Create the Right Context

Tailor Your Technique to Meet Specific Client Needs

By Douglas Nelson
[Table Lessons ]

Her exaggerated response startled me at first. “Are you OK?” I asked.

“I can’t believe it,” she said.

“Can’t believe what?”

“You went right to it. I mean, right to the place that has been bothering me for months, maybe even years. That’s just incredible.”

“Not that incredible,” I answered. “All the symptoms you described and everything I observed about your movements took me to this spot. It was a reasonable assumption that this muscle in your upper back was highly involved, as it checks all the boxes of your symptoms. I take it from your reaction that my assumption was correct.”

“You are right about that place being the center of it all,” she responded, “but that’s not the remarkable thing. What is remarkable is that I generally don’t let anyone touch that spot. In fact, I’m a bit hesitant to mess with it myself. It feels painful and, well, vulnerable. You went right to it without hesitation, and yet I watched myself be fine with it. I don’t understand how that is possible. Not only can I allow you to be there, it actually feels welcome to have someone pressing on the area that has been basically off-limits. Why would it be OK to have you touch it now?”

Her question was simple and yet quite profound. In my immediate reply to her, I explained that it was probably due to the way I approached the tissue. The real answer is far more complex and certainly more than could be addressed in a session.

I spend a lot of time reflecting on how to create deeper connections with clients. With my present client, creating an ideal context for therapy probably began with the family member who enthusiastically referred her to me. Since I had helped that person with a difficult problem, my present client probably had some fairly positive expectations. This client had also driven more than two hours to make the appointment, no small commitment on her part.

Furthermore, as I greeted her when she entered the clinic, there was something about her observation skills that caught my attention. Most people barely pay attention to their surroundings, but this woman seemed quite aware of the layout of the office, especially the artwork. I have several pieces of artwork from the Italian Renaissance period, and her facial expression changed when noticing them.

“Do you like this piece?” I asked, as we looked at a DaVinci drawing.

“Oh yes, very much so,” she answered with a smile. “As a professor, I’ve spent my whole academic life immersed in the Italian Renaissance period.”

“It is an era in which I have a deep interest, and I’d love to hear more, perhaps later if we have time,” I replied.

In this deep appreciation of art, we now shared a common bond, something that connected us as humans. This connection moved us past therapist and client to a person-to-person connection. 

“Please have a seat and tell me about the pain you are having,” I invited.

As she sat down and began to summarize her situation, the details were somewhat sparse at first. As my questions became more focused, she realized I was not interested in vague generalities. I think she, like many people, came in thinking that I had a rather routine approach to musculoskeletal discomfort. Through my questions, she realized the work would be highly tailored to her specific needs. After the questions, I began walking her through two possible reasons that might explain her symptoms—one highly likely and the other less so. I explained how we would explore both possibilities that day, since neither contraindicated the other.

The important point here is that an optimal context was set even before she was on my treatment table; a relationship of trust, safety, and understanding had already been established. When my hand gently addressed her tissue at this most sensitive area, the approach also mattered greatly. It was a hand that was asking questions and inviting connection, not one that was there to “correct” or give orders. In general, healing cannot be inflicted.

There is good evidence that the experience of pain is often largely dependent on the level of threat involved. All these components had reduced the level of potential threat (new situation, a new therapist she had never met) in significant ways.

As the session progressed, I noticed she was frequently glancing at her smartwatch. After several times of watching her do this, I had to ask what was going on.

“Do you need to be somewhere or are you getting multiple texts or phone calls?” I asked.

“No,” she replied. “I’m just monitoring my heart rate. Even though you are addressing one painful area after another, my heart rate keeps dropping. I find that absolutely fascinating.”

So do I.


Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 20-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