12/22/2024
In my own experience, articulating what one is experiencing during bodywork can be challenging but worth the effort because it increases our mindful body connection, which in turn opens the way for new ways of moving and feeling. So I can really relate to massage educator/author Douglas Nelson’s well-articulated points in his recent ABMP Massage and Bodywork article “The Language of Pain” (September/October 2024, pp 78-79). Copied below in full:
“I’m sorry,” she said. “I feel like I’m terrible at this.”
My client Ms. Kay was responding to my question about what she was experiencing as I treated her back,. I was treating her lower left lumbar area, which I thought might be responsible for her left hip and lateral thigh discomfort.
“I think you are doing just fine, but I’d love to hear more bout what you mean,” I said.
“I can feel how deliberate you are with you touch,” she said. “That amount of specificity deserves accurate feedback, but I’m struggling to do that. I was an English teacher, so I know the power of words to convey experience. I’m surprised at my inarticulateness and inability to give you helpful guidance. NO therapist in the past has asked for such specific feedback, and I have the sense that it really matters to your approach. This is refreshing but also far more challenging than I expected.”
“Thank you for being so thoughtful about your feedback,” I said. “It does indeed matter and has a major influence on the direction and creation of what we do and how we do it. Clients often assume I can guide my treatment just through what I feel in my hands. No matter how skilled, I can never fully know what the client experiences without them telling me. There are many kinds of feedback, but accurate, verbal feedback is crucial to success.”
I wonder why I find that so difficult?” Ms. Kay questioned.
“One strong possibility is our inadequate vocabulary to describe the experience of pain,” I said. “We have a few words like sharp, dull, aching, and burning, but they in no way encapsulate the full range of experiences comprised in pain.”
After that statement, I explained to Ms. Kay that I had a few extra minutes and would like to explore this idea further. We went back over each sensitive area previously treated, and she explained what she felt in the most descriptive way possible. It was a fun experiment, especially with someone whose command of language made the difficult process somewhat easier. I kept thinking that we need to come up with a better vocabulary to help clients like Ms. Kay articulate their experience.
After Ms. Kay left, I saw another new client, and the experience was vastly different from the moment I asked her why she came to see me and how I could help.
“It just hurts,” she said.
“What just hurts?” I asked.
“Well, maybe not painful, but tight and kind of congested,” she replied.
“But what area are we talking about,” I responded.
“I think it’s my neck.”
As vague as this sounds, further questions only made the situation less clear. I found myself getting impatient and frustrated, as if she were evading or dismissing my ever-pointed additional questions. At the height of my frustration, I realized she was sincere but incapable at giving me direction. I realized I was too focused on how I was supposed to respond and not focused enough on her struggle.
At that moment, I was lost in thought at the contrast of these clients. Here were two people, both in discomfort and both struggling with describing and conveying their experiences to me. It’s easy to see how both could be dismissed and invalidated by other health-care providers because their descriptions were so vague. The important point is that the source of their inadequate descriptions was different. The first person, Ms. Kay, struggle with clarity of language to describe her experience. The second client struggled with clarity of the experience itself because she was disconnected from her body, a condition in the psychological realm called alexithymia. In the context of bodywork, I might call it somatic illiteracy.
With Ms. Kay, I spent the session giving her the space to find language to describe her experience. Allowing her to find the right words took time, but she relished the process of codifying and articulating what she felt.
The session with the second client was very different—one not about creating language to describe experience but taking the time to fully discover life in the body. The session was a process of updating the somatic map in her brain and rewriting the software to a much higher resolution. I made sure to have her discriminate one area from the other, such as feeling scapular mobility as separate from the thoracic spine or feeling cervical motion as independent of shoulder motion. I was training her in somatosensory integration, a process of inner discovery and wonder. It was a bit fatiguing for her, like learning a new language, thrilling but exhausting. It was an honor and a privilege to be a guide and witness her process of self-discovery.
These two clients represent situations often encountered in clinical practice. Two people with similar presentations may have vastly different reasons for experiencing them. Knowledge is identifying the problem. Wisdom is identifying the underlying context that created it and responding appropriately.
~Douglas Nelson, “The Language of Pain”
ABMP Massage and Bodywork September/October 2024, pp 78-79
Image by master1305 on Freepik
