Clients and patients who seek massage therapy for pain or stress relief often carry a story with them. This story often contains a weave of prior experiences, expectations, emotions, and metaphors that shape their thoughts and actions, leading up to why they came to see us. Sometimes, they do not share that story with us because they probably do not expect to engage with massage therapists in such a way.
Patients pay and clinicians “fix.” That is the current expectation from both parties.
Of course, this doesn’t mean that massage therapists is cosplaying a psychologist or a similar mental health professional—and nor should they cross the professional boundary! Simply, this means that we should show genuine care and empathy to our clients’ and patients’ condition, not just going through the script and motions to “get through” the session.
As I get a better understanding of the biopsychosocial framework of pain and health every year, I realize that oftentimes the default treatment and communication style is not enough. For me, some clients reveal a layer or two of underlying reasons why they have could not turn their head in a certain direction or they have persistent low back pain for many years. Sometimes I don’t even ask and they reveal their story of their own choosing. My experience is similar to what Dr. Rita Charon, one of the main progenitors of narrative-based medicine in healthcare, said in an interview at Columbia University two years ago.
“I mean they would tell me about the death of their father or the trouble they’re having with their son or the fire they had in their house. I mean, it was anything, and the biggest challenge I had was to convince people that I wanted to listen to whatever they said. One lady said, ‘You mean you want me to talk?’” ~ Dr. Rita Charon
Patients and clients are not the only ones who carry narratives. Therapists carry narratives, too. Our narratives are based our education, work experience, biases, and perhaps even lifelong experiences outside of our professional life. Our narratives could influence our patients’ and clients’ outcome, for better or for worse. And this is why we must keep our narratives updated to current research and review our (presumed) understanding of how the human body and mind work.
Even so, we should be mindful that our narratives should not override those of the patients or clients, even if they have a different or “more wrong” narrative than ours. This brings to the concept of operator vs. interactor model of care, which was coined by physiotherapists Diane Jacobs and Jason Silvernail. They contrasted both paradigms succinctly:
“Traditional instructional books and courses on manual therapy often refer to the therapist as an ‘operator’. The implication of this terminology is that the patient is a passive recipient of the manual act.
“This seems at odds with not only the common practice of physical therapy, but the balance of research evidence which favors active over passive approaches. We feel a more current understanding of the mechanisms and processes of manual therapy leads naturally to a different understanding of the therapist’s role – that of an ‘interactor.’
“This interactor mode of manual therapy is consistent with the authors’ statement that ‘the context of the treatment including the technique, the provider, the participant, the environment, and the interaction between these factors may contribute to patient outcomes.’
“It is precisely this interaction between various factors that we need to consider, and not simply the performance of one or more techniques as an ‘operator.’
“We believe this interactive model to also be scientifically congruent with the emerging explanatory model of the multifactorial, biopsychosocial pain experience, the neuromatrix.”
Basically, the interactor model informs us therapists that our patients and clients aren’t just pieces of meat and bones that need to be “fixed” (operator mode). Instead, look at the bigger picture—their communication style, health history, prior experience with massage therapists, job, and lifestyle. What other factors could be contributing to their back pain? What does this issue they have mean to them?
In application, how would this apply to massage therapy? Well, there isn’t a formula for this because every client or patient we meet is unique. A thorough understanding of narrative-based medicine would be a foundation to applying this knowledge, as well as having practice. Lots of practice—which is something I had been doing for more than five years (maybe even 18 years if you include 13 years of personal training prior to my massage therapy career).
If we take our time to listen and acknowledge the person whom we work with in front of us, then that would be the first step in being more of an interactor and less of an operator.
1. Jacobs DF, Silvernail JL. Therapist as operator or interactor? Moving beyond the technique. J Man Manip Ther. 2011;19(2):120–121. doi:10.1179/106698111X12998437860794.