How Massage Therapists Execute a Whole Session with Established Clients

Luann Drolc Fortune, Alumna, Fielding's School of Human & Organizational Development (2012)

Despite recent scientific contributions that evaluate massage therapy's clinical efficacy, there is limited research that explores how massage therapists (MTs) construct their work and exercise clinical reasoning. This study explicates how some MTs understood their work process. This foundational understanding can contribute to improved translational research design in massage therapy studies. To identify fundamental assumptions, this exploratory, in-depth study examined how 10 MTs executed a whole treatment with established clients. Ethnomethodology and phenomenology principles framed this qualitative study. Data collection occurred by videotaping sessions, replaying videos to prompt stimulated recall, audio recording participant interviews, and analyzing researcher fieldwork journal entries. Computer assisted analysis identified patterns for thematic interpretation.

Analysis identified shared tacit understandings that were fundamental to the MTs executing their work: a) therapeutic massage is primarily biomechanical, b) safe touch was prerequisite, c) multitasking was not allowed, d) the work was physically risky for the MTs, and e) massage affects multiple systems. Shared basic commonsense knowledge also guided the work of these MTs: a) the MT imagined the intended point of contact, b) the client controlled the physiological release, and c) the work was inherently educational. Within with these commonalities, the findings further demonstrated that the MTs operationalized their work in highly individualized ways. In addition, the individual client relationship was critical to designing and evaluating the session’s effectiveness.

While massage is often viewed as a biomechanical intervention, the MTs studied understood their work in multiple ways in addition to muscular-skeletal parameters. One interpretation for the complex findings is that work of these MTs gravitated towards two dimensions: the physical and the symbolic. Both dimensions interacted synergistically, resulting in increasingly sophisticated constructions of the work. When both dimensions intersected, the MTs and their clients believed that the work expressed its full potential.