“Better, she replied. “So much better.”

“I’m thrilled to hear that,” I answered. “Tell me what you notice now.”

“I still get the sensations down my leg, but they happen with much less frequency. When they do happen, the intensity is still the same.”

My client, Mrs. H., was describing the symptoms of unexplained neural pain she had been experiencing in her left hip. She had struggled with this pain for the past six months, since having a surgical procedure on her low back. While the low-back surgery went well for what they were repairing, the aftermath of the surgery was unexpected neural symptoms in the path of the sciatic nerve. After some initial pharmacological treatment from her health-care providers, the advice she received from her neurologist was to wait this out, hoping the nerve pain would resolve itself over time. Not knowing where to turn, her husband and several friends suggested she see me. After several months of continued distress, she finally made that call. Today’s session was our fourth.

“I cannot tell you how important this improvement is to me,” Mrs. H. confided. “Having even a moderate change in the frequency of these symptoms is such an immense relief. After nothing had changed for so long, I was beginning to be, well, depressed about my situation. I’m sure that is why my husband was so insistent I call you. Now, I’m sorry I waited so long. Even though the improvement may not seem dramatic to anyone else, it’s very powerful to me.”

What followed was a period of silence as we both took in the moment. Taking care to make eye contact with me, she stated, “It’s about hope.”

For the rest of the day, I kept thinking about that statement and the power therein. For so many of my clients over the decades, hope was probably at the center of why they experienced continued improvement. This kind of hope was made possible by results—making a difference in the frequency, severity, or intensity of the presenting symptom. The person now realizes that change is possible and that they have some sense of agency in the process.

So many people in chronic pain feel powerless in the process, that there is very little they can do to affect their state. Often, our health-care system perpetuates this feeling with the idea that health is rather a commodity, something you can purchase or obtain. Mrs. H., like so many thousands of people with musculoskeletal pain, was diagnosed with a condition her providers did not know how to treat with the tools and knowledge available to them. We, as massage therapists, know that soft-tissue therapies can play a significant, and often overlooked, role in these cases.

Hope that surfaces in the presence of change is very different than wishing for something to be true, or the possibility of false hope. When Mrs. H. first came to see me, results were not immediate. The first two sessions yielded very little tangible results. Given the characteristics of neural sensitivity, this was not surprising. I took the time to explain the dynamics of neural irritation, bidirectional feedback loops, and how precise soft-tissue therapy might be of benefit. I also shared my previous experience with this condition and the research underpinnings of what I was doing and why. No promises were made as to outcomes, just a realistic overview of possible explanations and therefore treatment approaches to her pain. Should our initial approach fail, I also outlined two other possible treatment approaches we could pursue. It is my strong belief that laying out these options for her proposed not only a possible treatment solution, but also a process. If one avenue didn’t work, there were others to pursue.

This gave way to a second factor, which has been present in almost all the successful therapeutic encounters I have had—trust. Trust is generally earned, not given. Earning the trust of a client is a multifactorial process, one that spans many dimensions of the therapeutic encounter. There are many ways to earn it, and even more ways to lose it.

Additionally, trust can give rise to faith. Faith keeps one committed, even when there is little immediate feedback that the treatment/process is working. (If I didn’t have faith, I’d have never made it past my first few cello lessons three years ago.) Very few of the difficult cases I have seen over the years have had significant immediate results. Most of these clients come for two or three sessions before our work begins to pay dividends. What keeps them coming back? Faith in the process. Trust in each other. Hope that springs from the sense that improvement is actually possible, even if at first elusive. Hope. Trust. Faith. A powerful progression for making a difference.