Seeing the Whole Picture

By Nina McIntosh
[Heart of Bodywork]

“I know massage therapy is thought of as a holistic practice and the term holistic means we want to consider the whole person when we work with clients. But, to tell the truth, I’m not sure how to apply that in my practice. As I understand it, it would be outside my professional boundaries, for instance, to give advice in areas that aren’t related to massage. How do I use a holistic approach in my work and still be appropriate for massage therapy?”

C.S., St. Louis, Missouri

That’s a great question. Holistic is a familiar term, but we may not be totally clear on how it could apply to our practices. Approaching our practice from a holistic viewpoint means we see a client, not just as “the man with the bad back” but in a way that takes in a wider and more complex picture of who he is. It also involves the concept that physical symptoms are often, if not always, influenced by a variety of causes—emotional, environmental, genetic, psychological, spiritual, systemic, and more—often so intertwined that you can’t tell where one starts and the other ends.

For example, a sore back is—on one level—a bunch of tight muscles; however, that tightness could be part of a pattern of how the client deals with stress or could be a sign of an underlying disease. A client’s tension could stem from a crisis in his marriage or even a crisis in his spiritual life; the causes could go as deep as unresolved issues from an abusive childhood or could be as superficial as a job that requires the client to bend over repeatedly. Or all of these together. The holistic view takes all of these possible influences into account.

Being holistic doesn’t have to be complicated or a big deal. You’re probably already relating to your clients in a broader way, and not just as Ms. Sore Shoulders or Mr. Concrete Calves. You’re no doubt already being holistic in your attitude toward them, what you notice about them, and how you communicate with them.

Intentionally bringing a holistic approach to your work can make your professional relationships with clients more satisfying to them and more rewarding for you. Given this understanding on a practical level, how can you take into account a wide range of influences in your client’s life and stay within massage therapy’s scope of practice? Following are some simple suggestions for fine-tuning your approach and enriching your relationships with clients.

Adjust Your Attitude

Being holistic means having an attitude of both kindness and curiosity toward your clients. Seeing them in a more complete way means knowing that, as well as having tendons and muscles, they have hearts and spirits. In light of that, strive to bring respect, compassion, and a nonjudgmental attitude into your treatment room.

Sometimes it’s easy to have an open attitude toward the clients who are friendly and complimentary and not so easy to feel warmth toward the grumpy or demanding clients. Do you have clients who annoy you? (It’s okay. Everyone has at least one.) During your next session with that client, try putting aside your negative feelings and seeing that client as someone who is dealing with problems and challenges and who probably didn’t get up that morning thinking of how to ruin your day. Try seeing your clients as people who have had more than a fair share of broken hearts, lost dreams, and painful regrets. If you know anything about clients’ challenges, take those into account. Just for a few minutes, let your own heart open a little toward your clients.

Do remember, though, that being compassionate doesn’t mean losing yourself. Feeling clients’ pain doesn’t mean becoming overly involved and drained or allowing clients to take advantage of you. Maintain your own center in the process so you take care of yourself, too.

Observe with a Wider Lens

What do you notice about your clients? How do you observe them? Seeing clients without judgment changes your focus, as if you are using a softer, wider lens.

Every practitioner notices some aspects of clients more than others. Maybe you’re more aware of how they walk than of their facial expressions; or maybe you’re more attuned to their tone of voice than how they’re dressed.

Be a compassionate detective. Even your long-time regulars have subtle shifts from week to week. Does she look unusually happy, sad, or hurried today? You don’t necessarily have to say or do anything about clients’ states of mind or whatever you notice. Simply being aware of it will change the way you respond. Or, if you know a client well enough, you can say the obvious, without probing: “You seem a little sad today.”

Perhaps you’re skilled at observing the habits clients have that may be the cause of or contribute to their pain. It’s fun when you can solve the case by noticing, for instance, that the client with pain in his gluteal muscles carries a thick wallet in his back pocket. Or when you can suggest to a woman who wears very high heels that her lower back might feel better if she wore less punishing shoes.

Try this exercise with a colleague: each of you write down a description of a couple of clients (without revealing in any way who they are). Does your colleague notice aspects of his clients that you haven’t paid attention to in yours? When your colleague reads your description, does he have a pretty good idea of what that client is like or are there gaps?

With long-time regular clients, challenge yourself in your next sessions to notice something you haven’t been aware of about how they walk, their facial expressions, or the words they use. Again, it doesn’t have to be a big deal—just one small thing per client.

Even as you expand your repertoire of what you notice in clients, keep in mind it’s not your job to try to solve any problems other than those related to massage therapy. But being more observant of your clients can bring a depth to your work and your professional relationships.

Listen to Clients and Speak Their Language

Another way to deepen your relationship with clients is to notice their language and reflect it back to them, showing you understand them. First, you have to let clients describe in their own words what brings them to you. What words do they emphasize, what jumps out at you? Then, use those keywords later. It doesn’t have to be an unusual word or phrase. For instance, if a client tells you her neck hurts and she’s under a lot of tension, remember the words hurt and tension. When you’re working with her neck, you can say something like, “I see the tension here, and I understand why your neck hurts. I hope I can help that tension relax.” It doesn’t have to be a brilliant statement to impress a client, but it lets your clients know you have been listening to them. Just that acknowledgement can have a powerful impact.

Stick to Massage Therapy

Although you may begin to see the bigger picture, stick with what’s appropriate for your role as a massage therapist. You don’t have the right to probe, give advice, or make diagnoses in other areas, such as psychological or spiritual concerns. But you can use what you see to educate clients about the sources of their tension. It would be okay, for instance, to say, “Notice how tight your shoulders get when you talk about your boss?” It’s also within the scope of your practice to say, “It seems like you’ve reported having more pain in your neck since you started your new desk job.” And you can say what you’ve noticed: “It’s been a year since your husband died and you talk as if you’re not able to get going with your life and activities again. Do you think it would help to see a counselor?”

When we have a broader perspective on our clients, it changes the way we deal with them. We are able to be more patient and more sensitive to them. We don’t have to try to fix everything about a client. For one thing, it’s not our responsibility and for another, it’s impossible. However, it’s important to realize that part of the healing effect of our work is for clients simply to be seen and noticed with compassion and without judgment.

  Nina McIntosh combines more than 20 years of experience as a bodyworker with her previous years as a psychiatric social worker. She is the author of The Educated Heart: Professional Boundaries for Massage Therapists, Bodyworkers, and Movement Teachers, now in its second edition. For more information, contact Lippincott Williams & Wilkins at 800-638-3030 or visit learn more about professional boundaries and ethics,


To learn more about illustrator Mari Gayatri Stein, visit