As a physical therapist, I face certain expectations when a client first comes to see me for treatment. When they walk in my treatment room, a few may look around, wondering where the exercise equipment is hidden, as my room is a 9’ X 13” room with a massage table and little else. But most have been prepared in advance that their experience at my clinic, the Pain Relief Center, may be quite different than what they may have experienced in the past with other physical therapists. How did I prepare them before they walked in my door? I set the tone before they ever met me, both through the information contained on my website and through the packet of information they downloaded from my website (or I emailed to them prior to their first visit). I long ago changed my client’s expectations for what physical therapy can look like, as I had already changed that expectation for myself. People are referred to me due to my skill set; I am quite good at reducing/eliminating pain. My business name sets that intention and my website reinforces that fact. My referral sources speak of my skills and clients typically come to see me showing little shock at the altered nature of my physical therapy practice model. But what about you and your practice; is it time to change the rules so that client expectations are realistic?

Massage therapists make up a good percentage of the folks who take my Foundations in Myofascial Release Seminars and many of these therapists speak to the expectations that their clients hold. Expectations include; using oil/lotion during sessions, being relatively undressed under a drape sheet, and having the entire body attended to during a session. These expectations are valid, as this is the mindset of many when they think of massage therapy. But are your clients (or you!) so rigid that they are not willing to bend these expectations? If they are coming to you for relief from pain in an isolated area, does the elimination of pain in this area take precedence over the desire/expectation to have the entire body addressed in a single session? Is it you, the massage therapist, who is feeding these expectations? Are you simply unwilling to change the rules?

Myofascial release (MFR) tends to be considered a “dry modality”, contrasted with wet modalities where a lubricant is used. While there are exceptions to this generalization, most forms of MFR are performed on dry skin. MFR happens to be one of many very good modalities for the relief of pain and the improvement of function. Your license, as a massage therapist (or PT/OT/SLP), allows you to utilize a wide range of modalities and techniques, all which fall under the category of having a “license to touch”. My clients come to me to rid themselves of pain, no matter my choice of modalities. If you have skills and tools at your disposal to help meet your client’s goals, it may be up to you to change their expectations. Education is the key to all of this and it is your duty to educate your clients.

Here are some things you can do to start changing the expectations of your clients:

1. I am a strong advocate of having a website to allow potential clients to find you and learn about you and your practice/goals. I began my do-it-yourself website in 2005 and allowed it to develop over the course of a few years. In 2010 I paid a website designer to craft me a more professional looking site that links together my private practice, my seminars, and my blog. My website begins to lay out the expectations for my clients, whether they are interested in becoming a client or interested in taking one of my seminars. If you don’t have a website, get one, even if it a free one-page site provided by the various professional organizations. Your website’s message should not be about what modalities you use or who you trained with; it should be about what you can do for a client. My original website was a painful attempt at trying to convert the masses into believing that MFR was the greatest modality out there, and I went into great detail discussing why I thought it was so, including old worn out explanations of how fascia is the primary culprit responsible for most pain. People don’t care about this. Most, including myself, are somewhat selfish. I care about what you can do for me, not how you will go about doing it. I care that if I have a problem, you are the person to see for this problem. Later, I may ask about how you go about doing this (the modality), but not at the onset. If I cannot find out what you can do for me in the first few seconds of reading your website, I will move on to the next person’s website. What is seen when they first land on your website is key. For more information on this, please check out a post I made titled Above The E-Fold™.

2. If someone is coming to see you for your expertise, then tell/teach them what they will need to do to allow you to be most effective. With MFR, I am best able to work when a client is wearing shorts and a tank top or T-shirt, rather than them being fully clothed or undressed under a drape sheet. My introductory materials outline this need, as well as why it is important. I tell them to bring along an appropriate change of clothing to facilitate receiving the maximum benefit from my services. Additionally, I keep a drawer full of shorts and tank tops of various sizes, in case someone forgets their “uniform”. Educating your clients that having a drape sheet to maneuver around/over their undressed body may not be in their best interest is important to set expectations, both with MFR treatment and similar modalities. I tell them what I need in order to do my job and best meet their goals and that these are my expectations. If the person is seeing me based on my reputation, etc., they typically have no trouble working within these expectations.

3. Opinions vary widely as to how best accomplish pain relief, as is evident by the large number of named modalities available to each of us as manual therapists. With the type of myofascial release I practice and teach it is not necessary to treat the entire body or both sides of the body in order to reduce/eliminate an issue. However, if the commonly held expectation is that a client will receive a full-body treatment, then this expectations needs to be addressed before treatment is commenced. You can actually take care of this issue before you ever meet this person by including the information on your website and new client handouts. My handouts have a number of purposes. They collect the basic demographics I need in order to treat a person. They also set the rules in terms of my cancellation policy/No-Show policy. New clients read and sign a release, stating that they will abide by these rules. Set your expectations early on, through your website or handouts, so that there are no surprises or disappointments. If someone comes to you for a longstanding issue, neck pain for example, and after you have performed your evaluation, take a moment and ask them how they would like the session to flow. If the neck is their primary concern, ask if they have any objection with you spending the entire session working the neck issue. If they have issues with this, they need to let you know and not be mad when the session time is up and you have not gotten to the rest of their body. Set the expectation.

4. I am very punctual with my sessions. I start on-time 99% of the time and I finish promptly at the originally scheduled time. In my new client handouts, I state:

An appointment is a commitment to our work and a contract between us. On rare occasions we may not be able to start on time. This is usually because a treatment is taking slightly longer than expected. For this we ask for your understanding and assure you that you will receive a full treatment. Also be assured that at some point if you need a longer session, you will always be afforded the same consideration. In order for all of this to work, you need to be on time for your appointment. If you arrive late, your session will need to end at its originally scheduled time with the fee equal to the original length of the scheduled session. If you need to cancel, please call as soon as possible so that I can attempt to fill the vacant appointment. A 24-hour notice is required for cancellations to avoid payment of a $50 fee.

We teach people how we wish to be treated, both professionally and personally. I believe in firm, clear boundaries in all aspects of my practice. I expect you to be on time. If you are late, I will not extend the session to give you the “extra” time. I expect the full payment, whether or not you received the full session. If I am late starting, you will receive your full session length. Some may feel this is harsh. I feel that it is about having good boundaries.

5. Be clear with your intentions and always get verbal permission. At times I will wish to place a hand in areas of the body that may be misconstrued by someone not knowing my intentions. If I need to place my hand in any area where there may be questions, I will always:

a. Tell them what I am hoping to accomplish
b. Tell them where I will need to place my hand(s).
c. Ask for verbal permission and wait for the reply.
d. I use simple language and layman’s terms. My client may not know what the sacrum or sternum is, so I will both use layman’s terms (tailbone/breast bone) as well as point to the area on myself or them.
e. I speak clearly and with confidence. Client’s easily pick up if you sound shy or timid.

I speak at length to this topic in a blog post (here). During any of my Foundations in Myofascial Release Seminars, I ask therapists to practice wording these concepts with their lab partners throughout the seminar, in order to take the awkwardness out of the interaction.

“In order to try to reduce the tightness/pain in your lower back, I would like to be able to place a hand directly under your sacrum/tailbone. It is not necessary for me to be directly on your skin. Are you OK with this?”

This interaction becomes quite easy, once you have done it a few times. It takes any ambiguity out of the situation, protecting both you as well as your client.

If you work for someone else, many of these topics may be non-negotiable. But if clients come to you for your expertise, you may have a say in these matters. If that expertise includes MFR, you need to change the rules that your client believes exist. It is in their best interest to change their expectations, if they are interested in being helped by you. Don’t be shy about changing the rules. It may take some time before you are confident enough with MFR (or any other new modality) but act now to change the rules/expectations. It is your practice; treat it as such.

How do you set expectations?

Do you state the “rules” of your practice upfront?

For Now,

Walt Fritz, PT

www.FoundationsinMFR.com

Check out my New Patient Information here to compare it to your own.

Author: Walt Fritz