Key Point

• The skills of listening, noticing, and wondering help build the foundation of real, flexible, and ethical boundaries that allow us to connect meaningfully with our clients.

In last issue’s column (May/June 2024, page 82), we explored boundaries and the true nature of our relationships and connections with our clients. Are we in friendships with some of our clients? What does it mean to have healthy boundaries? I suspect every columnist in this magazine and every one of you have your own answers to these questions. That’s what’s so intriguing about ethics and boundaries—they’re about context, nuance, and self-awareness, and they’re rarely black and white. 

Interpersonal Aspects

It’s easy to think of ourselves as a pair of hands. We manipulate soft tissue and aid in physical healing, rehabilitation, and ongoing function. We certainly do these things, but when we think in this reductive way, we miss the opportunity to deliver on the true promise of the discipline of massage therapy that lies in the interpersonal aspects of our interactions. This nontactile aspect of our work makes many therapists a little nervous. In fact, if I had a dollar for every massage therapist who said, “I’m not a talk therapist,” I would have many, many dollars. 

We can connect intimately and receive the experience of our clients’ lives without even vaguely creeping into the scope of psychotherapy and without leaving ourselves or our clients feeling uneasy or unsafe. When we bring self-awareness, connected communication, attention to detail, collaborative spirit, and deep listening to our client interactions, that’s about humanity, not psychotherapy. These other aspects of interaction, often called soft skills (read: optional), are essential to effectively providing this thing we call massage therapy. 

No matter what “style” of massage therapy we provide, the system we most profoundly affect is the nervous system—ours and our client’s. Massage therapy education (and I’m looking at you, too, CE providers) would be wise to prioritize a strong knowledge of nervous system regulation patterns both inside ourselves and in those with whom we enter into therapeutic relationships. I am regularly grateful for the ways in which my training as both a palliative care massage therapist and practitioner of meditation have filled this essential gap in my foundational massage therapy education. 

Meditation and Me 

There is a lot I could say about how meditation practice has informed my approach to massage therapy. For now, I will say simply that the skill of curious observation can’t be overstated. In my meditation practice, my focus is not “achieving” a state of calm. It’s receptive curiosity. 

I am there to notice. I notice my mind racing. I notice my hip cramping. I notice a sense of settling in my shoulders. I notice my face feeling cold or hot. I just notice it all—without reacting. As I notice all of this, patterns emerge, and I learn about my experience. I do this same thing as I spend time with clients.  

Good Listening

This skill dovetails nicely with my work in palliative care, providing massage for seriously ill patients. Communication and pain and symptom management are the cornerstones of practice for all palliative providers—from physicians to speech therapists to chaplains. Effective practice requires connected listening and perspective-taking, not just technique and manual intervention. Listening and creating care plans that can minimize avoidable crises and thinking beyond what’s happening in my treatment room are key components of the care I provide. 

Many of us pride ourselves on being “good listeners.” We hear what people say and we care about it. Done and done. 

If you lean in, you’ll hear a sad trombone in the distance because that’s about 15 percent of what effective listening is about. Listening is not done only with the ears, and it’s more than “not talking.” When we listen, we need to hear and feel our own voice and the messages coming from within while also receiving messages from the words and bodies of our clients. Clients don’t always tell us what worries them, what they expect, or what scares or concerns them. We must listen to their bodies, to their facial expressions, and to the things they don’t say. 

We can listen to the way a client responds when we ask how they felt after their last appointment. Do they hesitate? Do they shuffle their feet or look away before answering? Are they vague? Do they reflexively say, “Great”? 

Expertise is not nearly as useful as our ability to support our clients in accessing the great wisdom and agency they already possess as the owners of the bodies in which they are traveling. Listening with curiosity allows us to move from, “I bet they’re nervous” to “I wonder what’s happening with them?” That wonder can inspire us to offer smaller and more specific invitations during the session for our clients to share more fully about their sense of things. 

These skills of listening, noticing, and wondering help build the foundation of real, flexible, and ethical boundaries that allow us to connect meaningfully with our clients, without feeling like we are losing our anchoring in the nuanced and complicated nature of these rightfully intimate relationships.