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It’s OK if your clients don’t get better

Have you ever had a client that, no matter what you tried, they just never improved? How did that make you feel?

If you’re like a lot of massage therapists I’ve met, you might feel disappointed, which is ok, or you might feel like you’ve failed, which is not ok.

Getting overly attached to client outcomes is a fast track to burnout

It’s one of the signs of countertransferance. It is not helpful to the client/student. It is not helpful to you. So just stop.

What is countertransferance?

Countertransferance occurs when a therapist becomes emotionally entangled with a client. An example might be when you consider your longest, most regular clients to be your friends. This happens more frequently than you think. Unfortunately, many therapists have learned, the hard way, that that ‘friendship’ was a one-way ride. The client doesn’t consider you a friend, just a great service provider.

Ok, so now that we’ve reviewed countertransferance a bit, how does it apply to clients who don’t get better? Or, more specifically, to how we react when a client doesn’t get better.

We’ve all had that client. They come in hurting. They’ve tried everything. They want to try massage, because it worked for a friend. You’ve treated them a few times. You’ve tried a few different techniques. They’ve done their homework. But they just aren’t improving. You’re both a bit bummed. If you’ve had this happen and your response to the client, and yourself, is:

Sometimes, massage isn’t the answer

you have good boundaries and a healthy attitude towards your client and their health.

If you get angry or disappointed, then you probably have weak boundaries and an unhealthy attitude towards your client. If you begin to doubt your abilities as a massage therapist or the effectiveness of massage as a treatment, it’s likely that you are too emotionally attached to your client and their outcome.

Yes, we all care about our clients, that’s not the issue. The problem is when you get overly attached to, or emotionally invested in, the outcome.

This blog post was triggered by a status update from Pam Slim, of Escape From Cubicle Nation. Pam is a business coach and had just posted about a client’s success and how happy she was. A bit of back and forth and Pam wrote this:

To clarify what I mean by attaching to outcomes, it is easy to get caught up in your client’s goals and attach your value and worth to whether or not they achieve them. This is dangerous because then you tend to assume ownership for something that is not really yours. That said, I love totally caring about my clients and their goals, and do everything I can to empower them to reach their own goals. – Pam Slim

In 2 sentences, she said everything I spend about 10 minutes trying to explain during ethics classes. Your client’s goals, failures, and successes are theirs. Not yours. You can support them. But when their outcome affects how you feel about your value and worth as a massage therapist, you can end up hurting yourself.

It’s our job to provide the best, correct massage we can. If your client isn’t seeing any improvement, then you should be referring them to another health care provider for a more detailed evaluation and diagnosis. Sometimes, that pain they are having is not muscular. Sometimes, the cause behind the pain requires a different treatment. Sometimes, your technique isn’t the right one for their problem.

It’s ok.

What’s not ok is to let this affect how you feel about your skills, yourself, or your profession.

I’ve talked to massage therapists who have been so disheartened when a client fails to improve that they consider leaving the profession.

“Nothing I do makes any difference.” Did you do your best? If yes, then let it go. Don’t give up or think yourself a failure just because there was someone you couldn’t help.

Sometimes, you can be a great massage therapist, but not the right massage therapist. Sometime, you can be the best massage therapist, but massage isn’t going to help their problem. If you let their outcomes affect how you feel about your massage, in both cases you are going to devalue your skills. Feel badly enough about your skills and, eventually, you’ll quit believing in yourself. Quit believing in yourself and you’ll burn out and drop out.

Trust me, it happens.

Have you ever had this happen to you? How did you deal with it? Let’s hear it in the comments.

You'll find this filed under: Ethics

8 Responses to It’s OK if your clients don’t get better

  1. Thanks for writing about countertransferance. But sometimes the patient is not getting better is your skills. I get most of my referrals from other therapists because my tool box has more in it than most. Yes there are patients whose emotional issues are manifesting their physical pain. But deep tissue does not fix everyone. If you are not getting results refer to a more experienced therapist and take more classes.

    • Taya – you’re right that it might just be that I don’t have the right techniques to help that client. Knowing when to refer a client out and, especially to whom, is an important skill. Having someone like you to refer people to would be a tremendous asset to every therapist and their clients.

  2. Hi Kelli. What an incredible post, and well-timed for me. The more people I see at my office, the more self-important I am tempted to feel: “Wow, look at all the clients I have! I must really know what I’m doing.” Then, when inevitably I’m not helping as many people as I would like (i.e. everybody all the time everywhere ; ), my ego goes from super-inflated to super-deflated.

    Bottom line: I am there to help my clients. Sometimes I blow their minds. Other times, I am treading water and wasting their time and money if I’m not referring them out or adjusting my technique.

    We (massage therapists) may have the tendency to have an overweening sense of our powers. Other healthcare practitioners refer out all the time: so should we.

    • “Other healthcare practitioners refer out all the time: so should we.” This is it in a nutshell. One of the things I like best about my primary doctor is that he seems to know the best specialists in town and he’s not afraid to refer out when needed. Sometimes, it’s not what you know but who you know. We can’t know everything.

  3. Thank you for this. I’m glad I took the time to read it. I feel this way too often – being hard on myself as a therapist when I can’t “fix” someone. I think I should go back to school, to re-take my massage classes because I can’t remember certain things. Continuing Education is great, to add new skills to my tool box, but when I doubt my skills, I wonder what classes I really should be taking.

    • CE classes are always wonderful, but sometimes the client’s problem can’t be solved with massage. Period. Sometimes, there’s an underlying issue that needs to be addressed. So don’t get too disturbed if a client or two doesn’t get better. Just refer them out.

  4. Kelli, AWESOME post! And I love what you said about referring, and knowing WHO to refer to. Sometimes it might be to another MT, and sometimes it may be to another healthcare professional. One of the things I am very clear about with my clients is that it is not my job to “fix” them. With clients who have had long term, chronic pain, especially if it has impacted their lifestyle and activities, we talk from day one about “what you plan to do with your time when you are out of pain.” Some folks need their pain, for whatever reason. I learned the hard way to let them go.

  5. Kelli, thank you for your thoughts on this subject. I have had the incredible opportunity to work with a chiropractor and an acupuncturist for 15 years. I often recommend clients add another therapy that is appropriate along with massage. Most of the clients I have suggested this too have good outcomes and feel very supported by the practioners or “team” they have chosen.

"Dream large, laddie!" - Local Hero, 1983