Takeaway: I often pose this question: “If you could have one thing different when you walk out that door, what do you want it to be?”

Science is a way of understanding why things work the way they do. Whether it’s anatomy, physiology, cellular processes, biochemistry, or neuroscience, the better I understand it, the more effective I am at my work. I’m more confident in delivering the desired result, and I’m better equipped to communicate about the body’s natural healing ability to physicians, other kinds of therapists, teachers, and my clients. 

But in this column, I want to talk about a different kind of communication, one that’s more of an art than a science: the art of communicating and connecting with our clients. What are some of the ways we can establish rapport and comfort? How can we make them feel heard and safe?

The Environment

I’ve had the good fortune to be able to personalize every space I’ve worked in, including shared spaces. Even now, at the Center for Integrative Medicine at the University of Pittsburgh Medical Center, I have relative autonomy over my treatment room decor (as long as there are no OSHA violations). It’s very important to me that the room sets a tone from the first moment my client sees it. That means no clutter or paperwork of any kind (other than theirs) on my desk. Not even a laptop. They are here to spend the next hour focused on their body, and I want to minimize any opportunities to remind them of potential pressing obligations outside the room. 

One thing that’s important to me is good art. And while that’s taken some time to properly curate, it’s been worth it. What’s on your walls? Does it just look nice and take up space, or does it speak to you? Is it an image that helps keep you centered?

Image 1 used to be in the lobby of my old center, but now it has a place of honor in my treatment room. It speaks volumes to me. The stone implies strength, but time has worn away the stone and made the hands soft. That suggests compassion and sensitivity. There’s a hint of robes—perhaps translating to knowledge and wisdom. And what’s in the hands? A sword? For swiftness and precision? But there’s also a metal circle, so is it something else? Maybe an anchor symbolizing grounding or stability?

That said, the piece of art clients notice most is Image 2. As a structural bodyworker and somatic problem solver, it also speaks to me. I thought the shape and structure would be a great visual reinforcement of what I do and a subtle suggestion of why people are there for treatment. Turns out it’s not so subtle—it’s a frequent topic of discussion during the first visit. People are drawn to it—and into it.

That’s the great thing about art. It takes us out of ourselves and allows for the opportunity to experience the familiar—in this case, a cool bridge in Pittsburgh—in a new way. Maybe this piece also subliminally suggests that the potential exists for them to see and experience themselves in a new way.

Whatever the attraction, the art gives us something to talk about that’s not about the client’s aches, pains, accidents, or problems. It’s an icebreaker, a point of connection that gives us a moment to relate before we get to that stuff.

Getting to “That Stuff”

I rarely read through new client paperwork before I see them. I find that when I do, I start to create a picture of who they are before I meet them, and that picture is often wrong. While their paperwork is helpful to go back to later, many clients like to speed through it. Details and nuances are often not there, so I prefer to talk.

For many people, talking about their “stuff” isn’t easy. Some are tired from talking through the shopping list of their accidents, injuries, and procedures. Some worry they sound whiny. Some are angry about the ways they have been mistreated, like being blamed by other professionals for not getting better results. Some are afraid they aren’t “fixable.” Most people are a combination of some or all of the above.

Just as people need to feel that there’s physical space for them to be in the room, we also need to make conversational space. One of the best ways to do that is with silence. When someone drops some heavy information and stops, do you feel like you have to fill the empty space? Next time, let the pause in the conversation be there for a few beats. Take a moment to absorb what they just told you. Sometimes they’ll fill the space for you. When they don’t, it’s your turn. Ask an open-ended question that elicits more information than a yes or no. 

Communication experts also recommend avoiding phrases like “I know” or “I understand.” It’s likely that you’ve never been through exactly what a client has described (unless you actually have). In that instance, it might be OK to offer that connection and follow up with something like, “Do you feel that loss physically, somewhere in your body?” Even when you’re empathizing, always turn it back to them—it’s always about them.

It’s not unusual for me to spend 50 percent of a first visit talking, but mostly listening. As far as I know, not one person has ever felt cheated that they didn’t get enough treatment time. On the contrary, clients are usually grateful when they feel seen and heard. Some feel validated in a way they never have, and that’s important.

The Big Question

Regardless of what strategies, protocols, and assessments you were taught, when you’re dealing with people with multiple symptoms, complex conditions, and chronic pain, it can be difficult to figure out the best place to start. I’ve found that most times, the best thing you can do is ask. I often pose this question: “If you could have one thing different when you walk out that door, what do you want it to be?” 

While it might seem scary to ask that question, I’ve found the effect can be profound. People don’t expect it. In that moment, they realize what they feel truly matters to me in a way that goes beyond techniques and procedures. They understand this is a partnership. And then I do everything in my ability to make sure they have that initial success in their first treatment. 

And sometimes, you just have to trust your gut.

Client Study: Moira

Moira was in her early 30s and her initial complaints were as complicated as they come. Chronic pain, physically injured on the job, a concussion that induced several conditions, including narcolepsy. She was on disability and came in with a working dog, a sweet collie named Copper, who watched for signs of unexpected drowsiness. Those were just a few of the highlights. 

She handed me a 24-page chronological dossier of her medical history. Every accident, every physical insult that had happened to her, the treatments she received, and her perceived outcomes. Then she did a curious thing. Instead of sitting in the designated patient chair, she perched on the treatment table. It’s rare people do that, but why make a fuss?

I paged through the document and assured her I’d read it thoroughly later. I knew this was going to be someone who would likely not respond to the conventional protocols in the expected way. So, I asked her to tell me where she was at right now, what her day-to-day life was like, what felt unaddressed and unresolved, and what she thought were the causes and perpetuating factors. While Moira was determined to get better, it was obvious she was feeling very down. Anyone who had been through all that would be. Then she mentioned something truly extraordinary: She had been struck by lightning.

Generally, I’m not big on making mirror statements, but sometimes you have to make sure what you heard was correct. “You were struck by lightning?” I repeated. Yes, she said.

“Would you mind telling me how that happened?”

“Well,” Moira said, “I was in my car at the time.” 

A car is one of the safest places you can be during a thunderstorm. Your car is a moving Faraday cage, a continuous shell that blocks electromagnetic fields from the outside. Many devices, like MRIs, have Faraday cages built in. But Moira had her sunroof open, creating a gap in the cage, so she got zapped. 

Like a movie in my mind, I saw what to do next and decided to take the risk. I got up from my desk and moved over to the treatment table. I sat right down next to her, touching shoulder to shoulder. Slightly astonished and with an edge of weary experience she said, “Most people move further away from me when I tell them about that.” 

“Well,” I said, “I’m not most people.”

A number of sessions later, Moira told me it was that moment when she knew she could trust me fully. 

We know that having healthy social connections improves physical and mental health. It can even improve immune function. Treatment starts before they ever get on the table. 

Resource

Stanford Medicine. “Connectedness & Health: The Science of Social Connection.” https://ccare.stanford.edu/uncategorized/connectedness-health-the-science-of-social-connection-infographic.