Are You Ready to Take Your Bodywork or Healing Practice to the Next Level?
The Impact of the Relationship Between Practitioner and Client

By Alexis Johnson, Ph.D.

Sally, a 48-year-old educated and highly intelligent woman, has been seeing you the past two months for injuries sustained from a car accident. She called you yesterday to book an appointment because of her overwhelming pain. You shuffle your schedule to accommodate her, but you are 15 minutes late for the appointment. Sally is absolutely furious with you and begins the session by berating you with a list of complaints about how you have mistreated her. What has happened with Sally? How has your tardiness triggered such an enormous issue for her? How do you respond?

Such is the subtle world of relationships that exists between therapists and clients. With this article, my hope is to illustrate how to integrate some important psychological insights into your practice, in order to gain perspective of the powerful role you have in your clients' life, ultimately helping you become more aware of how to work with these relationship dynamics. Themes of early childhood development, attunement, attachment and sense of self will be discussed in the context of how you can offer safety and trust in any professional bodywork practice.

When Sally comes to you for bodywork, one of the things she consciously or unconsciously needs is to be soothed and feel more relaxed. It is usually through physical relaxation that she can have a "felt sense" of wholeness. If she is tense and stressed, she feels separate - separate from her body, feelings and longings. Sally needs a particular kind of safety to permit this kind of relaxation, which is fundamental for any kind of healing to occur. Let's begin our journey to explore the type of safety Sally needs, how to create it, and what relationship tools you can use for an optimal healing container.

Creating a Healing Container
Your relationship with Sally began with her first phone call to you. What was her experience when she called you? Most likely she would have heard your voice on an answering machine with a particular message that represented you. What happened next? For a new client, your responsiveness to their first communication is very important. I have a personal policy of returning phone calls within 24 hours and if I can't, I say so on my machine. Be clear with yourself and your clients about your policy. If you need some time to respond to phone calls, perhaps say "I am very busy right now and probably won't get back to you for a few days." I know of a bodyworker who leaves the following message: "My practice is full right now, but please leave your name and phone number if you want me to get back to you when I have an opening. Meanwhile have a great day." You are saying: "Your time and needs are as important as my time and needs." Your response to an initial contact is an opportunity to establish reliability and predictability and to demonstrate your respect for a new client. Your client will respond to your reply, and you make a lasting impact because the relationship begins here.

Once your first appointment is made, the initial face-to-face meeting sets the emotional and psychological stage of your work. Your client yearns to be soothed and to feel safe on many levels. If the client does feel safe, she will more likely return for your services.

Is your physical space both psychologically and physically warm? Is it private? Is it soundproof or at least sound-insulated? Is your bathroom clean? Every-thing creates the container: your office, your reliability, your interest, your inner healing model and how you use it, and your ability to be empathic. In addition to feeling safe in the atmosphere you create, Sally needs to feel your desire to understand and connect with her. Your presence and attunement enhances her experience of being soothed and thereby, increases the effectiveness of your sessions.

What are your ways of centering yourself to be fully present for your time with Sally and all of your clients? If you are authentic and present, she will find you welcoming. If you are upset with the previous client, or thinking about your child or planning when you're going back to the gym, you aren't present for the current relationship and she will sense it. She won't feel attended to, safety will not be created, and an attachment bond will not begin to form. In order to attune to Sally, set aside your concerns and focus on her and her needs.

If you feel anxious that you can't do a good job or don't know what to do, take time before your session to take care of yourself: meditate, take a walk or listen to relaxing music. Your own internal preoccupations will separate you from Sally and she will take it in energetically according to her own dynamics. She might feel unseen. She might feel rejected. She might feel abandoned. She might feel you don't care or even found her repulsive in some way. We can't predict what she will feel, but we can predict that if you are internally preoccupied, some energetic separation will occur and things will not go as well as they need for a good connection to begin.

The healing container you want to create includes you and your inner world (which includes your healing model, but is much more than that), Sally and her inner world, and the relationship the two of you co-create. It is a lot to hold and think about. Creating this psychological container means you are alive and energetically responsive to what is happening in the moment. Perhaps the best metaphor for the healing container is that of interpenetrating energy fields. When your and Sally's energy fields interpenetrate, through empathy, you will be able to more easily access insights for her optimal healing. Your relationship is alive and in the present. This is the opposite of controlling the session; rather, you create space and trust that healing will occur. As a psychotherapist, I assume there are certain basic emotions, but I don't know which order they work within each client. If I hold the expectation that something specific needs to happen, the outcome will be very different than if I hold the expectation that something will unfold here. It is a subtle energetic difference, but it is critical. Intrinsic in this approach is trust in myself, the client and the space we create between us.

A Sense of Self
You are the embodiment of the model you use (massage, energy healing, cranial sacral, somatic therapy, etc.) as well as the environment the client steps into. Everything you do optimizes or minimizes this sense of safety and trust. Through conscious attention to the relational dynamics, you can provide the most favorable atmosphere for something to "go well" for the client. The safety model I teach is based on early childhood development, the foundation of adult relationships.

Psychologists have spent decades studying infant behavior trying to peer into the consciousness of the non-verbal world inside each of us. We all are familiar with the common belief that the first three years of life sets the mold for all subsequent years. As a bodyworker, you will be more present for the depth of your clients by knowing a bit about the profound experience of infancy and toddlerhood.

All babies develop a sense of being a "self" when mommy or daddy are able to attune and mirror their emotional states. By self, I mean the baby has a feeling of being whole, good and real, and can act on her own behalf. When Sally was a baby, like all babies, she only knew two states of being: comfort and discomfort. If Sally was lucky and blessed, her discomfort was discerned by her mother or father, taken care of, and she was soothed and returned to the world of comfort. She was totally dependent on the external environment to keep creating and changing things (changing a dirty diaper, rocking her back to sleep) so that she could get back to the world of comfort. When Sally was hungry, she was fed and put back in the world of comfort. When she was tired, she was placed in such a way as to be able to fall asleep.

The attuned mother and father approaches and looks at the baby. The baby is literally seen. The eye contact between them, mother and child or father and child, allows a connection to form. In the looking, the mother attunes to the baby. She sets aside what she is doing or thinking about and focuses on the baby's needs and feelings. Usually she picks her up and makes a guess as to what is needed - food, contact, a changed diaper. The more often her mother intuits what is needed, the more self-confident the baby becomes - "I can get my needs met, I can be soothed." If all went well for Sally, she was allowed to form a sense of self based on self-reliance and competence by being taken care of over and over again.

It was only when young Sally felt a sense of comfort that she developed autonomy, or a growing sense of agency (Stern), around getting her needs met. She formed a stable sense of self and an internalized trust in life due to a healthy attachment bond with her parents because her needs were met time and time again. She is able to meet her own needs as an adult only because of this healthy attunement she experienced as a baby. And, she is able to weather life's chaotic changes because she has an internalized trust based on her previous experiences of getting her needs met amidst fluctuations in her external environment (Bowlby). Grown-up Sally falls back upon her pre-existing sense of goodness, wholeness and contentment.

Now, if Sally had an unhealthy attachment with her parents, her adult self will have less trust in life and she will defend against her needs. In both scenarios her sense of self was formed through the attachment, healthy or dysfunctional, with her parents and was imbedded in her psyche-soma - the body's essential aliveness on the physical and psychological levels. You can imagine why the first three years of life are the root of everything that happens in one's adult life: this is when our sense of self is formed, for better or for worse.

Sally stored the experiences of being attended to in her psyche-soma and she stored all of the "misses," as well. There were many ways her mother may have missed opportunities for healthy self-formation. She may not have attuned to Sally. By this, I mean her eyes were still turned toward herself, even though she was looking at her baby. To the mother, her emotional state was important, not Sally's. So her face and her eyes didn't reflect to Sally "I see you and you're upset." Instead, her face and her eyes reflected, "I am too preoccupied with my needs to attend to yours." She may have done the right things, like pick up and change the baby's diaper with the first cries, but Sally was treated as a thing to be changed, not a person who needed caring. And in this exchange, the baby did not gather more bits of herself.

Growing from baby to toddler, Sally entered the rapproachment (Mahler) crisis, the bittersweet process of individuating from the mother. Margaret Mahler discovered that during 15-36 months of age, each child is consolidating the reality that she is both separate from and still needs the mother and father. Parents call this the terrible twos because the child wants to be taken care of and wants her independence. At times, the toddler wants to go back to being the baby who is taken care of: "Please be with me." At other times, she is in a place of "I can do it myself. I can resist you. Go away."

Regardless of the whimsical needs of the toddler, mother and father serve as a base for refueling and for safety. Refueling (Mahler) means to go back to the parent, touch base with them and venture out again. When the toddler is playing and something goes wrong, she runs over, touches mommy, sucks her thumb for a minute, then goes back and plays again. Sometimes the parent is expected to be available for refueling and other times for pushing against. The way a parent handles this individuation struggle is key. Oftentimes the parent exerts power and makes the toddler do it their way.

Under ideal circumstances, the parent does it as a means of power lending and allows the toddler to do it her way many times and mommy and daddy's way only some of the time. Healthy power lending would have strengthened Sally's sense of self as a whole self. If mother exercised too much power over Sally when she was a toddler, her sense of herself will be unstable and her self-esteem will fluctuate widely depending upon how the external environment views her. All of our intimate and continuous adult relationships will reenact some aspects of these first attachments. In our example, Sally acted out unfinished material from her childhood when she lashed out at you for being late for the appointment. Clearly your actions did not warrant such a volatile response, but Sally's old hurts were triggered. These enactments, whether overt or subtle, will occur between you and many of your clients. The dynamic doesn't need to be spoken about with every client, but it helps tremendously to be conscious of it.

Ken Wilbur, one of the foremost writers on consciousness and transpersonal psychology, speaks to the point that one does not leave anything behind. Every experience is carried forward to the next experience and literally, nothing is lost and nothing can be undone. As much as Sally may try to act as if she was not hurt and wounded in her early life, her psyche-soma has stored everything. These experiences and feelings might not be conscious and may never become conscious, but they impact her relationships nonetheless.

So, when the 48-year-old Sally walks into your office for a massage, she brings 48 years of experience with her - the good, the bad and everything between. Even though she comes to you as an adult for something very specific, Sally was once an infant, a toddler, a child, an adolescent, etc. All of these aspects of her are present in your office, including her unintegrated vulnerable parts. You cannot know what they are, but you can be aware they exist.

When Sally had her emotional outburst because you were late, her internal map (or psyche-soma) of what she expected to go well and what she expected not to go well was activated. The intimacy and power differential triggered her early childhood "misses" and she reacted from an unconscious survival perspective. Her outburst suggests that her terrible twos were handled poorly, leaving her with a deep ambivalence about any kind of intimate relationship. She is unconscious of her ambivalence to be in an intimate relationship and to be touched, literally and metaphorically, but her reaction tells you differently. She sends conflicting signals: "I can't take the intimacy, because it will reenact the power over or the abandonment I experienced from my mother when I was a young toddler. I am hungry to be separate and I am hungry to be attached. I want to be touched and in contact, but unconsciously I am ambivalent, so I will push you away."

If you offer Sally a relational container, you provide her an opportunity to transform past failures of bonding. If she stays with you over a long period of time, she will grow trust in your relationship and feel safe to take a risk and to try something new. She will strengthen her sense of self through your consistent attunement to her needs. And, she will grow as the two of you work through challenges where she feels met and not controlled by you. This type of contact with your clients will create a rewarding experience for both of you and will support the stability of your private practice.

Finding Your Healing Map
Some of my clients reenact their attachment and bonding misses in such extreme ways that it is imperative I let go of all expectations of what "should" happen during our sessions. One of my clients, "Gloria," illustrates an example of a highly intelligent and well-educated person who used to regress back to a tyrannical toddler in any relationship. She came to me after years of trying to get therapists to pay proper attention to her and to hold her in a specific way.

She felt her mother never paid adequate attention to her so she made it very clear, through a verbal demand, that I could not talk to her. I had to look at her, listen, but not speak. Any time I did speak to her it would derail her inner train of thought and she would lose her sense of self. I didn't say anything useful to her for six years.

Interestingly enough, she loved massage and would try to get massage therapists to meet her needs, but they all insisted on wanting her to do something she considered their way rather than her way. For example, when she told the massage therapist to spend the hour on her back and the therapist recommended it would be best to spend 30 minutes on her back and 30 minutes on her head and neck because of the tension, she felt "missed." She didn't care what anyone else knew or felt about what she needed; all feedback was invasive. She had room only to receive exactly what she wanted for herself.

What does this tell me about Gloria's early childhood development and attachment to her mother? Her adult sense of self is so tenuous that she cannot dialogue, she can only monologue, which indicates that the baby-mother dialogue did not go well enough or did not happen at all. Gloria was left with a sense of helplessness; she felt powerless and tried to keep everybody out. She lives with the belief the only way she can have herself and be autonomous in a relationship is to be in control.

The major accomplishment of our work was when we entered a dialogue. I am now able to ask a question or make a comment and she is able to receive it without feeling like I made a threat, an attack, or that I was a disorganizing intruder. I have to attune to her needs and be sure I am not losing myself. I know when we are in session, there is absolutely no room for any of my needs to be met, not even to look away from her face. I need to take care of myself outside of our work together to truly be able to be present for her. Over time, we have entered a place where our energy can intermingle, but she still has a difficult time finding a massage therapist who can hold space for her without trying to change Gloria's agendas for what is needed.

Many healing maps involve doing or fixing what is broken in the client: "I am fine. You are broken. I can fix you." This is a relationship of a certain type. And it certainly has its place in the world, such as in hospital settings, and some chiropractic offices and acupuncture clinics.

Returning to Sally, hopefully she was taken to an emergency room after her automobile accident and her injuries were properly attended to. The doctors saw her as a set of problems/injuries to be fixed. However, if you stay in a strict "doing" stance with Sally, you objectify her and turn her into an object to be fixed. She loses her personhood, her subjectivity, her adult capacities and potentials (Winnicott). This relational model asks you to be more holistic; it asks you to create an energetic link with your client. This healing container is created in a two-person dialogue, even though the "contract" is that only one needs healing. You see that Sally has strengths and weaknesses, skills and deficits. You care about her as a separate, unique person and you hold on to your own status as a separate, unique person. The healing container created by this stance gives wholeness to both participants.

The Need for Presence
In order to establish an energetic link with your client you need to be in the moment together, travel in the present and co-create. What is it like to be fully in present time together? It is a balance between "doing" and "being," between accessing everything you know from your model and surrendering to the unknown of the moment. It is an acceptance that sometimes the client leads and other times you lead. In this healing container you are open and curious about Sally's uniqueness because her needs will guide your techniques. Use the trust in your modality; relax into holding space for something to rise to the surface for Sally. As Sally (and all of your clients) feels the safety and trust, her fear will soften and her body will return to a state of optimal biochemistry in order to heal itself. This softening will make your techniques more effective. This is where the non-verbal, co-creative two-person dialogue between you and Sally will work to heal the injury. Instead of you and your client being separate energy fields, where you are doing something to make her body different, visualize that your two energy fields interpenetrate to allow healing to happen through you and from within her.

Do you sense the profound difference between doing (providing basic physical needs) versus being (offering a soothing and nurturing environment)? Fifty years ago, Harry Harlow conducted a series of studies with baby monkeys to learn whether infants attach to their mother based on having physical needs met or based on presence. Harlow felt it was the touching and clinging that formed the attachment between baby and mother. He took baby monkeys away from their mothers at birth and isolated them. He put each in a cage with two forms. One was a wire form that fed them all of their milk; he called this the wire mother. The other form was covered with terry cloth and was referred to as the cloth mother. He found the babies spent all of their time clinging to the cloth mothers and would run over to the nipple of the wire mother and suck what they had to, but spent no time there. It was the cloth mothers that provided them with their sense of security and their home base. It had nothing to do with the food.

The need for presence and soothing is basic to human beings as well. In the 1950s, Rene Spitz followed babies who were in orphanages and hospitals. He found that even though the babies were physically attended to, many of them died. He reported that the orphanages with the highest death rate were those who lived up to the 1950 standards of hygiene. They didn't touch the infants so as to not expose them to germs. The babies were fed and changed but never held and touched. Sadly enough, many of the babies became apathetic and died.

How do these studies relate to a bodyworker's practice? These speak to the hunger within each of us for someone who is steeped with a commitment to be deeply present and attentive. Your techniques will be taken in on many profound levels as you place as much attention on your presence as your method. The way you touch Sally sets the stage for her internal experience of "I am a real person" or "I am a used object." Remember earlier we mentioned that the mother can hold her baby as an object to be fixed or as a wonderful separate being to be taken care of. Touch offers you a powerful opportunity to strengthen or weaken the healing container with your client. The simplest metaphor is "I see you." But much more is conveyed in touch: "You exist for me. Your body is real. I care about you. I can remove some of your physical/psychic pain."

All of us experience failures in our practice, even when our contact skills are excellent and we provide a soothing presence for our clients. I worked with "Stanley," who had to hold his genitals whenever he felt an increased aliveness in his body. This was the most organic way for Stanley to be with himself when he experienced this surge. This was very disconcerting to me. I told him it felt too much like a private activity that was now in public space. I said I wasn't comfortable with it and Stanley decided to stop working with me. I recommended he try to work with a man to see if a male presence would feel more comfortable with his needs.

It was important I didn't try to blame him for the failure in our relationship. The truth was I felt he would be better off working with someone else, that I wasn't the right person to work with him. It was important to approach our failure in such a way that Stanley did not leave the relationship feeling he was once again wrong or bad. I brought it back to a two-person system and a place without blame. I tried to attune to Stanley and found I couldn't do so. These types of misses are inevitable. I am not the perfect psychotherapist for every potential client, and you will not be the perfect massage therapist for all of your interested clients. It is best to honor the truth of present relationship incompatibility so as not to re-traumatize yourself or your clients.

Relationship misses are inevitable and when you both survive these challenges, the healing container will strengthen. I had a situation happen with "Bob" that was tough to navigate. However, in the end it deepened the trust and intimacy of our relationship. Things were never easy with Bob, but it was going tentatively well. For a personal reason I had to call him to change his session time. I asked him if he could come an hour later. He did come to the session, but he was enraged and yelled at me. I said "I know I asked you to come an hour later and it wasn't convenient, but why are you so furious?" I learned the fury came from a couple of different places. While I was able to ask him to change his plans, he couldn't ask it of me because my practice was full with weekly clients. If he wanted to change his session time to an hour later on a permanent basis, it wasn't available. The other thing that infuriated him was that I asked for myself and this relationship was not about me, this relationship was about him. Asking for myself, in his mind, had no place in the relationship. In my mind, it did have a place in the relationship. For Bob's unconscious, this was about feeling like a used baby versus feeling attended to. My client felt used when I asked him to change the time.

Perhaps his first attachment was a one-way street going from him to the other and what he wanted from me was a one-way street going from me to him 100% of the time. Anything else was dangerous. I asked him if he thought he could bear it if I had to change our schedule occasionally given that I knew how painful it was for him to do so. He softened when I asked him this question because I honored the child aspect of Bob, his need, his demand, and the pain of his initial attachment. Also, I spoke to Bob as an adult, even though his fury came from a much younger place. If I had interpreted his rage as stemming from an adult issue, I might have stopped working with him. To stop the work would have been re-traumatizing for Bob. His experience of that would have been, "If I express my anger, I get abandoned." As importantly, if I ignored his outburst he would have felt completely unseen. His biggest charge would have been met with nothing. He would have ended up being completely unseen in a different way. Bob felt held and received when I asked his adult to explain his behavior and when we co-created an agreement about future schedule changes. We survived the conflict and it strengthened our relationship.

We began this journey by exploring the type of safety Sally needs from you and how to strengthen the relational healing container of your work. Hopefully, you discovered that the basis of the healing container for Sally and for each and every one of your clients is your willingness to be present, attuned, curious and welcoming. Who is this complex person in front of you who carries her lifetime experience in her psyche-soma?

What does her body language, tone of voice and story tell you about what she needs from you moment to moment? I invite you to embrace this exciting approach to your professional practice. Open to the mystery, the unknown, that exists in all of your client relationships and enter the co-creative dance. And as you enter the dance, be sure to bring your beingness as well as your techniques. I predict that your presence and willingness to be in the relationship will enhance your practice, lead to more long-term clients, and be extremely rewarding for you. Try it and you and your clients may benefit beyond your expectations.

References
Bowlby, John. Attachment and Loss (Vol. 2: Separation), Basic Books, 1973.
Harlow, H. "The Nature of Love." The American Psychologist, 3, pp 673-685, 1958.
Mahler, Margaret; Pine, Fred; and Bergman, Annie. The Psychological Birth of the Human Infant, Basic Books, Inc., 1975.
Spitz, R. Grief: A peril in infancy (film), University Park, PA: Penn State Audiovisual Services, 1947.
Stern, Daniel, The Interpersonal World of The Infant, Basic Books, 1985. Wilber, Ken, A Brief History of Everything, Shambala, 1996.
Winnicott, D.W. Through Paediatrics to Psycho-Analysis, Brunner/Mazel, 1992.

Alexis Johnson, Ph.D., was traditionally trained at Michigan State University, then in humanistic and transpersonal philosophies and methods at the Esalen Institute in Big Sur, Calif. She has studied and taught Core Energetics, family systems work and object relations. Currently, as the founder of the Center For Intentional Living, she is teaching in California, New York, Toronto and London. As a sensate and pragmatist, she has found that only by creating inner and outer relationships does life have full meaning and joy. For more information about Johnson and the teaching schedule for the Center for Intentional Living, visit www.intentionalliving.com.

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