THERAPY IN PRACTICE

I just wobble there!” or “I don’t have any muscles: I’m just fat everywhere!” Conversely, some clients’ anxiety may be expressed in statements such as “Don’t relax my muscles too much: I want them to be toned”, or clients may search for validation in statements such as “I’ve been training hard and lost half a stone. Can you tell?”

TOUCH Clients (including those in relationships) may be touch-deprived and be unfamiliar with the contact experienced through massage, or of trainers moving their limbs into position for exercise or stretching. The resulting nervousness can perpetuate body-shaming statements, which may be aimed at eliciting a response from the therapist. As Deane Juhan states, “touch is food” for our whole system (7), a statement supported by research with premature babies who thrived when massaged regularly (8).

BE POSITIVE As body-centred therapists, we have to be careful not to perpetuate our clients’ negativity and instead to focus on helping rather than potentially harming. It is easy to overempathise (“Oh, yes, I have love handles too!”, “Don’t worry, I’ve seen it all before”), to deny clients’ feelings (“No, no, you’re not fat at all”), to make a joke out of their statement (“Bingo wings!”) or even to jump into advising the client on how they can lose weight, thus giving the message that their current weight is not acceptable. All of these come from a place of judgement and move us out of the client-centred core that is at the heart of our profession – the place of “unconditional positive regard”, a term first coined by the pioneering psychologist and humanist Carl Rogers (12). Unconditional positive regard is a place of acceptance that we offer our clients, regardless of how successful their training regimen is, how much weight they have lost, what their body looks like or how they feel about their body. Researchers suggest that in women, both positive and negative body-oriented comments result in increases in body “surveillance” and body dissatisfaction (8), perhaps due to the indication that others are focusing on their outward appearance. This supports the idea that even seemingly innocuous comments may

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have “detrimental consequences for women’s self-objectification and body image” (9). I would suggest that our role as therapists is not to label these types of statement as “wrong” but to tread with caution when we hear people make such comments. We are in a position of power with our clients and have no idea whether our unintended flippant remark may initiate a downward cycle of anxiety or negative behaviour that could result in binge eating, exercise addiction, steroid use, purging or depression. Box 2 shows some typical examples of client–therapist dialogue. These examples may seem somewhat artificial or extreme, but my aim is to give you some food for thought in your upcoming treatments.

THERAPIST’S OWN BODY IMAGE

The ancient adage “Physician, heal thyself” applies to therapists, especially massage professionals: if we are working in this sometimes intimate field, and the body is the interface between us and our clients, then our hands, our words and our actions all have effect. If we touch the surface, we can stir the depths. If we too feel that we are in discord with our body, whether we are addicted to exercise, are constantly dieting, are somewhat narcissistic, or simply have the “normal” hang-ups about our “imperfections”, then the treatment room is not the place to share these. We need to create a professional and safe space for our clients and seek to explore our own body-based messages independently of our role as the one “in charge”. As an instructor and trainer, both observing and receiving massage over a number of years, I wonder whether our own negativity about body image is the reason why many massage professionals do not include abdominal massage in their work. Do we feel as comfortable working with gluteals as we do with quadriceps? Are we as confident treating people’s adductors as we are their abductors? Is there something more to this avoidance that we don’t always acknowledge? As professionals, we have a chance to educate our clients about their

BOX 2: CLIENT–THERAPIST DIALOGUE Client 1: “You want to work on my feet? I have horrible feet!” Negative responses: “You should see mine!”, “I have some elderly clients whose feet are like claws!” Neutral response: “Feet are really important in giving our body a stable base, and so it is really important to give them attention.”

Client 2: “My lower back is sore, probably because I’ve got all this weight up front.” Negative responses: “You enjoy a few beers, then?”, “Yes, well, we all have our crosses to bear!” Neutral response: “There are many reasons for back pain – it is a complex issue. I’m going to work on your back and gluteal muscles first and see what we find – are you comfortable with this?”

Client 3: “You probably won’t be able to feel my muscles under all this flab.” Negative responses: “Don’t worry – they’re in there somewhere!’, Did you give up the walking programme you were doing?” Neutral response: “Our bodies are all very different. My job is to support you in feeling better, to see whether you can breathe easily into your hard-working legs as I work.”

body and may have the luxury of time or an ongoing therapeutic relationship that other health professionals such as general practitioners do not. If we can provide more neutral or body as “functional instrument” rather than as “decorative ornament”-type answers, then, although our clients may not recognise it, we are offering them a new way to relate to their body. Instead of avoiding the abdominal area in a client with back pain, for example, we could take this opportunity to educate the client about the importance and function of core muscles and why it may be

important to include them in a massage session. We can then leave the decision to

the client, so when they are comfortable enough to

receive touch on this perhaps long-neglected area, they understand that our intention is to help them functionally, not to judge them aesthetically. We therefore allow the client to make the decision from a more informed place rather than from a place of fear of judgement.

THERAPIST SUPPORT We ourselves as therapists should seek support, supervision

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