Power and Responsibility in the Reflexology Relationship

Foot massagePower is an element occurring in many everyday human relationships. Consider for a moment the relationship between a parent and child – a teacher and pupil – a manager and worker – a doctor and patient?

In many commonly experienced human relationships power is certainly present.  In some cases power can provide a useful element of social or employment structure.  Sometimes power is cultural in origin.

Does Power Exist in Reflexology?

Elements of power exist in all therapeutic relationships.  Most typically power issues manifest as sub-conscious forms of transference and countertransference.  Sometimes power can present more explicitly, for example through associations with titles, uniforms and even environment.

Consider for a moment the manner in which a client might perceive the professional reflexology practitioner working from within a hospital or clinical setting?  How might this relationship differ from one formed with a home based practitioner? Might the client view the hospital based practitioner more formally, simply because of environment, or even because of practitioner attire?

Now take some time to consider how much power a practitioner is given to hold when engaging with an emotionally vulnerable and physically exhausted client – a client so tired they almost seem to fall unreservedly into your safe care and hands?

Certainly different forms of power have the potential to manifest within therapeutic relationships – and they can often be tied up with the concept of responsibility.

Understanding Transference and Counter-Transference

Transference literally means to ‘carry across’ (Fox, 2008), and was a phrase first coined by the psychodynamic theorist, Sigmund Freud, to label the way he felt patients transferred feelings – about, and stemming from – important people in their early lives – onto their therapist.  Counter-transference relates directly to the feelings the therapist develops towards the patient.

“Understanding transference and counter-transference can be useful in the therapeutic alliance.  It can open up a whole new dimension to the healing environment, if only in the benign guise of child and parent together.” (March-Smith, 2005)

Perhaps the most important aspect relating to the concept of  transference occurring within a reflexology context relates to the possibility of accepting, or adopting, a position of power within the relationship.

Power can be given to the practitioner, and the practitioner can also choose to hold power.

image“Every practitioner knows that the patient has walked into the consulting room in the hope they will be made to feel better.” (March-Smith)

Rosie March-Smith’s statement (above), highlights the potential weight of responsibility often silently placed upon the professional reflexology practitioners shoulders.  Many of our clients attend for reflexology because of chronic illness, pain, or exhaustion.  Every day professional practitioners are asked to take on the responsibility of trying to help clients feel better.

Transference in Action

In some cases a clients need to be cared for might be sub-consciously transferred onto the practitioner.  Perhaps in this case the client is transferring a deep inner need for touch, attention and care – at the same time becoming almost childlike in their passiveness towards better health.

  • In unwittingly giving power away is this client inhibiting their potential towards increased self-care?
  • How might such a relationship impact the practitioner?
  • Might the practitioner feel empowered?
  • Tired?
  • Overwhelmed?
  • What does the felt sense say?

Another example might be the client who seems quite determined to retain their condition and experience – repeatedly reporting no change – yet still insist on attending for sessions. Perhaps this client is transferring their own need to retain some form of authority, whilst still gaining from the encounter in some manner?

  • Why do clients such as these continue to attend?  
  • What feelings can clients such as these present to the practitioner?
  • Responsibility?
  • Fear?
  • Helplessness?
  • Pressure?
  • Needing to apologise?
  • What does the felt sense say?

Perhaps in another example the client fears disappointing the practitioner – worrying they may damage their new found friendship – potentially transferring fears of rejection?

  • Is there something identifiable preventing a more authentic relationship?
  • Is the practitioner aware of any sense of responsibility?
  • Are there feelings of flattery?
  • Pressure?
  • What does the felt sense say?

imageCounter-Transference and The Wounded Healer

Some theorists have suggested that counter-transference is present in some form at the very onset of many therapeutic encounters – the practitioners own initial sub-conscious call towards engaging in therapeutic work – their inner requirement to nourish and help care for others – representing a reflection of the practitioners own inner child’s need for care.

“We might replace the words Great Healer with Good Father or Good Mother, understanding that there is a similarity with the role of a caring, attentive parent offering, seemingly, endless time for this needy child: someone to take away the hurt, effectively to ‘kiss it better’, to murmur reassuring words, and to make the consulting room seem just like a cosy room at home from their childhood.” (March-Smith, 2005)

The theme of the wounded healer relates to such needs in practitioners.  Studies have shown that sometimes individuals who choose to follow careers paths involving caring or helping as an element:

“often as children experienced loneliness, illness, bereavement or the need to look after others” (March-Smith, 2005)

Researchers have suggested the ability to empathise develops to such an advanced degree in childhood – these adults individuals then feel compelled to care for others – and can be drawn towards more therapeutic professions.

“the presence of such a ‘wound’ in a healer gives them an excellent basis from which to understand and empathise with the wounds of clients.” (McLoud, 1998)

Practitioner Self Development

Highlighting some of the finer dynamics involved in relational encounters – such as becoming aware of the possibility of transference and counter-transference – and indeed concepts such as the wounded healer – help to demonstrate the real demand for good levels of self awareness in professional reflexology practitioners.  Practitioners can certainly benefit from enhanced levels of self development – becoming more swiftly able to recognise instances of transference of counter-transference – and able to take steps towards promoting more autonomous exchanges – choosing ultimately not to take responsibility for their clients.

imageSome of our wider therapeutic reflexology interactions then clearly possess hidden subconscious dynamics – dynamics not only capable of hindering the promotion of client autonomy and free choice – but when left unchecked can also induce practitioner burn out.  Practitioners who engage therefore in more regular instances of reflective self development can promote higher standards of client care, and increase their own levels of practitioner self care.

Recognising Somatic Counter-Transference

“We could say that all counter-transference, all the feelings that arise in the practitioner in relation to the client, are somatic counter-transference.” (Fox, 2008)

Practitioners might recognise instances of somatic counter-transference in their own felt sense responses. Perhaps the feeling might manifest as an overwhelming sense of tiredness as the practitioner works on the client – or perhaps it might display as a feeling of sickness or anxiety?  On a different occasion there might be a feeling of irritation or frustration, or perhaps even an awareness of tears emerging?  It is worth spending some time examining what the felt sense means to you personally?

Within The Therapeutic Relationship

The concepts of transference and counter-transference are not directly associated with the concept of building therapeutic relationships – but they are certainly worth becoming more familiar with.

“The reality is that transference phenomena belong to a much more superficial level of relating where people are still being symbols for each other.” (Means & Cooper, 2005)

Offering our clients the core conditions associated with a therapeutic relationship – empathy, congruence and unconditional positive regard – can help to reduce instances of transference and counter-transference occurring in the relationship.  Additionally practitioners are better able to promote the concepts of client autonomy and self-directed change – principally through encouraging more authentic, empathically driven, relational encounters.

We practitioners certainly play an enormous role in invoking some of the changes our clients experience.  It is important therefore we become more professionally aware and attentive to our potentially powerful, very real impact.

——————————–

imageOther Instances of Power Manefesting in Reflexology

The Association of Reflexologists posted an interesting question on their public facebook page recently – a question highlighting perfectly one example of a potential power concept occuring in reflexology.

Do clinical uniforms actually cause a barrier between client and therapist?’

Bethan Mair Williams, one of the contributors to the thread, enquired?

‘Do clients trust and respect as soon as they see a uniform, and is this a good thing?  What is the intention of wearing a uniform? Does wearing a uniform give someone power? Does it empower or disempower you or the client? ‘

If we consider the concept of transference and counter-transference, then what message might we be potentially portraying when we adopt a clinical type uniform?

  • Are we projecting the belief we can be trusted? Does our uniform say something about our intentions?  
  • What message are we potentially portraying to our clients – who all too frequently present craving change and autonomy – when we greet them in a clinical type uniform?
  • Is it really about keeping clean, or adopting a ‘professional’ attire? What do we mean by professional?  Do we mean clinical?  Might there be something about feeling we should align reflexology with something more medically and clinically acceptable?  Does the uniform make it ok?
  • Might there be something in us (the therapist) that feels safer associated with something more clinically acceptable?  Does the uniform help to form the persona of the therapist?

Taking time to consider some of these questions more closely can help us to challenge some of our own judgements and assumptions.  Can we somehow present professionally wearing non-clinical work attire?  How might that be possible? What elements might be required?  Try to remember there are no right or wrong answers.  We are all unique, and our opinions and personal boundaries are varied.

——————————–

Summary

Foot massageThinking a little deeper about how we relate with – and indeed present ourselves to clients –  is not only an ethically positive stance to adopt – but such consideration also helps us to relate with clients in a deeper, more meaningful way – without any perceived label of authority.

“Relations between people are the basis of social and individual life’s, and relational concepts are used to understand human life in all it’s complexity.” (Paul & Pelham, 2000)

It seems important as a profession we strive to stand in the true light of our modalities complex and innate power to invoke change multi-dimensionally.  If we are to further champion specifically the role of the practitioner, for example, then we must also become more accustomed with some of the components most often considered within a therapeutic relating context.

“Being alert to whatever may emerge from the unconscious might seem like extra and unexpected responsibility for the hardworking complementary practitioner. It could however, be a taste of things to come: for, as the government continues to tackle the lack of regulation nationwide, it is likely more and more training bodies will enhance their curricula to include a working knowledge of concepts such as transference and counter-transference, projection and projective identification. (March-Smith, 2005)

Ultimately good levels of practitioner self development and heightened self awareness help to reduce the possibility of power imbalances, and transference and counter-transference occurring within the therapeutic relationship.

Practitioners might find it helpful to discuss these topics further within supportive peer support or local group meetings.  Try to more finely define the path to knowing you are enough – that you the practitioner – within the context of the therapeutic relationship – supported by the physical component of the modality – have the capability to invoke therapeutic change.  There is simply no requirement for the concept of power, when we try to find genuine concern for another human being.

Bibliography

Fox, S. (2008). Relating to Clients. The Therapeutic Relationship For Complementary Therapists. London: JKP

March-Smith, R. (2005). Counselling Skills for Complementary Therapists. London: Open University Press

McLoud, J. (1998). An Introduction to Counselling. Buckingham: Open University Press

Mearns, D. & Cooper, M., (2005). Working at Relational Depth in Counselling and Psychotherapy. London:Sage

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