Better Communication, Better Practice

Tips for Successful Client-Therapist Relationships

By Anne Williams

Bodywork is a field fundamentally based on relationships, whether between a client and a therapist or among colleagues in a practice. Thanks to the amount and depth of personal interaction involved in building and maintaining a practice, becoming a better communicator can mean being a better and more successful massage therapist.

As you continue to grow and sustain your practice, here are some things to consider and evaluate in your own communication skills that will help you build more successful relationships.

Everyone Views the World Through a Filter

All of us have individual assumptions, attitudes, beliefs, experiences, needs, and values that become a “filter” for how we view the world, listen to others, communicate ideas, or feel in certain situations. Words that excite little or no emotional response from one person may be charged with particular meaning for another. Situations that make one person uncomfortable can cause another to shrug with indifference.

Communication often flows freely when we meet people who share many of our attitudes, beliefs, and values, or have faced similar experiences. These people have filters colored in a similar hue to our own. At other times, we may find that the ideas we try to communicate cause distrust, resistance, or even anger in another person because their filters are different. For example, the word “alcoholic” carries a particular charge in our society, but each individual will still view it differently. If my mother was an alcoholic and my childhood was disrupted by her behavior, then I’m likely to feel more emotion toward the word than another person who has no experience with alcoholism.

To minimize the impact of filters on communication, raise your awareness of your own filters and pay attention to the filters you notice in others. Notice the words that cause an emotional change in you when you hear them and explore your attitudes.

Squash Judgment

It is often difficult for people to converse without taking a side. This need to agree or disagree becomes a barrier to the exchange of ideas. Imagine three massage therapists at a massage clinic having a conversation on their lunch break. One says, “Energetic bodywork is really cool. I went to a workshop this weekend, and the instructor completely released the client’s muscle tension by using only holding positions with his hands.” The other two therapists immediately make judgments about what they just heard. The second one says, “You’re wrong—everyone knows that energetic bodywork is all hype.” The third says, “I agree that energetic bodywork is effective, but I don’t believe it can reduce muscle tension as well as Swedish massage.”

The two listeners reacted to their colleague’s communication by viewing it from their own perspectives and immediately evaluating it as right or wrong, good or bad. This may be a natural tendency, but it sets people up to misunderstand each other and become defensive. What if the listeners did not immediately judge the statement? What if the second person said, “Really? I haven’t heard that. Tell me more about what you know.” In this case, they potentially could have a real conversation, and all three might learn something new.

Some people fall into the habit of defining everything in terms of “should” and “ought.” They block communication by promoting their own ideas as the only right thing to do. Consider these phrases: “You should take better care of yourself.” “You really ought to do something about that.” “If I were you, I wouldn’t let her talk to me that way.” The implication in each statement is that the speaker is clearly right and the other person does not have the intelligence or fortitude to figure it out. Avoid using words and phrases like should, ought, and if I were you, especially in your role as a massage therapist. Such words increase the power differential with clients and can lead a client to feel shame or embarrassment. For example, saying, “Your tissue is completely dehydrated—you really ought to take care of yourself and drink more water,” sounds moralizing. Saying, “Your tissue feels a bit dehydrated today. Remember that drinking more water after we’re finished will help your body get the most from our session,” helps maintain a positive dynamic.

The more aware you are of communication, the easier it is to remove unhelpful, moralizing statements from your language. Then, when you recognize them in the language of others, you can choose not to react.

Avoid Labeling

People also have a natural tendency to label each other, which reduces understanding. A man in a group says, “I wish our clinic would do more to conserve energy and recycle. I’m really worried about global warming, and I’m afraid that polar bears will become extinct in my lifetime.” Others in the group evaluate his statement from their own perspective (filter). One of them thinks, “I never knew Robert was such a left-wing radical.” Another says, “Robert, you’re a big softy, but don’t worry, the polar bears will be fine.” These two people both just missed an opportunity to know Robert better. Instead of asking him more about his concerns and thoughts, they labeled him. Instead of seeing, hearing, and honoring him as a complex individual, they reduced him to a “left-wing radical” and a “softy.” When people fall into labeling, they often miss the point of the communication and get stuck on the label and how they view it (good or bad, right or wrong). Even labels with positive connotations (beauty, hard worker, intellectual, etc.) can cause fixation and not allow people to be understood as their perfect, imperfect, dynamic, multifaceted selves. With labels, people are convinced that they already know someone else and lose the opportunity for greater depth of understanding.

Extreme forms of labeling include bigotry, prejudice, racism, and stereotyping. We would like to think that these do not occur in the massage profession, but they do. In one example, a therapist was very physically fit and ate a vegan diet. He labeled anyone who was not physically fit or vegan as “carnivore,” “fat,” “lazy,” and “undisciplined.” His tendency to apply negative labels influenced his interactions with clients, and he was blind to the fact that he behaved unethically as a result. While talking with his supervisor about a client, he commented, “There is no way this person’s knee problems are going away without some serious weight loss. Massage is pointless until she gets her act together, goes on a diet, and starts to exercise.”

How could this therapist do quality, client-centered work? What about upholding ethical standards like “Do no harm” and “Value the inherent worth of all people?” When did it become his role to decide what is best for clients? In a client-centered therapeutic relationship, clients decide how to best facilitate their own health. Massage is one of many ways to approach wellness. If you find yourself labeling someone, imagine for a moment that the person is a client. How could this label affect your treatment decisions and your ability to provide the client with the best possible care?

Don’t Solve the Problem—Just Listen

Only rarely do people want someone else to solve their problems for them. Usually people just want someone else to listen while they talk through their problems to arrive at a solution. Problem-solvers block effective communication, and may send others a message that they don’t have the experience, knowledge, or understanding to work it out on their own. For example, Erin, a massage therapist, tells Deepti, the clinic owner, “I had a client the other day who asked me out on a date. I told him it was not appropriate for a massage therapist to date her client. He said he understood, and then said he would like to date me and find a different massage therapist. When I told him no, I didn’t want a date, and that I would have to end the session if he kept talking about it, he apologized, said he understood my position, and wouldn’t mention it again. We finished the session without incident. He’s a really nice person, and I think he’ll respect my feelings and not mention it again, but he called yesterday to book another appointment and I’m not sure what to do.”

At this point Erin is about to tell Deepti what she views as her options, but Deepti is ready to solve the problem herself. She says, “I’ll tell you what to do! You call that jerk and tell him he’s no longer welcome in the clinic. You tell him if you ever see him again, you’ll get a restraining order. Oh! Guys like that make me so mad! In fact, I’m going to call him right now and cancel all his appointments!” Erin is now in the uncomfortable position of having to defend the client to Deepti and calm Deepti down. When did the conversation become about Deepti and the types of men she doesn’t like? Deepti didn’t give Erin the chance to work it out for herself, and now Erin wishes she hadn’t told Deepti about the initial interaction. Instead of rushing in to “solve” Erin’s problem, Deepti could have promoted conversation and sharing by simply saying, “What do you plan to do?”

When It’s Bad, Let it Be Bad

Sometimes bad things happen to people. People who equalize always try to see the bright side of a situation, to balance out anything negative with a positive. While there is nothing wrong with cultivating a positive attitude to life’s ups and downs, it can be counterproductive when this type of equalizing doesn’t allow the person who is feeling bad to process his or her emotions. For example, a young man visits a massage therapist two years after recovering from a serious car accident. During the health intake interview, he opens up and talks about his concern that he will never be able to race road bikes again. His neck and shoulders still give him problems caused by the neck injury he sustained in the car accident, and when he rides, they ache so badly he has to stop. The therapist shakes his head in sympathy and says, “Yes, but at least you can walk. You must feel glad about that.”

People often work through emotionally painful things by talking with friends, grieving, and eventually finding a way to either change, or accept the situation and adapt. People find their way through grief in their own way. The therapist in this case needed only to hear and understand the biker’s concerns. He could have said something as simple as, “Oh man, that’s tough! How many minutes can you ride before the pain flares up?”

Avoid Psychoanalyzing

Popular psychology and self-help books lead some people to fall into pseudo-psychoanalysis, which derails honest and open communication. Someone psychoanalyzing generally breaks into conversations to say things like, “You seem really defensive right now, so take a deep breath—you need to breathe!” or “Your lateness was a sign of your hostility toward your client—perhaps you should take some anger management classes” or “It sounds like you were projecting your feelings onto the client. No wonder it went badly.” A person with this habit tends to judge others’ behavior as right or wrong, and tries to diagnose their psychological shortcomings, thereby falling into judging and labeling.

Avoid Inappropriate Reassurance

Sometimes people feel downhearted about some aspect of themselves or their lives because they haven’t lived up to their own expectations. It is natural to want to reassure a client, friend, or loved one but sometimes reassurance becomes a communication blocker. Kathy failed her anatomy exam and was sharing her feelings with Ichiro. She said, “I’ve just been so lazy and uncommitted, it’s no wonder I failed that test!” Ichiro replied, “You’re not lazy or uncommitted—that test was really hard and you are perfect just the way you are.” Kathy was exploring her feelings, but Ichiro sidetracked her. She had a moment of personal honesty and had recognized that she had been lazy and uncommitted to her studies. What she really needed was to feel those feelings and then seek to understand why she had been lazy and uncommitted. Ichiro reassured her, but now she doesn’t feel better because she is no closer to solving the problem. Ichiro could have simply said, “Why do you feel you have been lazy and uncommitted?” This would have given Kathy a chance to explore the situation freely.

Use Empathy, Not Sympathy

Empathy is the ability to identify with and understand another person’s feelings and difficulties. People who are empathetic for others can live in their skin, stand in their shoes, see through their eyes, and feel their emotions. Empathic people are nonjudgmental, open-minded, and understanding because they can see the situation from the other person’s point of view and comprehend how the situation impacts that person’s life. They say things like, “Wow, I can see why you are so upset about that, I would be upset, too.” Sympathy, on the other hand, can be a communication blocker when one person expresses pity or sorrow for the pain or distress of someone else. It puts the sympathizer in a more powerful position and weakens the other’s position, because the sympathizer can think and say, “Oh, poor, poor you! I’m so glad my partner doesn’t treat me that way” or “I feel so sorry for you! That must be so humiliating!” Receiving sympathy usually makes people feel uncomfortable and defensive. Instead of being able to simply feel and express their emotions, they are now in the position of defending their life.

Be Aware of Body Language

Most people have some skill at reading body language, although they may not be aware of it. A listener’s attentiveness to a speaker’s body language can reinforce that what the speaker is saying is true, alert the listener to an inconsistency between what the speaker says and truly feels, or tell the listener that the speaker is not verbalizing something important.

Imagine that you are conducting a health intake interview with an older adult client who was dropped at your office by a protective daughter. You ask the client if he is taking over-the-counter pain medications for his shoulder issues. He hesitates and crosses his arms over his chest, averts his eyes, and says “No.” Something is up. What he’s saying does not completely coincide with his body language. You decide to question him further about pain medications and find out that his daughter gets upset when he uses them regularly. You reassure him that his daughter will not see his health history forms and he uncrosses his arms, looks you in the eye, and says, “Then yes. I have taken pain medication today.” Your attention to his body language helped you realize that the situation needed further investigation that could protect this client from receiving techniques that are too deep for his tissue.

Body language also includes cues like body positions, facial expressions, gestures, and the pace and volume of words.

Be an Assertive Communicator

Assertive people communicate their ideas and opinions in an appropriate, direct manner, without encroaching on others. Communicating assertively (rather than submissively or aggressively) is an important skill, especially when working with clients. Assertive communication is clear, direct, and honest and carries a minimum of emotional overtones. In contrast, submissive communication involves hints of inadequacy, an inability to cope, and low self-esteem. Submissive speakers depreciate themselves and minimize ownership or responsibility. Aggressive communication, on the other hand, has antagonistic, defensive, and hostile overtones. It suggests deep-seated fears and a strong attachment to ideas. Compare the following examples:

Assertive communicator: “Afternoon appointments start promptly at 1:00 p.m. and end exactly at 2:00 p.m. I’m afraid you missed some of your appointment time.”

Submissive communicator: “Oh no, you’re late! I’m really sorry but I have to end the appointment at 2:00 p.m. because I will get in trouble if I don’t. I hope that’s OK with you?”

Aggressive communicator: “You’re late again and my other clients will manage to be on time, so I won’t be able to give you the entire hour.”


Clear, assertive communication leads to fewer hurt feelings, misunderstandings, and angry responses.

Assertive communication is also important in dealing with minor conflicts.

1. State Your Expectations

Let the other person know what you expect without using language that makes him or her feel judged or shamed. If a client refuses to fill in a health history form and says you do not need to know this personal health information to perform a massage, you might say assertively, “The policy at Sundance Massage Clinic is that we conduct a thorough health history intake process before we provide a massage to a client.” Remember to avoid language that is judgmental or aggressive.

2. Provide a Rationale

People like to know the reasons for things and why they should meet someone else’s expectations. You might say assertively, “It’s important to conduct a thorough health intake process to rule out conditions or medications that might make it unsafe for you to receive massage. The purpose is to ensure our clients’ safety and comfort.”

3. Describe Consequences

Sometimes you must describe the consequences of a behavior in order to establish how sessions will run in the future. Assertively, you might say, “I cannot provide a massage unless the health form is finished accurately and completely.”

4. Identify Obstacles

Sometimes people have obstacles that make it difficult for them to meet the expectations of others. As an assertive communicator, ask clients about potential obstacles and invite them to share their views. You might say, “Can you explain why you would prefer not to fill in the health history form?” It may be as simple as the client saying, “I don’t really mind filling out the form, but I forgot my glasses and I can’t read a word of it.” In this case, the solution is easy: you can read the form to the client and fill in the answers.

5. Clarify the Future

Finally, it is a good idea to summarize the conversation and confirm the plan. You might say, “I think I understand you now. If I will read the form to you, you will fill it out?” The client agrees, and you can now proceed with the massage session with no hard feelings.


Effective communication is much more than speaking clearly and looking someone in the eye. It’s all the tangibles and intangibles that we and the client bring to the table that make communication one of the more difficult business tools to master. Yet, with clarity, intention, and thoughtfulness, your communication skills can become one of the greatest tools for bringing your clients back to you again and again.


1. This text is adapted from the author’s textbook, Massage Mastery: From Student to Professional (Lippincott Williams & Wilkins), scheduled for release in February 2012.


Anne Williams, director of education for Associated Bodywork & Massage Professionals, is the author of Spa
Bodywork: A Guide for Massage Therapists
and Massage Mastery: From Student to Professional. For more information,
visit or contact her at