Transcript of a talk at The London School of Osteopathy
I want to talk to you today about one area of the work which I feel is not being paid enough attention to amongst complementary therapists, and that is the therapeutic relationship. In this talk I will try to explain why I see this relationship as an essential part of the healing process and I will aim to make some link between your work as osteopaths with your patients’ body and between the emotional dynamics this work can evoke.
To illustrate my ideas I will use the story of one of my supervisees – I will call her Jane – and her client whom I will call Ron.
Jane has been practicing bodywork for many years, using deep tissue massage and Rolfing techniques, combining this with Swedish and holistic massage. She has been working successfully with deep chronically held tensions and contractions as well as with more superficial relaxation.
Jane has a flourishing practice, thanks to her skills and her commitment to her work. She is constantly learning and developing her skills as well as being a warm, caring and lively person; she is also a very good practitioner and has an excellent reputation in her field.
She came to see me in distress, and told me the following story:
"I have been working with Ron for more than a year now and he is one of my regular clients. He would book a treatment once a week, and very rarely would miss or cancel his appointment. Ron is in his 40’s, heavily built, and suffers from chronic tension in his neck and shoulders. Over the years his whole upper body re-organised itself in a compensating posture, and all his muscles, ligaments and tendons were affected. Ron suffers from constant headaches, bordering on the edge of migraines, and when the pain started running down his arms, he realised he needed help and he came to see me.
It was not easy for a man like him to ask for help. He was used to being the provider, the head of the family and the company, but in the anonymity of my treatment room he could allow himself to let go, receive and- for once – be looked after. Gradually, he was letting go into my hands, and without even knowing it, his body relaxed, expanded. He was sleeping better, his headaches were nearly gone, and generally he felt better about himself and his life. I felt very satisfied with his progress,and enjoyed working with him. As time passed, I realised that
Inside this mass of flesh and contracted muscles hid a lonely, sensitive person who – as well as benefiting from the physical care and attention provided through the bodywork – really needed to talk to somebody and to be heard. And I listened. Listening to Ron as part of the treatment just seemed a natural ingredient of what we were doing: as I was gradually loosening up his muscles, freeing trapped blood vessels and opening blocked meridians, he would also loosen up emotionally, revealing the thoughts and worries which came into his mind while I was working. Having received treatments myself, this seemed quite natural to me. But after a while I realised how intense and new it all was for him: he had never talked to anybody like that before, he told me, he had never trusted anybody to such a degree. “You must be very special”, he said, “getting me to talk like that.”
Well, as a matter of fact I did not feel special at all – throughout my life people had shared their hearts with me. However, for Ron it was a profound, and the more I understood this, the more I felt moved by his trust and openness. Ron talked about his life: he was married and had three children. He was running a successful trucking company. He handled many tough guys and tons of machinery. There was an authoritative air about him which said: “I can take care of things. I am in control.”
With the gradual process of his muscular armour melting and his upper body loosening up, some emotional processes of letting go took place, and Ron revealed a softer side of himself. He talked about his memories of the past, about some of his relationships, and about his hopes for the future. It was very moving to see this sensitive side of him, and I felt happy that our work together allowed him to get in touch with this layer in himself.
But once, as he was talking about his brother who died when Ron was very young, he started crying. This intensified and I got somewhat alarmed because he did look out of control, sobbing deeply. He was holding onto my hand and squeezing it too strongly for my liking, but after a while, he got over it and reassured me that he felt better and probably would not need to cry like that again.
He had probably picked up some of my discomfort, but as he conveyed sensitivity to it, I soon returned to feeling at ease with him. I appreciated his concern for me: Ron also knew how to listen, and as he was eager to know about my life, from time to time I shared bits and pieces of information with him, regarding some of the struggles in my life.
Out of this kind of contact I once asked for his help with a tax return I had to submit, and this being an area of expertise which he had dealt with for years, he was very helpful, happy to “pay me back for all the good advice I had given him”.
Lulled by this easy-going atmosphere in our relationship, I did not notice that Ron’s attitude towards me was changing. It started with pleasant comments about my appearance and developed into full-blown compliments which were always given in a respectful, gentlemanly manner. I was a bit disturbed by small presents he was bringing from time to time, but did not want to upset him by rejecting these tokens of gratitude. When he invited me out for a meal or a drink with him, however, I declined, vaguely feeling that it was not a good idea. I felt I had to make some excuses for this irrational attitude of mine because I had no doubt about this being a sincere and honourable invitation.
Then one day he phoned me in distress saying that something had happened and he needed to talk to me urgently, so I agreed to meet him for a coffee.
After that, the dynamic between us changed: superficially Ron was as polite and grateful as ever, but after all this time I had got to know him well, I could not help but notice that instead of relaxing during the treatment, he was actually tensing up physically. Also, he noticeably talked less or not at all. I also felt tense and on guard, not knowing really what was going on, feeling more on more weary during these sessions, and confused after them. I was considering asking Ron what was the matter, but felt vaguely worried about his answer. What if he is falling in love with me? I asked myself. Or worse, what if he is disappointed with my treatment which is not so effective any more? What if he wants to stop, but feels unable and awkward about telling me? I did not want him to leave, but I did not want things to continue the way they were.
I came to see you because I feel confused and powerless and do not know how to handle it any more."
This is Jane’s story, and although she works with a technique which is different from your work as osteopaths, I am sure that those of you who are working with client will recognise some of the dynamics.
What can we learn from Jane’s story ?
In our days, the holistic principle is taking for granted in most complementary disciplines and trainings. We all know that working with the body implies working with the mind, and that most chronic tension and physical symptoms have emotional roots. Many disciplines work with the concept of ‘energy’ and suggest that when the therapist touches the client’s body they influence the energetic system. Some would even say that there is an interchange of energy between client and therapist and vice versa. However, very little is being taught about the actual implications of these abstract principles we all know and believe in. If we look closely into the principle of body and mind being one energetic system, what follows then is the understanding that every symptom picture we are treating – in whatever therapy we are practising – has an emotional component. There is an underlying energetic imbalance and there is a fixed pattern which is simultaneously physical, energetic and emotional. Any attempt to affect that pattern will result in reaction on all these levels. Thus, we cannot expect a successful treatment of any symptom without the emotional component being part and parcel of it.
What will happen when the therapist works with chronic, frozen blocks or tension ? What happens when a client is able to trust and relax ? What can happen when we attempt to challenge an imbalanced energetic system ? The answer is very simple: we can expect a reaction. But from here, things are becoming a bit more complicated because more than one reaction is possible: the client can relax, trust and open up the chronic tension is melting and what was held in and buried underneath can come up: a flood of tears, rage, tenderness, etc, depending on the client’s history and what had to be pushed down and suppressed. The opposite reaction is also possible: the body/mind system is not ready to change its unhealthy equilibrium, as unbalanced as it may be, it is still somehow protecting the client from experiencing greater pain or discomfort which might occur if he is balanced and relaxed. Therefore, with all his explicit wanting to ‘get better’, there is a part of him which is severely threatened by the therapist’s intervention. This part resists by intensifying the symptoms or stubbornly getting stuck.
In between these two polarities many reactions and responses are possible. However, what is common to all of them, is that they always occur in relation to the therapist and to the work.
The client who lets go and allows buried emotion, does so in the session with us. The client who resists, resists therapy and us.
So the complementary practitioner finds themselves in a familiar, impossible position of being on the receiving end of the client’s physical, emotional response to the treatment. It is familiar because every one of us who works as a therapist, know how often it happens. It is impossible because most complementary practitioner were not trained to work with these reactions.
If we go back to Ron’s story, we can see that opening up the physical-energetic system was followed by an emotional opening, an expression of feelings and reaching out. As long as Ron was in control of that and only needed Jane to listen to him, she was able to be there for him, but when a deeper dynamic was provoked and Ron was sobbing uncontrollably, Jane was out of her depths, scared and confused.
He then needed to ‘get a grip on himself’ and reassure her. In some way they switched roles: Ron had to take care of Jane because she could not handle him being so overwhelmed. I am not suggesting here that she should have been able to work with Ron as a psychotherapist and to assist him in addressing his deeper issues. By no means am I arguing that every complementary practitioner needs to train as a psychotherapist in order to practice the discipline they chose to work with. However, my experience as a complementary practitioner, supervisor and trainer taught me that the emotional dynamic is always present, although sometimes not explicitly expressed, and it often needs containment as part of the treatment. I see it as the therapist’s role and responsibility to contain the client and their emotional reactions to the treatment without attempting to engage with it in a way that will deepen the reaction or reject it. I am aware that this means walking a very fine line with inevitable falls and failures, but I am sure that if complementary training programs will include more teaching, both experiential and theoretical, on these issues, practitioners would feel more equipped and solid when these dynamics surface.
Most of my work as a supervisor focuses on the therapist and me understanding together the specific emotional issues of the client, their particular ways of handling of those issues and what happens to that during the treatment and in relation to the therapist. I find that usually trying to understand the client from that angle and of course understanding the therapist’s reaction to the client, helps the therapist to be present with their clients in a different way, we can say a more holistic, therapeutic way.
There are many more aspects and issues that can be discussed in this talk, but for now I would like to address the one that seems most crucial to me: when one hears the above about Jane’s experience with Ron, one cannot but wonder: what was going on for him in relation to her? How did he see her? What were his feelings towards her? What did he do with these feelings, and how did it affect the course of the treatment?
In Jane’s story it is rather obvious: Ron saw her as ‘special’ and developed ‘special’ feelings towards her. Jane did not need to do much, she just listened, but somehow, Ron was able to trust her and open up with her in a way he was not able to do before, even with the people he shared his life with and loved.
Why is that? Was she really so ‘special’?
No, I did not think so. Ron did not even know her, who she really was, how she thinks or feels, all he saw was a woman who gave him nourishment and attention, treated his aching body and was warm and non-judgmental towards him.
How often do we get this in our life? Most of our relationships are based on mutuality, shared perception of our responsibilities and rights as adults in the world. Very rarely we have a relationship in which by mutual agreement and consent, we are in the centre of attention. We are being looked after, nourished, cared for without any expectation that we will reciprocate in a similar way. All the client needs to do is to pay, no emotional ‘donation’ is expected of him. The therapist then is there for him, with him, rather unconditionally. This is a very unique and special relationship, and if we consider the regularity of the session a week over a long period of time, we can understand the potential inherent in this relationship to become powerfully significant for the client.
We can say generally that it resembles the only similar set of relationships some of us experienced before: the child-parent relationship. The client, therefore, develops a special feeling towards the therapist, most of which he is not aware of. Some clients are defended and cut off, and keep the therapist as a distant, kind figure in their life. But many clients develop a certain attachment and strong emotional responses towards the therapist, which has very little to do with who the therapist really is as a person, but more to do with their place of role in the client’s life. They give the therapist a lot of power, they ask their help and advice on problems and conflicts which has nothing to do with the treatment, want desperately the therapist to like them. Many clients want to develop a friendship and many fall in love with the therapist.
All this is based on the therapeutic relationship which, by definition, is unequal and evokes unconscious feelings and reactions.
Unfortunately, many complementary therapists are unaware of that, and like Jane with Ron, walk blindly into an intensifying dynamic. Jane was so confused and lost because she did not realise how Ron experienced her emotionally, what feelings her presence in his life had stimulated and the fact that he does not react to her only on the adult-to-adult level. Had she known all that, perhaps she could have related to him differently and would have been able to contain better his spontaneous, mostly unconscious, surge of feelings towards her. Had she been able to discuss that dynamic with another non-judgmental, supportive professional in time, she would have been able perhaps to find out more about her own emotional reaction to Ron’s attachment, to clarify for herself what had been provoked in her and what were her choices of how to handle the relationship and the role Ron had attributed to her in it.
Unfortunately, when Jane came to see me, the dynamic between her and Ron was way out of control, and the therapeutic relationship was not providing a safe container for the healing process. In our work together, Jane and I reflected on many areas which we considered to be crucial to creating a solid, containing therapeutic relationship: boundaries and how to introduce them into the work,negotiation of the therapeutic contract, i.e. fee, time, cancellations, arriving late to sessions etc. We looked at the client’s physical resistance versus melting and understood how closely these might be linked to the attachment the client develops to the therapist, and how the therapist then can respect this attachment without being too afraid too blindly manipulated by it.
We looked at the sexual dynamic which can arise in that setting and the predictable confusion between therapeutic touch and sexual touch.
Jane is still having regular supervision with me and it is a delight to see her growing as a therapist. From time to time we look back on her work with Ron, and there is still more that we can learn from mistakes that were innocently committed. Mostly, I think, Jane and I came to appreciate the complexity of the therapist’s task and their right to be heard and supported.