Somewhere between Nocebo and Depressing
I had a very interesting session the other day with a new client. When I addressed her presenting symptoms, she shared with me that she had seen another therapist in her home city. Since she was coming from more than two hours away, I was concerned about follow up sessions. By the look on her face, I could see her hesitation.
“Is that therapist not very skilled?” I asked.
“I think she has pretty good skills,” my client replied.
“Perhaps seeing that person for follow up sessions might make more sense than adding the long drive to see me. I can write down exactly what to treat.”
Again, I could see her hesitation.
“Actually, I’d rather just drive here. I don’t mind.”
After further conversation, the real reason she did not want to see this therapist was revealed. This therapist spent the whole session going through a checklist of things that were wrong with my client. Hips that were “off”. Hamstrings that were too tight. Pronation of her feet. Tightness here, structural misalignment there. My client said that the whole experience was thoroughly depressing. Thinking that the therapist would have gotten it out of her system, my client went back for a second session. Nope- even more reasons to wonder how she was even functioning and taking nourishment. My client decided never to visit this therapist again- even though her skills were better than other therapists she had seen.
The question remains: For whose benefit is all this information? Is it for the client? I don’t think so. I think it is for the therapist. I will let you surmise the reasons, but it is surely not for the client’s benefit.
Shouldn’t the client know what we are doing? Yes, and. . .
If the client presents with a pelvic distortion, should I tell them that? Maybe. On the other hand, if I can address muscles and change the distortion in ten or fifteen minutes and make the treatment feel relevant to his/her back pain, do I need to? Do I absolutely know that this distortion is causative for their back pain? (I most often don’t.) My fear is that they hear the word distortion and now think that the problem is serious and permanent. I’d rather change it than talk about it. If the pain goes away, what they will know is that “that guy” seems to know his stuff. Perhaps that is enough. If the distortion is gone but the pain remains, the distortion wasn’t relevant anyway. The whole discussion would have been a waste of time and they might worry about something that isn’t a negative. (This is the nocebo effect- the opposite of a placebo. While everyone seems to understand the power of the placebo, the opposite effect is just as powerful. We need to treat it with care.)
I have many clients who really want to know every detail and ask a copious amount of questions. I live in a very educated community and many of my clients want to explore the possible mechanisms and reasons for what I do. I really appreciate a client being fully engaged- wanting to know what I am doing and why. I answer every question fully and explain the paths we explored and the ones we left untraveled. It is an honor to do so.
As long as it is for their benefit, not mine.