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Chronic pain, your clients FIRST visit.

I've just had my most successful year so far with people suffering chronic pain. Thoracic outlet syndrome 9yrs , Migraine 20 yrs , Back Pain 8 yrs and many more.

I wish to state how important your clients first visit is, and how you might attempt to set yourself apart from "other professionals " in the eyes of your new client.

Time
You must allocate extra time to their first visit to enable them to relax and tell you everything thats on their minds in relation to their complaint, stress levels and previous treatments and medications.
You the therapist should fill out the intake form for them, whilst asking the questions on it, so that they can freely engage in conversation without the distraction of form filling themselves. Allow your higher self a free hand to engage/ask the right questions/Empathise with your client. Carefully explain the type of massage you will be doing, its effects and hoped for outcome. Empower the client, make sure they know this is teamwork and that feedback re pressure/pain 1 to 10 is very important. Make sure they are happy they have told you as much as possible related their problems before inviting them to change and get on your couch. = time

On this, the first visit, do not do, a postural/muscle length/strength assesment unless guided/instructed by the client. This may sound somewhat controversial but they already had this done umpteen times before and may associate it with previous failed treatments/professionals or time wasting.
The sooner you can start to soothe their condition and directly palpate/treat the chronic tissues the more quickly the clients confidence will grow in your ability to resolve their condition.

The chronic/depressed client may well be beyond being told they = have hammer toes, leg length discrepencies, tilted hips, scoliosed spine, one ear higher than the other ....! Right now they just want a good nights sleep, less pain, to feel human again ! do what you do best, get your hands on them and get on with the massage. Give them what they are most in need of, time and treatment.

Regards steve

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Comment by Marissa on December 23, 2009 at 9:49am: Spot on, Stephen! This is really great for those that are just graduating and are ready to burst they are so full of knowledge they are wanting to "indulge" in. No offense to the newbies. I was there once as well. :) You have it and you want to flaunt it.
A new gentleman came to see me this year with an extravagant list of medical issues, prescriptions, health professionals, participating in medical "studies", dos and do nots from past treatments, etc. It took a full 20 minutes just for him to finally be able to say, "I think that's it." and be done with the intake. I took it all in, did a quick assessment(sorry) that I kept to myself, and told him that as an "educated guess" (one of my favorite do not diagnose phrases) I believed that he was overly stimulated with everything and that his body was simply stressed out. For 9 months now, he comes in every 2-3 weeks for an hour of swedish massage. No deep tissue, no MFR, no NMT, and nothing except a quick assessment for my personal records. He walks in hunched over his cane, breathing erratically, and shaking like a leaf. He bounces out with out the use of a cane, a smile on his face, and usually with tears in his eyes. Like you said, sometimes these clients just need to be "treated". Not assessed and compartmentalized. Treated.

Comment by Marilyn St.John on December 22, 2009 at 11:17pm: This is very good advice, Steve. I had an experience a couple years ago with a MT who was quite well known locally. She had been practicing for many years and I went to check her out, figuring I could learn a thing or two. She didn't ask me to fill out an intake form, just asked a few brief questions; she then proceeded to spend the first 50 minutes of the 60 minute massage I paid for, doing an assessment...mostly a bit of poking around (no ROM nor strength noted) during which time she just said, "Hmmm" a lot, then suggested I come back in three days for more "work!". Yup, I learned plenty, but I don't think she did!
Good thread here.