Working with difficult clients is challenging in any profession, but for bodyworkers, whose job requires a delicate balance of strong boundaries and gentle care, working with difficult people can be both exhausting and unsettling. Whether in a doctor’s office, spa, or private practice, most massage therapists have dealt with the challenging client who requires extra care and attention. Recognizing and preparing beforehand to work with these clients will make your sessions and days go more smoothly, and solidify your own boundaries and policies as well.
The Overly Talkative
Every massage therapist has at least a few clients who like to talk before, during, and after a massage if they have had a stressful or exciting day. Talking to discuss health issues is necessary, and discussing a client’s great day is always welcome, but when talking becomes excessive and interrupts the session, both practitioner and client will be more stressed and less focused on the healing process. Asking clients not to talk can also produce stress in those who are verbal and need to vent bottled-up frustrations. For a talker, feeling heard and being allowed to talk are necessary for his or her therapeutic process. Providing time, permission, and limits will calm the client and build trust.
Before the Massage
Let your client know you want to spend five minutes to discuss his health issues and anything he feels he needs to share that has affected his health recently. Being specific about time will give a client the time to be heard, and help him know when the talking should end and the session begin.
During the Massage
In my practice, I have been blessed with many challenging clients who have taught me to arrange my sessions with them in mind. For the talkative, I choose very slow music and begin with gentle rocking or aspects of Trager work to calm the nervous system. A gentle Thai series or shiatsu is effective as well.
Reiki Master and massage therapist Junko Hayakawa suggests adding simple breath work to your routine. “Before beginning your regular massage, have your clients do three deep breaths with long six-count exhales to occupy and relax the throat while calming the body. Also, save extra time for neck work at the end of the massage. Talkative clients are anxious and need extra help to calm down.”
Remind talkers to feel free to speak when they need to and you will find the need is lessened. Get in the habit of redirecting conversations back to health issues and asking short, relevant yes or no questions.
After the Massage
Ideally, your client is both delighted and relaxed, so you can simply discuss how he feels and when he would like to book again. In my practice, I have to curb my own tendency to chat too long about extra advice on self-care, but I feel a few minutes after a session or during the payment process is invaluable to my clients. To shorten talks, politely walk your client to the door and tell him you would love to hear more the next session.
The Type A Thinker
The most stressed clients are often those who worry constantly and have trouble turning off their brain. Telling a thinker to relax can actually aggravate him since he will be trying to do the work of relaxing instead of letting go of thoughts. Calming the client’s body with breath work and then distracting his mind with creative visualization helps him use the power of his own mind to relax and heal.
Before the Massage
Discuss your plan for the massage with your type A client so he can relax instead of needing to know what’s next. To relieve your client of the burden of “needing to achieve” anything during a session, ask him to simply focus his attention on his breath and areas of tension. This way he will feel empowered and useful.
During the Massage
To calm the areas that usually hold the most tension for chronic thinkers, start the session supine with a gentle face, jaw, scalp, and shoulder massage. Next, walk your client through a few minutes of visualization. A positive image will replace stressful “To Do” lists and allow your client to begin focusing on healing rather than pain. Continue your regular routine with progressively slower strokes so you can slow the body down in stages. Again, choose music that is slow and nonverbal.
After the Massage
Give honest, positive feedback, since most thinkers will analyze their “relaxation performance.” Provide self-care instructions or suggest meditation tapes. Dynamic stretching and exercises such as tai chi and qigong are excellent for type A thinkers, so I refer clients to local teachers. Keeping a great referral list of classes, health website links, and practitioners will empower your clients and help type A personalities manage their own health in a way that makes sense to them.
The great advantage to working with type A personalities is that they are engaged and active in their healing process and happy to learn more. When you recognize and praise these qualities, you get an amazing client who turns from negatively stressed to positively relaxed.
The High Maintenance
The high-maintenance personality includes clients who ask for special treatment, request off-the-schedule appointment times, continue to ask for more work even after the treatment time has ended, and arrive with a bevy of requests or issues that cannot possibly be treated in one session. Every client wants to be heard, but certain clients feel entitled to demand more of you. Unfortunately, this can be exhausting to a bodyworker who is already in a giving profession. Protecting your boundaries is vital when working with these clients.
Before the Massage
Ask your client what she would like to focus on so you both create a custom session she agrees upon beforehand. High-maintenance clients benefit from knowing the time constraints of a therapist’s schedule, and then being gently reminded of it at the end of a session.
During the Massage
Check in with your client several times on pressure, face cradle comfort, and temperature of the room and table. Mention what you can change during the session versus the things you can’t—if you work in a spa, you may not be able to change the temperature, but you will be able to add a blanket.
For these clients, it’s best to end the massage in a few steps. Let the client know the session is almost over and ask her to take three long breaths while you cover her eyes with an eye pillow. Then suggest she take a minute to get up before meeting you in the waiting area. Concluding the session this way is polite and professional without rushing the client.
After the Massage
Keep several self-care sheets on various topics such as stretching, nutrition, or pain relief so clients can manage their own care and feel supported long after their session is over. Ideally, send a weekly email to remind clients of your availability, hours, and cancellation policy.
The Skeptic
No matter where you work, you will encounter a client at some point who believes nothing will help. The client who walks in blaming every professional she has seen before begins the session with a negative, counterproductive attitude that can affect a therapist’s confidence and mood, no matter how experienced.
Before the Massage
With negative clients, use a detailed health history form and ask plenty of questions before the session to see if you can find the true source of illness, doubt, and stress. Ask your client if she would like to focus the entire session on the areas she has been concerned about, so that you are fully addressing her needs. Cynicism is usually due to not feeling heard or not experiencing a positive outcome from a therapy. If someone is in pain, we have to remember that person will be skeptical until some part of the pain or stress is removed. It is important to discuss treatment options with skeptical clients so they feel they can choose. Acupuncturist and massage therapist Elaine Ataba says, “We can’t be all things to all people. If I have a client who has had a bad experience before with massage or acupuncture, my job is to educate the client, empower him to manage his own care, and help him have a great new experience. But you can’t please everyone.”
For the negative client, we can only do our best and hope the attitude changes. We can only do what we know; to expect that we can help everyone is naive. Referring clients any time you feel you cannot help is not only the right thing to do, it also fosters trust and helps the negative client try alternative health services again, whether with you or someone else.
During the Massage
If you have the facilities, it helps to speak to your client for a few minutes outside the therapy room over a cup of chamomile tea. During a pre-massage chat, try to understand where the negativity originated and be realistic with treatment results. Avoid feeding into negativity by validating any poor treatments received previously; simply focus on the present.
In Chinese medicine, negativity or anger relates to the liver, and a stagnant liver can cause all sorts of health issues. Remembering that an angry or negative client is suffering and uncomfortable will enable the therapist to focus on the healing of a pain-ridden body, rather than being defensive about a negative personality. During the massage, add gentle but firm shiatsu or acupressure along the Liver and Gallbladder Meridians, and save extra time for the hands and feet.
With this client, it’s important to protect yourself first to ensure you remain present during a treatment. Do a series of qigong or deep breathing exercises before you step into the session.
After the Massage
It helps the skeptic to receive emailed links on information for her specific condition, as well as referrals for experts. If you can provide information with supporting evidence, you can help a naysayer gain confidence about your sessions. There is no better feeling than helping turn a skeptic into an advocate.
the Boundary-less
One of the most challenging clients is the one without boundaries. In massage school, ethics courses cover how to establish boundaries and recognize transference. Most therapists in a spa setting or chiropractic office may not have to worry about boundary issues since they are somewhat protected by office policies. In your own practice, however, you need to establish your boundaries and policies immediately. There are two main types of boundary-less clients you are apt to deal with: 1) the client who is chronically late or changes appointments without regard to your schedule and, 2) the client who makes you feel uncomfortable either verbally or physically.
Before the Massage
You will likely recognize this type of client fairly quickly by the way they charge into a session sharing too much personal information, complaining about people, or ignoring the time, even if they are late. Once you recognize that a client has his own timetable or agenda, simply review the health information succinctly and instruct him on how to get ready for the session. Keep the conversation as brief as possible and, if necessary, tell him politely that you’d like to get started immediately so he receives the full time. Establish boundaries immediately and put all of your policies in writing on your paperwork so your clients understand and, ideally, respect your time and business from the first session.
During the Massage
If a client’s comments are counter to the healing process, they can be helped through redirection. If clients are too demanding or personal, then using direct, honest communication is helpful. Using creative visualization to redirect any negative talk, and energy work to calm an overworked adrenal system, can help.
If a client discusses something that makes you uncomfortable, check how you feel around this person, be nonjudgmental, and continue the massage while redirecting the conversation. If you have one verbal incident that feels uncomfortable, you might let it slide if it was not offensive to you. If someone continues to make you uncomfortable, you may need to refer them to someone else. Asking your client to refrain from comments or telling them they are making you feel uncomfortable already sets up an uneasy situation once you have started the session.
If someone crosses any physical boundaries, then you need to stop the session. Being prepared for this scenario is not a bad idea since it is better to know how you would handle it than to be caught unprepared. In a chiropractic or physical therapist office, it is easy to simply discuss the client with your boss or colleague and keep them apprised of any issues. In your own practice, however, it is helpful to be prepared to take action.
After the Massage
For clients who are always late or disregard appointment times, reminder calls and emails with cancellation policies included are a necessity. For clients who have breached your boundaries, suggest they will get better care with someone else. Unless the offense was unethical, the more politely you can refer, the better. It is important to know your own limits and your own boundaries, because even if someone else can handle a disrespectful or challenging client, you might not be able to. It is in your client’s and your own best interest to refer them on to another health-care professional.
the Noncompliant
As health practitioners, we strive to help every client become healthier, but we all know that is simply impossible. Ideally, every client follows our self-care suggestions, but many clients expect their therapist to fix them in one session, or they return with the same complaint after ignoring any advice that might have been given. The majority of clients are amazing. They listen and take responsibility for their own health. Then there are the clients who want no part in their own care. Noncompliant clients are difficult for all health practitioners.
With the first session, you might notice on your health form that your client has had a chronic complaint and not followed protocol from previous health professionals, or you might have a skeptic who complains that no one helped her, but she never followed her therapist’s advice. Prepare yourself for a client who will come to you for “the fix,” but will not be willing to listen. Take a more detailed health history to identify the client’s resistance to following advice so that the same problem can be avoided in your sessions.
Ataba reminds clients to follow her suggestions for herbal remedies via email and during follow-up appointments. “I always discuss whether my clients have been following my advice and discuss the positive results they will get if they do,” she says. “I try not to focus on the negative, but I do remind them every session.”
Therapists cannot expect all clients to follow their advice, but we can hope the majority will take responsibility for their own health. For noncompliant clients, we can offer support and a detailed treatment plan, but we cannot ensure follow-through. To work with these clients effectively, we must simply focus on what we are able to do and not worry about what we cannot change.
Every client poses a challenge to a massage therapist—they are all wonderful opportunities for us to grow as professionals and use what we know to help them relax and heal. Being prepared is the best way to ensure you can take care of yourself and your challenging clients effectively and compassionately.
Vanessa King, an MT, holistic health practitioner, clinical nutritionist, and yoga and somatic therapist, has been practicing massage therapy since 1991. She writes and edits for technology and health websites, and runs her private bodywork practice at Sage Acupuncture and The Keller Clinic in San Diego, California. Visit www.sageacupuncture.com.