VERBAL SKILLS FOR MASSAGE THERAPISTS

Note:  These guidelines are not meant to imply that you need to talk a lot during a massage session.

  Often, very little needs to be said. Verbal intervention should be used minimally and subtlely to keep some contact and check on the client's well-being. If the answers are congruent with the client's body language e.g the client says "I'm fine" and the breathing appears flowing and you have a sense of ease and peace, no more needs to be said.

If the client's response to a question is not congruent, e.g the client says "I'm really enjoying this" but you notice that the breathing is very shallow and the client's eyes are wide open and 'on guard', you need to sharpen your observations and begin to ask yourself what is happening. Don't rush in to asking questions or commenting. Its important to give the client space.

 Verbal interventions include instructions, questions, reflections, suggestions.

  Instructions. These are especially important with new clients who may be very anxious about what the're supposed to do. e.g "I'm just going to wash my hands. You can get undressed - leaving on your underwear - and get on to the table in between the sheets."

  Questions.

Ask open-ended questions  - eg. "how does this feel?"  - unless you have a reason for wanting more specific information e.g "does this muscle on your arm here feel very tender?"

 Its often best to start with an open-ended question but if your client answers in a very general neutral way, you may want to follow up with something more specific. On the other hand if you ask a lot of very specific questions, your client may feel they're being interrogated! It may be best to just ask one question which can be answered in various ways.

  Content of questions

The broad categories of interest, in approximate order of intensity or charge are: thoughts,sensations, images, memories,  feelings, relationship. You may ask a general question eg. what's happening? and the answers can contain one or a combination of the following.

  Thoughts. "I'm thinking about work". Thoughts may be on the road to the feeling e.g the client may continue, "I had a row with my boss and I still feel angry.." Thoughts may be an avoidance of feelings, "I was just admiring the wallpaper", or revealing general anxiety. 

  Sensations. These are particularly important to encourage, and perhaps explore, when working with massage. For the client, noticing and describing sensations is vital in building embodied self- awareness. It can be a fresh way to get in touch with experience without going down familiar thought pathways. It can be a very subtle and safe way for the client to expand their vocabulary for their sense of themselves.

E.g.'s  "how does this leg feel?", "is this painful?", "are you aware of how cold your feet are?" "does this pressure feel okay?" "is this comfortable?" "can you feel this muscle?" "does it feel tight?"  etc

 It can be helpful to bring the client's awareness to areas that are numb, or cut off - but be careful: you don't want to increase anxiety, or make the client feel judged.

  Remember, particularly in British rather repressed and 'body-shy' society, people are not used to talking about body feelings and sensations. They may find your questions very strange!  You may need to start with simple practical questions, "are you warm enough" so that they begin to feel that its okay to listen to their body, and that you care about their well-being.

  When people do become aware of a sensation that is not numbness or pain, they may find this frightening, particularly if it is a feeling of aliveness, inner movement, etc such as tingling.  As with any subject, your tone of voice can help convey gentle interest, acceptance and understanding.

  Images

For the more sophisticated client, when there is a sense of something stirring which they can't easily put into words, you can ask if they have an image. A certain proportion of people thrive on visual imagery, but again, its important that the client doesn't feel they have failed if they don't have an image. Sometimes visual imagery is a way of splitting off from what's happening in the body and it is a sign that the client is quite frightened. (There will be other signs of fear too, in the breathing etc)  You have to consider, does the image resonate? can you find a connection between what is going on in the client's body and the imagery they are using? E.g "there is a bubble of tears around my heart" - this is an embodied image that is concrete and suggests feeling.

  Memories

 There may be an overlap between images and memories. The client may see a picture of themselves somewhere or they may be seeing from the perspective of then, e.g feeling small and looking up at an adult. Being in the observer position is slightly more detached and may be necessary to keep the feelings manageable.

 Some memories are pleasant, some stir up conflicting feelings. Sometimes the client knows quite clearly that they are remembering. Sometimes its more like a dream - there is uncertainty - did this happen? It is important not to assume immediately that it is a memory. It is much more important to support the client in recognising the feeling content and giving that space.

  Memories of Abuse

Sometimes people are frightened that memories of abuse are surfacing and they will ask, "do you believe me?" If the client's memory is very specific and has a context - you can indicate your acceptance of the client and your willingness to listen and try to understand. If the details are vague, it may be wiser just to confirm your trust in the client's feelings, eg. "I can see you are very frightened. I don't know what happened to you but I will support you in finding out".

 The massage table is not the place to explore this kind of trauma unless you are very experienced. When a client is overwhelmed by fear, it is helpful to (a) get them upright - sitting on the table or on a chair (b) keep eye contact - this helps bring the client back into the present (c) keep them warm, covered and supported with blankets and cushions.

  Recovering memories is not the objective of biodynamic massage - it is something that can happen in the process as the client becomes alive to their history as it has been preserved in their body. If the client has suffered major trauma,  you need to consider whether massage is appropriate. Is the client in therapy? Has the therapist given permission for massage ? (You always need to obtain the therapist's consent before starting massage) What is the client's life situation? Will they be able to get enough support to hold them during an intense process?

  When a body memory is emerging there may be strong internal conflict between the part that has kept it suppressed and  the feeling which wants release and completion. It is at this point that verbal intervention is most valuable to support the client in making sense of what is going on. Clients can quickly re-bury feelings and memories without very clear external support and encouragement. You need to strike a balance between asking questions to gain information, perhaps feeding back what you see, and giving the client space to actually experience what's going on. Don't press for resolution and insight - remain open to all sources of information especially your own and the client's intutitions.

  Feelings

You may become aware of the client's feelings rising by changes in their breathing, changes in colour (particularly the face), increased restlessness or increased stiffness. They may not be aware of these feelings - keep the questions open, and be aware of your tone.If the client is regressed, if there is a lot of sadness or fear, you will probably instinctively soften your voice. This may be reassuring for the client. However, it is still important to remain separate: if you find yourself too drawn in and involved, you will not be maintaing safety. It is possible to be gentle and matter of fact. 

  If the clients can allow and make sense of their feelings - ie. understand what they are connected to, the feelings may only need acknowledgement and space. If you are not sure what's going on, you can ask questions to help clarify. e.g if the client says "I'm remembering how unhappy I was a few years ago", you might ask, "are you feeling unhappy now?" , or you might ask them where the feeling is in the body. Notice whether your questions or comments are followed by signs of opening (more breath, more feeling, more contact) or closing down.(holding the breath, tightening muscles). (1)

 Sometimes the best thing you can do is wait, stay present to what's going on in you, keep a contact with your hands. You can place your hands where you feel/see the conflict or charge, or in a place of support such as the lower back, or on the diaphragm (at the back), or, if the client is on their back, you might hold their feet (if there is fear and the client needs grounding), hold their hand, or place a hand behind the neck to create a bridge between head and body.

 It is not possible to give a comprehensive guide to how to meet, contain, and support a feeling process here. It is something you learn throughout the training. In biodynamic terms there are considered to be two channels for feeling: the expressive route, which means encouraging the feeling to come out through tears, movement, kicking, making sounds, putting things into words; and 'melting', which is grounding the emotional charge by supporting the downward flow of energy and abdominal discharge through peristalsis. Clover Southwell explores the indications and contraindications for these approaches in depth in her article on equilibrium. (2) In working with clients where there is not a psychotherapy contract, it is best to aim for melting and relaxation. (3)

 There is a third more psychodynamic option, particularly appropriate for working in a psychotherapy process, which can include both the above but which focuses more on containment through finding words, making connections, exploring the relationship. In this approach sessions might include more verbal work before and/or after getting on the table.

  The therapeutic relationship

In biodynamic massage, the relationship between client and therapist is of paramount importance. The relationship always reveals something about the client's process and the therapist's process. It is never neutral. Everything that happens in the client's body is, at least partly, is a manifestation of that relationship. If the client is breathing shallowly, this is in relationship to you as the therapist. If you feel protective of, irritated by, uninterest in, the client, this is a reflection of the relationship between you. Hence the importance of the massage therapist being able to own their feelings, and recognize their typical patterns.

 As a beginner, it may be difficult to take into account all the aspects of what is going on, especially when you are learning new techniques and just starting to find your way around a body. But it can be reassuring to know that everything that the client does or feels is not neccessarily a reflection of your skill, but has at least as much to do with their history and your presence.

 It is not neccessary to do anything with this information or any information. Initially you just need to notice things, feel things, observe and ask yourself a few questions. If the relationship does not seem to be getting in the way of a process -e.g you are doing a membrane massage and the client is gradually relaxing - you do not need to do any more.

  When the relationship appears to be affecting the client's ability to relax, express, or surrender to the process (sometimes described as "resistance"), then you need to reflect on what is happening. This is often the aspect of experience that the client is least aware of. It is not always appropriate to follow this up on a verbal level - it really depends on the nature of your contract with the client, their readiness or 'ripeness' to explore the relationship, their capacity to respond to and understand  the nature of your questions or comments.It can be very intimidating if the client feels that the therapist is trying to "get at" something. Softly, softly may be the best approach, eg. do you feel you're getting what you need/want from me today?" However a client who is more therapeutically experienced might prefer a more direct question, e.g "how are you feeling with me right now?"

  Reflections

These can cover any of the above categories, and make an alternative to asking questions. They need to give the client some information that can be usefully assimilated which they might not quite have noticed for themselves yet. eg. "your breathing has changed since I started working on your legs. How are you feeling as I work here?" By reflecting and then asking a question you are educating the client as to possible links between breathing and feeling etc. One or two such reflections in a session is plenty unless there is a strong process going on otherwise the  client may feel judged, analysed, examined.

  Suggestions

The occasional postive suggestion which gives the client permission to let go and be themselves can be valuable, especially with clients new to a process.. These should be simple, "feel your belly (or legs, or hands etc)", "notice what's happening...", "let yourself breathe", "allow yourself  some space to let go". Such suggestions belong in the session when the client is very close to opening, relaxing etc and these offer the extra support needed. They are not appropriate when they go against the prevailing tone of the session, eg. if you sense hostility, you don't want to try and infer safety.

 

  Resonant moments: when it all comes together.

The separating of experience into components, eg. focussing on the sensation, or on a past memory, or on a detail can be, ultimately, from a psychotherapeutic point of view, a way of managing overwhelming feeling. We have all developed strong protection from being fully open and conscious. When, as massage therapists, we work on the body, we work directly with that protection in its energetic and physiological form., |If we are connected to our feelings, and in addition we have the verbal skills to evoke and trace a process, we have very powerful tools. The bringing to awareness of all dimensions - feelings, memories, thoughts, sensations - in the context of a relationship in the present constitutes an intense experience which touches and changes both the client and the therapist.

  There is a parallel between the connections the massage therapist makes on a body level - between limbs and trunk, between layers of tissue, between an awareness from inside and a sense of being contacted from outside - and the connection made in any theraeutic context, between client and therapist, past and present, words and meanings, feelings and thoughts etc. Connections are relationships and the more complete our  relationships the more alive we are.

 In using words as massage therapists the aim is to invite the client to be present with as much as is right and ripe for them in that moment, and no more. Massage is process oriented and not goal oriented. For one client, allowing a single deep sigh or a feeling more warmth in their feet can be a huge stride.

 

Notes

(1) In  Body-centred Psychotherapy: The Hakomi Method (Liferhythm, Mendocino, 1990) Ron Kurtz  gives lots of examples of phrases and indications of process when working with the body.
See also Dreambody and Working with the Dreaming Body (Routledge and Kegan, London1984 & 1985). Arnold Mindell explores imagery and bodywork, giving exampes of how to find meaning through amplification etc. In Palpatory Literacy Leon Chaitow gives an in-depth guide to discriminations in quality, tone and texture of muscles, tissue, skin etc

(2) Clover Southwell, "Biodynamic Massage as a Therapeutic Tool - the Concept of Equilibrium"

  (3) In order to working professionally with clients you need: a Certificate in Biodynamic Massage from Chiron or CPD; to belong to a professional association such as AHBMT (Association of Holistic Biodynamic Massagr Therapists) or AMP (Association of Massage Practitioners); insurance; and supervision. Supervision supports you in making and maintaining suitable contracts with clients, appropriate to their needs, wants and your qualification and  level of experience.

top

previous page

Psychotherapy, Supervision, Consultation and Training

email Roz Carroll