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Some issues I am not sure how to handle with a client
I recently started seeing a client, she actually seeked me out from a friend that referred me because I went to her house to do a massage. I am not a mobile massage therapist, I am really not comfortable going into other people's homes, so it is not a regular practice of mine. I decided to do this for her because she needs massage due to a rotator cuff surgery and the therapist she was working with previously couldn't accomodate her schedule. She likes to be scheduled early morning on weekends and late evening during the week. ( I know late evenings during the week is normal because of people's work schedules)Since my finacee and I have had financial problems I went back to a full time job that is 9-6 so I figued that these times would be acceptable, I had no idea the taxing on my family it would take though. That being said I have 2 issues I am unsure how to handle, professionally and personally.
Professionally: She has been ordered by her dr to have another round of 12 sessions. Her insurance/workmans comp is paying for the sessions. In the month I have been working with her (2 times a week) I feel I have made very little progress and this is due to her not letting me do what needs to be done. I try to work within her pain threshold, however the slightest touch sends her jumping so she then askes for a "light" massage. I have explined that what the dr is asking for,may be a little uncomfotable to start off but in due time that will ease off, so we have compromised at working 40 minutes deep tissue and then 20 minutes swedish so she can have the relaxing effect as well. I am torn though because I am not being paid by workmens comp to do relaxing I am being paid to provide a therapeutic service. I am also wondering if it would be out of line to contact her previous therapist to find out what she was doing to help her and if she was able to achive release in any of the affected areas. I feel like everything I have done is not helping and am wondering if I need to insist on the full hour to do therapeutic.I feel like I am rushing the warming of the muscles to work deeper faster and even the warming of the muslces is difficult because the slightest amount of pain she asks me to back off.
Personally: I had to reschedule a session with her because my youngest was sick with the flu, we wereup all night and this was one of the early morning sessions. She asked me if I ever needed to get in touch with her to use her cell number and calling or texting was fine, since my daughter was laying right next to me and had finally fallen asleep I opted to text. I finally fell asleep as we were not up and down anymore to then I awaken to her texting me asking why I wasn't there yet. She apparently did not get my text and proceeded to get after me through texting back and forth. Now I understand the frustration, I should have just picked up the phone and called. I feel that she has no regard for the fact that I had a family issue that I needed to tend to, because she demanded that I come the following day right after I get off work. She also talks on the phone while on the table and I am trying to massage, I feel like she is crossing my personal boundries
I really do not know how to handle either situation, please feel free to give me some advice and be as honest as possible. I need constrctive critizism at this point. This is the first time I am dealing with a workmans comp type thing, so I am not even sure that the proper things have been done in that aspect. I wonder if I should be in touch with the Dr, or if I should release her as a client since I feel we have not made any progress. I am stressing about it to the point that I am dreading her sessions, and I know that is not healthy.
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Replies to This Discussion
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Permalink Reply by Lavinna V. Rendon on
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I just want to rephrase that first sentence, I don't like the way it sounds. " I just recently started Working with a new client"
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Permalink Reply by Jimswife on
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I would see about getting in contact with the previois therapist and her doctor. Ask questions. Have you seen her "script"?
Honestly, if it were me in your shoes I would refer out. For many reasons. But the main ones being: 1- you are already dreading the sessions. Making it difficult for you to be client centered. She isn't being respectful of you or your time. This will just continue to cause feelings of resentment. 2- you haven't been able to make further progress with her because of her tolerance. And basically her refusal to let you do the work that needs to be done. It seems like she is wanting Swedish not the therapeutic massage hat she needs. Making me question her desire to get better. (because of being a comp case.... Thinking disability, bigger pay out and more time off work). Is she workig with a physical therapist? You would think that the doctor would have her doing therapy. 3- this is taxing on you and your family. It's stressing you out. Is it worth it?!? Doubt it.
Honestly, if I was in this situation I would release her as a client. Even if I don't have someone to refer her out to. Let her doctor make suggestions.
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That is one thing I have not seen yet, is ther script. She was working with a PT however they released her. You make a great point, I hadn't even thouight along those lines, her desire to get better. And you are even more right, I cannot be client centered, I am supposed to have a session with her tonight and even told myslef, I need to let go of this issue so I can have a clear mind while working on her.
As far as getting in touch with her Dr, do I need to contact him directly or does she need to give him permission to speak with me. Like I said this is the first time I have had this kind of situation all around, definitely a learing experience.
Jimswife said:I would see about getting in contact with the previois therapist and her doctor. Ask questions. Have you seen her "script"?
Honestly, if it were me in your shoes I would refer out. For many reasons. But the main ones being: 1- you are already dreading the sessions. Making it difficult for you to be client centered. She isn't being respectful of you or your time. This will just continue to cause feelings of resentment. 2- you haven't been able to make further progress with her because of her tolerance. And basically her refusal to let you do the work that needs to be done. It seems like she is wanting Swedish not the therapeutic massage hat she needs. Making me question her desire to get better. (because of being a comp case.... Thinking disability, bigger pay out and more time off work). Is she workig with a physical therapist? You would think that the doctor would have her doing therapy. 3- this is taxing on you and your family. It's stressing you out. Is it worth it?!? Doubt it.
Honestly, if I was in this situation I would release her as a client. Even if I don't have someone to refer her out to. Let her doctor make suggestions.
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I am not sure about how to contact the doctor. I work in a chiropractors office. So I have access to their chart and can talk directly with the doctor and the PT.
I would request a copy of her script from her. I would think that the script would have specific information about what the dr wants you to do.
You have me wondering... How are you getting paid? directly from her? or are you waiting for payment that may never come? I am wondering if you can be paid without the script? (Does she really have one?) Doesn't it have to be approved by the work comp? Otherwise couldn't she just go where ever for a massage and submit the bill to get reimbursed? Do you know the other therapist or where she is located? Can you call her to ask questions? I know you were told she quit due to schedule conflict. But did she really quit because of non payment or because of the same issues you are having?
Just seems to be several red flags.
Keep us posted on what you decide to do.
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I am thinking I should request to see the script from her before continuing any other sessions. As far as getting paid, she said I have to send her the invoice to which she sends that to her lawyer and then the workmans comp, she is to recieve the check and then she signs it over to me. I haven't sent her an invoice yet, I actually was planning on doing that tomorrow as by then we will have done 5 sessions.I don't know who the other therapist is but am sure I can find out. I agree, the dr should have specifics as to what he wants done. I feel I have been very gullible in this situation not knowing the in's and out's.
I will definitely keep you posted.
Jimswife said:I am not sure about how to contact the doctor. I work in a chiropractors office. So I have access to their chart and can talk directly with the doctor and the PT.
I would request a copy of her script from her. I would think that the script would have specific information about what the dr wants you to do.
You have me wondering... How are you getting paid? directly from her? or are you waiting for payment that may never come? I am wondering if you can be paid without the script? (Does she really have one?) Doesn't it have to be approved by the work comp? Otherwise couldn't she just go where ever for a massage and submit the bill to get reimbursed? Do you know the other therapist or where she is located? Can you call her to ask questions? I know you were told she quit due to schedule conflict. But did she really quit because of non payment or because of the same issues you are having?
Just seems to be several red flags.
Keep us posted on what you decide to do.
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Permalink Reply by Lee Edelberg on
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Lavinna,
Who can say what WC wants you to do? Doctors don't usually know much of anything about massage and its benefits so I'd be surprised if they had anything very specific in mind regarding techniques. If you think about treating her pain and not her tissues, you might feel better about the results.
You could try coaxing her to relax through more general integrative work and see if that helps her out. If she was hurting enough to have surgery then her tissues must be traumatized and it sounds like she's telling you that the last thing she wants right now is more pain.
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Permalink Reply by Jody C. Hutchinson on
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Lavinna,
I am sorry to hear of your struggle with this client. I have worked in the W/C system before, in my practice and in doctor's offices. The patients can be challenging because they have "no skin in the game." When they are not paying (committed) for their treatments, it can go south quickly. They were injured at work and may act entitled( and will break your boundaries,) and selfish. I wonder if your going to her house is OK with W/C.
You are absolutely right about the work you are doing. You must stay within the Treatment Protocol. You could contact the referring MD, but you may not get anywhere. I would suggest having a conversation with this client and remind her that she needs to be compliant or you will discharge her. It can be very frustrating to work with this type of client and a painful learning experience as you grow in your practice and maintain your boundaries.
Best of luck.
JH
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Very good points Lee, thank you for your input :)
Lee Edelberg said:Lavinna,
Who can say what WC wants you to do? Doctors don't usually know much of anything about massage and its benefits so I'd be surprised if they had anything very specific in mind regarding techniques. If you think about treating her pain and not her tissues, you might feel better about the results.
You could try coaxing her to relax through more general integrative work and see if that helps her out. If she was hurting enough to have surgery then her tissues must be traumatized and it sounds like she's telling you that the last thing she wants right now is more pain.
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I considered that as weel Jody, the fact that she feels entitled. Yes it is rather frusterating, and I am not sure how to further apporach the issue. I am going to take the approach Lee recomended, not thinking about treating the tissues, but treating her pain.
You also make a good point, about WC if they apporve of it being in her home. Definitely a learning experience, But I have always said... If you aren't learning, you aren't growing! So I will take it for all it's worth :)
Jody C. Hutchinson said:Lavinna,
I am sorry to hear of your struggle with this client. I have worked in the W/C system before, in my practice and in doctor's offices. The patients can be challenging because they have "no skin in the game." When they are not paying (committed) for their treatments, it can go south quickly. They were injured at work and may act entitled( and will break your boundaries,) and selfish. I wonder if your going to her house is OK with W/C.
You are absolutely right about the work you are doing. You must stay within the Treatment Protocol. You could contact the referring MD, but you may not get anywhere. I would suggest having a conversation with this client and remind her that she needs to be compliant or you will discharge her. It can be very frustrating to work with this type of client and a painful learning experience as you grow in your practice and maintain your boundaries.
Best of luck.
JH
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Lavinna,
I am going to play devil's advocate and say that I disagree with Lee. The W/C case I had last year involved several phone calls with the referring MD and the W/C carrier. I am in California and W/C is very hard to deal with and I have not gotten authorization for more than four visits for several years. I also disagree with trying to work with entitled clients. It is draining and while it may be a "learning experience," it sounds too painful to continue. If this person doesn't respect you, wants what she wants when she wants it, and isn't compliant-why bother? If this woman talks on her phone and berates you for your family responsibilities, is this really worth it? Shoulder pain post-surgery is normal for many months-especially if there was any decompression work performed, and if this client won't cooperate with you, is she really being compliant at all?
Have you seen the referral script? This should clear up any questions about what to do. I would insist, for your own protection, that you get the file in order. Besides, if the script calls for manual therapy, MRF, and/or soft-tissue mobilization-you will have to document this and be able to defend what you did.
I understand that you may have had a bad start with this person, learning when to move on is learning.
my 2 cents.
JH
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Very fair statement Jody! I actually am awaiting a phone call back from W/C here in Colorado because I haven't seen anything, that I am authorized or even know of codes o use if any. I have gone into day 2 of looking into all of this, hearing others opinions and advice and am thankful for it all. I have not, in fact seen her script. I also have compliled everthing I have done so far, I try to be as thourough as I can in my SOAPs. as well as have contacted her, letting her know that I cannot continue our sessions until I have proper paperwork stating that I am authorized and what exactly I need to do.
I am also looking into other therapists whom I actually think she would benefit better. All in all my gut is saying to release her completely, for both personal and professional reasons.
Thank you all for the input!!
Jody C. Hutchinson said:Lavinna,
I am going to play devil's advocate and say that I disagree with Lee. The W/C case I had last year involved several phone calls with the referring MD and the W/C carrier. I am in California and W/C is very hard to deal with and I have not gotten authorization for more than four visits for several years. I also disagree with trying to work with entitled clients. It is draining and while it may be a "learning experience," it sounds too painful to continue. If this person doesn't respect you, wants what she wants when she wants it, and isn't compliant-why bother? If this woman talks on her phone and berates you for your family responsibilities, is this really worth it? Shoulder pain post-surgery is normal for many months-especially if there was any decompression work performed, and if this client won't cooperate with you, is she really being compliant at all?
Have you seen the referral script? This should clear up any questions about what to do. I would insist, for your own protection, that you get the file in order. Besides, if the script calls for manual therapy, MRF, and/or soft-tissue mobilization-you will have to document this and be able to defend what you did.
I understand that you may have had a bad start with this person, learning when to move on is learning.
my 2 cents.
JH
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