I am going to keep this post short and simple, with a followup blog in the near future.
How many therapists (PTs, MTs, OTs, SLPs, etc.) feel they have the training and legal ability, through their professional scope of practice/practice act, to deal with the emotional aspects of their patient’s pain/dysfunction? To define my term “deal with”, I am speaking of moving past a sense of supporting a patient/client when their emotional past or present comes to the surface. I am speaking of purposefully using methods you learned in your schooling or post-schooling to encourage, facilitate, or even provoke emotional release.
I do realize there is a HUGE amount of wiggle room here, as most who were taught emotional work/emotional release (myself included) were told that we never lead, only follow. But in hindsight, revisiting my learning experiences, I can now see there was much more happening than just following my patient’s lead. I believe that the mere suggestion to a patient that they may experience an emotional awareness/release/experience is enough to set forth an an expectation, or even possibly an agenda. Having an expectation for emotional release or seeing my patient begin to emote and acting in a way to encourage them to dive into this emotion exceed my scope of practice. Perhaps even using manual techniques that foster or aim to provoke an emotional reaction is beyond my scope of practice.
Why am I asking this question? It is not fear-based, as some may portray this, but out of concern. I am concerned that therapists who are ill-trained for dealing with true emotional/psychological problems can easily get in over their head. There are reasons why mental health therapists are required to have a minimum of a Master’s degree, with many at the PhD level, to practice mental health therapy and counseling.
I hadn’t looked at mine in a long time. You can look at it here: The Model Practice Act for Physical Therapy
If my scope of practice makes no mention of something, I am not legally allowed to practice it. My physical therapy scope of practice/practice act makes no mention of emotional work or emotions in general.
Does your scope of practice allow you to do “emotional work”? How fuzzy is the line defining ’emotional work’?”
Are you qualified to do “emotional work”?
For now,
Walt Fritz, PT
Foundations in Myofascial Release Seminars
Perhaps we should refer them to Hazelden rehab so they can be loaded with psychotropic drugs and live life as an illusion or worse act on one of the side effects, suicidal thoughts. I wonder what Robin Williams’ family is thinking?
Those statements make no sense, Bob, Hazelden is a drug/alcohol rehab center where people go to get clean. And, do you think Robin William’s family is paying attention to this conversation? Whether or not certain mental health professionals are qualified or not has nothing to do with manual therapists acting beyond their scope of practice. One does not justify the other.
Trying to ‘evoke’ an emotional response is out of the scope of practice of psychologists too. A massage therapist trying to ‘evoke’ an emotional response is not only out of scope, but unprofessional.
Emotional release just happens during massage. Yes I do think it is true that saying it will happen also sets a person up. I have also had others come in under tremendous stress and grief saying that they expect an emotional release to happen but it usually doesn’t. I have also had clients say they went to other practitioners and were warned that there could be an emotional release and they didn’t want to continue with that person as what they were coming for was massage – not emotional work.
The only thing we can do is just be there for them and allow them to process what they need and that shows them that they can handle their emotions.
I have patients come to me after visiting other therapists in town who stopped working with them, saying it seemed that all they were concerned about was the emotional release and that they kept saying that if one does not release the emotions, the pain will never go away. Sad.
Does your scope of practice allow you to do “emotional work”? As a massage therapist in Illinois, NO.
How fuzzy is the line defining ‘emotional work’?” No fuzzy line at all in our MT scope of practice in Illinois. We are only legally able to provide massage therapy for the purpose of general health and well being.
That said, if someone feels better emotionally after a massage, that’s fine. If clients cry during my massage, then I am likely not doing a good job of massaging them! If they cry because they feel comfortable telling me about a fight they had with their sig other, that’s not an emotional release, that is one person sharing their feelings with another they feel safe with. (They may also share these feelings with a friend, a hairdresser or a bartender. But perhaps not with tears if others were around.)
However, if someone in Illinois has any of the non-licensed certifications (Ortho-bionamy, Reiki, etc.) then they can pretty much do what they want, claim what they want and advertise what they want…because our license act was specifically written to exclude those certifications. From what I understand, at the time the Illinois MT license Act was being written, those with a stake in non-massage bodywork were powerful enough to keep their bodywork modalities out of the MT practice act. So in this way, MTs are severely restricted, but if you get a non-MT bodywork modality certification that is specifically exempt in our MT Practice Act, you can be as fuzzy, as emotional-inducing as you like…as long as you do not infringe on another scope of practice such as licensed professional counselor, psychologist, etc.
I had had some “treatments” from bodyworkers who believe their work should include emotional releases and, as a client, I felt an intense pressure to cry, emote, have some sort of emotional catharsis whether I needed it and wanted it or not. Which as a client was invasive and creepy. When I have experienced this type of bodywork, I don’t go back and I don’t refer to this person. Over time I have learned to read the people that have this approach and don’t seek it out. In my book, it is evidence of poor boundaries by the bodyworker.
Are you qualified to do “emotional work”? Actually, I am NEARLY qualified to do “emotional work.” I recently graduated with a masters degree in clinical psychology and once, I pass my national boards and obtain my actual LPC (Licensed professional counselor), then yes, at that point, I will be legally qualified to do emotional work. Would I do it in my massage practice though? NO.
From what I have studied about psychology and counseling, the idea of emotional release is more popular among those who study Gestalt and who are psychodynamically-oriented. CBT (cognitive behavioral therapy) is becoming the main evidence-based approach used in counseling and CBT involves cognitive processes moreso than emotional release. Emotions may be experienced and discussed, but getting someone to emote is not the goal.
Research has shown that emotional catharsis is not only not sufficient for people to heal and adopt healthier behaviors, it can also be tramatizing. This link below is to an article explaining the concept of catharsis and includes much of the psych research notations that are useful in this discussion, including a decent explanation of the difference between psychological catharsis and emotional release. Link here: http://primal-page.com/cathar.htm
I am grateful for you taking the time to share, Sue.
“I will be legally qualified to do emotional work. Would I do it in my massage practice though? NO.”
If I could add one of those smiley faces here, I would.
Walt
A BIG NO. WE ARE NOT TRAINED. We could cause harm and further distress and also are not trained to observe if someone has a more serious psychosis of some type.
In Jin Shin Jyutsu, each depth has an “attitude” when it is out of harmony/balance. For example Fear is 4th depth, Kidney and Bladder etc. “Attitudes” of not in balance, (worry, fear, anger, sadness, trying too/pretense) are also connected with the meridians in acupuncture, and also in Shiatsu. All NYS LMTs are required to study Shiatsu, as there are questions on the state boards regarding such. BUT these attitudes of not being in balance are only an indication/clue of the imbalance (not balanced) of that depth and part of the puzzle in figuring out how to help the person. What in Jin Shin Jyutsu is called the order of the disorder. But this is different than observing and addressing the WHY of the clients “fear” in a psychoanalytical mode.
The depths all have an effect on each other. In JSJ we call it burdeners, supporters, energizers. So if someone is a worrier for example, it could be the result of the fourth depth (fear) not energizing the 1st depth (worry). Often if the 2nd depth (lung, Large Intestine–sadness) is out of harmony it can burden third depth (Liver/ Gall Bladder–anger). This is in interesting if you think about the grief process. In Shiatsu, and acupuncture the understanding of how the meridians affect each other, the charts are slightly different than in JSJ.
Once I get my degree in psychology I am within a licensed capacity to address these issues. As an MT…not at all. Should any SOP Act mention emotional work I imagine it would be challenged by local Psychiatry and Psychology Boards.
As an Ashtanga teacher we do discuss the emotions and mental states of the body, but only as a philosophical discussion within the yogic framework and never as part of any kind of therapy. Those who do I would believe are ethically guilty of practicing psychology/psychiatry without a license. This very topic came up in my Psy class two days ago, as the doctor sought to phrase “Yoga teachers who think they know what they are doing” politely as not to insult me (I quickly assured her my agreement).
Emotional releases happen in many ways during body work. Sometimes it is a release of heat, a softening off the tissue a deep, cleansing breath or a flood of tears. If the release is deeper or more traumatic then the client should be referred to a mental health practioner. I am a CranioSacral therapist and have a degree in psychology, so I may be trained a little more with dialoguing with the client through a release of trauma. There is specific training through the Upledger Institute called SomatoEmotional Release that is specifically for helping the client work through “energy cysts” in the body that were formed through some kind of trauma. So, it really depends on the therapist’s training and the client’s trust and willingness.
Thanks, Trisha. Training through an established school/facility, such as the Upledger Program prepares a therapist for this work, and I respect programs such as these. But, does that make an MT/PT/OT qualified, or legally able, to do this work? There may be no perfect consensus in answering this question, as people interpret their scopes of practice in many different ways.
No, I am not qualified, trained nor pretend to have an understanding of the psychological effects of the work that I do. In the ten years that I have seen clients and patients, I have experienced quite a few that have exhibited one form or another of an emotional release. There has never been a spoken word exchanged when confronted with a client/patient. My training explicitly instructed me to remain still and let the emotion take its course. As Trisha noted, the client’s trust is at stake here; to involve yourself in an area we are not trained/certified/credentialed is unethical.
LMT & Upledegder trained, my thought is yes if my training qualifies me to do SamtoEmotional release then Iam leagally allowed to do emotional work and to advise clients that it is a possablity for emotions to be release. Now that being said it’s much more facilitation then interaction with the process. It is important that I do not give opinions or direction on moving forward and just allow the unwinding. Tears, stories, laughter ect. are very therapeutic responces and are normal. I’m also quick to refer to Talk therapies for clients requesting emotional work, in NY those types of therapies are Hands off so working in tandem has a maximum benefit to the client.
Hi Patrick, At times I work in tandem with a licensed mental health therapist and it is quite powerful. Touch can be a great facilitator. I am curious, though, if training in this constitutes legal ability/permission under your practice act?
You can’t put your hands on someone withing evoking an emotional component. The cart is dragged along by the horse.
Each of the zillion therapeutic approaches has its own ‘belief system’. Being well trained and deeply experienced is how we come to be ‘expert’ at any one system. Becoming expert at one system does not make you an expert in another, even if similar.
Technically, trying to wander into a theoretical realm you have not been trained in takes you outside your scope of practice, and so not having trained in psychology or at least some kind of accredidation with talk therapy certainly would exceed most PT or MT training and thus scope of practice.
Being present during any kind of catalyzed emotional component and allowing it to move through seems essential, but that doesn’t mean you start asking how your client feels about that. This is the realm of talk therapy and is an integration of analytical mind and emotions all mixed together.
Conversely, a talk therapist is not trained to perform manual therapy and would be equally outside their scope of practice working with soft tissue. Nonetheless, their therapy would have physical results as well. That doesn’t mean they have crossed boundaries.
Stick to what you’re good at, leave the rest to others.
Well said, Chris.
I do not feel that my LMT license, or even my NCMMT certification gives me the tools or qualifications to help someone though an emotional release if they have one. But due to the nature of this work, and the fact that I am treating many people who have been injured in auto accidents or other traumatic ways, they do sometimes show up. Not having the time or financial resources to get a degree in psychology or psychiatry, but wanting to not feel completely out of my depth when they do, I decided to study clinical hypnotherapy and EFT. I am now certified in both, and advertise neither. But when emotional issues do come up, (and I do not set it up that way by telling my patients that it might happen) I feel that I at least have some tools to hold the space for them to process it themselves.
It is wonderful you dove deeper for the extra training.
I will ask again to you, as I did previously, if training in this constitutes legal ability/permission under your practice act? I do not know the answer myself.
new website coming.
Seems like most of us are on the page to allow and not guide. I do believe the legal line is fuzzy. Listening is not TALK therapy. Telling someone to expect an emotional release seems like it would cause tension, but to let them know that tissue does hold memories and give them permission to feel whatever they feel… is NOT emotional therapy. Just permission. ( and they do not have to share the memory or the feeling, they can just FEEL and hopefully release) but how do I know if they released it??? I don’t. I just allow the process to carry on and continue the work that I know how to do. As I teach movement as well, there are times that certain work (psoas for instance) can bring all kinds of reactions. Again, let it happen instead of directing or making suggestions.
So, do we do emotional work? Can it be separated?
I think we just have to keep our own opinions out of it and not counsel. If they need counseling send them out or if you are educated in that, then make a separate appointment. Just giving the body time to do its own work in a body “work” appointment might be just what they need.
That’s my 2 cents.
Best to you all, everyone is giving something through the passion of their work.
Hi ZoyaMarie, I agree with so much of what you’ve said here. I will take issue with a commonly spread misconception. It is a wonderful thought that the tissues hold memories/feelings, but this is not accurate. No doubt, when we work with people they often experience emotional responses, but this is a far cry from saying the emotions lie in the fascia/muscle. This myth is perpetuated by many, but memory/emotions are a process of the nervous system. Saying that does not impinge upon our effect, it is just more accurate.
I realize this is a very contentious topic and many have differing views. I believe we all come in to this work (manual therapies) with noble intentions and if we have taken classes in emotional work, see ourselves as that passive listener. Most times there is no one looking over our shoulders assuring any rigid laws, boundaries, and rules; we just behave. But slipping past a passive listener role into emotional trauma work is such an easy step for many. If we see it demonstrated in class we see how easy it appears and how apparently beneficial it is for the client. When a client presents an opening as we saw demonstrated in class, it is just way too easy to give it a try. What is the harm, right? Despite what you have been told, there are risks, both to the client, who is being treated by someone who has little real training in mental health, as well as for the therapist, who risks loss of career and worse.
While writing this post I came upon an 11 year old article written by Ben Benjamin and Cherie Sohnen-Moe which I believe puts much of this into perspective: The Ethics of Touch, Part 3