Dr. Ida Rolf (the originator of Rolfing structural integration) organized her sessions into three phases: preparation, differentiation, and integration. In this issue, we examine how integration might be applied to other kinds of hands-on work as well.

What is Integration?

The word integration is very widely used in our field. An internet search for word combinations like “integration + bodywork” or “integration + massage” returns over 27 million results. But what does integration actually mean?
The word’s original Latin root, integrare, means to renew or restore, to make whole, or to finish. In psychology, integration refers to the coordination of processes within the nervous system, as in sensory motor integration. In the specialized vernacular of Rolfing and related forms of structural integration bodywork, integration is a very nuanced term that can imply balance, unity, completion, alignment, ease, and much more. In its dictionary meaning, integration simply signifies the process of combining or uniting multiple things, so they become a single whole. In our Advanced Myofascial Techniques trainings, we use the word mainly in this sense: the “integration” phase of our work reminds the client that their body is not simply differentiated parts, but is, in fact, an irreducible, undivided whole (Image 1).

Integration and Completion Techniques

When wrapping up a session, it can be useful to think of addressing the biological or physical aspects of integration first; then, the psychological or inner side of the work; and finally, the social or interactive aspects of taking the work out into one’s life (even though in practice, all these functions probably need to be addressed together, rather than sequentially).

Biological/Physical Aspects

The physical or biological aspects of integration and closure typically include attention to overall balance and territorial completeness. As we come toward the end of a technique, session, or series of sessions, the key question is: Does the work feel balanced and complete enough to the client to comfortably end for now?
Different manual therapy modalities will accomplish this “complete enough” state in diverse ways. Massage therapists who, in their entry-level training, are sometimes taught to work the entire body in every session—or to work both sides of the body in a similar way—can advance their skill by learning to achieve a sense of completeness even when working asymmetrically. On the other hand, physical therapists or physiotherapists, who typically receive a detailed education about individual conditions and anatomical structures, can often round out their approach by looking for larger, often less-predictable connections in the body as a part of balancing and completing their focused work.

Psychological/Inner Aspects

One of the best techniques for achieving a sense of overall balance is to simply ask the client or patient about their “felt sense of completeness” before your time with them is over. This psycho- (internal experience) social (interpersonal) approach might be phrased as, “If you check in with your body, is there anything else that would help you feel complete for now?” This question is very different than a question like, “Is your pain still there?” which potentially opens a new chapter, rather than closing the existing one.
Dr. Rolf ended most all of her sessions with neck work1 and a pelvic lift technique.2 Her consistent use of this two-part closing ritual (probably rooted in her osteopathic influences) has been interpreted in many different ways. Explanations include ensuring adaptability at each end of the spine to prevent later discomfort; working the midline of the body after working each side; and quieting the nervous system by working the cranial and caudal ends of the spine, which were thought to be the two main areas of parasympathetic concentration (though more recent evidence strongly suggests that sacral plexus is not parasympathetic).3 But, whatever the explanation (and even though we have evolved or diverged in many ways from Rolf’s original protocols in our Advanced Myofascial Techniques approach), we typically honor this closing custom by including some sort of neck and sacrum work at the end of our Advanced Myofascial Techniques session sequences.
At the end of a technique, session, or series, our intention switches from separating, freeing, and differentiating distinct parts to emphasizing a broader awareness of larger connections and relationships between those parts. Sometimes this is done physically, with direct touch or pressure (Image 2).4 Other times, we use the client’s inner experience (the middle part of “biopsychosocial”) through guided awareness and sensory exploration (Image 3).5
Typically, in the integration phase of a technique or session, our touch style becomes receptive rather than active, or listening and sensing rather than differentiating or manipulating. This allows the client’s own proprioceptive awareness to come to the fore and builds in a resting phase after more active work.

Social Aspects

The final, “social” aspect of our integration phase refers to the client’s ability to integrate or incorporate any new awareness and changes from the session or series into actual interactions and daily life. This can be thought of as a social-level consideration in at least two ways.
1. New somatic patterns and awareness can be more challenging to recall and revisit when in relationship with other people and things, than when they are in the quiet, internal focus of the practice room. Our interactions with clients as they rise, reschedule, and depart are valuable opportunities to tactfully invite clients to continue the proprioceptive awareness that will help carry the practice-room experience out into their lives.
2. Many modalities include client “homework,” such as awareness practices or physical exercises, to help integrate and continue the work of the session. While such homework is undoubtedly useful (some would say indispensable), clients are notoriously inconsistent in their between-session practice.
How does homework relate to the social level of our biopsychosocial progression? Factors affecting “compliance,” the client or patient’s adherence to the practitioner’s homework, prescriptions, or recommendations (Image 4), have been extensively studied in both physical and behavioral medicine. Influences, such as client knowledge about their condition, social support6 (family or social group awareness of practitioner recommendations), and client/practitioner rapport7 all significantly increase the likelihood that homework recommendations will be followed.
While most manual therapy practitioners probably see social support as being outside their typical scope of practice or sphere of influence, simply suggesting that clients share impressions of their sessions, or teach their homework to a friend, spouse, or family member, can help leverage the powerful social-support effect, and is likely to increase the integration of the hands-on work into the client’s habits and daily life.
Whether we’re thinking about an individual technique, a session, or a series of sessions, paying attention to how we end and complete our work helps the client make the results their own. When the client has this kind of ownership of their sessions’ results, the benefits of your work together become integrated into the client’s new sense of somatic normal, and become habitual, sustainable, and enduring.

Review of the Three-Part Sequencing Cycle

Preparation, Differentiation, and Integration

In the earlier preparation phase of our three-part sequencing cycle,1 we reversed the ordering of “biopsychosocial,” emphasizing the establishment of a helpful inter- and intrapersonal (i.e., psychosocial) context, before working on the biological (or structural) level. The middle phase, differentiation, is often the bulk of a session, and refers to work that helps refine, define, or distinguish individual anatomical structures, movements, or sensations from one another.2 In the final integration phase, we return to the original ordering of “biopsychosocial.”

Notes

1. For more information, see “The Many Meanings of Preparation” in Massage & Bodywork (July/August 2019, page 90).
2. For more about this three-part cycle, see “Sequencing Your Techniques” in Massage & Bodywork (January/February 2016, page 108).

Notes

1. For more information, see the cervical core/sleeve technique in “Working with Whiplash, Part II” (Massage & Bodywork, May/June 2010, page 109).
2. For more information, see “Working with the Sacrum” in Massage & Bodywork (November/December 2015, page 90).
3. For more information, see “The Sympathetic Sacrum” in Massage & Bodywork (March/April 2017, page 96).
4. As in the core point technique in “Working with Bone” in Massage & Bodywork (November/December 2013, page 114).
5. For examples, see the psoas technique (Massage & Bodywork, July/August 2015, page 108) or breath motility technique (Massage & Bodywork, March/April 2010, page 109).
6. M. Robin DiMatteo, “Social Support and Patient Adherence to Medical Treatment: A Meta-Analysis,” Health Psychology 23, no. 2 (2004): 207–18, https://doi.org/10.1037/0278-6133.23.2.207.
7. Irene M. Howgego et al., “The Therapeutic Alliance: The Key To Effective Patient Outcome? A Descriptive Review of the Evidence in Community Mental Health Case Management,” Australian and New Zealand Journal of Psychiatry 37, no 2 (2003): 169–83, https://doi.org/10.1046/j.1440-1614.2003.01131.x.