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Similarities and Differences

“Hello John”

“Hi Rahel”

John looks different today. He’s walking slowly as we head into the clinic space. I walk behind him to check for any altered Gait. I also happened to notice when we said hello that his face looks strained. He’s holding in pain, I’ve seen pain many times before and I can recognize it.

We enter the treatment room and face each other.

“How are you feeling? You look like you’re struggling today? That’s a change from our last appointment…what happened?”

“Yeah, just yesterday, I threw my back out. I can hardly move. I’m desperate.”

“How did this come to be?”

“Well, you know me. Always lifting boxes, I never pay attention and I don’t bend from the knees like you said I should. I guess my Back finally gave up on me.”

I want to say, you gave up on yourself. Actually I want to pit his resignation and effort against each other in a two-chair cage match and my top dog wants to bet $100 on effort. On a less I-it note, I want the two to come together and hug it out. I wonder if my client’s physical suffering might be better suited to such treatment, instead of a massage. Who’s to know? I can’t go there. Not in this role. Not at the risk of toppling the CMTO (College of massage therapists), a fragile house of cards…and the regulatory body of my profession. But, excuse me for I digress (it’s a primary interjector thing).

With some further assessment, I inform John of my goals regarding treatment and how I intend to reach them. Though I’m almost sure by the glazed look on his face that some of my treatment plans sound like, garbled gook, he unquestioningly nods yes. This makes me feel uncomfortable.

I leave momentarily so he can undress and get on the table, face down.

One of my favourite things about the job, a small thing, is the variation in response I get upon re-entering the treatment space:

“Come in”



“Come on In”

Some people use different inflection. Some don’t say a thing. I project that it has to do with how a client owns the space and owns their treatment.

John says “I think I’m ready” he’s the type to wait for things to happen to him (resignation?) maybe.

I turn the lights down, increase the soothing sound, and approach John. I always like to start by introducing my hands to a client’s body which is also a method of assessment. I sheer my hands over the entire body and feel for any discrepancies, anywhere that is not integrated.

I can tell when something is not integrated from varying factors. The tone of the tissue, its temperature, the texture of the tissue, its responsiveness to my touch or to guided movement, and if any of these things together or apart are appropriate within the context of their location. These factors can be sensed through my hands, sometimes my eyes, even the sounds the client makes, or the sound of cracking etc.

Then there’s something else. There’s something intuitive. Though all the above indicators dictate the areas I am to work on, it is my intuition that determines how I do that work.

It is essential to working in the “here and now” because a person such as John might come in with usual areas of tension, but needing different pressure or styles of technique from time to time.

And speaking of John…

After my hands-intro/assessment, I decided to start from the neck and work down. His neck is stiff like a group of full water hoses. This leads into his shoulders, down the middle of his back along the sides of his spine, and into a mass of hard tension that forms a constrictive band across his low back. I imagine a giant has John in the palm of its grasp and is squeezing fiercely. I imagine that wouldn’t be very comfortable, and almost a total loss of control (or a giving up of control? hehe sorry I can’t help myself…maybe I’m a primary projector?..hmm)

When I begin firmly kneading John’s neck the first thing I notice is resistance from the tissue to my pressure (Quel surprise/eye roll, Gee something about other people’s resistance really makes me smug…)

This means as is usually the case, that I cannot just dive in, I must softly enter from the side, getting deeper as the tissue warms to me.  That’s cool. We’ll get nowhere if I am attached to my version of what John needs and I don’t involve him.

In fact, this is the only way I can truly be creative. My creativity is indelibly connected to all the techniques I am capable of and aware that I have, as well as the needs that call them. So the toolbox is open, the state of John’s tissue in each moment and my sense of what’s needed dictate how the techniques and which tools I use, flow from my hands to/with him. We create a symbiotic fulfillment. A harmony or balance where both our needs are met all the while our integrity is maintained. To do my job, I must afford this commitment to all the clients I work with. I always pull out all the stops. No matter who the client is, I am committed to balance and integration. Worst case scenario, I refuse to treat someone.

Slowly, on a moment to moment basis, the path to balance is revealed. The sounds John makes have become warmer and softer, and flow like his oxygenated, lively tissue. His breathing is deeper and rhythmical. His body reminds me of the environment in which it lays. As it turns out, we have dealt a large focus to his upper back, neck and shoulders. His Low back received the attention of course, but by the time we got there, it had relaxed. Sometimes this will happen if I focus on compensatory structures first. Curious is it not?

Though there is still some residual tension, we stop for now.

The hour has just about finished. Enough time remains for John to change, and for him and me to address his current state of being.

I leave the room and let him do so.

Shortly after this, he opens the door fully dressed, a relaxed expression. He says “wow” and thanks me. I am split between joy and discomfort. Joy at his obvious harmony, discomfort at his obvious gratitude. We did it together…

I enter the room and close the door for this last piece of work. I explain what was discovered, and he tells me he is no longer in pain. I recommend a treatment next week for the residual tension and advise him not to overdo it. Then I give him some homework to accentuate the treatment, and I escort him back out to the foyer.

In Massage Therapy, as in Gestalt, the role of contact is dynamic. There is an opportunity for freshness around each turn. What I love about being a Therapist in all forms and variations is the opportunity to work with Universal manifestations of stuckness, so as to co-create wholeness. I’m pretty good at massaging through all the knots.

Rahel Kay, RMT, CR, CYI is a Registered Massage Therapist, Certified Reflexologist and Yoga Instructor.  She has been studying Gestalt Therapy at the Gestalt Institute of Toronto to expand learning and add depth to her practice.  She is available for Swedish massage, deep tissue massage, trigger point, lymphatic drainage and reflexology treatments at The Pacific Wellness Institute.  To arrange your session with Rahel call us at 416-929-6958.