I always tell my students “when you get into the real world… you may be the best technical massage therapist but without great communication and listening skills you may not have the most successful practice”.
I remember when I was in Massage Therapy College, immersed in anatomy, physiology and manual skills (sometimes known as the hard skills) then once a week, we would go to a class where we worked on self-reflection, communication and listening skills (the so-called soft skills).
I know many of my classmates thought this class was a waste of time and completely irrelevant to the education they were now immersed in.
Me on the other hand, I love this stuff.
Over the years I have spent many hours in training and working on crisis lines, communication, conflict resolution courses and even peer counseling.
My passion for communication and listening came from, like many of us, a pretty tough childhood and teen years. When I was 12 years old a friend of mine took his own life.
Now (and to some extent then) in retrospect and had I known how, I may have been able to stop this tragedy. This event shaped my passion for listening and communication.
But this work requires a lifelong commitment with constant work and no matter how skilled you are, you may still miss things. This became all too real to me this January when at 4 am, my phone rang, it was news that another person close to me had taken their own life.
In retrospect, I could see the signs, but they were quite subtle. This is one of the reasons I am an advocate for communication and listening.
Now not all situations will be this intense but as healthcare professionals, we need to have superior skills in the areas of communication and listening and this is why I am writing blog posts on communication, starting with the basics.
Building Rapport With Massage Therapy Patients
One of those make it or break it skills for all Massage Therapists.
If a patient does not feel comfortable with you in the first 20 seconds it may hinder your ability to really help them.
Some of the things you can do to help build rapport are:
- When you first meet the person look them in the eye.
- Call them by name (sometimes it’s best to ask an elderly person permission to call them by their first name.)
- I normally shake the person’s hand.
- I always check if they need to use the washroom before we get started.
- Invite them into the room.
Remember most of the communication is not the words, in fact more than 50% of communication happens in the body language and much is also connected to the tone or rhythm of the voice.
- Be on time, nothing destroys rapport more than always being late.
- Watch their face, do they look calm?
- When you go to shake their hand do they pull away or do they move towards you?
- Is their voice quiet and timid?
- When you make eye contact do they hold your contact or look away?
The best way to build initial rapport is to meet them where they are.
Don’t hold eye contact too long if they are showing signs of being uncomfortable, give them space if they pull away and meet their tone and rhythm of voice with yours.
Set up your treatment area so it’s calming but professional.
Remember the power differential, if you sit and talk to your patient (at eye level) it is less threatening and can make the person feel more comfortable in your presence.
Utilize the space between you and the patient, if you are too far away you will seem distant and uncaring, being too close might make the person feel defensive, I find 4 feet seems to be a good distance.
Take notes during the interview and special tests but do not allow your note taking to interfere with you being present with your patient.
- Be professional at all times.
- Be present at all times during the interview.
- Use clear communication.
- Avoid using slang and overusing of technical terms (or educate the patient so they understand).
- When a patient says something important, paraphrase (repeat back what they said to you) so they know they have been heard.
- Clarify what they have said so you understand what they meant.
- Get a detailed history around their general health, details of the current issue and any pain related questions or physical limitations due to the condition.
- Ask them what their goal for the treatment is.
- Finally ask the patient what they would like you to address today (every so often I have a patient come in and describe many health concerns, then, when I ask, they request work on an unrelated problem).
The interview is your opportunity to recognize any contraindications that your patient may have, create a hypothesis for the condition you believe is affecting your patient and consider the level of special testing to either confirm or rule out your clinical reasoning around your patient’s complaint.
We as Massage Therapists are very well trained in assessment using range of motion, manual muscle testing and other various special tests to confirm or rule out conditions.
We have to remember that every patient is unique and just because the last three people had back pain due to trigger points in the gluts, it does not mean your next patient has the same issue.
A good assessment can narrow down the cause of the issue, help speed up recovery time and most importantly get our patients get back to their normal activities.
- Consider a test that could confirm and a test that could rule out the condition you suspect.
- Remember to ask permission before placing your hands on the patient.
- Explain your special testing before you do it.
- What you are testing for?
- What a positive result will feel like?
- Always test the unaffected side first.
- Be honest with what you find.
- Remember as a massage therapist it is not within our scope of practice to diagnose a condition, although we can state that the patient is presenting signs and symptoms consistent with a condition
A thorough assessment will help create confidence from your patients, reduce recovery times and help the profession by creating consistency in massage therapy treatments.
Create Your Treatment Plan
Now that you have the history and have done assessments, the next step is to create a treatment plan.
For this treatment, then for subsequent treatments and the home care exercises (stretching and strengthening) hydrotherapy and any changes to activities of daily living.
When you give patients a solid treatment plan they are more likely to trust you, follow the plan and recover more quickly.
This is where research and experience comes very handy, if you understand the condition and the length of time the patient has been affected by it you can start formulate a plan.
When my patients come in with an acute issue I normally start them off with one treatment per week for four weeks then we reassess and back off from there but this always depends on the condition.
- Discuss the techniques you will be using and why.
- Discuss the areas of the body you would like to work with and why you recommend working with these areas.
- Discuss a pain scale or intensity scale.
- Discuss the possible side effects or complications of the treatment.
- Discuss the level of dress.
- Get consent to treat.
I always check in and regain consent when I am about to work with a more sensitive area like the gluts, lateral rotators, abdomen or the adductors (especially with new patients).
We are also required to monitor the intensity of treatment with the patient, so I always check in to ensure the treatment is not too intense (I am 240 pounds and have very strong hands), some patients may not tell you it’s too much unless you ask.
Before you leave the room to allow the patient privacy to dress down and get on the table, remember to discuss the level of dress and how to get on the table between the sheets with their face in the headpiece.
Don’t assume they understand the routine.
I have heard stories of more than one RMT returning to the room only to find the patient naked on top of the blanket.
Knock on the door before you re-enter the room, this way you can be sure the person had enough time to get on the table.
There is a debate in the world of massage if we should talk during the treatment or not.
I always say the difference between getting a massage and getting a massage therapy treatment is the fact that we educate the patient. After I know a patient and if they prefer I will talk a lot less during a treatment. Remember to keep your conversation within your scope of practice. Many of my students have asked me why I should be concerned about what I say or how I say it in my practice. We have to take into consideration the dynamic of the session and balance of power in a treatment. The patient (in many circumstances) is naked or nearly naked on the table (covered by sheets and a blanket) we, as the therapist, are pretty much towering above them speaking down to them. The patient (depending on the treatment) may be in a very relaxed or semiconscious state and these facts could possibly put the patient in a little too open state and cause them to believe what we say without question. At the end of the treatment, give everyone some form of home care and ask permission to send a follow up email with pictures, videos and details of the stretching and strengthening exercises.
- Improved Listening Skills For Massage Therapists - November 7, 2016
- Basic Communication Improvements For Massage Therapists - August 22, 2016