Verbal Communication and Client Emotional Disclosure in Reflexology - Practitioner Survey Findings
From: Relational Reflexology
The Existential Tales of a Modern Day Reflexologist
POSTED ON MAY 4, 2014
The survey was an informal existential enquiry designed to explore the attitudes of professional practitioners regarding verbal communication and client emotional disclosure within their reflexology practice.
The survey findings suggest verbal communications (instructional, supportive or explanatory) to be fairly common in reflexology.
The findings also suggest the presence of client emotional content to be fairly common in reflexology - with many participants considering emotional content as a simply naturally occurring phenomenon in reflexology.
Findings also suggest professional practitioners have a good understanding of professional concepts related to both competency boundaries, and professional referral within reflexology.
Survey Method and Participants
The survey was constructed of six multiple choice questions, with space provided for additional participant comments. The survey required no identifying participant information. The survey was live and accessible for one week and offered to professional reflexology practitioners via social networking reflexology groups on both Facebook and Twitter. The survey data was shared with Tracey Smith (Research Manager - Association of Reflexologists, UK) to encourage transparency, and reduce bias.
The survey returned 142 completed responses, with 495 individual comments - from practitioners in 16 countries.
- UK - 69% (98)
- United States - 11% (15)
- Ireland - 5% (7)
- Canada - 3% (4)
- New Zealand - 2% (3)
- Norway, Greece, France, Australia - 1% each (2)
- Portugal, Romania, Malta, India, Spain, Hungary, Jordan - 1% each (1)
Survey Coding
Due to the high number of written comments existing in the survey data (495) the Duquesne method was chosen to evaluate the information. The Duquesne method is a qualitative research tool associated specifically with phenomenological research. The procedures for collating information in this manner were first written about within a social science context by Colaizzi (1978), then Bullington and Karlsson (1984), Wertz (1984), Hycner (1985), Polkinghorne (1989) and Moustakas (1994).
The ultimate research goal associated with this phenomenological approach is 'to elucidate the essence of the phenomenon being studied, as it exists in participants' concrete experience' (McLoud, 2001). The researcher is therefore attempting to identify central themes or meanings implicit in the statements of the participants - before integrating these meanings into a single description of any phenomenon.
The Questions
Q1. Do you ever talk/chat with your clients during a reflexology session?
The question provided 142 responses (0 skips) and 104 individual comments.
- It depends on the individual client - 73.5% (107)
- Yes, I often chat with my clients - 15.49% (22)
- Yes, but only ever during the consultation period - 4.93% (7)
- No, I would never encourage talking during a session - 4.23% (6)
Q1. Themes - 'Client Leads'
The overwhelming theme emerging from Q1. comments is associated with the concept of remaining respectful of the client's choice in how they use the therapeutic reflexology space. The survey suggests many practitioners seem content to engage in verbal exchanges if initiated by the client. Comments suggest participants try to focus on the client's presenting needs - and adapt to verbal interaction where necessary.
"I let the client decide. It's their time".
"You can gauge if a client wants to relax, or if they want to chat.
I go with the flow."
"It should be client led for optimum effectiveness."
"I am led by the client."
"Some clients need to chat so I adapt my treatments accordingly."
"Some people want to chat, others don't. I let the client lead the way".
"I am always listening and reading between the lines to see what the client wants and what they need. It's a dance."
Q2. Do you provide any form of interpretation to your reflexology clients? For example, to help explain why a certain point might feel painful, or tender?
The question provided 127 response (15 skips) and 98 individual comments.
- Yes, I always attempt to give an interpretation to clients - 88% (112)
- No, I never attempt to offer an interpretation - 12% (15)
Q2. Themes - 'Clients Often Want to Know - But I Don't Diagnose'
Three interrelated themes emerged from the comments relating to Q2. They are respectively connected to interpretation being offered when requested by the client. The nature of those interpretations, and finally, the existence of a transparent practitioner consciousness relating to the concept of avoiding diagnosis in reflexology.
Participant comments seem to suggest that whilst interpretation in some form is frequently occurring within reflexology exchanges, many of these interpretations are manifesting as a result of client enquiries, or responses to pain.
Participant comments additionally seem to suggest the existence of a clear attentiveness towards avoiding interactions, or conversations, that may potentially be interpreted by the client diagnostically. The survey suggests interpretations are therefore often delivered multi-theoretically, i.e. possible direct foot issues, foot map associations, cross reflex associations, TCM associations, etc. Offering such conscious multi-theoretical interpretations seems to ensure practitioners avoid making definite statements.
"I interpret in general terms according to the client's level of interest."
"Yes, if a point is painful and they ask about it, I give a few different interpretations so it's not a definite truth, but instead a little insight."
"I like to inform clients that there are different interpretations for certain areas & this often leads to more in depth conversations."
"Yes, because most clients ask "why is this area tender" then I will answer."
"If I can interpret it into a physical or emotional, or both. I offer this up as to why the area may be painful. Then the client can elaborate if they want to. I never diagnose or say this IS what it is ."
"I explain which reflex point they are feeling. I don't offer a diagnosis."
"I keep the information very general, simply stating that they may be a little out of balance in the corresponding part of the body, or referred part of the body, or even say it may be a problem with the foot."
"Very careful not to scare, but share thoughts on possibilities for the discomfort."
"Only when they ask will I then interpret, but stating different opinions of various schools of thought (reflexology, TCM, emotions, etc). I try not to produce nocebo."
"Not always - but I find most clients want to know "what have you found" and I explain this as a tension in a certain area. They then ask what reflex it is and then some do ask what I think it means - to which I say I can never claim to diagnose."
Q3. How do you feel about the presence of client emotional content in your therapy room?
The question provided 139 responses (3 skips) and 84 individual comments.
- I feel confident in my ability to deal with client emotional content in my therapy room - 81.29% (113)
- I am fine with the presence of client emotional content in my therapy room, but don't always feel confident in my relating skills - 13.67% (19)
- I feel very uncomfortable with the presence of client emotional content in my therapy room - 5.04% (7)
- I try very hard not to encourage the disclosure of client emotional content in my therapy room - 0%
Q3. Themes - 'Reflexology and Emotion'
The first theme emerging from Q3. relates to the participants' wider intellectual definition of reflexology - specifically that many practitioners acknowledge a close association existing between the physical modality, and the presence - or release of - client emotional content.
"It goes without saying there will be some emotional clearing with a treatment."
"The physical self and emotional self are after all interconnected."
"A therapist's ability to be open to a client's emotional needs is one of the core benefits of any kind of therapy."
"No one comes in the door without emotion."
"(Emotional release) is an important part of the treatment."
"I believe the physical act of reflexology and listening to emotive subjects goes hand in hand."
"Emotions are an intrinsic part of the holistic approach to health."
"(Emotion) is part of reflexology."
"I find that emotional and physical problems are connected."
Q3. Themes - 'Professional Boundaries and Referral'
The second theme emerging from Q3. relates to a wide acknowledgement of professional concepts in the comments. For example, subjects such as boundaries and limitations existing within the practitioner's professional remit are mentioned, as well as the concept of professional referral. Additionally, some reference was made to prior, or potentially required, relational/emotional concept training.
"I know my limits and boundaries."
"I am mindful of my professional boundaries."
"Sometimes I feel I should do a counselling course."
"Sometimes I'm unsure how to help."
"I'm very happy to recommend that professional help may be necessary."
"If the client needs counseling or referring - I would do so."
"(In a multidisciplinary team) you know that you have the support and further services to refer a client if you need to."
"I have experience of emotional/psychological issues from a previous career."
"My previous work (nursing) taught me the skill of listening."
"(I've) worked for a helpline charity."
Q3 Themes - 'Intention and Listening'
The third theme emerging from Q3. relates to the practitioner's general intention within the reflexology environment. Participants made heavy mention of the concept of listening within this context.
"I encourage (clients) to be open and let them know their information will be treated as confidential."
"I consider it as an honour and privilege when a client opens up to me about their issues."
"It's all about creating a space for (clients) to release what they need to release."
"I have a lot to offer, a lot of experience to draw on.
"I don't feel the need to offer advice or to take a stance on any given situation, but feel that my 'being there' as an outsider can prove very helpful."
"I offer an open ear and sometimes that's enough for the client."
"We are there to listen."
"If a client feels confident enough in me to want to discuss their feelings with them that is fine by me."
"Sometimes a client is happy to talk and I just sit and listen."
"Listening is a part of the professional service."
Q4. In which setting do you normally work as a Reflexologist?
The question provided 141 responses (1 skip) and 68 individual comments.
- Private Practice - 80% (113)
- A Clinical/Medical Type Setting - 11% (16)
- A Spa/Beauty Type Setting - 6% (8)
- A Hospice Type Setting - 3% (4)
Q4. Themes - 'In Private Practice'
The comments relating to Q4. mostly verified the information provided in the associated multiple choice question. Perhaps the most interesting theme to emerge from this question relates to the heavy lean in responses from practitioners in private practice - this perhaps mirroring generally the existing ratio of clinically based/privately practicing Reflexologists. This small, informal survey perhaps provides us with an interesting interpretation of how reflexology is practiced generally - and therefore experienced by the general public.
Q5. Reflexology equates to what % of your weekly work?
The question provided 140 responses (2 skips) and 64 individual comments.
- Reflexology equates to 50-75% of my client base - 37.14% (52)
- I practice reflexology exclusively - 35.71% (50)
- Reflexology equates to less than 25% of my client base - 14.29% (20)
- Reflexology equates to 25-50% of my client base - 12.86% (18)
The comments relating to Q5. mostly verified the information provided in the multiple choice question. Comments in the section demonstrated a mix of full-time and part-time therapists - some practitioners retaining part-time employment outside of their reflexology practice - whilst another significant group practiced reflexology alongside an additional therapeutic modality.
"I practice other therapies e.g. Aromatherapy/Massage etc."
"50% practice nurse, 50% reflexology."
"I am also a qualified acupuncturist and combine the 2 treatments very nicely."
"I have an additional part-time job."
Q6. Do you offer advice to your clients regarding diet, exercise, or relaxation techniques etc?
The question provided 140 responses (2 skips) and 77 individual comments.
- Yes, I give general advice regarding water, increased rest periods etc - 57.86% (81)
- Yes, I give specific advice to each client - 40% (56)
- No, I never give advice - 2.14% (4)
Q6. Themes - "I Give Advice - But I Know My Boundaries"
Overall two themes emerged from the comments associated with Q6. The comments mostly made reference to any advice as offered specific to client needs. The comments seem to suggest whilst the advice is general in essence - it can cover a broad spectrum of subjects depending on the client, including: increasing mobility, cutting back on detrimental food types, increasing periods of self care, hydration, and teaching relaxation techniques. A large group of participants also made reference to working within professional competencies with regards to giving advice, and appeared mindful of utilising professional referral.
"I offer common sense advice: meditate if stressed, have me time, etc."
"I also teach meditation techniques for relaxation etc."
"They all get an aftercare sheet, if they are having a problem I show them on their hands - they can do it themselves."
"It depends on the client what I say and again it's more if they ask. I am qualified in lots if therapies and have lots of experience and knowledge beyond reflexology. I always lead by the client though."
"I give general advice and also more specific advice in areas in which I am qualified."
"I share that I know a little about a lot and often guide them to another professional in the field of health if need be."
Summary
This survey findings suggest many professional reflexology practitioners are engaging verbally on some level with their clients - either on an instructional (advice), supportive (listening and reflection) or explanatory (interpretation) level - or a combination of the three. Much of that interaction appears to be client led.
The survey also suggests the presence of client emotional disclosure/release is considered by many participants as somewhere between desirable and expected.
Encouragingly, the vast majority of respondents made unprompted acknowledgment of their attentiveness towards professional boundaries - and of utilising professional referral where necessary.
The survey perhaps also interestingly demonstrates how much power a client holds in their freedom to utilise the reflexology space as they wish. Reflexology practitioners seem willing and open to accept the multidimensional nature of many clients - content to hold the body - whilst accommodating any accompanying emotions. Reflexologists seem to accept their clients with hands outstretched and ears wide open; ready to touch, listen and support.
Future Recommendations
- In order to promote a more objective multidimensional interpretation of the reflexology package, clearly more formal research is required to assess the potential impact of the client/practitioner relationship.
- Existing practitioners can choose to actively enhance their knowledge of therapeutic relational skills.
- Professional training schools can choose to widen the perimeters of their course syllabus to incorporate modules related to therapeutic relational skills.
- Practitioners with duel training (reflexology/counseling) might consider constructing good quality CPD courses addressing these concepts.
Researcher's Comments
The Middle Place - The Listening Place
"The growth of complementary therapies to meet demand is unequivocal. Psychological trauma is at its most concentrated; we are suffering from overload and we need a safe space in which we may tell our story." (March-Smith, 2005)
There is a place within the concept of relating - a place deeper than general associating, but not quite the probing exploration associated with counseling and psychotherapy - that place involves active listening. Reflexologists seem to be adept at offering a space in which clients choose to be heard.
This middle place - the listening place - is already acknowledged with our wider society as highly valuable and required. Well known organisations here in the UK - such as the Samaritans, Child Line, St John Ambulance, and Victim Support, for example, provide a listening service to members of the general public. Additionally, there any many other community based projects and support charities offering similar listening services.
The greater majority of these organisations require their volunteers to engage in at least some basic relational and boundary skills training.
"Very little is taught about the therapeutic relationship, it's importance and how to create effective ones, on complementary therapy trainings. Research shows that the most important factor in a successful psychotherapy treatment is the relationship between the therapist and the client, not the school or model of counseling used. If these findings are translatable to complementary therapy then it could mean that the relationship with an individual CAM practitioner is as important as the therapy she or he practices." (Fox, 2008)
If we are to begin to fully champion and acknowledge the potential multidimensional impact of the reflexology package - and therefore start to focus more fully on the impact of the relationship between the client and the practitioner - in the future, as a CAM industry, we might fair well from introducing relational skills into our training programmes. Research suggests many therapists are drawn to our type of profession processing innate natural relating skills - and a real desire to help others. Is that quite enough in this modern world of standardisation and defined boundaries? Should we, like other listening services, begin to absorb basic relating concepts into our training?
"If you work with the body using touch, your hands will have learned how to listen to the tissues, or to energy flow. What would it be like to listen to the words a person says with the same sensitivity and single channel attention?" (Fox, 2008)
Perhaps the time has come for the wider reflexology industry to start to highlight the often intimate interactions between practitioner and client - in doing so championing our modality in its full multidimensional wonder? Perhaps also the time has come for professional practitioners to begin to become attentive during their professional development time to the relating side of their reflexology practice.
It is after all mind, body, spirit.
Bibliography
Fox, S. (2008). Relating to Clients. The Therapeutic Relationship For Complementary Therapists. London: JKP
March-Smith, R. (2005). Counseling Skills for Complementary Therapists. London: Open University Press
McLeod, J. (2001). Qualitative Research in Counseling and Psychotherapy. London: Sage
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