Working with an Audience

By Cynthia Bologna

If you’re a massage and bodywork practitioner who works with clients in a healthcare facility or in a client’s home, you may sometimes find yourself in the position of working with an audience. That is when a family member, caregiver, or medical staff person either enters the room while you are giving a massage or asks if she may observe your session. In either case, it is helpful to know how to be gracious and instructive.

At first, any interruption in your session may seem like an intrusion. You are, after all, a skilled professional who prefers to give all of your attention to your client without being under the watchful eye of someone else, especially if that person is not versed in what a session entails. However, when someone you are working with resides at home with caregivers or lives in a medical or hospice facility, most of the people involved with her care, by extension, are also your “clients”—not in the sense that you will be providing them with bodywork, but as part of the client’s circle, deserving of attention and respect. In some instances, one of these various persons may even have been designated to speak for your client if she is unable to speak for herself, so you will want to include her in your session.

The Interruption
It is best to begin by reframing the concept of interruption (the stopping or hindering of progress; a break in continuity, according to Merriam-Webster’s Collegiate Dictionary). Any staff coming into your client’s room has some legitimate reason for doing so and needs to be recognized as part of the continuity of care of which you are a part. It may be the nurse coming in to give medication; an aide to remove and refill the bedside water bottle; or housekeeping bringing clean laundry to be hung in the closet. At first, you may feel tempted to hang a sign on the door that reads, “Massage Therapy Session in Progress—Please Do Not Disturb.” But by letting staff do their jobs in their time frames, you actually create an environment of rapport that, in the long run, will be beneficial to you and your client and increase your potential for being referred to additional clients at the facility. It is better to be perceived as someone who is making the staff’s jobs easier than harder. You also remove any uneasiness staff might feel by a sign that tries to exclude them from the room and their patient.

The first time someone comes into the room while you are working, introduce yourself if you haven’t already done so. It takes less than a minute to be pleasant, say hello, and inquire as to how he or she is doing that day. It is possible to remain engaged with your client, either by continuing the massage as you speak to the staff person or by including your client in the conversation. Most times, staff only want to be acknowledged and will not continue with a lengthy dialogue. It is unlikely someone will pull up a chair and start telling you about a recent vacation.

The number of times people come into the room while you are giving a massage can vary from visit to visit. Some days there will be none, and other days there may be six or seven in the course of an hour session. Some people may even question what you are doing.

An aide once asked me about a client with dementia in what at first could have been interpreted as an accusatory tone: “Why are you massaging her head?” Realizing this question came from someone who was only familiar with back rubs I replied, “Sometimes when a person lies on her back, the back of her head can become sore or numb.” As I continued to work, I added, “Look at her face. See how well she is responding?”

By directly answering her question and involving my client’s response to the work, the mystery was removed and she said, “That looks good to me.” Staff members are often only being protective of their patients and want to make sure the best care is being provided.

When a doctor enters the room, it is usually best to offer to excuse oneself. Doctors often make rounds from facility to facility and have precious little time with patients. They may tell you to continue with your session while they are doing their examination or thank you and expect you to temporarily leave the room. In that moment, you may feel what you are doing for the client is more supportive than what the doctor has to offer, but while working in a medical environment, whether in hospitals, skilled nursing facilities, or hospices, doctors’ priorities always take precedence over everyone else’s, even the administrator’s.

Other types of breaks in a session can be caused by a client needing to use the bathroom, a disruptive patient entering the wrong room, a client receiving a phone call, or even the local fire department conducting a drill. In a healthcare environment, the unpredictable is the norm. Rarely are any two days alike. The environment is very different from the calm you often encounter when working out of your own office, with your own table and sheets, and your client’s favorite, soothing music playing in the background. It is possible, however, to provide very good, relaxing work even in the midst of bustling activity. The key is to remain focused, attentive, and above all else, flexible.

Concerned Caregivers
Every now and then a family member or a live-in caregiver will ask to observe one of your sessions. This request usually comes out of curiosity, whether you have worked with your client for a short while or over a longer period of time. Or, you may have been referred to a new client and a family member may want to observe your interaction in order to assess whether or not to hire you. Both instances may at first take you by surprise. But it is to the benefit of all involved—the client, the family member, and yourself—if you incorporate the observer into your session. The question is, how can you do this effectively?

Let’s say you have a client with multiple sclerosis (MS) whom you have been seeing in her home for a number of years. She has a son who lives out of state and comes for an extended visit once or twice each year. He sees that his mother’s condition is stable, that she continues to enjoy being massaged, and would like to see for himself the type of work you are providing to his mother. Before inviting him to join your session, ask your client for her permission.

“Patricia—Mike would like to sit in on our massage session in order to learn a little more about what you and I do together. How would that be?” If Patricia says, “No,” then you can tell Mike his mother would prefer not to have him sit in. If she says, “Yes,” then arrange the room in a way that is conducive to all parties being able to observe and communicate with each other. For instance, you don’t want to have Mike sitting behind you, since this would cause you to turn your back to your client when speaking to him. Also remember that he is not a massage student. He can sit off to one side with a good view, but does not necessarily need to see every, individual stroke you are using.

A word of caution before you start. It is very tempting in these situations to “perform,” that is, to pull some moves out of your massage tool bag that you’ve never used with this client because it might look good to her son. This is not a good idea. Whatever you have been doing with this client over the long term that has made her a satisfied customer will be quite sufficient. Her son wants to see what it is you do with his mother on a regular basis—not what you do just when he is in town or in the room.

Treat your client as you would during any other session. Talk with her—if that is what you normally would do, play her favorite music on the CD player, and relax into your session. Then, begin to include her son. Invite him to make comments or ask questions. After assessing your client’s needs, make a choice where to begin and mention that choice briefly.

“Your mother’s legs seem especially tight today, so I’m going to begin with some simple Swedish strokes to help loosen muscles and also increase circulation.” Then to your client ask, “How does that sound?”

In this simple way, you are engaging with both mother and son, and they will also begin to engage with each other. “How does that feel, Mom?” Mike might ask, for instance. Hopefully, his mother’s response will be, “Wonderful!” Or, it might not be. She might say you are using too much pressure. So you adjust your touch, just as you normally would, and ask her if that feels better. It will be more comforting to her son to see that you are responsive to his mother’s needs rather than perfect in everything you do.

An observer might also ask a question out of the blue about a type of bodywork with which you are familiar but not trained or skilled. Be honest. Tell him you’ve heard of craniosacral work, for example, but you haven’t studied it. Ask him what intrigues him about it. Usually these questions have more to do with the relief of specific symptoms than they do about a precise technique. Or it may be that he’s read something on the Internet saying that craniosacral work was found to be beneficial in people with MS, and he is just trying to give his mother every possible treatment available.

You can respond a number of ways. You can tell him you will do some more research on that type of bodywork and MS, and thank him for bringing it to your attention. (As practitioners, we do try our best to remain current, but we may miss something from time to time.) You can also mention you know someone who specializes in that type of work and will talk to her to find out what she knows in relation to MS. In addition, you can find out about which symptoms he is most concerned and convey to him your approach, with the training you have, and how it has been beneficial to his mother.

After fifteen minutes, he may feel he has seen enough and excuse himself, or he may remain for the entire session. No matter how long he observes, include him. Briefly tell him what you are doing and why. “I’m providing some simple stretches here to help your mother’s legs remain mobile”—all the while communicating with your client, too. In the time it takes to conduct one session, you will have enhanced both your client’s and family member’s overall massage experience.

The New Client
Perhaps the most challenging situation is the one in which you are meeting a new client, together with a family member, for the first time. Whereas you already have a familiarity with a client whom you’ve seen for a while, the new client situation calls on your ability to establish rapport quickly and efficiently, with both client and caregiver.

Say a woman calls and wants to make an appointment with you for her father who lives in a residential facility. The father has enjoyed receiving regular, weekly massages in his practitioner’s office up until a few months ago, when he suffered a stroke and moved from a different state to be closer to his daughter. Now they want to resume massage sessions for the father who is in a wheelchair and unable to get onto a massage table. You offer to meet them (since you already have other clients in the facility) and provide a fifteen-minute demonstration of your work.

Upon meeting them and after introductions, you will first need to make a quick assessment about the father, what he needs, what he is able to tolerate, and where to begin your session while conveying your assessment to his daughter. When working with someone who has recently made a long-distance move and may be disoriented and confused, it is often better to situate yourself in front of him rather than behind. This will make it easier to maintain eye contact and build trust. A simple foot massage may be good for this type of short session, if the
client is agreeable.

If the father is less than articulate (which is often the case in these situations), it is almost second nature to direct all of your communication to his daughter. But the daughter is in the room because she wants to get an idea about how you will interact with her father. It may take more time and patience to converse with him, but that is precisely what the daughter wants to observe, in addition to your massage style. In only fifteen or twenty minutes, you have to show that you are compassionate, interested, sensitive to your client’s needs, a good listener, and a skilled bodywork practitioner. You can do this by listening to both parties, answering questions, noticing your potential client’s response to your touch, and using gentle, non-jarring strokes in your massage.

If, at the end of your demonstration, nothing is said about hiring you, ask if you can call her in a week’s time after she’s had time to discuss the possibility with her father. This will eliminate any awkwardness that might be present about having to make a quick decision and shows that you have respect for the relationship between the father and daughter. If the converse is true and she hires you right there, schedule an appointment at a time that is good for you and the client, and let the daughter know she is welcome to observe again.

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In situations such as these, we are being observed during some of our most intimate work. Practitioners often think of massage and bodywork sessions as private—a time and space where a client is free to relax and receive our full attention. This is not often possible for those living in a healthcare facility or even in a private home with 24-hour care. But nevertheless, we can make such sessions enjoyable when we are inclusive of those who have a stake in the health and well-being of our clients, and treat them respectfully by addressing their concerns.

Cynthia Bologna , MA, CBT, of Petaluma, California, works
exclusively with clients who have dementia and other life-threatening illnesses. She also offers personalized internships for massage students and certified bodywork practitioners. She can be reached at cmbologna@aol.com.

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