Category Archives: Touchy Situations

Aw Shucks, Twern’t Nuthin’…

Sometimes clients love their massage so much they bring me gifts. I love a nice card or a bottle of olive oil. A box of cupcakes? Oh please, don’t feed me!

I have to admit it is wonderful for the ego. One long day – a Saturday – my clients brought me lunch. How did they know? Are we psychically linked?

Gifts are wonderful expressions of thanks, but are there a place to draw the line? Do we massage therapists’ need one?

When I worked at a newspaper we had strict rules because we didn’t want any implied or perceived favoritism through gifts. We in the news section picked up the lunch check; we turned down the offered goodies. But it was not all black and white. One day the business editor decided it was OK to accept goodies if it could be consumed in an afternoon. The next day the business section got a case of wine. Meanwhile, the travel editors and the sports guys did all kinds of things for free.

But in the therapeutic realm, is there a reason to turn down gifts? I don’t know. A sandwich and a box of cupcakes seem fine. What about a Hawaiian vacation? A free refi? Sponsorship at the country club? If it is a substantial gift is it still OK?

One of my good friends, a personal trainer, got a nice-looking pair of diamond earrings from a client at the holidays. She was fine with it, actually pretty giddy. It seemed to me fine to accept, as long as the client was not doing it for romantic reasons, which he wasn’t.

I guess I will think that one through if it ever comes up for me.

How do therapists feel about gifts? Are they bonuses for a job well done? Will they cause a problem in the therapeutic relationship? Are they any different from other tips?

Oh my the question virus has bitten me today. I suspect gifts are OK as long as they don’t stand in for something else – an invitation to a personal relationship or some obligation outside the massage room. That makes the free helicopter sightseeing ride a no-no because a lonely male client offers it. But the free use of the vacation home for a weekend seems all right. Therapists, what do you think?

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Get Online with It: Face the Facts

I had a very good feeling about the practitioner I was learning about online – the picture, the story, the information fit what I was looking for in a massage therapist.

         
So I went to my first appointment – and I couldn’t believe my eyes – the person I expected to meet had aged 20 years since I looked at the photo online. I didn’t quite know what to do. I definitely didn’t say anything.

         
Is it naïve to expect the picture online to look like the person you meet? This wasn’t a dating site. I was looking for a good massage. Before this I didn’t think age was an issue in a massage therapist.

         
Just for yucks I went back to the website afterwards. The picture I saw did have a few clues that it was an old shot – the hairstyle was out of date ‘80s, the focus was fuzzy, the clothes style much gone by.

         
Still, I did not know what to do, if anything about the discrepancy. But I felt bad, that as a fellow massage therapist, I had said nothing during the first session.

         
I went back for another session, and this time I got my scriblets together and decided to bring it up.

         
“Gee, you do such a great massage. I was surprised that you use such an old picture on your site. Perhaps it is time to update.”

       

Nothing like jumping right into the lake.

         

A long, frigid and deafening silence followed my remark.


“Oh you noticed that, did you,” the therapist said.

That went so well. After I drove away I parked at a convenience store to have a little private cringe. Old portrait photos online apparently are in the same category as comb-overs. Never to be noticed or mentioned. All I can say is fellow therapists, don’t let this happen to you.
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Through the Sheets

Sometimes in the course of massage therapy practice, we will meet clients who want to have some delicate and sensitive areas relieved of trigger points and adhesions.

           
My most recent experience was with a client who had gone into a full-body clench during a car accident, braced with both feet on the brake pedal as the vehicle did a dervish and ended upside down.
           
It is almost a cliché to say that people who are unaware they are about to have an accident are better off. They don’t have time to react in terror, they don’t have the cascade of hormones and the emotions of fear.
          
The ones who see it coming, if they brace with arms and legs can end up with not only their accident injury, but a cascade of spastic muscles from jamming into the brake pedal, steering wheel and seat belt.
           
In addition to the usual back and neck pain, this client developed rectal and vaginal pain referred from injuries to the adductors, hamstrings and glutes.
           
As a therapist, the last thing I want to do is trigger more trauma to these areas with massage techniques.
           
First I like to talk to the clients about what areas are involved and could be helped by massage. Then I suggest making sure the client knows he/she is in control and are able to tell me to stop or lighten up at any time.
           
With these areas, because they are near areas of vulnerability I feel need some special security, especially for female clients. The clients are always draped with a sheet, and if they want they can also wear their outer clothes and underwear. The layers make the massage methods such as trigger point less invasive.
           
That said, I have always found that it is better to be cautious about client comfort when dealing with delicate areas.
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Table Talk


Have you caught yourself talking too much during a session? We massage therapists can all lead with our chins on this one, can we not?

            
One of my therapist friends believes every session should be hushed – no talk of any kind, music only, and if the client tries to talk only answer with “hmmms” and “ah-huhs.” She felt any speech beyond the basic whispered: “let me know if you want more or less pressure,” disturbed the energy of the session. The outside world is too noisy, so the massage session should be the one quiet spot in a person’s schedule.
             
I like to let the client set the tone, but I notice that some clients seem too chatty, some too tight-lipped. I will often go with my instinct to encourage conversation about the session if the client seems too silent. I try to dampen non-stop chatterers with some wasting Swedish strokes.
            
Having a bit of chat at the start of a client’s first-ever massage can also help ease the awkwardness if that is an issue. But I have had friends who have gotten massages on vacations that they are happiest when the massage is somewhat anonymous – a silent rub with hands only making the impression.
             
If the client tells me they didn’t like their last massage because the therapist was chatty, I definitely take note and keep it quiet. 

 

At the risk of setting off some fiery debate, is there an acceptable level of chat during a massage?

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Massage as Rehab

This massage therapist loves a challenge, and I frequently get them. Yet sometimes I wonder if I am doing the “right” thing. You know, the right thing as in “Do the Right Thing.”


Massage therapists are darned good at shaving a few points off a golf game. We excel at getting rid of the post-lunch headache. I’ve never met a trigger point I couldn’t conquer.

But what happened the other day got me good and flummoxed.

Here’s what happened: A new client with a long record of running lots of Ironman triathalons came in for relief from back pain from two crushed discs – so he can continue to compete in many more Ironmans.

I have to admit I asked a good many questions. And the bottom line came back to competition. He has to be able to go back to compete. If massage won’t help, he plans to take a year off to have back surgery (even the surgeon told him he didn’t need it) so he can go back to racing. It is that important.

What is the right thing? Frankly, the client is “the decider.” Yes, I am unqualified to decide what another person wants or desires or what is right for them. I can ask questions, I can offer ideas, but it is the client’s choice. It was time to pull up my big girl panties and see what I could do to help this client.

How would you deal with this?

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Massage School Memories

 Going to massage school, this massage therapist learned a lot about dealing with “tense” situations and people. The other day my local association asked for some massage schools memories and it made me laugh.
Warm Fuzzy? More like shrieking students levitating on the practice tables.
 My first scream came during the first class. We were supposed to practice a simple effleurage of the leg. My practice partner, whom I had just met, swooped up my inside leg, aimed right for my crotch and at the last possible second – and I mean the last possible second – swooped laterally to finish the stroke.
 “That was very uncomfortable,” I recall saying.
“I have to do the whole muscle,” she said.

That night our first student quit. He didn’t want to take off his necklace for a demo, and the teacher said he had to.
“I never take it off,” I recall him saying, as he backed out of the room, never to be seen again.
 
Some classes later, what was left of us were learning face massage. My practice partner this time was a very talented Asian man who had been doing acupressure for years and was kind of annoyed by the namby-pamby Swedish stuff we were learning.
Suddenly two hands formed a V and thanars pushed straight across and down across my cheeks, with what felt like the full weight of his upper body. The next day I had a business meeting in Los Angeles. I felt like I had a fiery helmet glued to the front of my sinuses. I did not think harmonious thoughts of world peace.
I will admit I performed some of the mayhem as well. Something large, rubbery and unmoving presented itself in the upper trapezius of my victim. I pushed on it with my ulnar, steamrolling down toward the spine of the scapula. Move, I thought. Move!
My practice partner’s shoulder came up off the table and pushed back right into my arm.
“What’s going on?” I asked.
“I have a right to protect myself,’” she said.
Somehow, come graduation about 18 months later, our hardy group was able to stand and walk to the stage to get our certificates. Our horrors had become vignettes.
“Remember that time I said your stomach was just like Play dough?” one of my classmates whispered to me.
“Yes,” I said. “Just remember, next time I do an effleurage on your leg, I might just ‘have to do the whole muscle.’
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Blinded by the $10 Grand Solution

Folks with big troubles like this client – blinding headaches and vertigo – shop around for help. This massage therapist has been working with this client for a while. Her headaches get better with massage and heat packs but it never seems quite enough to make them go away.
This client has tried injections, acupuncture, a full course program at a pain management clinic and a few other things. Some treatments don’t work; some work a little and some have proven really toxic dead-ends.

The latest sojourn was to new clinic advertising a low-level electro-magnetic treatment. The client went to a presentation and tried a free treatment. The full course of therapy requires treatment every weekday for a month. Cost upfront $10,000. No insurance coverage.

The treatment seemed fine at first, the client said, then it seemed like her headache suddenly got worse. She told the technician administering the treatment. “She said no one had ever complained before,” the client said.

 The treatment continued, although after she complained again, the technician turned the machine down some.

 And then there was the $10,000.

 “For $10,000, I want to know that the treatment will work. That’s a lot of money,” she said.  Oh yes indeedy. There were too many red flags for her, from a lack of concern about her feedback to the big price tag etc.

 Then the big question.
“What do you think?”

“I think you made the right decision. A new treatment. New clinic. Big price and what sounds like an inexperienced staff. Plus people who know what they are doing never blow off a complaint with a comment like no one has complained before.”

 I have to admit, though, that my inner wheels were turning. I wondered about offering the client a free massage every day for a month. If the headaches get lost, why not pay me $10,000.

 Somehow, somewhere, smarter folks than I decided that paying only if treatment works is somehow unethical. I’m still looking that one up, but I’m pretty sure it is on the books as a no-no. Fudge crumpets. The idea of this lady getting better – and my spouse and I going on a Hawaiian vacation – was pretty tempting.

After she left, I had the mental picture of myself running after her car offering the deal.
 “Waaaaiiitttttt….” Puff-puff-puff.

Fee for service is a major tenant of our profession, however, and one that other health professions may have been wiser to stick to.

 Fudge crumpets.

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Family Matters

Holidays bring out the best in people – and the visiting relatives. I have just moved the office and the massage therapy room still looked a little bit like a MASH unit. My phone message, for a change, said I was off for two days before and after the holiday – but the calls just kept coming.

Despite a long history of scoliosis, this client had never had massage for the condition. She had enjoyed the occasional vacation massage here and there.
Holiday massages tend to be emergencies, anyways. This time I had a referral from a client. This was a young lady with mild scoliosis, who between funny positions on the couch and airplane rides and long conversations with the parents had woke up to find that turning to the left was impossible. O Joy.
While going over her intake, I suggested she do regular massage to keep discomfort in check and possibly to help prevent the scoliosis from getting tighter.  “How do I find a massage therapist who specializes in scoliosis?” she asked. I felt a bit surprised by the question. I explained that so many massage clients have slight to mild scoliosis I consider scoliosis therapy part of the mainstream of therapeutic massage.
Perhaps look for a more therapeutic massage person, I suggested.  I felt on thin ground. All massages, in my mind, are therapeutic, even the ones where intent is solely to relax the person while on vacation. That is a pretty awesome skill.
This client comes from an area of the country with very minimal requirements for massage licensing. It is also known for having lots of people who are into a kind of flower-child view of life and massage.
“I don’t really mind that stuff as long as it is not the only thing in the massage,” she said. “I would also like to get some work done on my problem spots.”
Oh heck, I might as well dive into the pool. “I understand what you are saying,” I said. “I’ve had those massages where the person giving them is off on their own trip and not that into why you are there. It is no guarantee, but if you look for someone with boards or more education than the minimum, you have a chance of getting someone into therapy.”
Good advice, I thought, for a person looking for therapeutic massage. But as a therapist, I felt pretty uncomfortable. Rarely, I have had great massages from people with little education or experience. But the norm is I get a bad massage from someone who has no idea what they are doing.
It is very controversial in our field. Is a great relaxation massage at a resort not therapeutic? Is a highly trained therapist capable of being clueless? What about those folks who chant and tap in to the energy of the universe? Are their skills just different?
The answer, I think, is client by client. If clients want a massage therapist to focus on their scoliosis, they need to find someone they believe will help them. Oh heavens, I’ve said the famous “good fit” cliché.
Clichés, however, tend to be a bit truthful. “Finding a massage therapist is like finding a dentist,” I told her. “You can do all the research, look at qualifications, get referrals, but you won’t know if you like them until you are sitting in that chair.”
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Touch and the End of the World as We Know It

Stress comes in all forms, and I feel it on my massage table. Most likely it is a personal issue, a problem, a challenge in life or relationships. But a lot of people get their biggest stress from work, most specifically the feeling of being out of control, powerless, voiceless.


It is a tall order to unwind all that. I try. Massage therapy is not going to change the world, of course, just our reaction to it.


One of my regular fellows has been stressing for months about the national election. He has told me straight out on a number of times that if his candidate did not win, or more importantly if the other guy didn’t lose, that he would be out of business overnight.

Long hard years of work and dedication down the drain. Mentored employees adrift. An entire sophisticated market kaputz, with the eventuality the ruin of the quality medical care in the United States. Instead of working on the important stuff, he might just be trying to come up with the next Sham-Wow, while sitting in an old rv somewhere trying to stay one park ahead of his creditors.

Ok. That is pretty dreadful.

Well, the national election didn’t go too well for his guys. On top of that, Californians, apparently insane from overdoses of Twinkies and silicone, actually voted to raise their own taxes.

And you just don’t talk politics with clients. I can mumble a sympathetic “that’s terrible” here and there, but otherwise it is a game out of bounds for massage therapy.

I was thinking, though, that it has been my experience that if someone tries to frighten your vote, they are on thin ground. I don’t vote that way and never have. Well, that’s an opinion I kept to myself.

I felt somehow that the blow could be softened. I suggested that it would be best to let the political process play out. If the industry was on a precipice and ready to be demolished by new taxes and regulations, surely the major economic interests involved would make themselves heard. Those in government, ever mindful of the power of money, jobs and investments, will certainly listen. Give it time, I said.

          “I s’pose,” he said.

Solace? Perhaps I can offer just a little candlelight at the end of a long hard-fought campaign….

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To Glute or not to Glute…

Hey, it happens. A humble massage therapist is massaging someone who has a freak-out during the session and leaves. Later, the client wails in an online review that the massage was unprofessional because…(drum roll please)…the therapist massaged her glutes.

This scenario happened to a friend of mine and believe me, it was not a fun day at that office. We are not in the business of triggering people’s fears. We want to help people feel better.
 
I talked with my friend about this the other day and she was still steaming about the review and the session. It is not the client’s fault, I said, because people have triggers and they often do not express them. They have trust issues, abuse issues, etc. and in many cases the expectation is that we will be mind readers and know what they do not like.
 
Clients may have had few or no massages, I explained, and the ones they had may have been at a spa that offers general massages and managers do not allow glutei massage. Schools are turning out therapists for these spas, so many are not teaching glute massage.
 
And here we are, my friend and I, old-school therapists who went to school in the therapy-driven ‘90s and we learned not only are glute massages beneficial; they are often the key to unlocking back pain.
 
The way I dealt with glute massage in a spa environment was to ask clients what they wanted from their massage that day. And I would ask if there are areas they did not want massaged.
 
Now in private practice, I have the question on the client intake. I read the intake and go over it with the client before the massage starts.
 
If there is some reason to massage glutes, such as lumbar pain, I will tell the client that glute massage will help resolve the problem – so if they ever want to try it, just let me know. That gives the client both the reason and the control.
 
And sometimes, after they develop some trust in me, they will say OK.
 
The bottom line is, as always, the client is always right. If a client feels glutes are off-limits, then they are. Find out first before you get a bad reaction in a massage, or even worse, in this net age, a bad review online.
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