My client’s hesitation and reluctance to answer my question was obvious as she glanced toward the floor. “Has there been any improvement in your neck pain since our last session? Anything you noticed?” I asked again.
“Not really,” she replied, looking uncomfortable in admitting that the work I had done had no effect.
“Were you sore after the last session?” I asked.
“No, not that I remember,” she said. “The pain and stiffness weren’t better, nor were they worse. Just unchanged.”
Of all the possible outcomes, having a client’s symptoms completely unaffected by my treatment approach is proof positive that I am completely lost. Even if a client’s symptoms are aggravated, it shows that I have at least stumbled on the source of discomfort and need to approach it differently.
The clients who challenge you are the ones who change you.
For context, this was my fourth session with this client. She presented with neck pain and stiffness that was quite remarkable. Her range of motion was very limited, with left rotation the most restricted. In addition, one of her most distressing symptoms was a shooting pain from her upper cervical area to the occiput. This pain wasn’t a dull ache but more like a lightning bolt that happened intermittently, making it a bit harder to replicate.
In the first session, I treated the major muscles that might limit rotation, especially a left rotation limitation. I treated the left semispinalis cervicis, left sternocleidomastoid, and the splenius muscles on the right side. All of them were sensitive, but the improvement in discomfort was only marginal by the end of the session. The splenius and semispinalis muscle attachments at the thoracic spine were also sensitive, as was the iliocostalis cervicis on the right. The first session was 45 minutes in length, as were the following sessions. At first, I thought the lack of progress was due to the severity of her limitation, and we just needed to do more sessions. I encouraged her to that effect and decreased the time between sessions, as that is often the factor that is overlooked. It was now clear that none of that was working, and I was totally off the mark.
One question I always ask myself with a new client is whether this is a soft-tissue problem or potentially something else. Essentially, is this solvable by me or should I refer to a different discipline? In this case, she had already seen her doctor, who had referred her to me. All signs pointed to the problem being soft-tissue related, yet the answer was a total mystery.
“Let’s talk for a minute before we begin,” I said. “In the overwhelming number of clients I see, significant progress would have already happened by now. We should have seen clear and measurable improvements after the second or third session.”
“Maybe this is just something I will have to live with,” she said. “I completely understand if you want to stop the treatment.”
“On the contrary, I have a proposal for you to consider,” I responded. “Your neck restriction is now officially personal,” I said in a teasing fashion. “I’d like to continue to see you but under the following conditions: First, there is no charge for the work we will do. Second, I would ask that you be willing to come in as often as asked or be willing to vary the duration of treatment. Some sessions might be short, others longer. Third, however long this takes, we are both in it until your neck is better.”
Looking at her to gauge her reaction, all I saw was a blank stare.
“Well?” I asked.
“I’m stunned,” she said hesitantly. “It’s just that I have seen many practitioners in the past, and when they couldn’t seem to help me, they just passed me on to someone else and didn’t want to be bothered with a problem they could not solve. This is so different.”
“Well, I’m sure you might think this is altruistic, but actually it is quite selfish,” I joked. “I learn the most from the people with whom I am unsuccessful. What I learn in researching and exploring your symptoms will expand my capacities as a therapist. Even if we aren’t successful, what I learn might help someone else.”
Recently, I was at a large gathering of massage therapists from across the country. I happened to share that I keep a list of the clients with whom I am struggling, and one therapist was quite surprised at this. As I shared with her, the only way a therapist doesn’t struggle is if they don’t have a practice or they don’t see new clients with challenging conditions. The clients who challenge you are the ones who change you. Embrace the challenge, the learning will follow.
As to my client, I still haven’t solved the puzzle. Game on . . .
