Recent client. Middle-aged. Overweight. Single parent. Stressful job. Financial struggles. The weekly massage is the best part of the week, hands down.
Mentioned that in recent visits to both the chiropractor and the physical therapist they directly and indirectly mentioned weight and that the client needs to lose it. Client said "you have no idea how I feel when someone says that. I feel like they're saying 'you're bad, you're broken' and I just don't need to hear that!"
And I said "And that's why you will never ever hear me 'advise' you about your weight."
I've talked about this in some online forums before. I think it is tricky (at best) and irresponsible / way outside our scope of practice (at worst) to engage our clients, unbidden, in a conversation about their weight. I have very little to say about it even if the client starts the conversation.
1. I am not professionally trained in weight management. In my massage room with my clients, I am the professional. There is no way to have that conversation and not have it be perceived as coming from a "professional".
2. I do not keep up with the current research or medical literature on weight management. So anything I say is extremely likely to be out of date, at best.
3. I get most of my info about weight management from the same places my clients do -- the internet, TV, newspapers, and my doctors (who, frankly, aren't up to date on this either). So I've got nothing new to add to this conversation.
4. My personal experience is just as confusing and frustrating as the client's.
5. I've yet to meet a client that didn't know if they were overweight (and didn't feel sh***y about themselves because of that sometimes). Every one of them knows at least as much as I do about weight management.
6. I don't want to make someone feel crappy about themselves unless I'm 100% certain that I can give them something useful to counter-balance the crappy feeling. When it comes to weight management, I can't. I cannot know how someone will hear my comments about weight management and it's not worth the risk.
7. People are coming to me as a massage therapist. Not a dietician. Not a nutritionist. Not an MD. Not a naturopath. I don't comment on their thyroid levels, their liver functions, or their visual acuity either because these are outside my scope of practice and I don't know enough about to discuss intelligently.
But (you may cry) we're health care professionals! There's an obesity crisis in this country! Don't we have an obligation to say something about that?!?
If we're not trained, not current on the research, and getting our information from the mass media then NO we should not say anything. That's not what a professional does.
And why am I talking about this in a blog about business and massage? Because it pisses me off.
It makes me angry when I'm quizzed or lectured about my weight by a massage therapist who barely knows me (the ones who do know me know better than to say anything).
It drives me nuts that some MTs think calling ourselves "health care professionals" gives us license to talk about anything we want to.
But mostly because I heard the frustration in my client's voice, I saw the pain on my client's face, and I know enough about my client's life to know they really are, honest to God, doing the very best they can with the resources they have. They deserve to be treated better than that. All our clients do.
Very good points! I am also an ACE Certified Health Coach, but when I am in my capacity as a Massage Therapist it is out of my scope to give advice on weight management. My other certifications do not apply to my position as a therapist and employee.
ReplyDeleteI have had clients feeling crappy about things other professionals have told them about their weight, when they are trying their best to make changes. Makes me want to say "Ah screw 'em....let's have a deep breath and a great massage!!" Admittedly the clients I know very well DO get that response, haha!
Well, I'll begin this in this way: Being a massage therapist living in an extra large body, I have a different opinion on this than you. And being very sensitive to the things you said, about you, and about our work, I still have some things to add.
ReplyDeleteI think you are correct, it is not in our scope to offer advice about 'how' to lose weight, if we are not trained for that. However, I disagree about not talking about that if we are 'just' a massage therapist. I think it's totally within our scope.
Advise unbidden? That seems to me to be the turning point on this.
Many of my clients come to me with pain, in their hips, low backs, lower abdomens, mid back, upper back, shoulders, and neck. I have been trained in the relationship between muscles and skeletal structure, and, to a degree in kinesiology (actually those are both the same thing, but I'm trying to sound intelligent here), and if someone comes to me with any of those issues and asks what can they do about it, I feel a responsibility to educate them about their pain, and about the possible causes. Often pain in the larger joints- knees, hips, ankles- can be alleviated by relatively small amounts of weight loss, 5 lbs. Most people don't realize that, so they don't try. When someone carries belly weight, as I do, that pulls on the spine. That's often going to create low back pain. I think helping people to understand that relationship is responsible health care for them.
If I've built a good relationship with my clients, and we trust each other, then I'm going to be able to have a gentle conversation with them about cause and effect in their body. Would I neglect to talk about stress and it's effect on the body. Probably not. Stress is acceptable to talk about. It's not a 'sensitive' issue. But weight? Ohhh baby, that's a tough one. No one wants to talk about that.
No, we are not trained to talk to them about how, but can I have an available resource list that I can share if they want information? You betcha.
And Kelly, if you had a weight thing and it was affecting your body comfort, I love you enough that I'd talk with you about it. But we'd do it gently, and you wouldn't feel judged. You'd feel cared for.
And I think that's the difference. Finding a way to put myself on the same side of the table, instead of across the table, so that we're sitting together.....that's the difference between doing therapy and being a therapist.
Lol, my daughter wrote in her blog last night, and said that they hardest part of writing is beginning and ending. She's write.
I'm done.
Thanks.
And then there are the spelling issues. Last paragraph- the, not they, and right, not write. More coffee?
DeleteMore great points, tough issue! I will freely admit that, because I am an employee, my situation is much more restrictive in terms of advice I am allowed to provide on many things. So I just tend to keep it quiet.
ReplyDelete