Therapeutic Relationships

By Terrie Yardley-Nohr
[Ethics and Etiquette]

The dynamics of the relationship between the therapist and client can be diverse and complex. Successful bodyworkers pay close attention not only to the techniques they use, but also to the many details involved in cultivating and maintaining the client relationship. Ethical issues often play an important part in this partnership, and the therapist should be aware as challenging situations can happen. 

The Client

Clients who seek you out as a massage therapist do so because they believe you are well-trained and reliable. Clients want to trust that professionals know what they are doing and look to them to provide a quality service. For example, when you take a ring to the jewelry store to be fixed, you assume the jeweler knows what to do. But what guarantees do you have? You simply assume this person has the ability to fix it. The public assigns power to professionals and, in turn, many professionals act on this power because clients expect them to. This power develops from a psychological expectation, in many cases, rather than actual facts. For example, a client may assume that a bodyworker can give a full assessment of the range of motion in a knee. Some bodyworkers can identify a problem, but a full evaluation and cause of malfunction may be beyond the scope of practice for some practitioners.

A client’s assumptions can give a therapist a great deal of power. This shift of authority in the client-therapist relationship is called a power differential. A responsible therapist is consciously aware of the dynamics that can happen within this power differential and takes care not to take advantage of the client.

It is common for clients to look to a therapist for advice regarding their overall health. While a therapist may be familiar with symptoms and diseases to help formulate a proper treatment program for a client, it is beyond the scope of practice for therapists to diagnose a condition or disease for a client. When clients start talking about what may be physically wrong with them and venture into forbidden territory, the bodyworker can respond by explaining that it is beyond the scope of practice for a bodyworker to diagnosis conditions. 

The power differential can include other dimensions related to why a client may be seeking you out as a therapist. A client could feel comfortable confiding in you or the sessions are helping to heal some emotional pain. This adds another layer of responsibility to the relationship.

As the therapeutic relationship develops over time, the responsible therapist more fully understands why a client wants to receive massage. It is much like fitting the pieces of a puzzle together to form a complete picture. Clients come for a massage with a purpose and give the therapist the power to make them feel better. Some may simply need relaxation, while others need pain relief, corrected posture, or positive touch. A certain number of clients may be able to tell you during the initial interview what they are hoping to achieve. Others may have a difficult time verbalizing their needs and goals; only over time will you begin to understand why they have become clients. Because of the power differential, you have the responsibility to shape and maintain the relationship.

The Therapist

The power differential also affects the therapist in a variety of ways. First, therapists are expected to develop and maintain the client relationship, in addition to knowing how to treat the client’s condition. Having to pay close attention to all the small details can be difficult for a new therapist, but expertise in handling those details is an important component in being successful. As therapists gain more experience, it becomes easier for them to understand the need for follow-up with clients. This realm can include following up with a client the day after a tough session, following up with another health care provider who has referred a client, or gathering information that will help treat a client.

Second, it may be difficult for a therapist to figure out what the client needs, especially if the client does not give the therapist much information. A thorough intake form can help you see the initial issues a client has, but as most therapists know, the physical and even emotional issues clients may have usually run a great deal deeper than what can be initially observed. How many times have you been performing a technique when a client suddenly remembers that an area was injured years before and had been forgotten? The pieces of the puzzle start to come together. A therapist should know that reading between the lines could lead to some wrong assumptions and frequently checking in with your client can help avoid misinterpretations. Thorough assessment takes time and should always be done while protecting the client.

Another challenge is not internalizing a client’s problems. Therapists are faced daily with many physical and even emotional situations that can be challenging. It can be very difficult for a therapist to not feel sad for a client who is suffering from a painful disease or to not get angry when we hear a client is treated unfairly. For example, a client may have been injured in an accident and an insurance company will not allow treatment that could help the client. A therapist has to find the best way possible to treat the client within his or her area of expertise, while still providing quality care.

Find the Balance

Maintaining a constant connection with the client and obtaining feedback are important components in the therapeutic relationship. A therapist who assumes the client should always agree with his or her opinion eliminates the opportunity for the crucial feedback required for a healthy therapeutic relationship. This cycle of feedback and constant interaction is what makes the therapeutic relationship work. The open dialog and mutual agreement of the goals for the sessions will help both the client and therapist feel truly involved in the treatment and should enhance the outcomes for everyone. The therapist should continually guide the dynamics of the therapeutic relationship for the client’s best interests.

  Terrie Yardley-Nohr, LMT, has been a massage therapist for 18 years, working both in private practice and medical settings. She began teaching massage techniques and ethics 12 years ago and became program manager at Allied College in St. Louis, Missouri, nine years ago. She is the author of Ethics for Massage Therapists (Lippincott Williams & Wilkins, 2006). Contact her at