Most massage therapists think of boundaries in terms of physical boundaries such as draping and appropriate touch. They are examined on these aspects of massage, both at the school level and the provincial level if they are practising in an area where massage is a regulated health profession. They are also well aware of the ultimate physical boundary: that of sexual touch or sexual impropriety with a client. Sometimes they are less aware of the very important emotional boundaries.
SHIFTS IN THE THERAPEUTIC RELATIONSHIP: COUNTER TRANSFERENCE
In order to understand the concept of “counter transference,” it will be helpful to consider the therapeutic relationship and how it is different from social relationships.
In a social relationship or friendship, the people involved may confide in each other, share stories and problems, and occasionally vent their feelings. In the therapeutic relationship, the focus should be entirely on the client, with the therapist giving his or her total attention to the client’s needs and to the treatment being performed.
Counter transference represents a shift in the therapeutic relationship, in which the therapist is using their client as a confidante, counsellor, mother or father figure: a person to whom they tell their plans and troubles. I am concerned when clients tell me that their therapist has shared personal problems with them. Some clients realize that this is inappropriate and it decreases their satisfaction with the massage treatment. There is a power differential in the relationship between client and therapist that makes it difficult for most clients to express their dissatisfaction when the therapist spends the session talking about his or her personal life.
An elderly friend told me that her therapist spends the entire session talking about her wedding plans. The client is not at all interested and would prefer to relax in a quiet atmosphere, but she is too polite to assert herself with the therapist.
A new client said she was leaving her former therapist who had just gone through the breakup of a relationship. The therapist spent the therapy time complaining about her ex-boyfriend, and during one treatment was actually yelling her angry complaints while the client was on the table! The client did not feel comfortable talking to the therapist about this behaviour: she simply did not book with her again.
Many clients do not realize that this sharing of personal problems is inappropriate. They are quite willing to listen to the therapist’s problems, and I feel that this is a larger concern. In my own clinic, I usually don’t hear about this until a therapist has left my employ. Then I will often hear from their former clients.
Isn’t it too bad that Joe’s wife left him that Joe is having trouble with his wrists/ that Joe is having financial troubles? or Have you heard from Mary? Is her mother’s cancer responding to the chemotherapy? Was her daughter thrown out of school? Is her partner being transferred to another town?
Most clients do not realize that it was inappropriate for the massage therapist to share their personal problems, and they are genuinely concerned. This is what we call “counter-transference”: a situation where the client has become the caregiver for the therapist. Therapist must remember that the time the client spends on the massage table is their time. During that treatment time the therapist’s attention and focus should be totally on the client, with the client’s physical concerns, comfort and emotional needs always the top priority.
THE CLIENT WHO LIKES TO TALK
Therapists often claim that their clients like to talk, and that they are just responding to the clients’ conversations. We must be very clear in our minds that the therapist is responsible for the interaction that takes place in the therapy room, and we want to keep our attention on the client. Most clients are not clear on what the therapeutic relationship should be: they are acting and responding as if they are in a social situation, and they often feel that it is polite to ask questions of the therapist and to keep a conversation going. Some clients are uncomfortable with silence. Others may be somewhat nervous about receiving a massage, and ask questions to learn something about their new therapist so they can get to “know” this person who is touching them. In some cases clients want to talk about the stressful issues in their lives: as their muscles relax and they let go of their tension, they vocalize the incidents that caused that tension.
To create a peaceful environment, consider each client and think about why they want conversation while they are on the table.
CREATING A PEACEFUL ENVIRONMENT
For those clients who talk to be polite, or because they are uncomfortable with silence, we can give them permission to enjoy their massage in silence. When I show clients how to position themselves on the table I will say something like:
Please let me know if anything is uncomfortable, or if my touch is too deep and I will change my technique. Feel free to ask any questions. Other than that, you can relax quietly and listen to the music.
When clients ask the “getting to know you” questions, such as “how long have you been in practice?” or “do you have any children?” I answer with a brief and positive reply, giving the information the client needs to feel comfortable with me. Then I turn the focus back to the client by asking whether the pressure of my technique is comfortable. Longtime clients may feel that they know a great deal about my personal life. They know how long I have been in practice and how many children and grandchildren I have. What they may not realize is that they never hear about personal problems, either mine or my family’s.
GIVING TOO MUCH INFORMATION
When a client asks a polite question such as “how was your holiday?” we can respond in different ways.
I would merely say, “It was lovely. It was so nice to enjoy two weeks of sun during February.”
The alternative could be a long rant about how the plane was late, they gave me the wrong room at the resort, service at the hotel was terrible, the food wasn’t to my liking, etc. That is really too much information: more than the client wants to know. It would take my attention and concentration away from the client, and it would create a negative atmosphere around the massage. Remember that the client is just being polite and doesn’t really want to know all the therapist’s troubles. The short, simple answer is the best.
For some clients, verbalizing their problems is a part of their release of tension. This may be necessary and possibly therapeutic for certain clients but therapists need to be aware that this is an expression of the client’s needs. This is not a cue for the therapist to respond by sharing his or her problems. We need only respond with empathic phrases that show we are listening, rather than matching each complaint with our own horror stories. As the client relaxes, the conversation will probably wind down, as long as the therapist does not keep it going by sharing his or her own problems.
We can often redirect the client by encouraging deep breathing, or asking questions relevant to the treatment.
A LONELY PROFESSION
Many therapists work in isolation: in offices or clinics where they have little opportunity for conversation with anyone except their clients. It is easy to fall into the habit of putting clients in the role of friends or confidantes.
I suggest that no matter how busy we are, we should make a conscious effort to maintain social activities outside of our practice so that we have friends and family to talk with and confide in.
We can maintain professional contacts by attending seminars and workshops. In this electronic age, we can find contact with massage therapists and other health-care professionals around the world through Internet chat groups. There are many interesting discussion groups available that enable us to stay abreast of the latest developments in the profession.
WHY DO YOUR CLIENTS CHOOSE YOU?
We want to feel that clients are receiving massage therapy to fill their own needs for relaxation or soft tissue treatments and they are choosing their therapist because of his or her competence and effectiveness. Sharing your personal problems, viewpoints and feelings with your client does not support the therapeutic relationship; rather, it changes the dynamic of the relationship to one of “friendship” or “camaraderie,” or may even cast the client in the role of a support person. It takes conscious and continuous effort on the part of the therapist to maintain a professional demeanour and it is the responsibility of the therapist to maintain the therapeutic relationship.
MAINTAINING YOUR FOCUS
It is not easy to be the totally centred, aware therapist all day, every day. The following is a suggestion to help you on that path.
Before each massage, stop outside the treatment room door and spend a few moments balancing your energy and shifting your focus from the concerns of your daily life to a total focus on your client. Mentally leave your problems outside the door, take a few deep breaths, and walk into the treatment room with a conscious intent to do your very best for that client.
Lee Kalpin has been a registered massage therapist and clinic owner since 1984. She has also written and taught courses for massage therapy programs for many years, and strives to remain current in the science and ethics of massage therapy. Many past students continue to contact her for guidance and mentorship.