stuff you learned to do with them, but this is incomplete. Resist the temptation to believe that your hands and your brain are your most valuable tools. Meaningful massage therapy is more than clever tissue manipulation.

Every person’s life could fill a novel. No course about technique or anatomy or disease states will allow you to reasonably encapsulate the contents of that novel. We love the idea of Jung’s pithy, concise wisdom. We print it out and tack it up on our fridge or office door, but we actually buck against the truth of it. Because if it’s true, that means that the thousands of hours and dollars I have spent learning stuff won’t save me from having to not know. Truly meaningful connection will still mean I have to show up for every single person I touch and for every person I say I love. I can learn all the knowable things and still, to be connected to another person in a meaningful and healing way, I have to show up in the nakedness of not knowing. I have to be here now. All the time. Every time. (Cue sad trombone.)

Personally, I like to make people uncomfortable—an odd skill for a massage therapist, perhaps, but invaluable in cultivating real knowing and connection. When we get honest about the things that prevent us from truly connecting with each other, it’s uncomfortable, but that’s where the living is. That’s where the real is. The beautifully hard truth is that humans are neurologically wired to avoid discomfort. We feel most at ease when we think we know what’s next and what we’ll do and say when it happens. We understand this experience as safety and safety is good. We cultivate personalities that allow us to skip off the surface of each other in brief and connection-ish experiences that help us feel useful and less alone while we remain protected and invulnerable.

Think of this article as a hall pass. This hall pass will give you permission to stop telling stories that let you keep skipping off your life and the people in it. The first story you can stop telling is that your clients want you to be an expert in “what’s wrong” with them or even in “how to fix” them.


Let’s Get Concrete

A client shows up in my office or is in a hospital bed in front of me. I assume my job is to make it better; whatever “it” is. The patient or client assumes that part of me making it better means I already know who they are and what’s important to them.

You can laugh, but this is what happens.

I hear this from massage therapists all the time: “I can’t possibly learn what’s important in the less than five minutes I have to conduct an intake.” The other tack many massage therapists take is to decide that they already know. They let intake become a formality or, worse yet, a chance to show the client how much they know about them and/or their condition.

Here’s a practical tip: during intake, the client should speak about 75 percent more than you and most of your speaking should be questions. Short ones.


A Tale of Two Intakes

These are two very human exchanges. Neither of them is “wrong,” but can you see the different intent in each? One is designed, probably unconsciously, to show the client how much the therapist knows. One is designed to learn about the client and to let the client guide the session and focus.

I invite you to imagine that you are the client in each of these. How would the first intake likely make you feel? What about the second?

Intake 1 (2 minutes)

You noticed on this person’s intake form that they indicated they were treated for breast cancer five years ago. The person did not contact you for “oncology massage.” This person is a new client.


Therapist: I see from your intake that you were treated for breast cancer in 2014. Did you have lymph nodes removed? Lymphedema can be a big concern.


Client: I think I had lymph nodes removed. I can’t remember whether I did or even how many.


Therapist: OK. If you had nodes removed, then you maybe had radiation, which means that you’re at risk for lymphedema anyway, so we can keep that in mind.


Client: OK, but it was five years ago. Do you really think it matters?


Therapist: It’s hard to believe, but lymphedema is actually a lifelong risk. What about neuropathy? It looks like you had a couple of chemo drugs that can cause neuropathy.


Client: Sort of? I mean, my toes are a little tingly sometimes, but it’s not that bad. I don’t really think about it.


Therapist: OK, so nothing serious. We won’t worry about that today, but I do know a protocol to address that if you decide you want to do that next time.


Client: OK.

Therapist: I noticed that you said you’re taking Herceptin. Lots of my clients complain about hot flashes, hair thinning, joint pain. When my mom was taking it, she had every symptom you can imagine. I was always putting the hot rice bag in the microwave for her.


Client: Well, I do, but it doesn’t really affect me that much. And I’m 59, so it’s hard to know if it’s the medication or just actual menopause.


Therapist: I guess that’s true. Herceptin is notorious for causing symptoms that mimic menopause, so who knows?


Client: I didn’t know that about Herceptin.


Therapist: It says here that you row. I saw a woman last week who races those dragon boats. That’s really popular with breast cancer survivors around here.

Client: Yeah. I just started. A friend kind of made me go. She’s always trying to get me to do social things and meet new people and “live” (rolls her eyes gently). I’m not sure about it yet.


Therapist: All my clients who do it love it. I’m sure you will too.


Client: So, last week after a rowing meetup, my shoulder started hurting right here [client points to anterior deltoid/pec attachment]. I always worry when I get new pains, but I’m guessing it’s just from the rowing.


Therapist: In that location, it’s really unlikely that it’s a cancer recurrence and the range of motion issues that often go with breast cancer treatment can cause pain for survivors when they wouldn’t cause pain for healthy people.


Client: [somewhat stunned by the suggestion, even if indirect, that her shoulder pain could be pain from an undetected recurrence] Well, it hurts when I move it, and it’s been hard to sleep on it.


Therapist: Sounds good. Let’s get you on the table. I’m going to have you lie face up just to stay mindful about lymphedema, and I’m not going to work too deeply because of your history. Any questions?

Intake 2 (2 minutes)

You noticed that this person has a breast cancer treatment history, but it was five years ago and this person did not contact you for an “oncology massage.”


Therapist: Hi. What brings you in today?

Client: So, last week after a rowing meetup, my shoulder started hurting right here [client points to anterior deltoid/pec attachment]. I always worry when I get new pains, but I’m guessing this is probably just from the rowing.


Therapist: After the rowing meetup was the first time you felt it?


Client: I think so. I mean, I work at a desk all day, so my neck and shoulders are always cranky, but this did feel different. 


Therapist: Are you able to tell me what feels different about it?


Client: Well, it hurts really specifically in this one spot and only when I move it or lie on it. My neck and shoulders back here [gesturing generally to her posterior neck and shoulder area] just kind of ache all the time.


Therapist: Ah. That’s helpful to know. We can definitely look at that. If you don’t mind, I’d like to go back for a second. You said you always worry when you get new pains. Can you tell me more about that?


Client: Ha! Well, I know it’s totally crazy, but when you’ve had cancer, any kind of pain that feels new raises a little antenna in your brain that says, “This might be cancer.” It’s fine. I’m not really worried. I just hate that my brain does that now.


Therapist: Ugh. Yeah. I can definitely see how your brain could go in that direction. Let’s see what your muscles think when we get you on the table.


Client: [smiles, somewhat relieved] OK. Good. I mean, I know that I should be getting massage more often anyway, so I figured it can’t hurt.


Therapist: [smiling back] That sounds like solid reasoning to me. I know it was five years ago, but is there anything related to your experience of cancer that you think would be useful for me to know for today’s session?


Client: Hmm … I don’t know. I mean, like what?


Therapist: For instance, I always want to be mindful of lymphedema risk. Do you know whether you had lymph nodes removed during your treatment or whether you received radiation therapy?


Client: Oh! Jeez. Yeah. I did have nodes removed. Maybe … four? I don’t actually remember. But … [pumps fist triumphantly] I did not have radiation.


Therapist: [smiling back] OK. Any episodes of swelling or fullness in your arm or torso on the side where the nodes were removed?


Client: Nope!


Therapist: Excellent. And basically, I just like to know if there are any other ways that treatment continues to affect your life. Like, do you feel like you have the amount of energy you wish you had? Any neuropathy? Joint pain? That kind of stuff.


Client: Hahaha! Oh, man. I’m not anywhere near as tired as I was during treatment, but I don’t think I’ll ever be back to “normal.” I was lucky to dodge the neuropathy bullet. As for those other things, I am taking Herceptin and they say that mimics menopause, but I think I’m probably just in menopause. I mean, I’m 59. It’s about time, right?


Therapist: [laughing]. That’s certainly possible. OK, so I’m thinking we will do a full-body massage to say hello to all of you, but I’ll focus with your neck and shoulders, and we’ll do some focused work in that area of your shoulder where the new issue is. How does that plan sound?

Set Up to Fail

The intake examples on pages 59 and 60 might give the impression that I think this is easy, this whole “knowing people” thing. It’s not. Clients want you to know them and to really care about the things they feel are important. And yet, they skip whole sections of the intake form when you ask them to complete it. They give you monosyllabic answers to the questions you think you’re asking. They ask your advice on all kinds of things that are solidly outside your scope. Many of our clients expect us to know as much as they think their doctor knows, about them and about everything else. The other story that gets told is that massage therapists are particularly caring and intuitive people. We want to believe that story as much as our clients do.

We feel pressure because clients show up expecting us to know the things. We act like we know the things (and sometimes we actually do know a few things), but very little of what would support us in meeting this specific person on this specific day exactly where they are is actually shared or known.

When this happens, we’re both at fault. Stick with me here.

It’s true that many clients don’t want a deep, personal connection with you. It’s also true that the only thing many clients really want to know about you is that you’re going to make them feel better.

We’re tricky things, humans. We want people to listen to what we’re saying, but we really want people to listen to what we’re not saying and even to know what we’re not saying. When it comes to our clients, this is a tall order, but far from impossible.

Curiosity and real listening will quiet the insistent helpfulness of our “expertise” and allow us to hear what matters.

At a mindful leadership summit late last year, one of the speakers suggested to the audience that, “If you always have the answer, people will stop telling you the truth.” When you only make enough room for the person in front of you to confirm your assumptions, you stay safe in those assumptions and the actions that are informed by them. You never have to do anything different than what you planned to do. You set up a sweet little system where you welcome information that supports your hypotheses, and you discount or reject anything that would require you to shift.

If this is how you do it, congratulations. More proof that you’re a functioning human organism. Your brain is designed to function in exactly this way. This is efficient and your brain is all about efficiency. Your brain knows that moment-to-moment perception of what’s actually in front of you is really hard work and your brain is not interested in hard work. It has enough to do.

Here’s the rub. When you give in to the evolutionary pull toward knowing, toward assuming that what’s happening is something you already know, you skip off the real, the challenging, the new and useful information (verbal and nonverbal) in any given moment.

Instead, what if you use your hall pass to ask your brain to do something different? What if you and your brain break out of your easy patterns and choose instead to seek connection over certainty?

Wait. Listen and patiently sink.

When you sink, you drop below the surface where you can see and feel past what’s easy and readily available. You see and hear much more than you already thought or expected.

Genuine curiosity. Seeing. These things are not the product of minutes or hours. They are the product of intent, of a deep desire to be surprised by things you couldn’t learn any other way than by shutting up, sitting still, and asking the occasional open-ended question. Surprise is the gateway to deep connection and meaningful truth, but everything we’re taught by society and business tells us that only suckers get surprised. The unprepared, the ignorant, the out of control—these are the people who get surprised.


It’s a Two-Way Street

I read an article in the October 2018 issue of the Buddhist magazine Lion’s Roar. It was called “Our Opportunity to Include All Genders in Buddhist Communities.” The author of the article is a transgender person who reports that they have felt, and often still feel, isolated and unwelcome in the sangha (meditation community). As a gender-fluid person who has spent a lot of time in the Buddhist community, I thought this would be a useful article for me to read. I thought, “Aw, man. I’m being disenfranchised and I didn’t even realize it! I should read this and learn how to advocate for myself.” (And, yes, I thought I could learn some things about how to “never get it wrong.”)

The author detailed five specific areas of Buddhist practice and community that made them feel isolated and suggested that this sense of isolation was the fault of the teachers or even of the meditation community as a whole. As I read, I realized this article was not about transgender inclusion. It was about the sense of unique struggle we each feel as a result of our expectation for the whole world to never get it wrong. Each of us wants all of our needs to be met without ever having to share those needs out loud.

We want to be seen, but we don’t want to do the hard work of letting people see us.

As a massage therapist, this is essential to understand. This is how humans are. All humans. It’s not reasonable to expect our clients to show up in a vulnerable, sharing, open frame of mind. That’s just not how people walk around, and it’s certainly not how people in pain walk around. And yet, they are people. And people want you to “just know” that they’re hurting in ways that have nothing to do with their IT band.

It would be utterly impossible to specifically and directly account for all the ways each person wants to be seen and wants to feel in their body. It’s on each of us to know ourselves and to know our own struggles and sore points so we can bring tenderness to that experience and, when it makes sense, educate others by example.

We have to get much better at truly discovering what it’s like for the person in front of us to be in their body, to be in their life, to be whoever it is they are. Nobody is “a cancer patient” or “a runner with patellofemoral syndrome” or “an MS sufferer.” Everybody is inescapably themselves. The only expert on the person in front of you is the person in front of you.

We will never, ever learn about this person right here from a class. We can (and we should!) learn categories of questions, common issues, and other useful information that can guide us in forming effective and kind inquiry, but at the end of the day, what’s most essential is that we do all we can to elicit and integrate real information. We will always get it wrong unless we get really curious about ourselves and others.

We have to really want to know.

“What is it like to be you?”

“Where do you hurt?”

“How do you hurt?”

“What makes you like your body?”

“What makes you hate your body?”

“How does it feel to be in your skin every day?”

I am not offering you actual questions you should ask your clients and the people you meet. This is not a script. These questions are just the very beginning of a spirit that can guide meaningful intake with clients and patients and meaningful connection with all the humans you love.

Lauren Cates is an educator, writer, and speaker on topics ranging from massage therapy in the hospital setting to end of life and massage therapy policy and regulation. A founding director of the Society for Oncology Massage from 2007–2014 and current executive director and founder of Healwell, Cates works within and beyond the massage therapy community to elevate the level of practice and integration of massage overall, and in health care specifically.