Reflections on my personal and professional journey; the metamorphosis from client to shiatsu therapist to complementary therapist.
INTRODUCTION
While reading the description of complementary therapy and in some moments of personal reflection, I asked myself what it means to be a complementary therapist, how I have come up against these issues and how they have evolved during my career, what views have I altered, what have I learnt? What can I still change and what influence can I bring to my field in the next 20 years of my career? How to assist my clients by creating from the first meeting a good environment to promote the therapeutic process? How to create relationships based on trust and not limit myself to considering health in terms of shiatsu therapy but as an integral system of complementary medicine centred on the client. How to work in a therapeutic team of different disciplines to bring a holistic experience to the client.
I started my shiatsu studies when I was 18 years old, I was the youngest in my class.I am fortunate to have come to my career so early, my interest stemmed from a motorbike accident when I was 16 in which I fractured three bones in my foot, the fractures were undiagnosed; this led to two years where I could barely walk and many orthopaedic visits where I was told it was a sprain, that it would pass, not to whine and complain. I had lost hope until I visited yet another surgeon who found the problem and solved it with an ankle fusion. What I remember most clearly was not feeling listened to and that after barely a glance I was given a diagnosis and with a series of big words I was silenced, at the time I remember the frustration of not being taken seriously.
So I developed an interest in medicine, healing and after a short university course as a nurse I decided to give it all up and pursue a career in complementary therapy.
That is when I started my shiatsu training and in the many hours of treatment I received my body began to reconnect. I was exposed to a completely different, proactive, integral concept of health in which the client is the centre of his or her own health and an active participant in the process.
In this essay, I explore the initial phase of the client approach (the interview/meeting), the goals of therapy, the complementary resources and services that can be accessed, collaboration and limitations of one’s own discipline. In the conclusion section, I discuss the role and future directions of complementary therapy in light of the previous reflections.
In my practice I follow an all-female clientele consequently in this essay I will refer to the client as a woman based on my practice.
The interview – the encounter
In classical medicine the first interview often takes place with a general practitioner who is often only interested in treating momentary symptoms without caring about the patient’s general psycho-physical health context. This is also due to a great lack of time to establish a relationship with the client.
The initial interview in shiatsu was so different from what I had experienced with doctors and physiotherapists, there was a great element of care, attention, many aspects were considered, my opinion was valued, the approach was friendly, the therapeutic relationship was based on respect and listening. At the beginning of each session I was seen as a new person, although some factors remained present and constant at the same time my ability to heal and change played a decisive role.
Given my personal experiences, I promised myself to create a different environment from the one in which I had initially been received in a hospital setting, a safe environment where I could find the starting point, to be able to change, heal or grow. Many indications are given from the first moment, the way of walking, body language, tone of voice, before the words themselves.To create the space where the client can confront many factors come into play, trust, feeling welcomed, being treated with respect. The therapeutic space needs to be calm, cosy and warm to be able to relax and feel safe. From a practical point of view for me this translates into impeccable hygiene, the use of an essence diffuser, the right temperature, lots of plants and a few personal touches.
Each therapist values different things, but the common factor remains in creating a comfortable, safe, discreet and welcoming space for the therapeutic process.
One of the things I have learnt and reassessed in my career is time.
Having the perfect therapeutic space is no substitute for having adequate time, up until about 5 years ago my working day was distinguished by successive appointments, my aim was to help as many clients as possible, this created enormous stress as soon as an unforeseen event occurred. If the client arrived 5 minutes late she was not easily able to relax and open up, consequently the first interview often did not feel complete, to improve the exchange with the client I often ended up late and the rhythm of my day was always chaotic. At the same time, if a client needed a few more minutes to use the bathroom or to explain her story, pressure would build up for me and the client. One of the best working choices I have made is to change this simple time factor. Now I always have 15 minutes between each client and every 3 clients I have a half-hour break. What used to seem like a waste and a waste of time is a factor in my practice, it has made my days lighter and more pleasant. When the same situation is recreated of the client being 5 minutes late, I can immediately communicate that although punctuality is appreciated there is no need to fret, this immediately establishes a more serene relationship, it removes the basic tension. On a practical level during the pandemic I already had adequate measures in place to minimise customer encounters and gave me the time I needed to sterilise the room, services and handles.
This point of reflection popped up after a session where I as a client arrived a few minutes late, I realised that the idea of helping as many people as possible although well intentioned was fundamentally flawed, so I refocused my focus on quality rather than quantity.
Therapy goals
Another factor I have reflected on and refined my perception on is how to choose goals together with clients, offer options and leave the choice to the client on her own therapeutic path. At the beginning of my career my goal was to restore my clients’ health.
The cure or absence of disease is not the aim of therapy.
The WHO definition of health: “Health is a state of complete physical mental and social well-being not merely the absence of disease.”
After the accident my focus was on being as I was before, for me that was the only possible solution, the only way to be healthy and healed. Many years have passed and I have been confronted both personally and professionally with many different health-illness situations. After working for a long time with oncology or palliative care clients I have re-evaluated the purpose of therapy. With palliative care clients healing was not the goal, this made me reflect on how I could find a new definition of therapy that would fit my new experiences and knowledge. Complementary therapy in simple words is support to live to the best of one’s situation, to make a positive influence and start a process of personal change through self-awareness and listening.
This can mean different things to different people, for some clients who were undergoing chemotherapy at the same time it could mean a reduction in pain, an increase in range of motion, for some an hour to rest and disconnect from the world could mean a possible decrease in side effects. For others, the effect of the therapy could mean an increase in appetite or better rest, for some people help to externise emotions that had been locked in the body.The effects cannot be trivialised between a simple ‘sick and healthy’ but rather by a sometimes almost imperceptible direction in which we move towards a new balance.
What has been difficult for me is to understand that my client’s goal is not necessarily what I think their goal should be.
Now in the first meeting after we have discussed the current situation I talk to my client and ask what would you like to achieve through this therapy? The answers are so varied and not always predictable. My therapeutic work is strongly focused on pain management and pain reduction but for example in a first meeting with a client with lower back and sciatic pain we set the goal of being able to go skiing with her daughter in the Christmas holidays, clearly this can translate into a reduction of pain and inflammation but it is much more profound it represents her freedom of movement, something that gives her joy and makes her feel like a good mum, in her words. The goals are individual and it is important that the client can set goals based on her needs and formulate them in a way that is coherent and relatable to her.
I find it important that the goals are clear and measurable, feeling better is one of the answers I often hear, this is very subjective and difficult to measure, in these cases we look at the factors that are present, for example my digestion is very slow I have a bowel movement 3 times a week, or I have a headache every afternoon together we note the starting point and after 4 sessions we assess the progress, in this way we can measure and the time factor helps to perceive possible changes.
But if healing is not the goal, why pursue a career as a complementary therapist?
The purpose of the therapeutic process becomes the client’s growth, adaptability to both internal and external change. Our body constantly speaks to us through both positive and negative feedback messages and we adapt accordingly, just as on a cold evening we feel chills that lead us to wear something warmer, other changes also lead us to adapt to the present moment. We as therapists are only accompanying and supporting health, therapy is client-centred and client-centred in our ability to self-heal and self-regulate.
Resources
I find a good discussion point comes to light when open questions are asked about the client’s vision of their own health and next steps. The client takes responsibility for her own health while actively seeking solutions. Often I ask if there is anything that has brought the client out of balance and at the same time I ask if there are any possible factors that could help regain wellbeing.Emotional trauma, work stress, accidents, divorce are just some of the countless changes that have an effect on homeostasis.By asking questions the client opens herself up to personal resources that can be unpredictable and imagination is the only limit to the possible positive factors and resources.
In a recent common trunk course we were confronted with the topic of resources and how to access them. The list was long for many, nature, family, leisure, sun, various therapies, animals, babysitter, cleaning lady etc. were determining factors of one’s well-being, for me personally a resource is also money. This sparked a lively discussion, for many it was unimaginable to have money as a resource, I remain of the opinion that in order to have access to many services that help my psycho-physical well-being money is a resource, it allows me to have free time, less stress, access to services such as being able to see a complementary therapist on a regular basis. This discussion made me realise that as a therapist it is important to let your client ask herself about her own resources, because they are centred on her way of being, her values, what is present in her life; at the same time to be able to add new resources that are still unknown territory, such as breathing and stretching exercises targeted on the psychophysical state of the moment, and resources targeted on my therapy. In shiatsu for example some of the resources are nutrition, stretches based on the imbalances detected in the therapy.
Together with the goals in the first meeting we note useful resources by focusing on already existing resources and then adding new positive factors where possible. In a consultation with a client with migraine for example when we reflected on already existing resources we noted drinking a lot of water, sleep, and resting for 10 minutes with a fresh towel as already existing resources and then added some stretching, shiatsu and delegation as new strategies.
Collaboration, cooperation and the limits of one’s own discipline.
It is precisely in this search for resources that I have often been confronted with other disciplines and therapists from both complementary and classical medicine. Each method has its own strengths, but at the same time there are therapies that are better suited to certain specific problems. In this personal dualism of being a therapist and client at the same time, I have been confronted with this issue in depth. The synergy between therapists is a great point of reference both personally and professionally, together with a group of female therapists we meet regularly and discuss topics based on our work and health experience. We find a space to confront each other, ask questions and gain access to new ideas. When we exchange, we are each able to bring to light the approach of our own therapeutic discipline and experience. The experience is not only limited to one’s own method, but everyone is committed and brings a positive influence to others. We also discuss issues of marketing, customer dialogue, software, courses, etc. We have a real network of resources between us that is much larger if we unite, each one brings their own strengths and receives support in points of doubt. For example, in my practice I follow many women through pregnancy and I am able to suggest an osteopath who only works with pre- and post-natal women, a physiotherapist who does pelvic floor rehabilitation, different midwives depending on what language is desired. For my clients it is a great relief to have, where desired, a multi-disciplinary approach. This group work and exchange is never forced and always only in the context where the client is favourable.
Which disciplines interact positively with each other and how do you put the client at the centre?
In my opinion there are no disciplines that cannot cooperate with each other, I for example see my shiatsu therapist and at the same time I see a kiniesologist, both bring a positive effect and in both treatments I actively work on different aspects of my health. Clearly I have a great love for shiatsu, which has accompanied me for almost twenty years, but at the same time I remain curious about other disciplines.shiatsu is not always the most suitable for my client and in that case it is important to have the client’s interest as a priority and to steer them in the path considered most suitable, the choice always remains with the client, for example after a car accident with whiplash cranio sacral therapy is more suitable at first in my opinion. The same applies to interactions between classical medicine and complementary medicine the ultimate goal is the collaboration and well-being of the client, I find centres where different disciplines are integrated optimal.
I worked for several years in a physiotherapy, acupuncture, massage, shiatsu and pilates studio, here not only the vision of health was holistic but at the same time the vision of medicine itself. Over the years there have been points of tension between the physiotherapy team (classical medicine) and the rest (complementary or alternative medicine) e.g. initially the internal workshops were divided by discipline, physiotherapists had access to workshops for physiotherapists etc. This maintained an us/them mentality. After a few suggestions, each workshop was opened up to everyone, the team became closer and the clients experienced many benefits. Although each therapist could not use the specific techniques shown in the workshops that were not relevant to their own therapy, for example only the acupuncturist used cupping, the workshop helped to better understand the other disciplines and consequently better understand the treatment that the joint clients were receiving and helped the team to direct clients to the most appropriate therapy for each case.
I also had the opportunity to work in a residential clinic for people with eating disorders as a shiatsu therapist. Most of the girls suffered from anorexia nervosa, some in very advanced stages. They were followed by a team of psychiatrists, psychologists, nutritionists, physiotherapists and shiatsu was the only complementary therapy offered.
The first month I went home in tears every day, they were girls like me, but instead of weighing 60-70 kilos they weighed 30-40. I felt helpless while some were hospitalised for assisted nutrition. Then something happened, I realised that although many of the clients would open up to me it was absolutely not in my remit to spend whole sessions listening to their childhood problems and stories and I started to direct this type of exchange to the psychologist and psychiatrist, and I reassumed my role as a shiatsu therapist using therapeutic touch to assist them in centring and connecting with themselves. Given the high risk of osteoporosis and bodily fragility the treatment had to be adapted, I distinctly remember that for some clients it was mainly palpation of the abdomen in a supine position, and some magically began to breathe deeply and no longer superficially, or some colour returned to the face. This brought my personal balance back from this experience where my role was simply that of a shiatsu therapist in a multi-disciplinary team, all with their own skills and a common goal: to accompany the centre’s residents towards a process of awareness, change, balance and self-regulation.
I realised that my therapeutic limits were not clear, I used to come back in tears because some of the girls touched me too personally and I couldn’t break away, it took me years to fully understand this experience and to elaborate on my role as a therapist, the accompanying figure in the client’s journey of growth and rebalancing.
CONCLUSION
During the study for the federal degree as complemetary therapists we asked ourselves in which future direction complementary medicine should head.
I think the concept in itself of a division between classical and complementary medicine is wrong, they are branches of the same tree, the tree of health. Just as the division of health into physical mental and emotional does not reflect the holistic principle of unity, so does this split. My future vision of health includes both medicines working together for a common purpose, the client.
As ambassadors of this new profession, we are the cornerstone of the future, I hope to be an active part of raising awareness and providing information. Most of the people we interact with do not know exactly what complementary therapy is and it is our role as pioneers of this profession to act professionally, knowing our limits and our role and creating connection and dialogue.
I look forward to a future with more interdisciplinary centres, both at hospital and private practice level. Just as the limits of our clients’ resources are only in our imagination, the limits of the possibilities of a team of therapists working together with staff from classical medicine do not exist.
My future vision is to work in tune with other therapists and specialists in a multidisciplinary practice focused on women’s health.The professions I would like to collaborate with are acupuncture, osteopathy, shiatsu, pelvic floor physiotherapy, naturopathy, and kinesiology, and I remain open to other related professions, both complementary and not.
I think one of the most important assets for me as a freelance therapist is my work network. First in Geneva where I lived for four years and now in Zurich where I have been living for six months, I have dedicated myself to educating the public about health and shiatsu and the other methods I practise, and to creating a real ‘health team’.
In these few months I have already established collaborations with an acupuncturist specialising in women, an obstetrician, two gynaecologists, an osteopath, a baby sleep consultant, a lactation consultant and a physiotherapist specialising in pelvic floor rehabilitation. My goal is to give my clients access not only to my therapeutic method but to a real team.
This is a job that never ends, it continues and develops organically every day.