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Massage Today
August, 2001, Vol. 01, Issue 08

How to Say "No," Continued...

By Ruth Werner, LMP, NCTMB

Dear Readers:

I am absolutely overwhelmed with the volume and heartfelt quality of your replies to my last challenge ("How do you say 'No' when your client says 'Yes'?").

I received dozens of letters from all over the country, from people with extraordinary stories to tell. I was so excited to share with you the wonderful ideas and experiences people have sent me. And then my hard drive melted. I was able to salvage some things, but not, alas, any of my e-mail. It disappeared into the ether. It is gone, gone, gone.

I quickly (well, as quickly as I could think of it) sent a letter to Massage Today, asking if they could put a squib in the July issue to request that my respondents resend their wonderful letters --but of course, I missed the deadline.

So, wonderful letter-writers, if you still have copies of the letters you sent me, could you please send them again? I promise I'll be conscientious and save them not only in an e-mail file, but also in a place where they can be restored if necessary.

In the meantime, I did have a few letters that I have been able to save. It's hard to choose what topic to address, since so many rich ones came up, including...

  • working with cancer patients;
  • working with clients who are intoxicated;
  • working with obviously sick clients who were sent by their doctors;
  • working in clinics or spas with no support to protect clients from poor judgment;
  • working with clients who are abuse survivors;
  • and whole bunches of others!

This month, I decided to try to address the most common theme I heard. Here's an excerpt from a registered massage therapist in Texas:

One thing I've learned is that the typical client is very uneducated regarding the effects of massage. The average client viewpoint is, "I don't want a light massage, I want to feel my body being worked, therefore I must want deep tissue massage."

I respond to these clients by educating them on the effects of a deep tissue massage on a body that has not been prepared for it (extreme soreness, nausea, headaches, flu like symptoms, and the process of how the body eliminates metabolic wastes and toxins from the body, etc.). I tell them that this is not the type of massage they will receive from me, as it is not in the best interest of their body at this time. If a deep tissue massage is what they want to work towards, then we set up regular scheduled appointments to accomplish that.

I refuse to do any type of bodywork, on any client, that I feel is not in their best interest at that time. I would rather lose that client.

My advice is, the massage therapist is the professional and educated person in these situations, and the client relies on us to know what we practice and what is in their best interest. We need to act like the professional educated people that we are, and say "no" when we know it's the right thing to do for that client.

Our profession loses many potential clients due to negative experiences resulting from a therapist not saying "no" when they should have.

Among many important issues raised here is who is in charge of a session. This therapist absolutely nailed my point: in the client-therapist relationship, the therapist is the authority. We are obligated to make decisions for our clients' best interest, even when it's not what they think they want. This writer went on to describe another situation in which massage therapist complied with a client's wishes for a deep tissue massage, against better judgment. The client was injured, she required extensive physical therapy to recover, and she will never seek massage again. How much damage is done to our profession when this happens?

Many writers had wonderful insights about how to frame difficult conversations with clients. Based on these and my own experiences with clients, students, and active listening skills, here are some basic guidelines that are pretty universally applicable:

  1. State your observation. Of course, this needs to be done in a gentle, non-panicked, nonjudgmental way. Saying, "I notice you have a raised, red area here. Do you know what it's from?" works better than, "Eeeew, what is that on your leg?"
  2. State your concern. Again, this has to be done in a way that doesn't create fear or panic, but that lets your client know you have his or her best interest at heart. "I'm concerned that your rash could be contagious. I don't want to spread it on you, or risk having other clients pick it up from me" works better than, "I'm not touching that -- are you crazy?" (Even though that's what we may be saying in our heads!)
  3. State your choices. This will be determined by the situation at hand. In the rash scenario, you could chose to locally avoid the area, or to terminate the massage until the rash is cleared up or diagnosed as noncontagious. Some therapists might offer to reduce their charge, or make their next appointment free in order to induce their client to get appropriate medical attention; that's a matter of personal business style.

This is a simple format for difficult conversations that can be applied to a wide variety of problems, from health concerns, to chronic lateness, to someone who has a habit of canceling appointments at the last minute. Sadly, when we're on the spot, sensible communication skills go right out of our heads. That's why it can be useful to have a simple, clear-cut formula for dealing with these difficult situations. In my next article, I'll outline some other communication guidelines that can make these relationships nurturing, fruitful experiences that can allow both therapists and clients to grow and benefit. I will also describe some of the other alarming scenarios that therapists have described to me in recent months.

Again, to those of you who wrote last time, and to any other readers who have problems they would like to see addressed, please, please, please resend your letters! Until then, good health and happiness.

Click here for previous articles by Ruth Werner, LMP, NCTMB.


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