Key Points 

• A client’s sensations and experience in a session likely have more to do with their brain’s sensory predictions than about what we actually do with our hands. 

• We can use this principle to help shift our clients’ habitual tension, pain, or movement challenges by working with them to help their brains discover new experiences and update its predictions.

Your client’s brain is an always-on prediction machine. That’s not to say that it’s always whirring away generating weather reports or stock forecasts during their bodywork session (at least, we hope it isn’t). Instead, your client’s brain is busy predicting every detail of their bodywork experience—from how your touch feels to them to how comfortable they are on your table to their sense of the session’s overall helpfulness (or lack of it).

The concept of predictive coding suggests your client’s actual in-the-moment sensory information plays only a minor role in their brain’s formation of its perceptions and impressions about your work. The majority of our internal experience, predictive coding says, is shaped by matching tiny snippets of in-the-moment sensory data (the pressure of your touch, for example), with past experiences (have I felt something like this before?), contextual cues (in a place or relationship like this?), all flavored by autonomic predispositions (did I come in feeling relaxed and safe, or on-alert and watchful?). 

Visual perception provides a fascinating example of how prediction forms our perceptive experience. Your eye sends detailed information to your brain from just a tiny portion of your retinal field—as a result, your brain “sees” only a very small area (it’s about the size of a dime held at arm’s length) with any clarity. But this bit of detailed vision (relayed from the eye’s pinpoint-size fovea centralis, to be precise) is all your brain needs to extrapolate or predict the subjective clarity with which you “see” your entire visual field (Image 1). The brain accomplishes this by “remembering” the details of what it saw or expected to see in other visual areas, and then reassembling these into the prediction that we experience as our central and peripheral fields of vision. 

What’s more, the brain also predicts the sensory information it expects in your retinal blind spot—the portion of your visual field where the optic nerve exits and where there are zero light-sensitive cells. If our brains didn’t do visual predicting as well as they do, we wouldn’t be able to drive a car, find our keys, or read an article.  

In his book The Body Keeps the Score, psychiatrist and trauma researcher Bessel van der Kolk writes, “The most important job of the brain is to ensure our survival . . . everything else is secondary.”¹ Though he was writing about the brain and trauma, the concept applies to predictive coding as well. Predictions are our brain’s way of preparing us for what might happen next, so we can be ready to keep ourselves safe. 

Chronic pain may be an example of this preparation going tragically wrong. In her book How Emotions Are Made, neuroscientist Lisa Feldman Barrett makes the case that chronic pain may result from our brain’s (predicted) present-day sensory predictions based on past injury or stress.² When the brain fails to update its predictions, those attempts at preparatory protection based on our past can become self-perpetuating and self-fulfilling sources of real pain in our present-day lives.

How You Can Use It

As bodyworkers, we can use these ideas to introduce a sense of possibility and relief to our clients. For example, clients with shoulder pain will often feel better when a practitioner gently, skillfully, and patiently moves them through a pain-free range of motion—you can think of this as disrupting their brain’s prediction habits. The clients’ brain now has a new piece of information about their shoulder movement—that it is possible to move without pain. When this learning is integrated, this new possibility becomes part of the set of expectations that inform their ongoing shoulder experience. This may be one reason why clients report significant improvements in their pain, kinesiophobia, and guarding as a result of the “simple” interventions we typically perform as hands-on therapists. 

Interventions that actively involve the client can even more powerfully disrupt and rewire habitual sensory predictions. Inviting your client to slowly and actively explore the range of motion that doesn’t cause them pain, within the safe context of your hands-on work, helps add new, nonthreatening options to their repertoire of movement predictions. A practice example: Clients often respond well to the invitation to gently “explore the corners” (the places they don’t usually go) of their usual movement range. Each time a client goes into one of these new kinesthetic “corners” with curiosity and attention, the experience refines their proprioceptive awareness and provides more possibilities for safety and ease.

Following are a few more ways to bring the power of predictive coding into your treatment room.

Pre-Session: Your Assessment Can Also Be a Treatment

When a client tells you about a movement limitation during your intake conversation, ask them to demonstrate the limited movement. Often, they will move quickly as they show it to you. If we invite them to slow down and describe the sense of limitation using sensory language (bony, muscular, sharp, dull, etc.), not only can we get intuitive clues about how to “get hold” of that limitation, but their experience itself will often change because of their exploration and description.

During Session: Recruit Your Client as a Partner

A client’s feedback and active participation during your work can give you clarity on what has been effective so far and what still needs to be done. Something as simple as drawing a client’s attention to a side-to-side comparison of proprioceptive sensation (“What difference do you feel between this and that?”) can enrich and refine their felt experience and help them take on new information.

Post-Session: Integrate the Changes

This could be the most important tool in your toolbox. Save a few minutes at the end of a session to help your client register and integrate their new experiences. This could mean returning to any movements discussed during your intake conversation or suggesting a slow walk around your treatment room, letting whatever has changed come to light. 

In each of these cases, we draw our client’s attention to how they feel right here and now. This attention causes the brain to update its predictions based on new information. These updated predictions can then become part of what our client experiences as available and possible.

Bringing It Together

Predictive coding gives us a framework to understand one way that our work offers the benefits it does. It also invites us to bring our clients on board as active participants in the work we do together. By shifting our orientation from doing things to our clients in order to change them toward working together with them to shift their habitual predictive coding, we help our clients feel empowered and at ease in the felt experience of their lives. 

Notes

1. Bessel A. Van der Kolk, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma (New York, NY: Penguin Books, 2015).

2. Lisa Feldman Barrett, How Emotions Are Made: The Secret Life of the Brain (Boston: Mariner Books, 2018).