There are many styles of touch: directive, loving, nurturing, abusive, healing, calming, patronizing and seductive. We can become richer therapists by developing our abilities to notice as wide a range of these as possible. Not even necessarily omitting the ?negative? as we should have them in our vocabulary, if only so that we can recognize them when they arise.
For most of us, in our profession, touch is essential; it?s needed to refresh us, comfort us and nurture us. Touch is required for most of our work and as a necessary method of communication as we make our way through the world. Much has been written of the many types of touch, much research carried out on its effects but very little has gone into explaining the process of our style of therapeutic touch.
The purpose of this article is to give a framework, to look at how we touch, and put the beginnings of a vocabulary onto what it is that we do, not to add further technique. By naming a phenomenon we can deepen the understanding of it. It is my hope that by talking of how we touch and by looking at the stages of therapeutic touch we can create a framework through which the communication of ideas is easier and thereby we gain further understanding.
Montagu,(1) in his classic text, wrote about the nurturing effects of contact well documented in the research literature and so well summarized by him, but little has been written about the mechanics of our main method of therapeutic input. Different authors and teachers have emphasized various aspects of a stroke depending on their own experience. Chaitow(2) talks of melting into the tissue, Hungerford(3) warns us ?not to drop the connective tissue,? Myers(4) talks about the three ?I?s of invitation, intention and information but few have managed to give a complete and adaptive model or vocabulary to explain a complete stroke or intervention.
My hope is that by using a staged model, we can begin to put a language together that can facilitate discussion, let us use words to express the various methods we employ and gradually develop a forum through which we can become more conversant not only with the tissue and its wonderful variations but also with each other and the many diverse backgrounds we emerge from. The language that I find useful and accessible is that of the Fascial Release Technique (FRT).
Under the hands of a skilled practitioner, Fascial Release Technique is wonderfully releasing and pleasurable. Even so, it may be a challenging experience. This tool, when wielded by a novice, can also be painful and uncomfortable. I have been ?mauled?, not only by neophytes but also by some supposedly accomplished therapists. In order to avoid traumatizing your clients, I recommend spending some time working through and playing with the five stages below. As a client centered therapy it is incumbent upon us to stay aware of the entirety of the person below our hands rather than the collection of dysfunctional tissue crying out for our saving, healing and sometimes over eager touch.
Much of this five stage model is worded for the novice practitioner. This is deliberate in order that you can see where your style may differ or what you may be leaving out, what could/would you add to this idea that will clarify for the benefit of the student or anyone trying to, as Tiger Woods did not so long ago, break down and rebuild their stroke.
The five stages, Development, Assessment, Strategy, Intervention and Ending (DASIE) is not my invention and I claim no authorship over its use, I have merely redirected it from counseling models into bodywork (Nelson- Jones(5)).
Development
Many bodywork approaches talk of ?melting? into the tissue, ?sinking through the layers? and FRT is no different from that. Be aware of the layers as you pass through them, allowing the tissue to give way rather than bulldozing your way. Allow your hands, fingers, knuckles or whichever tool you are using to mould to the shape of the body part being worked, using only enough tension and pressure to get you to that first layer of resistance. Wait to be invited in.
<img src=’https://novo.pedroprado.com.br/imgs/2009/975-1.jpg’>
In this stage you are ?developing your rapport? with the tissue. It is the initial engagement, the journey from being in their auric field through each successive layer of tissue to get to the target structure. But it is also more than that; the process is mindful, sensitive to the transfer of energy (of whichever and any and all forms you?re sensitive to), sensing that relationship waiting for that invitation (Myers) or the absorption into the sponge (an image used by Maupin(6)).
Some schools teach that you can ask your client to exhale as you melt in and I often find this a useful addition in difficult or challenging areas but occasionally overused and distracting from the touch. Experiment with using your exhale to sink your bodyweight into the tissue. Having your centre of gravity high, keeping your back heel raised may allow you to position yourself over the area, exhaling (quietly!) and dropping your centre of gravity (or sinking your Hara) is much easier for the client to receive than ?pushing? into it. The tension necessary to push will result in the client?s tissue resisting and set up a struggle that, however gentle, one of you has to win.
Maintaining a relaxed point of contact avoids putting tension into the area being worked but also keeps you much more sensitive to variations in the myofascia. The less tension you have in your working limb the better able you are to sense the changes in your client.
Achieve this by getting as much of your force from muscles as distant from the point of contact as possible. For example, if you are using your fingertips they should retain only the tension needed to get through the layers, the initial force comes from your bodyweight coming over the area. As you need to get to deeper levels increase your bodyweight by altering the angle of your back foot, push from the back foot (remembering to engage your core), stabilize your shoulder girdle and arm, or gently lock your elbow and wrist. Only as a last resort should you push with your fingers, as it will then be likely to feel ?pokey? and uncomfortable.
Assessment
So now that you?ve got ?somewhere? you need to check two things: first, are you where you want to be? Let?s say you are trying to find the peroneals. Do you know that you are really on them? If you are on them, how do they feel? What kind of work do they need; what kind of tool should you choose? Would it be better to use your fingers, knuckles or elbow?
This is the stage of questioning and obtaining information. Using both active and passive movement you can gain much of the information you need. Ask your client to invert/evert the foot as you search for the peroneals to help you differentiate them from the soleus. Feel for the quality of the movement and you can assess which parts of the muscle open too much or not at all. In this way, you can begin to find the areas you?ll need to focus on and also determine how to accomplish your goals.
Pick (1999, cited in Chaitow & Fritz 2006) describes three tissue levels: surface, working and rejection, each of them being subsequently deeper than the next and they are not specific layers of the body but dependent on the level of dysfunction or sensitivity in any given area. The surface level mostly refers to the skin, the working level is where most bodywork interventions will take place and the rejection level is where any resistance experienced is overridden and pain is experienced. The practitioner must decide at which of these levels they want or need to work and, of course, if it is within the rejection level then it should be negotiated with the client.
Strategy
You are now where you want to be and you?ve found something that needs to be worked. Now you have to decide how you?re going to do it. Which direction will best engage that area? Which movement will you ask for? Which tool (fingers, knuckles, forearm etc) will best fit the area? In the words of every protective parent: what exactly is your intention?
Practitioners often skip the stages of Assessment and Strategy. These are not discrete moments in time but merely part of an on-going thought process, a mindful decision-making which ensures that your work is specific to the needs of the client rather than a treatment by rote. Of course, a certain amount of a recipe is needed for beginning practitioners. Those of us from a massage background were given a basic sequence to get through the early days of practice but as we become more comfortable with the techniques, more aware of their effects on the variations of clients and their tissue, the more we could adapt that template to suit the presenting requirements. The use of FRT requires this discretion with each and every stroke.
These are also stages that will become richer with experience. With each client and every venture into tissue you build a wider vocabulary in your fingers. Every time you perform a stroke and reassess, you have a palpatory picture of success or failure. You are laying down foundations of understanding which styles, strengths or other variations of touch will work (or fail) on that type of sensation but the speed at which you create this reference tool will depend on how you proceed through the next stage, intervention.
Intervention
You have now reached the stage of doing the work. You have allowed the tissue to let you in, checked the area you?re working on and decided how to work it. Finally, you can allow yourself to begin.
As part of your strategy you?ve already chosen which tool to use, you?re locked into the appropriate level and area and now you slowly glide and/or ask the client to move. However, for this stage it is not so much how you perform the stroke but much more about the effect of that stroke. The practitioner has to constantly monitor what is happening below and around the point of contact. Is the tissue releasing? Is the right area being challenged with the movement? Is the tissue lifting or moving? Is the client able to receive and process the information you?re offering?
Throughout the intervention, or stroke, you set up a feedback loop assessing its effectiveness. What changes can you make as you go through to assist you in the goals set above? With each change you have to re-evaluate.
With the feedback loop in place you are truly listening to the client and their tissue; you?ve set up what is sometimes referred to as a ?communication between two intelligent systems.? With your strategy in mind you are offering information to the client, asking their tissue if it can change and asking if the work makes sense both to the tissue you are working with as well as the entirety of the client. By listening to the collection of systems under your hands and keeping yourself open to the messages coming back to you, you will be able to reflect the abilities of the client?s tissue in your work. This is achieved by giving different options to the tissue, keeping all of the range of tools and variations of speed, pressure, depth etc., available and using them selectively to address the issues within the target tissue. But, keep in mind that you have to attune your ear to the language their tissue uses to inform you in response to your contact because it will talk back to you in response to your touch.
Schwind(7) encourages us to use as many of the other, non-working surfaces of the hands as possible to aid this communication. Using the supporting hand as a ?mother-hand?, for a nurturing contact or as a ?listening? hand is common among many bodywork traditions but it is only of maximum benefit if it enters into part of this conversation. It should not be there just to provide passive comfort and ease.
This is how to grow the vocabulary in your touch, experimenting with all of the many variables and ?listening? for the changes that take place. Schleip(8) has shown us the many types of mechanoreceptors in the fascial tissue and that each will respond to different forms of stress in their surrounding fibres. We need to learn how to talk to each of them, as they will have different languages.
The same variation will occur between clients and their own nervous system tuning. There will be variations in the type of dysfunction, in fascial layers or structures, whether it is the regular or irregular dense tissue, the areolar or even the adipose. Each of them may have a different language, or maybe just a slight accent, but the wider the range of touch we can integrate into our toolbox then the clearer our conversation will be.
Ending
As you begin, so should you finish.
My experience has been that therapists can forget that they are working with a sensitive human being. They are so relieved to reach the end of a stroke that they jump out of the tissue. Now, I?m not saying it?s wrong, just a little impolite perhaps.
If you take all that time to take care of your client, sinking into the tissue, feeling its condition, listening to it as you work, then give it the same respect by coming out slowly. Take your body weight back into your forward leg. A mortal sin in my book is to push into the client to jerk yourself up. Once you have your weight back in your legs then you can lift yourself out of the stroke allowing the tissue time to settle back in rather than letting it snap back.
Sometimes it can be more pleasant for the client to spiral (Aston(9)) out of the contact, slowly peeling your skin out of contact with theirs. This is especially true when you work in areas where the skin may be more sensitive such as around the armpit or the thigh adductors.
Remember, though, that this is just a style and that the exit could be part of the intent. By shocking the tissue you could be getting the desired response also by either allowing a recoil effect or perhaps to increase tone and awareness in the area. The important thing is that it is a conscious decision and is coherent with your intention to create change with the client.
Your client may be unaware of them but, this accumulation of small, continuous, attentions to detail makes a huge difference to the experience. Fascial release can be a challenging treatment and the more comfortable we can make it for the client the better they will be able to accept it.
I fully realize that the model may seem formulaic for many practitioners; this is deliberate. As a teacher I?ve often relied too much on my ?natural? or ?intuitive? sense and ability to touch. This skill came quite naturally to me and I expected others to discover their own as well. Each of us must develop an awareness of what mysteriously draws us to the ?right? layer, informs us of which direction to work and with which tool. For me, it is the ?intuition? that comes of unconscious competence, that heightened sensibility to respond to the needs of the tissue through either an innate sympathy with it or, like a chess player?s exposure to so many openings, recognizing the patterns and responding with almost automatic tuning. My mind has become attuned to the language of the tissue and have gone through these stages with very little conscious awareness on our part.
DASIE is, however, not a technique or even a style of touch, but rather a way of describing the process and what we should be considering as we interact with our clients? tissue. It is an attempt to formulate a framework for a language to facilitate communication with students and for reflecting on our own practice by asking how much consideration we give to each stage. By doing so, I hope that we can bring even more depth to the three dimensionality of our work. Listening to the tissue at every stage and taking, initially, a conscious direction to our work and gradually, with growth of expertise, allowing that to become a preconscious process but never an unconscious treatment by rote. We should always be aware of the entire person and their many levels as we treat, being responsive to the needs of each level and reacting in such a way as to develop a three dimensional communication through touch.
References
1. Montagu, A, 1986, Touch, The Human Significance of the Skin, New York, Harper & Collins
2. Chaitow L & Frit S, 2006, A Massage Therapist?s Guide to Understanding, Locating and Treating Myofascial Trigger Points, Edinburgh, Churchill Livingstone
3. Hungerford M, 1999, Lecture Notes
4. Myers T, 2001, Anatomy Trains, Edinburgh, Churchill Livingstone
5. Nelson-Jones R, 1995, The Theory and Practice of Counselling, New York, Cassell
6. Maupin E, 2005, A Dynamic relation to Gravity Volume 1 ? The Elements of Structural Integration, Dawn Eve Press.
7. Schwind P, 2006, Fascial and Membrane Technique. A manual for comprehensive treatment of the connective tissue system, Edinburgh, Churchill Livingstone
8. Schleip R, 2003, ?Fascial Plasticity ? a new neurobiological explanation: Parts 1 & 2?, Journal of Bodywork and Movement Therapies, Edinburgh, Elsevier, Jan;7(1) 11-19 and 2003 Apr;7(2) 104-116
9. Aston J, 2006, Lecture Notes
James Earls holds a BA in Psychology, certified in Structural Integration at KMI, and has trained widely in other bodywork professions. He is the founder/director of Ultimate Massage Solutions and is on the faculty of Kinesis, Inc. and Kinesis UK, teaching Structural Integration training and workshops. He teaches extensively throughout the UK, Ireland, Europe and the USA. He lives in Belfast, North Ireland, and can be reached at +44 (0)2890 481267 or [email protected][:de]There are many styles of touch: directive, loving, nurturing, abusive, healing, calming, patronizing and seductive. We can become richer therapists by developing our abilities to notice as wide a range of these as possible. Not even necessarily omitting the ?negative? as we should have them in our vocabulary, if only so that we can recognize them when they arise.
For most of us, in our profession, touch is essential; it?s needed to refresh us, comfort us and nurture us. Touch is required for most of our work and as a necessary method of communication as we make our way through the world. Much has been written of the many types of touch, much research carried out on its effects but very little has gone into explaining the process of our style of therapeutic touch.
The purpose of this article is to give a framework, to look at how we touch, and put the beginnings of a vocabulary onto what it is that we do, not to add further technique. By naming a phenomenon we can deepen the understanding of it. It is my hope that by talking of how we touch and by looking at the stages of therapeutic touch we can create a framework through which the communication of ideas is easier and thereby we gain further understanding.
Montagu,(1) in his classic text, wrote about the nurturing effects of contact well documented in the research literature and so well summarized by him, but little has been written about the mechanics of our main method of therapeutic input. Different authors and teachers have emphasized various aspects of a stroke depending on their own experience. Chaitow(2) talks of melting into the tissue, Hungerford(3) warns us ?not to drop the connective tissue,? Myers(4) talks about the three ?I?s of invitation, intention and information but few have managed to give a complete and adaptive model or vocabulary to explain a complete stroke or intervention.
My hope is that by using a staged model, we can begin to put a language together that can facilitate discussion, let us use words to express the various methods we employ and gradually develop a forum through which we can become more conversant not only with the tissue and its wonderful variations but also with each other and the many diverse backgrounds we emerge from. The language that I find useful and accessible is that of the Fascial Release Technique (FRT).
Under the hands of a skilled practitioner, Fascial Release Technique is wonderfully releasing and pleasurable. Even so, it may be a challenging experience. This tool, when wielded by a novice, can also be painful and uncomfortable. I have been ?mauled?, not only by neophytes but also by some supposedly accomplished therapists. In order to avoid traumatizing your clients, I recommend spending some time working through and playing with the five stages below. As a client centered therapy it is incumbent upon us to stay aware of the entirety of the person below our hands rather than the collection of dysfunctional tissue crying out for our saving, healing and sometimes over eager touch.
Much of this five stage model is worded for the novice practitioner. This is deliberate in order that you can see where your style may differ or what you may be leaving out, what could/would you add to this idea that will clarify for the benefit of the student or anyone trying to, as Tiger Woods did not so long ago, break down and rebuild their stroke.
The five stages, Development, Assessment, Strategy, Intervention and Ending (DASIE) is not my invention and I claim no authorship over its use, I have merely redirected it from counseling models into bodywork (Nelson- Jones(5)).
Development
Many bodywork approaches talk of ?melting? into the tissue, ?sinking through the layers? and FRT is no different from that. Be aware of the layers as you pass through them, allowing the tissue to give way rather than bulldozing your way. Allow your hands, fingers, knuckles or whichever tool you are using to mould to the shape of the body part being worked, using only enough tension and pressure to get you to that first layer of resistance. Wait to be invited in.
<img src=’https://novo.pedroprado.com.br/imgs/2009/975-1.jpg’>
In this stage you are ?developing your rapport? with the tissue. It is the initial engagement, the journey from being in their auric field through each successive layer of tissue to get to the target structure. But it is also more than that; the process is mindful, sensitive to the transfer of energy (of whichever and any and all forms you?re sensitive to), sensing that relationship waiting for that invitation (Myers) or the absorption into the sponge (an image used by Maupin(6)).
Some schools teach that you can ask your client to exhale as you melt in and I often find this a useful addition in difficult or challenging areas but occasionally overused and distracting from the touch. Experiment with using your exhale to sink your bodyweight into the tissue. Having your centre of gravity high, keeping your back heel raised may allow you to position yourself over the area, exhaling (quietly!) and dropping your centre of gravity (or sinking your Hara) is much easier for the client to receive than ?pushing? into it. The tension necessary to push will result in the client?s tissue resisting and set up a struggle that, however gentle, one of you has to win.
Maintaining a relaxed point of contact avoids putting tension into the area being worked but also keeps you much more sensitive to variations in the myofascia. The less tension you have in your working limb the better able you are to sense the changes in your client.
Achieve this by getting as much of your force from muscles as distant from the point of contact as possible. For example, if you are using your fingertips they should retain only the tension needed to get through the layers, the initial force comes from your bodyweight coming over the area. As you need to get to deeper levels increase your bodyweight by altering the angle of your back foot, push from the back foot (remembering to engage your core), stabilize your shoulder girdle and arm, or gently lock your elbow and wrist. Only as a last resort should you push with your fingers, as it will then be likely to feel ?pokey? and uncomfortable.
Assessment
So now that you?ve got ?somewhere? you need to check two things: first, are you where you want to be? Let?s say you are trying to find the peroneals. Do you know that you are really on them? If you are on them, how do they feel? What kind of work do they need; what kind of tool should you choose? Would it be better to use your fingers, knuckles or elbow?
This is the stage of questioning and obtaining information. Using both active and passive movement you can gain much of the information you need. Ask your client to invert/evert the foot as you search for the peroneals to help you differentiate them from the soleus. Feel for the quality of the movement and you can assess which parts of the muscle open too much or not at all. In this way, you can begin to find the areas you?ll need to focus on and also determine how to accomplish your goals.
Pick (1999, cited in Chaitow & Fritz 2006) describes three tissue levels: surface, working and rejection, each of them being subsequently deeper than the next and they are not specific layers of the body but dependent on the level of dysfunction or sensitivity in any given area. The surface level mostly refers to the skin, the working level is where most bodywork interventions will take place and the rejection level is where any resistance experienced is overridden and pain is experienced. The practitioner must decide at which of these levels they want or need to work and, of course, if it is within the rejection level then it should be negotiated with the client.
Strategy
You are now where you want to be and you?ve found something that needs to be worked. Now you have to decide how you?re going to do it. Which direction will best engage that area? Which movement will you ask for? Which tool (fingers, knuckles, forearm etc) will best fit the area? In the words of every protective parent: what exactly is your intention?
Practitioners often skip the stages of Assessment and Strategy. These are not discrete moments in time but merely part of an on-going thought process, a mindful decision-making which ensures that your work is specific to the needs of the client rather than a treatment by rote. Of course, a certain amount of a recipe is needed for beginning practitioners. Those of us from a massage background were given a basic sequence to get through the early days of practice but as we become more comfortable with the techniques, more aware of their effects on the variations of clients and their tissue, the more we could adapt that template to suit the presenting requirements. The use of FRT requires this discretion with each and every stroke.
These are also stages that will become richer with experience. With each client and every venture into tissue you build a wider vocabulary in your fingers. Every time you perform a stroke and reassess, you have a palpatory picture of success or failure. You are laying down foundations of understanding which styles, strengths or other variations of touch will work (or fail) on that type of sensation but the speed at which you create this reference tool will depend on how you proceed through the next stage, intervention.
Intervention
You have now reached the stage of doing the work. You have allowed the tissue to let you in, checked the area you?re working on and decided how to work it. Finally, you can allow yourself to begin.
As part of your strategy you?ve already chosen which tool to use, you?re locked into the appropriate level and area and now you slowly glide and/or ask the client to move. However, for this stage it is not so much how you perform the stroke but much more about the effect of that stroke. The practitioner has to constantly monitor what is happening below and around the point of contact. Is the tissue releasing? Is the right area being challenged with the movement? Is the tissue lifting or moving? Is the client able to receive and process the information you?re offering?
Throughout the intervention, or stroke, you set up a feedback loop assessing its effectiveness. What changes can you make as you go through to assist you in the goals set above? With each change you have to re-evaluate.
With the feedback loop in place you are truly listening to the client and their tissue; you?ve set up what is sometimes referred to as a ?communication between two intelligent systems.? With your strategy in mind you are offering information to the client, asking their tissue if it can change and asking if the work makes sense both to the tissue you are working with as well as the entirety of the client. By listening to the collection of systems under your hands and keeping yourself open to the messages coming back to you, you will be able to reflect the abilities of the client?s tissue in your work. This is achieved by giving different options to the tissue, keeping all of the range of tools and variations of speed, pressure, depth etc., available and using them selectively to address the issues within the target tissue. But, keep in mind that you have to attune your ear to the language their tissue uses to inform you in response to your contact because it will talk back to you in response to your touch.
Schwind(7) encourages us to use as many of the other, non-working surfaces of the hands as possible to aid this communication. Using the supporting hand as a ?mother-hand?, for a nurturing contact or as a ?listening? hand is common among many bodywork traditions but it is only of maximum benefit if it enters into part of this conversation. It should not be there just to provide passive comfort and ease.
This is how to grow the vocabulary in your touch, experimenting with all of the many variables and ?listening? for the changes that take place. Schleip(8) has shown us the many types of mechanoreceptors in the fascial tissue and that each will respond to different forms of stress in their surrounding fibres. We need to learn how to talk to each of them, as they will have different languages.
The same variation will occur between clients and their own nervous system tuning. There will be variations in the type of dysfunction, in fascial layers or structures, whether it is the regular or irregular dense tissue, the areolar or even the adipose. Each of them may have a different language, or maybe just a slight accent, but the wider the range of touch we can integrate into our toolbox then the clearer our conversation will be.
Ending
As you begin, so should you finish.
My experience has been that therapists can forget that they are working with a sensitive human being. They are so relieved to reach the end of a stroke that they jump out of the tissue. Now, I?m not saying it?s wrong, just a little impolite perhaps.
If you take all that time to take care of your client, sinking into the tissue, feeling its condition, listening to it as you work, then give it the same respect by coming out slowly. Take your body weight back into your forward leg. A mortal sin in my book is to push into the client to jerk yourself up. Once you have your weight back in your legs then you can lift yourself out of the stroke allowing the tissue time to settle back in rather than letting it snap back.
Sometimes it can be more pleasant for the client to spiral (Aston(9)) out of the contact, slowly peeling your skin out of contact with theirs. This is especially true when you work in areas where the skin may be more sensitive such as around the armpit or the thigh adductors.
Remember, though, that this is just a style and that the exit could be part of the intent. By shocking the tissue you could be getting the desired response also by either allowing a recoil effect or perhaps to increase tone and awareness in the area. The important thing is that it is a conscious decision and is coherent with your intention to create change with the client.
Your client may be unaware of them but, this accumulation of small, continuous, attentions to detail makes a huge difference to the experience. Fascial release can be a challenging treatment and the more comfortable we can make it for the client the better they will be able to accept it.
I fully realize that the model may seem formulaic for many practitioners; this is deliberate. As a teacher I?ve often relied too much on my ?natural? or ?intuitive? sense and ability to touch. This skill came quite naturally to me and I expected others to discover their own as well. Each of us must develop an awareness of what mysteriously draws us to the ?right? layer, informs us of which direction to work and with which tool. For me, it is the ?intuition? that comes of unconscious competence, that heightened sensibility to respond to the needs of the tissue through either an innate sympathy with it or, like a chess player?s exposure to so many openings, recognizing the patterns and responding with almost automatic tuning. My mind has become attuned to the language of the tissue and have gone through these stages with very little conscious awareness on our part.
DASIE is, however, not a technique or even a style of touch, but rather a way of describing the process and what we should be considering as we interact with our clients? tissue. It is an attempt to formulate a framework for a language to facilitate communication with students and for reflecting on our own practice by asking how much consideration we give to each stage. By doing so, I hope that we can bring even more depth to the three dimensionality of our work. Listening to the tissue at every stage and taking, initially, a conscious direction to our work and gradually, with growth of expertise, allowing that to become a preconscious process but never an unconscious treatment by rote. We should always be aware of the entire person and their many levels as we treat, being responsive to the needs of each level and reacting in such a way as to develop a three dimensional communication through touch.
References
1. Montagu, A, 1986, Touch, The Human Significance of the Skin, New York, Harper & Collins
2. Chaitow L & Frit S, 2006, A Massage Therapist?s Guide to Understanding, Locating and Treating Myofascial Trigger Points, Edinburgh, Churchill Livingstone
3. Hungerford M, 1999, Lecture Notes
4. Myers T, 2001, Anatomy Trains, Edinburgh, Churchill Livingstone
5. Nelson-Jones R, 1995, The Theory and Practice of Counselling, New York, Cassell
6. Maupin E, 2005, A Dynamic relation to Gravity Volume 1 ? The Elements of Structural Integration, Dawn Eve Press.
7. Schwind P, 2006, Fascial and Membrane Technique. A manual for comprehensive treatment of the connective tissue system, Edinburgh, Churchill Livingstone
8. Schleip R, 2003, ?Fascial Plasticity ? a new neurobiological explanation: Parts 1 & 2?, Journal of Bodywork and Movement Therapies, Edinburgh, Elsevier, Jan;7(1) 11-19 and 2003 Apr;7(2) 104-116
9. Aston J, 2006, Lecture Notes
James Earls holds a BA in Psychology, certified in Structural Integration at KMI, and has trained widely in other bodywork professions. He is the founder/director of Ultimate Massage Solutions and is on the faculty of Kinesis, Inc. and Kinesis UK, teaching Structural Integration training and workshops. He teaches extensively throughout the UK, Ireland, Europe and the USA. He lives in Belfast, North Ireland, and can be reached at +44 (0)2890 481267 or [email protected][:fr]There are many styles of touch: directive, loving, nurturing, abusive, healing, calming, patronizing and seductive. We can become richer therapists by developing our abilities to notice as wide a range of these as possible. Not even necessarily omitting the ?negative? as we should have them in our vocabulary, if only so that we can recognize them when they arise.
For most of us, in our profession, touch is essential; it?s needed to refresh us, comfort us and nurture us. Touch is required for most of our work and as a necessary method of communication as we make our way through the world. Much has been written of the many types of touch, much research carried out on its effects but very little has gone into explaining the process of our style of therapeutic touch.
The purpose of this article is to give a framework, to look at how we touch, and put the beginnings of a vocabulary onto what it is that we do, not to add further technique. By naming a phenomenon we can deepen the understanding of it. It is my hope that by talking of how we touch and by looking at the stages of therapeutic touch we can create a framework through which the communication of ideas is easier and thereby we gain further understanding.
Montagu,(1) in his classic text, wrote about the nurturing effects of contact well documented in the research literature and so well summarized by him, but little has been written about the mechanics of our main method of therapeutic input. Different authors and teachers have emphasized various aspects of a stroke depending on their own experience. Chaitow(2) talks of melting into the tissue, Hungerford(3) warns us ?not to drop the connective tissue,? Myers(4) talks about the three ?I?s of invitation, intention and information but few have managed to give a complete and adaptive model or vocabulary to explain a complete stroke or intervention.
My hope is that by using a staged model, we can begin to put a language together that can facilitate discussion, let us use words to express the various methods we employ and gradually develop a forum through which we can become more conversant not only with the tissue and its wonderful variations but also with each other and the many diverse backgrounds we emerge from. The language that I find useful and accessible is that of the Fascial Release Technique (FRT).
Under the hands of a skilled practitioner, Fascial Release Technique is wonderfully releasing and pleasurable. Even so, it may be a challenging experience. This tool, when wielded by a novice, can also be painful and uncomfortable. I have been ?mauled?, not only by neophytes but also by some supposedly accomplished therapists. In order to avoid traumatizing your clients, I recommend spending some time working through and playing with the five stages below. As a client centered therapy it is incumbent upon us to stay aware of the entirety of the person below our hands rather than the collection of dysfunctional tissue crying out for our saving, healing and sometimes over eager touch.
Much of this five stage model is worded for the novice practitioner. This is deliberate in order that you can see where your style may differ or what you may be leaving out, what could/would you add to this idea that will clarify for the benefit of the student or anyone trying to, as Tiger Woods did not so long ago, break down and rebuild their stroke.
The five stages, Development, Assessment, Strategy, Intervention and Ending (DASIE) is not my invention and I claim no authorship over its use, I have merely redirected it from counseling models into bodywork (Nelson- Jones(5)).
Development
Many bodywork approaches talk of ?melting? into the tissue, ?sinking through the layers? and FRT is no different from that. Be aware of the layers as you pass through them, allowing the tissue to give way rather than bulldozing your way. Allow your hands, fingers, knuckles or whichever tool you are using to mould to the shape of the body part being worked, using only enough tension and pressure to get you to that first layer of resistance. Wait to be invited in.
<img src=’https://novo.pedroprado.com.br/imgs/2009/975-1.jpg’>
In this stage you are ?developing your rapport? with the tissue. It is the initial engagement, the journey from being in their auric field through each successive layer of tissue to get to the target structure. But it is also more than that; the process is mindful, sensitive to the transfer of energy (of whichever and any and all forms you?re sensitive to), sensing that relationship waiting for that invitation (Myers) or the absorption into the sponge (an image used by Maupin(6)).
Some schools teach that you can ask your client to exhale as you melt in and I often find this a useful addition in difficult or challenging areas but occasionally overused and distracting from the touch. Experiment with using your exhale to sink your bodyweight into the tissue. Having your centre of gravity high, keeping your back heel raised may allow you to position yourself over the area, exhaling (quietly!) and dropping your centre of gravity (or sinking your Hara) is much easier for the client to receive than ?pushing? into it. The tension necessary to push will result in the client?s tissue resisting and set up a struggle that, however gentle, one of you has to win.
Maintaining a relaxed point of contact avoids putting tension into the area being worked but also keeps you much more sensitive to variations in the myofascia. The less tension you have in your working limb the better able you are to sense the changes in your client.
Achieve this by getting as much of your force from muscles as distant from the point of contact as possible. For example, if you are using your fingertips they should retain only the tension needed to get through the layers, the initial force comes from your bodyweight coming over the area. As you need to get to deeper levels increase your bodyweight by altering the angle of your back foot, push from the back foot (remembering to engage your core), stabilize your shoulder girdle and arm, or gently lock your elbow and wrist. Only as a last resort should you push with your fingers, as it will then be likely to feel ?pokey? and uncomfortable.
Assessment
So now that you?ve got ?somewhere? you need to check two things: first, are you where you want to be? Let?s say you are trying to find the peroneals. Do you know that you are really on them? If you are on them, how do they feel? What kind of work do they need; what kind of tool should you choose? Would it be better to use your fingers, knuckles or elbow?
This is the stage of questioning and obtaining information. Using both active and passive movement you can gain much of the information you need. Ask your client to invert/evert the foot as you search for the peroneals to help you differentiate them from the soleus. Feel for the quality of the movement and you can assess which parts of the muscle open too much or not at all. In this way, you can begin to find the areas you?ll need to focus on and also determine how to accomplish your goals.
Pick (1999, cited in Chaitow & Fritz 2006) describes three tissue levels: surface, working and rejection, each of them being subsequently deeper than the next and they are not specific layers of the body but dependent on the level of dysfunction or sensitivity in any given area. The surface level mostly refers to the skin, the working level is where most bodywork interventions will take place and the rejection level is where any resistance experienced is overridden and pain is experienced. The practitioner must decide at which of these levels they want or need to work and, of course, if it is within the rejection level then it should be negotiated with the client.
Strategy
You are now where you want to be and you?ve found something that needs to be worked. Now you have to decide how you?re going to do it. Which direction will best engage that area? Which movement will you ask for? Which tool (fingers, knuckles, forearm etc) will best fit the area? In the words of every protective parent: what exactly is your intention?
Practitioners often skip the stages of Assessment and Strategy. These are not discrete moments in time but merely part of an on-going thought process, a mindful decision-making which ensures that your work is specific to the needs of the client rather than a treatment by rote. Of course, a certain amount of a recipe is needed for beginning practitioners. Those of us from a massage background were given a basic sequence to get through the early days of practice but as we become more comfortable with the techniques, more aware of their effects on the variations of clients and their tissue, the more we could adapt that template to suit the presenting requirements. The use of FRT requires this discretion with each and every stroke.
These are also stages that will become richer with experience. With each client and every venture into tissue you build a wider vocabulary in your fingers. Every time you perform a stroke and reassess, you have a palpatory picture of success or failure. You are laying down foundations of understanding which styles, strengths or other variations of touch will work (or fail) on that type of sensation but the speed at which you create this reference tool will depend on how you proceed through the next stage, intervention.
Intervention
You have now reached the stage of doing the work. You have allowed the tissue to let you in, checked the area you?re working on and decided how to work it. Finally, you can allow yourself to begin.
As part of your strategy you?ve already chosen which tool to use, you?re locked into the appropriate level and area and now you slowly glide and/or ask the client to move. However, for this stage it is not so much how you perform the stroke but much more about the effect of that stroke. The practitioner has to constantly monitor what is happening below and around the point of contact. Is the tissue releasing? Is the right area being challenged with the movement? Is the tissue lifting or moving? Is the client able to receive and process the information you?re offering?
Throughout the intervention, or stroke, you set up a feedback loop assessing its effectiveness. What changes can you make as you go through to assist you in the goals set above? With each change you have to re-evaluate.
With the feedback loop in place you are truly listening to the client and their tissue; you?ve set up what is sometimes referred to as a ?communication between two intelligent systems.? With your strategy in mind you are offering information to the client, asking their tissue if it can change and asking if the work makes sense both to the tissue you are working with as well as the entirety of the client. By listening to the collection of systems under your hands and keeping yourself open to the messages coming back to you, you will be able to reflect the abilities of the client?s tissue in your work. This is achieved by giving different options to the tissue, keeping all of the range of tools and variations of speed, pressure, depth etc., available and using them selectively to address the issues within the target tissue. But, keep in mind that you have to attune your ear to the language their tissue uses to inform you in response to your contact because it will talk back to you in response to your touch.
Schwind(7) encourages us to use as many of the other, non-working surfaces of the hands as possible to aid this communication. Using the supporting hand as a ?mother-hand?, for a nurturing contact or as a ?listening? hand is common among many bodywork traditions but it is only of maximum benefit if it enters into part of this conversation. It should not be there just to provide passive comfort and ease.
This is how to grow the vocabulary in your touch, experimenting with all of the many variables and ?listening? for the changes that take place. Schleip(8) has shown us the many types of mechanoreceptors in the fascial tissue and that each will respond to different forms of stress in their surrounding fibres. We need to learn how to talk to each of them, as they will have different languages.
The same variation will occur between clients and their own nervous system tuning. There will be variations in the type of dysfunction, in fascial layers or structures, whether it is the regular or irregular dense tissue, the areolar or even the adipose. Each of them may have a different language, or maybe just a slight accent, but the wider the range of touch we can integrate into our toolbox then the clearer our conversation will be.
Ending
As you begin, so should you finish.
My experience has been that therapists can forget that they are working with a sensitive human being. They are so relieved to reach the end of a stroke that they jump out of the tissue. Now, I?m not saying it?s wrong, just a little impolite perhaps.
If you take all that time to take care of your client, sinking into the tissue, feeling its condition, listening to it as you work, then give it the same respect by coming out slowly. Take your body weight back into your forward leg. A mortal sin in my book is to push into the client to jerk yourself up. Once you have your weight back in your legs then you can lift yourself out of the stroke allowing the tissue time to settle back in rather than letting it snap back.
Sometimes it can be more pleasant for the client to spiral (Aston(9)) out of the contact, slowly peeling your skin out of contact with theirs. This is especially true when you work in areas where the skin may be more sensitive such as around the armpit or the thigh adductors.
Remember, though, that this is just a style and that the exit could be part of the intent. By shocking the tissue you could be getting the desired response also by either allowing a recoil effect or perhaps to increase tone and awareness in the area. The important thing is that it is a conscious decision and is coherent with your intention to create change with the client.
Your client may be unaware of them but, this accumulation of small, continuous, attentions to detail makes a huge difference to the experience. Fascial release can be a challenging treatment and the more comfortable we can make it for the client the better they will be able to accept it.
I fully realize that the model may seem formulaic for many practitioners; this is deliberate. As a teacher I?ve often relied too much on my ?natural? or ?intuitive? sense and ability to touch. This skill came quite naturally to me and I expected others to discover their own as well. Each of us must develop an awareness of what mysteriously draws us to the ?right? layer, informs us of which direction to work and with which tool. For me, it is the ?intuition? that comes of unconscious competence, that heightened sensibility to respond to the needs of the tissue through either an innate sympathy with it or, like a chess player?s exposure to so many openings, recognizing the patterns and responding with almost automatic tuning. My mind has become attuned to the language of the tissue and have gone through these stages with very little conscious awareness on our part.
DASIE is, however, not a technique or even a style of touch, but rather a way of describing the process and what we should be considering as we interact with our clients? tissue. It is an attempt to formulate a framework for a language to facilitate communication with students and for reflecting on our own practice by asking how much consideration we give to each stage. By doing so, I hope that we can bring even more depth to the three dimensionality of our work. Listening to the tissue at every stage and taking, initially, a conscious direction to our work and gradually, with growth of expertise, allowing that to become a preconscious process but never an unconscious treatment by rote. We should always be aware of the entire person and their many levels as we treat, being responsive to the needs of each level and reacting in such a way as to develop a three dimensional communication through touch.
References
1. Montagu, A, 1986, Touch, The Human Significance of the Skin, New York, Harper & Collins
2. Chaitow L & Frit S, 2006, A Massage Therapist?s Guide to Understanding, Locating and Treating Myofascial Trigger Points, Edinburgh, Churchill Livingstone
3. Hungerford M, 1999, Lecture Notes
4. Myers T, 2001, Anatomy Trains, Edinburgh, Churchill Livingstone
5. Nelson-Jones R, 1995, The Theory and Practice of Counselling, New York, Cassell
6. Maupin E, 2005, A Dynamic relation to Gravity Volume 1 ? The Elements of Structural Integration, Dawn Eve Press.
7. Schwind P, 2006, Fascial and Membrane Technique. A manual for comprehensive treatment of the connective tissue system, Edinburgh, Churchill Livingstone
8. Schleip R, 2003, ?Fascial Plasticity ? a new neurobiological explanation: Parts 1 & 2?, Journal of Bodywork and Movement Therapies, Edinburgh, Elsevier, Jan;7(1) 11-19 and 2003 Apr;7(2) 104-116
9. Aston J, 2006, Lecture Notes
James Earls holds a BA in Psychology, certified in Structural Integration at KMI, and has trained widely in other bodywork professions. He is the founder/director of Ultimate Massage Solutions and is on the faculty of Kinesis, Inc. and Kinesis UK, teaching Structural Integration training and workshops. He teaches extensively throughout the UK, Ireland, Europe and the USA. He lives in Belfast, North Ireland, and can be reached at +44 (0)2890 481267 or [email protected][:es]There are many styles of touch: directive, loving, nurturing, abusive, healing, calming, patronizing and seductive. We can become richer therapists by developing our abilities to notice as wide a range of these as possible. Not even necessarily omitting the ?negative? as we should have them in our vocabulary, if only so that we can recognize them when they arise.
For most of us, in our profession, touch is essential; it?s needed to refresh us, comfort us and nurture us. Touch is required for most of our work and as a necessary method of communication as we make our way through the world. Much has been written of the many types of touch, much research carried out on its effects but very little has gone into explaining the process of our style of therapeutic touch.
The purpose of this article is to give a framework, to look at how we touch, and put the beginnings of a vocabulary onto what it is that we do, not to add further technique. By naming a phenomenon we can deepen the understanding of it. It is my hope that by talking of how we touch and by looking at the stages of therapeutic touch we can create a framework through which the communication of ideas is easier and thereby we gain further understanding.
Montagu,(1) in his classic text, wrote about the nurturing effects of contact well documented in the research literature and so well summarized by him, but little has been written about the mechanics of our main method of therapeutic input. Different authors and teachers have emphasized various aspects of a stroke depending on their own experience. Chaitow(2) talks of melting into the tissue, Hungerford(3) warns us ?not to drop the connective tissue,? Myers(4) talks about the three ?I?s of invitation, intention and information but few have managed to give a complete and adaptive model or vocabulary to explain a complete stroke or intervention.
My hope is that by using a staged model, we can begin to put a language together that can facilitate discussion, let us use words to express the various methods we employ and gradually develop a forum through which we can become more conversant not only with the tissue and its wonderful variations but also with each other and the many diverse backgrounds we emerge from. The language that I find useful and accessible is that of the Fascial Release Technique (FRT).
Under the hands of a skilled practitioner, Fascial Release Technique is wonderfully releasing and pleasurable. Even so, it may be a challenging experience. This tool, when wielded by a novice, can also be painful and uncomfortable. I have been ?mauled?, not only by neophytes but also by some supposedly accomplished therapists. In order to avoid traumatizing your clients, I recommend spending some time working through and playing with the five stages below. As a client centered therapy it is incumbent upon us to stay aware of the entirety of the person below our hands rather than the collection of dysfunctional tissue crying out for our saving, healing and sometimes over eager touch.
Much of this five stage model is worded for the novice practitioner. This is deliberate in order that you can see where your style may differ or what you may be leaving out, what could/would you add to this idea that will clarify for the benefit of the student or anyone trying to, as Tiger Woods did not so long ago, break down and rebuild their stroke.
The five stages, Development, Assessment, Strategy, Intervention and Ending (DASIE) is not my invention and I claim no authorship over its use, I have merely redirected it from counseling models into bodywork (Nelson- Jones(5)).
Development
Many bodywork approaches talk of ?melting? into the tissue, ?sinking through the layers? and FRT is no different from that. Be aware of the layers as you pass through them, allowing the tissue to give way rather than bulldozing your way. Allow your hands, fingers, knuckles or whichever tool you are using to mould to the shape of the body part being worked, using only enough tension and pressure to get you to that first layer of resistance. Wait to be invited in.
<img src=’https://novo.pedroprado.com.br/imgs/2009/975-1.jpg’>
In this stage you are ?developing your rapport? with the tissue. It is the initial engagement, the journey from being in their auric field through each successive layer of tissue to get to the target structure. But it is also more than that; the process is mindful, sensitive to the transfer of energy (of whichever and any and all forms you?re sensitive to), sensing that relationship waiting for that invitation (Myers) or the absorption into the sponge (an image used by Maupin(6)).
Some schools teach that you can ask your client to exhale as you melt in and I often find this a useful addition in difficult or challenging areas but occasionally overused and distracting from the touch. Experiment with using your exhale to sink your bodyweight into the tissue. Having your centre of gravity high, keeping your back heel raised may allow you to position yourself over the area, exhaling (quietly!) and dropping your centre of gravity (or sinking your Hara) is much easier for the client to receive than ?pushing? into it. The tension necessary to push will result in the client?s tissue resisting and set up a struggle that, however gentle, one of you has to win.
Maintaining a relaxed point of contact avoids putting tension into the area being worked but also keeps you much more sensitive to variations in the myofascia. The less tension you have in your working limb the better able you are to sense the changes in your client.
Achieve this by getting as much of your force from muscles as distant from the point of contact as possible. For example, if you are using your fingertips they should retain only the tension needed to get through the layers, the initial force comes from your bodyweight coming over the area. As you need to get to deeper levels increase your bodyweight by altering the angle of your back foot, push from the back foot (remembering to engage your core), stabilize your shoulder girdle and arm, or gently lock your elbow and wrist. Only as a last resort should you push with your fingers, as it will then be likely to feel ?pokey? and uncomfortable.
Assessment
So now that you?ve got ?somewhere? you need to check two things: first, are you where you want to be? Let?s say you are trying to find the peroneals. Do you know that you are really on them? If you are on them, how do they feel? What kind of work do they need; what kind of tool should you choose? Would it be better to use your fingers, knuckles or elbow?
This is the stage of questioning and obtaining information. Using both active and passive movement you can gain much of the information you need. Ask your client to invert/evert the foot as you search for the peroneals to help you differentiate them from the soleus. Feel for the quality of the movement and you can assess which parts of the muscle open too much or not at all. In this way, you can begin to find the areas you?ll need to focus on and also determine how to accomplish your goals.
Pick (1999, cited in Chaitow & Fritz 2006) describes three tissue levels: surface, working and rejection, each of them being subsequently deeper than the next and they are not specific layers of the body but dependent on the level of dysfunction or sensitivity in any given area. The surface level mostly refers to the skin, the working level is where most bodywork interventions will take place and the rejection level is where any resistance experienced is overridden and pain is experienced. The practitioner must decide at which of these levels they want or need to work and, of course, if it is within the rejection level then it should be negotiated with the client.
Strategy
You are now where you want to be and you?ve found something that needs to be worked. Now you have to decide how you?re going to do it. Which direction will best engage that area? Which movement will you ask for? Which tool (fingers, knuckles, forearm etc) will best fit the area? In the words of every protective parent: what exactly is your intention?
Practitioners often skip the stages of Assessment and Strategy. These are not discrete moments in time but merely part of an on-going thought process, a mindful decision-making which ensures that your work is specific to the needs of the client rather than a treatment by rote. Of course, a certain amount of a recipe is needed for beginning practitioners. Those of us from a massage background were given a basic sequence to get through the early days of practice but as we become more comfortable with the techniques, more aware of their effects on the variations of clients and their tissue, the more we could adapt that template to suit the presenting requirements. The use of FRT requires this discretion with each and every stroke.
These are also stages that will become richer with experience. With each client and every venture into tissue you build a wider vocabulary in your fingers. Every time you perform a stroke and reassess, you have a palpatory picture of success or failure. You are laying down foundations of understanding which styles, strengths or other variations of touch will work (or fail) on that type of sensation but the speed at which you create this reference tool will depend on how you proceed through the next stage, intervention.
Intervention
You have now reached the stage of doing the work. You have allowed the tissue to let you in, checked the area you?re working on and decided how to work it. Finally, you can allow yourself to begin.
As part of your strategy you?ve already chosen which tool to use, you?re locked into the appropriate level and area and now you slowly glide and/or ask the client to move. However, for this stage it is not so much how you perform the stroke but much more about the effect of that stroke. The practitioner has to constantly monitor what is happening below and around the point of contact. Is the tissue releasing? Is the right area being challenged with the movement? Is the tissue lifting or moving? Is the client able to receive and process the information you?re offering?
Throughout the intervention, or stroke, you set up a feedback loop assessing its effectiveness. What changes can you make as you go through to assist you in the goals set above? With each change you have to re-evaluate.
With the feedback loop in place you are truly listening to the client and their tissue; you?ve set up what is sometimes referred to as a ?communication between two intelligent systems.? With your strategy in mind you are offering information to the client, asking their tissue if it can change and asking if the work makes sense both to the tissue you are working with as well as the entirety of the client. By listening to the collection of systems under your hands and keeping yourself open to the messages coming back to you, you will be able to reflect the abilities of the client?s tissue in your work. This is achieved by giving different options to the tissue, keeping all of the range of tools and variations of speed, pressure, depth etc., available and using them selectively to address the issues within the target tissue. But, keep in mind that you have to attune your ear to the language their tissue uses to inform you in response to your contact because it will talk back to you in response to your touch.
Schwind(7) encourages us to use as many of the other, non-working surfaces of the hands as possible to aid this communication. Using the supporting hand as a ?mother-hand?, for a nurturing contact or as a ?listening? hand is common among many bodywork traditions but it is only of maximum benefit if it enters into part of this conversation. It should not be there just to provide passive comfort and ease.
This is how to grow the vocabulary in your touch, experimenting with all of the many variables and ?listening? for the changes that take place. Schleip(8) has shown us the many types of mechanoreceptors in the fascial tissue and that each will respond to different forms of stress in their surrounding fibres. We need to learn how to talk to each of them, as they will have different languages.
The same variation will occur between clients and their own nervous system tuning. There will be variations in the type of dysfunction, in fascial layers or structures, whether it is the regular or irregular dense tissue, the areolar or even the adipose. Each of them may have a different language, or maybe just a slight accent, but the wider the range of touch we can integrate into our toolbox then the clearer our conversation will be.
Ending
As you begin, so should you finish.
My experience has been that therapists can forget that they are working with a sensitive human being. They are so relieved to reach the end of a stroke that they jump out of the tissue. Now, I?m not saying it?s wrong, just a little impolite perhaps.
If you take all that time to take care of your client, sinking into the tissue, feeling its condition, listening to it as you work, then give it the same respect by coming out slowly. Take your body weight back into your forward leg. A mortal sin in my book is to push into the client to jerk yourself up. Once you have your weight back in your legs then you can lift yourself out of the stroke allowing the tissue time to settle back in rather than letting it snap back.
Sometimes it can be more pleasant for the client to spiral (Aston(9)) out of the contact, slowly peeling your skin out of contact with theirs. This is especially true when you work in areas where the skin may be more sensitive such as around the armpit or the thigh adductors.
Remember, though, that this is just a style and that the exit could be part of the intent. By shocking the tissue you could be getting the desired response also by either allowing a recoil effect or perhaps to increase tone and awareness in the area. The important thing is that it is a conscious decision and is coherent with your intention to create change with the client.
Your client may be unaware of them but, this accumulation of small, continuous, attentions to detail makes a huge difference to the experience. Fascial release can be a challenging treatment and the more comfortable we can make it for the client the better they will be able to accept it.
I fully realize that the model may seem formulaic for many practitioners; this is deliberate. As a teacher I?ve often relied too much on my ?natural? or ?intuitive? sense and ability to touch. This skill came quite naturally to me and I expected others to discover their own as well. Each of us must develop an awareness of what mysteriously draws us to the ?right? layer, informs us of which direction to work and with which tool. For me, it is the ?intuition? that comes of unconscious competence, that heightened sensibility to respond to the needs of the tissue through either an innate sympathy with it or, like a chess player?s exposure to so many openings, recognizing the patterns and responding with almost automatic tuning. My mind has become attuned to the language of the tissue and have gone through these stages with very little conscious awareness on our part.
DASIE is, however, not a technique or even a style of touch, but rather a way of describing the process and what we should be considering as we interact with our clients? tissue. It is an attempt to formulate a framework for a language to facilitate communication with students and for reflecting on our own practice by asking how much consideration we give to each stage. By doing so, I hope that we can bring even more depth to the three dimensionality of our work. Listening to the tissue at every stage and taking, initially, a conscious direction to our work and gradually, with growth of expertise, allowing that to become a preconscious process but never an unconscious treatment by rote. We should always be aware of the entire person and their many levels as we treat, being responsive to the needs of each level and reacting in such a way as to develop a three dimensional communication through touch.
References
1. Montagu, A, 1986, Touch, The Human Significance of the Skin, New York, Harper & Collins
2. Chaitow L & Frit S, 2006, A Massage Therapist?s Guide to Understanding, Locating and Treating Myofascial Trigger Points, Edinburgh, Churchill Livingstone
3. Hungerford M, 1999, Lecture Notes
4. Myers T, 2001, Anatomy Trains, Edinburgh, Churchill Livingstone
5. Nelson-Jones R, 1995, The Theory and Practice of Counselling, New York, Cassell
6. Maupin E, 2005, A Dynamic relation to Gravity Volume 1 ? The Elements of Structural Integration, Dawn Eve Press.
7. Schwind P, 2006, Fascial and Membrane Technique. A manual for comprehensive treatment of the connective tissue system, Edinburgh, Churchill Livingstone
8. Schleip R, 2003, ?Fascial Plasticity ? a new neurobiological explanation: Parts 1 & 2?, Journal of Bodywork and Movement Therapies, Edinburgh, Elsevier, Jan;7(1) 11-19 and 2003 Apr;7(2) 104-116
9. Aston J, 2006, Lecture Notes
James Earls holds a BA in Psychology, certified in Structural Integration at KMI, and has trained widely in other bodywork professions. He is the founder/director of Ultimate Massage Solutions and is on the faculty of Kinesis, Inc. and Kinesis UK, teaching Structural Integration training and workshops. He teaches extensively throughout the UK, Ireland, Europe and the USA. He lives in Belfast, North Ireland, and can be reached at +44 (0)2890 481267 or [email protected][:ja]There are many styles of touch: directive, loving, nurturing, abusive, healing, calming, patronizing and seductive. We can become richer therapists by developing our abilities to notice as wide a range of these as possible. Not even necessarily omitting the ?negative? as we should have them in our vocabulary, if only so that we can recognize them when they arise.
For most of us, in our profession, touch is essential; it?s needed to refresh us, comfort us and nurture us. Touch is required for most of our work and as a necessary method of communication as we make our way through the world. Much has been written of the many types of touch, much research carried out on its effects but very little has gone into explaining the process of our style of therapeutic touch.
The purpose of this article is to give a framework, to look at how we touch, and put the beginnings of a vocabulary onto what it is that we do, not to add further technique. By naming a phenomenon we can deepen the understanding of it. It is my hope that by talking of how we touch and by looking at the stages of therapeutic touch we can create a framework through which the communication of ideas is easier and thereby we gain further understanding.
Montagu,(1) in his classic text, wrote about the nurturing effects of contact well documented in the research literature and so well summarized by him, but little has been written about the mechanics of our main method of therapeutic input. Different authors and teachers have emphasized various aspects of a stroke depending on their own experience. Chaitow(2) talks of melting into the tissue, Hungerford(3) warns us ?not to drop the connective tissue,? Myers(4) talks about the three ?I?s of invitation, intention and information but few have managed to give a complete and adaptive model or vocabulary to explain a complete stroke or intervention.
My hope is that by using a staged model, we can begin to put a language together that can facilitate discussion, let us use words to express the various methods we employ and gradually develop a forum through which we can become more conversant not only with the tissue and its wonderful variations but also with each other and the many diverse backgrounds we emerge from. The language that I find useful and accessible is that of the Fascial Release Technique (FRT).
Under the hands of a skilled practitioner, Fascial Release Technique is wonderfully releasing and pleasurable. Even so, it may be a challenging experience. This tool, when wielded by a novice, can also be painful and uncomfortable. I have been ?mauled?, not only by neophytes but also by some supposedly accomplished therapists. In order to avoid traumatizing your clients, I recommend spending some time working through and playing with the five stages below. As a client centered therapy it is incumbent upon us to stay aware of the entirety of the person below our hands rather than the collection of dysfunctional tissue crying out for our saving, healing and sometimes over eager touch.
Much of this five stage model is worded for the novice practitioner. This is deliberate in order that you can see where your style may differ or what you may be leaving out, what could/would you add to this idea that will clarify for the benefit of the student or anyone trying to, as Tiger Woods did not so long ago, break down and rebuild their stroke.
The five stages, Development, Assessment, Strategy, Intervention and Ending (DASIE) is not my invention and I claim no authorship over its use, I have merely redirected it from counseling models into bodywork (Nelson- Jones(5)).
Development
Many bodywork approaches talk of ?melting? into the tissue, ?sinking through the layers? and FRT is no different from that. Be aware of the layers as you pass through them, allowing the tissue to give way rather than bulldozing your way. Allow your hands, fingers, knuckles or whichever tool you are using to mould to the shape of the body part being worked, using only enough tension and pressure to get you to that first layer of resistance. Wait to be invited in.
<img src=’https://novo.pedroprado.com.br/imgs/2009/975-1.jpg’>
In this stage you are ?developing your rapport? with the tissue. It is the initial engagement, the journey from being in their auric field through each successive layer of tissue to get to the target structure. But it is also more than that; the process is mindful, sensitive to the transfer of energy (of whichever and any and all forms you?re sensitive to), sensing that relationship waiting for that invitation (Myers) or the absorption into the sponge (an image used by Maupin(6)).
Some schools teach that you can ask your client to exhale as you melt in and I often find this a useful addition in difficult or challenging areas but occasionally overused and distracting from the touch. Experiment with using your exhale to sink your bodyweight into the tissue. Having your centre of gravity high, keeping your back heel raised may allow you to position yourself over the area, exhaling (quietly!) and dropping your centre of gravity (or sinking your Hara) is much easier for the client to receive than ?pushing? into it. The tension necessary to push will result in the client?s tissue resisting and set up a struggle that, however gentle, one of you has to win.
Maintaining a relaxed point of contact avoids putting tension into the area being worked but also keeps you much more sensitive to variations in the myofascia. The less tension you have in your working limb the better able you are to sense the changes in your client.
Achieve this by getting as much of your force from muscles as distant from the point of contact as possible. For example, if you are using your fingertips they should retain only the tension needed to get through the layers, the initial force comes from your bodyweight coming over the area. As you need to get to deeper levels increase your bodyweight by altering the angle of your back foot, push from the back foot (remembering to engage your core), stabilize your shoulder girdle and arm, or gently lock your elbow and wrist. Only as a last resort should you push with your fingers, as it will then be likely to feel ?pokey? and uncomfortable.
Assessment
So now that you?ve got ?somewhere? you need to check two things: first, are you where you want to be? Let?s say you are trying to find the peroneals. Do you know that you are really on them? If you are on them, how do they feel? What kind of work do they need; what kind of tool should you choose? Would it be better to use your fingers, knuckles or elbow?
This is the stage of questioning and obtaining information. Using both active and passive movement you can gain much of the information you need. Ask your client to invert/evert the foot as you search for the peroneals to help you differentiate them from the soleus. Feel for the quality of the movement and you can assess which parts of the muscle open too much or not at all. In this way, you can begin to find the areas you?ll need to focus on and also determine how to accomplish your goals.
Pick (1999, cited in Chaitow & Fritz 2006) describes three tissue levels: surface, working and rejection, each of them being subsequently deeper than the next and they are not specific layers of the body but dependent on the level of dysfunction or sensitivity in any given area. The surface level mostly refers to the skin, the working level is where most bodywork interventions will take place and the rejection level is where any resistance experienced is overridden and pain is experienced. The practitioner must decide at which of these levels they want or need to work and, of course, if it is within the rejection level then it should be negotiated with the client.
Strategy
You are now where you want to be and you?ve found something that needs to be worked. Now you have to decide how you?re going to do it. Which direction will best engage that area? Which movement will you ask for? Which tool (fingers, knuckles, forearm etc) will best fit the area? In the words of every protective parent: what exactly is your intention?
Practitioners often skip the stages of Assessment and Strategy. These are not discrete moments in time but merely part of an on-going thought process, a mindful decision-making which ensures that your work is specific to the needs of the client rather than a treatment by rote. Of course, a certain amount of a recipe is needed for beginning practitioners. Those of us from a massage background were given a basic sequence to get through the early days of practice but as we become more comfortable with the techniques, more aware of their effects on the variations of clients and their tissue, the more we could adapt that template to suit the presenting requirements. The use of FRT requires this discretion with each and every stroke.
These are also stages that will become richer with experience. With each client and every venture into tissue you build a wider vocabulary in your fingers. Every time you perform a stroke and reassess, you have a palpatory picture of success or failure. You are laying down foundations of understanding which styles, strengths or other variations of touch will work (or fail) on that type of sensation but the speed at which you create this reference tool will depend on how you proceed through the next stage, intervention.
Intervention
You have now reached the stage of doing the work. You have allowed the tissue to let you in, checked the area you?re working on and decided how to work it. Finally, you can allow yourself to begin.
As part of your strategy you?ve already chosen which tool to use, you?re locked into the appropriate level and area and now you slowly glide and/or ask the client to move. However, for this stage it is not so much how you perform the stroke but much more about the effect of that stroke. The practitioner has to constantly monitor what is happening below and around the point of contact. Is the tissue releasing? Is the right area being challenged with the movement? Is the tissue lifting or moving? Is the client able to receive and process the information you?re offering?
Throughout the intervention, or stroke, you set up a feedback loop assessing its effectiveness. What changes can you make as you go through to assist you in the goals set above? With each change you have to re-evaluate.
With the feedback loop in place you are truly listening to the client and their tissue; you?ve set up what is sometimes referred to as a ?communication between two intelligent systems.? With your strategy in mind you are offering information to the client, asking their tissue if it can change and asking if the work makes sense both to the tissue you are working with as well as the entirety of the client. By listening to the collection of systems under your hands and keeping yourself open to the messages coming back to you, you will be able to reflect the abilities of the client?s tissue in your work. This is achieved by giving different options to the tissue, keeping all of the range of tools and variations of speed, pressure, depth etc., available and using them selectively to address the issues within the target tissue. But, keep in mind that you have to attune your ear to the language their tissue uses to inform you in response to your contact because it will talk back to you in response to your touch.
Schwind(7) encourages us to use as many of the other, non-working surfaces of the hands as possible to aid this communication. Using the supporting hand as a ?mother-hand?, for a nurturing contact or as a ?listening? hand is common among many bodywork traditions but it is only of maximum benefit if it enters into part of this conversation. It should not be there just to provide passive comfort and ease.
This is how to grow the vocabulary in your touch, experimenting with all of the many variables and ?listening? for the changes that take place. Schleip(8) has shown us the many types of mechanoreceptors in the fascial tissue and that each will respond to different forms of stress in their surrounding fibres. We need to learn how to talk to each of them, as they will have different languages.
The same variation will occur between clients and their own nervous system tuning. There will be variations in the type of dysfunction, in fascial layers or structures, whether it is the regular or irregular dense tissue, the areolar or even the adipose. Each of them may have a different language, or maybe just a slight accent, but the wider the range of touch we can integrate into our toolbox then the clearer our conversation will be.
Ending
As you begin, so should you finish.
My experience has been that therapists can forget that they are working with a sensitive human being. They are so relieved to reach the end of a stroke that they jump out of the tissue. Now, I?m not saying it?s wrong, just a little impolite perhaps.
If you take all that time to take care of your client, sinking into the tissue, feeling its condition, listening to it as you work, then give it the same respect by coming out slowly. Take your body weight back into your forward leg. A mortal sin in my book is to push into the client to jerk yourself up. Once you have your weight back in your legs then you can lift yourself out of the stroke allowing the tissue time to settle back in rather than letting it snap back.
Sometimes it can be more pleasant for the client to spiral (Aston(9)) out of the contact, slowly peeling your skin out of contact with theirs. This is especially true when you work in areas where the skin may be more sensitive such as around the armpit or the thigh adductors.
Remember, though, that this is just a style and that the exit could be part of the intent. By shocking the tissue you could be getting the desired response also by either allowing a recoil effect or perhaps to increase tone and awareness in the area. The important thing is that it is a conscious decision and is coherent with your intention to create change with the client.
Your client may be unaware of them but, this accumulation of small, continuous, attentions to detail makes a huge difference to the experience. Fascial release can be a challenging treatment and the more comfortable we can make it for the client the better they will be able to accept it.
I fully realize that the model may seem formulaic for many practitioners; this is deliberate. As a teacher I?ve often relied too much on my ?natural? or ?intuitive? sense and ability to touch. This skill came quite naturally to me and I expected others to discover their own as well. Each of us must develop an awareness of what mysteriously draws us to the ?right? layer, informs us of which direction to work and with which tool. For me, it is the ?intuition? that comes of unconscious competence, that heightened sensibility to respond to the needs of the tissue through either an innate sympathy with it or, like a chess player?s exposure to so many openings, recognizing the patterns and responding with almost automatic tuning. My mind has become attuned to the language of the tissue and have gone through these stages with very little conscious awareness on our part.
DASIE is, however, not a technique or even a style of touch, but rather a way of describing the process and what we should be considering as we interact with our clients? tissue. It is an attempt to formulate a framework for a language to facilitate communication with students and for reflecting on our own practice by asking how much consideration we give to each stage. By doing so, I hope that we can bring even more depth to the three dimensionality of our work. Listening to the tissue at every stage and taking, initially, a conscious direction to our work and gradually, with growth of expertise, allowing that to become a preconscious process but never an unconscious treatment by rote. We should always be aware of the entire person and their many levels as we treat, being responsive to the needs of each level and reacting in such a way as to develop a three dimensional communication through touch.
References
1. Montagu, A, 1986, Touch, The Human Significance of the Skin, New York, Harper & Collins
2. Chaitow L & Frit S, 2006, A Massage Therapist?s Guide to Understanding, Locating and Treating Myofascial Trigger Points, Edinburgh, Churchill Livingstone
3. Hungerford M, 1999, Lecture Notes
4. Myers T, 2001, Anatomy Trains, Edinburgh, Churchill Livingstone
5. Nelson-Jones R, 1995, The Theory and Practice of Counselling, New York, Cassell
6. Maupin E, 2005, A Dynamic relation to Gravity Volume 1 ? The Elements of Structural Integration, Dawn Eve Press.
7. Schwind P, 2006, Fascial and Membrane Technique. A manual for comprehensive treatment of the connective tissue system, Edinburgh, Churchill Livingstone
8. Schleip R, 2003, ?Fascial Plasticity ? a new neurobiological explanation: Parts 1 & 2?, Journal of Bodywork and Movement Therapies, Edinburgh, Elsevier, Jan;7(1) 11-19 and 2003 Apr;7(2) 104-116
9. Aston J, 2006, Lecture Notes
James Earls holds a BA in Psychology, certified in Structural Integration at KMI, and has trained widely in other bodywork professions. He is the founder/director of Ultimate Massage Solutions and is on the faculty of Kinesis, Inc. and Kinesis UK, teaching Structural Integration training and workshops. He teaches extensively throughout the UK, Ireland, Europe and the USA. He lives in Belfast, North Ireland, and can be reached at +44 (0)2890 481267 or [email protected][:it]There are many styles of touch: directive, loving, nurturing, abusive, healing, calming, patronizing and seductive. We can become richer therapists by developing our abilities to notice as wide a range of these as possible. Not even necessarily omitting the ?negative? as we should have them in our vocabulary, if only so that we can recognize them when they arise.
For most of us, in our profession, touch is essential; it?s needed to refresh us, comfort us and nurture us. Touch is required for most of our work and as a necessary method of communication as we make our way through the world. Much has been written of the many types of touch, much research carried out on its effects but very little has gone into explaining the process of our style of therapeutic touch.
The purpose of this article is to give a framework, to look at how we touch, and put the beginnings of a vocabulary onto what it is that we do, not to add further technique. By naming a phenomenon we can deepen the understanding of it. It is my hope that by talking of how we touch and by looking at the stages of therapeutic touch we can create a framework through which the communication of ideas is easier and thereby we gain further understanding.
Montagu,(1) in his classic text, wrote about the nurturing effects of contact well documented in the research literature and so well summarized by him, but little has been written about the mechanics of our main method of therapeutic input. Different authors and teachers have emphasized various aspects of a stroke depending on their own experience. Chaitow(2) talks of melting into the tissue, Hungerford(3) warns us ?not to drop the connective tissue,? Myers(4) talks about the three ?I?s of invitation, intention and information but few have managed to give a complete and adaptive model or vocabulary to explain a complete stroke or intervention.
My hope is that by using a staged model, we can begin to put a language together that can facilitate discussion, let us use words to express the various methods we employ and gradually develop a forum through which we can become more conversant not only with the tissue and its wonderful variations but also with each other and the many diverse backgrounds we emerge from. The language that I find useful and accessible is that of the Fascial Release Technique (FRT).
Under the hands of a skilled practitioner, Fascial Release Technique is wonderfully releasing and pleasurable. Even so, it may be a challenging experience. This tool, when wielded by a novice, can also be painful and uncomfortable. I have been ?mauled?, not only by neophytes but also by some supposedly accomplished therapists. In order to avoid traumatizing your clients, I recommend spending some time working through and playing with the five stages below. As a client centered therapy it is incumbent upon us to stay aware of the entirety of the person below our hands rather than the collection of dysfunctional tissue crying out for our saving, healing and sometimes over eager touch.
Much of this five stage model is worded for the novice practitioner. This is deliberate in order that you can see where your style may differ or what you may be leaving out, what could/would you add to this idea that will clarify for the benefit of the student or anyone trying to, as Tiger Woods did not so long ago, break down and rebuild their stroke.
The five stages, Development, Assessment, Strategy, Intervention and Ending (DASIE) is not my invention and I claim no authorship over its use, I have merely redirected it from counseling models into bodywork (Nelson- Jones(5)).
Development
Many bodywork approaches talk of ?melting? into the tissue, ?sinking through the layers? and FRT is no different from that. Be aware of the layers as you pass through them, allowing the tissue to give way rather than bulldozing your way. Allow your hands, fingers, knuckles or whichever tool you are using to mould to the shape of the body part being worked, using only enough tension and pressure to get you to that first layer of resistance. Wait to be invited in.
<img src=’https://novo.pedroprado.com.br/imgs/2009/975-1.jpg’>
In this stage you are ?developing your rapport? with the tissue. It is the initial engagement, the journey from being in their auric field through each successive layer of tissue to get to the target structure. But it is also more than that; the process is mindful, sensitive to the transfer of energy (of whichever and any and all forms you?re sensitive to), sensing that relationship waiting for that invitation (Myers) or the absorption into the sponge (an image used by Maupin(6)).
Some schools teach that you can ask your client to exhale as you melt in and I often find this a useful addition in difficult or challenging areas but occasionally overused and distracting from the touch. Experiment with using your exhale to sink your bodyweight into the tissue. Having your centre of gravity high, keeping your back heel raised may allow you to position yourself over the area, exhaling (quietly!) and dropping your centre of gravity (or sinking your Hara) is much easier for the client to receive than ?pushing? into it. The tension necessary to push will result in the client?s tissue resisting and set up a struggle that, however gentle, one of you has to win.
Maintaining a relaxed point of contact avoids putting tension into the area being worked but also keeps you much more sensitive to variations in the myofascia. The less tension you have in your working limb the better able you are to sense the changes in your client.
Achieve this by getting as much of your force from muscles as distant from the point of contact as possible. For example, if you are using your fingertips they should retain only the tension needed to get through the layers, the initial force comes from your bodyweight coming over the area. As you need to get to deeper levels increase your bodyweight by altering the angle of your back foot, push from the back foot (remembering to engage your core), stabilize your shoulder girdle and arm, or gently lock your elbow and wrist. Only as a last resort should you push with your fingers, as it will then be likely to feel ?pokey? and uncomfortable.
Assessment
So now that you?ve got ?somewhere? you need to check two things: first, are you where you want to be? Let?s say you are trying to find the peroneals. Do you know that you are really on them? If you are on them, how do they feel? What kind of work do they need; what kind of tool should you choose? Would it be better to use your fingers, knuckles or elbow?
This is the stage of questioning and obtaining information. Using both active and passive movement you can gain much of the information you need. Ask your client to invert/evert the foot as you search for the peroneals to help you differentiate them from the soleus. Feel for the quality of the movement and you can assess which parts of the muscle open too much or not at all. In this way, you can begin to find the areas you?ll need to focus on and also determine how to accomplish your goals.
Pick (1999, cited in Chaitow & Fritz 2006) describes three tissue levels: surface, working and rejection, each of them being subsequently deeper than the next and they are not specific layers of the body but dependent on the level of dysfunction or sensitivity in any given area. The surface level mostly refers to the skin, the working level is where most bodywork interventions will take place and the rejection level is where any resistance experienced is overridden and pain is experienced. The practitioner must decide at which of these levels they want or need to work and, of course, if it is within the rejection level then it should be negotiated with the client.
Strategy
You are now where you want to be and you?ve found something that needs to be worked. Now you have to decide how you?re going to do it. Which direction will best engage that area? Which movement will you ask for? Which tool (fingers, knuckles, forearm etc) will best fit the area? In the words of every protective parent: what exactly is your intention?
Practitioners often skip the stages of Assessment and Strategy. These are not discrete moments in time but merely part of an on-going thought process, a mindful decision-making which ensures that your work is specific to the needs of the client rather than a treatment by rote. Of course, a certain amount of a recipe is needed for beginning practitioners. Those of us from a massage background were given a basic sequence to get through the early days of practice but as we become more comfortable with the techniques, more aware of their effects on the variations of clients and their tissue, the more we could adapt that template to suit the presenting requirements. The use of FRT requires this discretion with each and every stroke.
These are also stages that will become richer with experience. With each client and every venture into tissue you build a wider vocabulary in your fingers. Every time you perform a stroke and reassess, you have a palpatory picture of success or failure. You are laying down foundations of understanding which styles, strengths or other variations of touch will work (or fail) on that type of sensation but the speed at which you create this reference tool will depend on how you proceed through the next stage, intervention.
Intervention
You have now reached the stage of doing the work. You have allowed the tissue to let you in, checked the area you?re working on and decided how to work it. Finally, you can allow yourself to begin.
As part of your strategy you?ve already chosen which tool to use, you?re locked into the appropriate level and area and now you slowly glide and/or ask the client to move. However, for this stage it is not so much how you perform the stroke but much more about the effect of that stroke. The practitioner has to constantly monitor what is happening below and around the point of contact. Is the tissue releasing? Is the right area being challenged with the movement? Is the tissue lifting or moving? Is the client able to receive and process the information you?re offering?
Throughout the intervention, or stroke, you set up a feedback loop assessing its effectiveness. What changes can you make as you go through to assist you in the goals set above? With each change you have to re-evaluate.
With the feedback loop in place you are truly listening to the client and their tissue; you?ve set up what is sometimes referred to as a ?communication between two intelligent systems.? With your strategy in mind you are offering information to the client, asking their tissue if it can change and asking if the work makes sense both to the tissue you are working with as well as the entirety of the client. By listening to the collection of systems under your hands and keeping yourself open to the messages coming back to you, you will be able to reflect the abilities of the client?s tissue in your work. This is achieved by giving different options to the tissue, keeping all of the range of tools and variations of speed, pressure, depth etc., available and using them selectively to address the issues within the target tissue. But, keep in mind that you have to attune your ear to the language their tissue uses to inform you in response to your contact because it will talk back to you in response to your touch.
Schwind(7) encourages us to use as many of the other, non-working surfaces of the hands as possible to aid this communication. Using the supporting hand as a ?mother-hand?, for a nurturing contact or as a ?listening? hand is common among many bodywork traditions but it is only of maximum benefit if it enters into part of this conversation. It should not be there just to provide passive comfort and ease.
This is how to grow the vocabulary in your touch, experimenting with all of the many variables and ?listening? for the changes that take place. Schleip(8) has shown us the many types of mechanoreceptors in the fascial tissue and that each will respond to different forms of stress in their surrounding fibres. We need to learn how to talk to each of them, as they will have different languages.
The same variation will occur between clients and their own nervous system tuning. There will be variations in the type of dysfunction, in fascial layers or structures, whether it is the regular or irregular dense tissue, the areolar or even the adipose. Each of them may have a different language, or maybe just a slight accent, but the wider the range of touch we can integrate into our toolbox then the clearer our conversation will be.
Ending
As you begin, so should you finish.
My experience has been that therapists can forget that they are working with a sensitive human being. They are so relieved to reach the end of a stroke that they jump out of the tissue. Now, I?m not saying it?s wrong, just a little impolite perhaps.
If you take all that time to take care of your client, sinking into the tissue, feeling its condition, listening to it as you work, then give it the same respect by coming out slowly. Take your body weight back into your forward leg. A mortal sin in my book is to push into the client to jerk yourself up. Once you have your weight back in your legs then you can lift yourself out of the stroke allowing the tissue time to settle back in rather than letting it snap back.
Sometimes it can be more pleasant for the client to spiral (Aston(9)) out of the contact, slowly peeling your skin out of contact with theirs. This is especially true when you work in areas where the skin may be more sensitive such as around the armpit or the thigh adductors.
Remember, though, that this is just a style and that the exit could be part of the intent. By shocking the tissue you could be getting the desired response also by either allowing a recoil effect or perhaps to increase tone and awareness in the area. The important thing is that it is a conscious decision and is coherent with your intention to create change with the client.
Your client may be unaware of them but, this accumulation of small, continuous, attentions to detail makes a huge difference to the experience. Fascial release can be a challenging treatment and the more comfortable we can make it for the client the better they will be able to accept it.
I fully realize that the model may seem formulaic for many practitioners; this is deliberate. As a teacher I?ve often relied too much on my ?natural? or ?intuitive? sense and ability to touch. This skill came quite naturally to me and I expected others to discover their own as well. Each of us must develop an awareness of what mysteriously draws us to the ?right? layer, informs us of which direction to work and with which tool. For me, it is the ?intuition? that comes of unconscious competence, that heightened sensibility to respond to the needs of the tissue through either an innate sympathy with it or, like a chess player?s exposure to so many openings, recognizing the patterns and responding with almost automatic tuning. My mind has become attuned to the language of the tissue and have gone through these stages with very little conscious awareness on our part.
DASIE is, however, not a technique or even a style of touch, but rather a way of describing the process and what we should be considering as we interact with our clients? tissue. It is an attempt to formulate a framework for a language to facilitate communication with students and for reflecting on our own practice by asking how much consideration we give to each stage. By doing so, I hope that we can bring even more depth to the three dimensionality of our work. Listening to the tissue at every stage and taking, initially, a conscious direction to our work and gradually, with growth of expertise, allowing that to become a preconscious process but never an unconscious treatment by rote. We should always be aware of the entire person and their many levels as we treat, being responsive to the needs of each level and reacting in such a way as to develop a three dimensional communication through touch.
References
1. Montagu, A, 1986, Touch, The Human Significance of the Skin, New York, Harper & Collins
2. Chaitow L & Frit S, 2006, A Massage Therapist?s Guide to Understanding, Locating and Treating Myofascial Trigger Points, Edinburgh, Churchill Livingstone
3. Hungerford M, 1999, Lecture Notes
4. Myers T, 2001, Anatomy Trains, Edinburgh, Churchill Livingstone
5. Nelson-Jones R, 1995, The Theory and Practice of Counselling, New York, Cassell
6. Maupin E, 2005, A Dynamic relation to Gravity Volume 1 ? The Elements of Structural Integration, Dawn Eve Press.
7. Schwind P, 2006, Fascial and Membrane Technique. A manual for comprehensive treatment of the connective tissue system, Edinburgh, Churchill Livingstone
8. Schleip R, 2003, ?Fascial Plasticity ? a new neurobiological explanation: Parts 1 & 2?, Journal of Bodywork and Movement Therapies, Edinburgh, Elsevier, Jan;7(1) 11-19 and 2003 Apr;7(2) 104-116
9. Aston J, 2006, Lecture Notes
James Earls holds a BA in Psychology, certified in Structural Integration at KMI, and has trained widely in other bodywork professions. He is the founder/director of Ultimate Massage Solutions and is on the faculty of Kinesis, Inc. and Kinesis UK, teaching Structural Integration training and workshops. He teaches extensively throughout the UK, Ireland, Europe and the USA. He lives in Belfast, North Ireland, and can be reached at +44 (0)2890 481267 or [email protected][:pb]There are many styles of touch: directive, loving, nurturing, abusive, healing, calming, patronizing and seductive. We can become richer therapists by developing our abilities to notice as wide a range of these as possible. Not even necessarily omitting the ?negative? as we should have them in our vocabulary, if only so that we can recognize them when they arise.
For most of us, in our profession, touch is essential; it?s needed to refresh us, comfort us and nurture us. Touch is required for most of our work and as a necessary method of communication as we make our way through the world. Much has been written of the many types of touch, much research carried out on its effects but very little has gone into explaining the process of our style of therapeutic touch.
The purpose of this article is to give a framework, to look at how we touch, and put the beginnings of a vocabulary onto what it is that we do, not to add further technique. By naming a phenomenon we can deepen the understanding of it. It is my hope that by talking of how we touch and by looking at the stages of therapeutic touch we can create a framework through which the communication of ideas is easier and thereby we gain further understanding.
Montagu,(1) in his classic text, wrote about the nurturing effects of contact well documented in the research literature and so well summarized by him, but little has been written about the mechanics of our main method of therapeutic input. Different authors and teachers have emphasized various aspects of a stroke depending on their own experience. Chaitow(2) talks of melting into the tissue, Hungerford(3) warns us ?not to drop the connective tissue,? Myers(4) talks about the three ?I?s of invitation, intention and information but few have managed to give a complete and adaptive model or vocabulary to explain a complete stroke or intervention.
My hope is that by using a staged model, we can begin to put a language together that can facilitate discussion, let us use words to express the various methods we employ and gradually develop a forum through which we can become more conversant not only with the tissue and its wonderful variations but also with each other and the many diverse backgrounds we emerge from. The language that I find useful and accessible is that of the Fascial Release Technique (FRT).
Under the hands of a skilled practitioner, Fascial Release Technique is wonderfully releasing and pleasurable. Even so, it may be a challenging experience. This tool, when wielded by a novice, can also be painful and uncomfortable. I have been ?mauled?, not only by neophytes but also by some supposedly accomplished therapists. In order to avoid traumatizing your clients, I recommend spending some time working through and playing with the five stages below. As a client centered therapy it is incumbent upon us to stay aware of the entirety of the person below our hands rather than the collection of dysfunctional tissue crying out for our saving, healing and sometimes over eager touch.
Much of this five stage model is worded for the novice practitioner. This is deliberate in order that you can see where your style may differ or what you may be leaving out, what could/would you add to this idea that will clarify for the benefit of the student or anyone trying to, as Tiger Woods did not so long ago, break down and rebuild their stroke.
The five stages, Development, Assessment, Strategy, Intervention and Ending (DASIE) is not my invention and I claim no authorship over its use, I have merely redirected it from counseling models into bodywork (Nelson- Jones(5)).
Development
Many bodywork approaches talk of ?melting? into the tissue, ?sinking through the layers? and FRT is no different from that. Be aware of the layers as you pass through them, allowing the tissue to give way rather than bulldozing your way. Allow your hands, fingers, knuckles or whichever tool you are using to mould to the shape of the body part being worked, using only enough tension and pressure to get you to that first layer of resistance. Wait to be invited in.
<img src=’https://novo.pedroprado.com.br/imgs/2009/975-1.jpg’>
In this stage you are ?developing your rapport? with the tissue. It is the initial engagement, the journey from being in their auric field through each successive layer of tissue to get to the target structure. But it is also more than that; the process is mindful, sensitive to the transfer of energy (of whichever and any and all forms you?re sensitive to), sensing that relationship waiting for that invitation (Myers) or the absorption into the sponge (an image used by Maupin(6)).
Some schools teach that you can ask your client to exhale as you melt in and I often find this a useful addition in difficult or challenging areas but occasionally overused and distracting from the touch. Experiment with using your exhale to sink your bodyweight into the tissue. Having your centre of gravity high, keeping your back heel raised may allow you to position yourself over the area, exhaling (quietly!) and dropping your centre of gravity (or sinking your Hara) is much easier for the client to receive than ?pushing? into it. The tension necessary to push will result in the client?s tissue resisting and set up a struggle that, however gentle, one of you has to win.
Maintaining a relaxed point of contact avoids putting tension into the area being worked but also keeps you much more sensitive to variations in the myofascia. The less tension you have in your working limb the better able you are to sense the changes in your client.
Achieve this by getting as much of your force from muscles as distant from the point of contact as possible. For example, if you are using your fingertips they should retain only the tension needed to get through the layers, the initial force comes from your bodyweight coming over the area. As you need to get to deeper levels increase your bodyweight by altering the angle of your back foot, push from the back foot (remembering to engage your core), stabilize your shoulder girdle and arm, or gently lock your elbow and wrist. Only as a last resort should you push with your fingers, as it will then be likely to feel ?pokey? and uncomfortable.
Assessment
So now that you?ve got ?somewhere? you need to check two things: first, are you where you want to be? Let?s say you are trying to find the peroneals. Do you know that you are really on them? If you are on them, how do they feel? What kind of work do they need; what kind of tool should you choose? Would it be better to use your fingers, knuckles or elbow?
This is the stage of questioning and obtaining information. Using both active and passive movement you can gain much of the information you need. Ask your client to invert/evert the foot as you search for the peroneals to help you differentiate them from the soleus. Feel for the quality of the movement and you can assess which parts of the muscle open too much or not at all. In this way, you can begin to find the areas you?ll need to focus on and also determine how to accomplish your goals.
Pick (1999, cited in Chaitow & Fritz 2006) describes three tissue levels: surface, working and rejection, each of them being subsequently deeper than the next and they are not specific layers of the body but dependent on the level of dysfunction or sensitivity in any given area. The surface level mostly refers to the skin, the working level is where most bodywork interventions will take place and the rejection level is where any resistance experienced is overridden and pain is experienced. The practitioner must decide at which of these levels they want or need to work and, of course, if it is within the rejection level then it should be negotiated with the client.
Strategy
You are now where you want to be and you?ve found something that needs to be worked. Now you have to decide how you?re going to do it. Which direction will best engage that area? Which movement will you ask for? Which tool (fingers, knuckles, forearm etc) will best fit the area? In the words of every protective parent: what exactly is your intention?
Practitioners often skip the stages of Assessment and Strategy. These are not discrete moments in time but merely part of an on-going thought process, a mindful decision-making which ensures that your work is specific to the needs of the client rather than a treatment by rote. Of course, a certain amount of a recipe is needed for beginning practitioners. Those of us from a massage background were given a basic sequence to get through the early days of practice but as we become more comfortable with the techniques, more aware of their effects on the variations of clients and their tissue, the more we could adapt that template to suit the presenting requirements. The use of FRT requires this discretion with each and every stroke.
These are also stages that will become richer with experience. With each client and every venture into tissue you build a wider vocabulary in your fingers. Every time you perform a stroke and reassess, you have a palpatory picture of success or failure. You are laying down foundations of understanding which styles, strengths or other variations of touch will work (or fail) on that type of sensation but the speed at which you create this reference tool will depend on how you proceed through the next stage, intervention.
Intervention
You have now reached the stage of doing the work. You have allowed the tissue to let you in, checked the area you?re working on and decided how to work it. Finally, you can allow yourself to begin.
As part of your strategy you?ve already chosen which tool to use, you?re locked into the appropriate level and area and now you slowly glide and/or ask the client to move. However, for this stage it is not so much how you perform the stroke but much more about the effect of that stroke. The practitioner has to constantly monitor what is happening below and around the point of contact. Is the tissue releasing? Is the right area being challenged with the movement? Is the tissue lifting or moving? Is the client able to receive and process the information you?re offering?
Throughout the intervention, or stroke, you set up a feedback loop assessing its effectiveness. What changes can you make as you go through to assist you in the goals set above? With each change you have to re-evaluate.
With the feedback loop in place you are truly listening to the client and their tissue; you?ve set up what is sometimes referred to as a ?communication between two intelligent systems.? With your strategy in mind you are offering information to the client, asking their tissue if it can change and asking if the work makes sense both to the tissue you are working with as well as the entirety of the client. By listening to the collection of systems under your hands and keeping yourself open to the messages coming back to you, you will be able to reflect the abilities of the client?s tissue in your work. This is achieved by giving different options to the tissue, keeping all of the range of tools and variations of speed, pressure, depth etc., available and using them selectively to address the issues within the target tissue. But, keep in mind that you have to attune your ear to the language their tissue uses to inform you in response to your contact because it will talk back to you in response to your touch.
Schwind(7) encourages us to use as many of the other, non-working surfaces of the hands as possible to aid this communication. Using the supporting hand as a ?mother-hand?, for a nurturing contact or as a ?listening? hand is common among many bodywork traditions but it is only of maximum benefit if it enters into part of this conversation. It should not be there just to provide passive comfort and ease.
This is how to grow the vocabulary in your touch, experimenting with all of the many variables and ?listening? for the changes that take place. Schleip(8) has shown us the many types of mechanoreceptors in the fascial tissue and that each will respond to different forms of stress in their surrounding fibres. We need to learn how to talk to each of them, as they will have different languages.
The same variation will occur between clients and their own nervous system tuning. There will be variations in the type of dysfunction, in fascial layers or structures, whether it is the regular or irregular dense tissue, the areolar or even the adipose. Each of them may have a different language, or maybe just a slight accent, but the wider the range of touch we can integrate into our toolbox then the clearer our conversation will be.
Ending
As you begin, so should you finish.
My experience has been that therapists can forget that they are working with a sensitive human being. They are so relieved to reach the end of a stroke that they jump out of the tissue. Now, I?m not saying it?s wrong, just a little impolite perhaps.
If you take all that time to take care of your client, sinking into the tissue, feeling its condition, listening to it as you work, then give it the same respect by coming out slowly. Take your body weight back into your forward leg. A mortal sin in my book is to push into the client to jerk yourself up. Once you have your weight back in your legs then you can lift yourself out of the stroke allowing the tissue time to settle back in rather than letting it snap back.
Sometimes it can be more pleasant for the client to spiral (Aston(9)) out of the contact, slowly peeling your skin out of contact with theirs. This is especially true when you work in areas where the skin may be more sensitive such as around the armpit or the thigh adductors.
Remember, though, that this is just a style and that the exit could be part of the intent. By shocking the tissue you could be getting the desired response also by either allowing a recoil effect or perhaps to increase tone and awareness in the area. The important thing is that it is a conscious decision and is coherent with your intention to create change with the client.
Your client may be unaware of them but, this accumulation of small, continuous, attentions to detail makes a huge difference to the experience. Fascial release can be a challenging treatment and the more comfortable we can make it for the client the better they will be able to accept it.
I fully realize that the model may seem formulaic for many practitioners; this is deliberate. As a teacher I?ve often relied too much on my ?natural? or ?intuitive? sense and ability to touch. This skill came quite naturally to me and I expected others to discover their own as well. Each of us must develop an awareness of what mysteriously draws us to the ?right? layer, informs us of which direction to work and with which tool. For me, it is the ?intuition? that comes of unconscious competence, that heightened sensibility to respond to the needs of the tissue through either an innate sympathy with it or, like a chess player?s exposure to so many openings, recognizing the patterns and responding with almost automatic tuning. My mind has become attuned to the language of the tissue and have gone through these stages with very little conscious awareness on our part.
DASIE is, however, not a technique or even a style of touch, but rather a way of describing the process and what we should be considering as we interact with our clients? tissue. It is an attempt to formulate a framework for a language to facilitate communication with students and for reflecting on our own practice by asking how much consideration we give to each stage. By doing so, I hope that we can bring even more depth to the three dimensionality of our work. Listening to the tissue at every stage and taking, initially, a conscious direction to our work and gradually, with growth of expertise, allowing that to become a preconscious process but never an unconscious treatment by rote. We should always be aware of the entire person and their many levels as we treat, being responsive to the needs of each level and reacting in such a way as to develop a three dimensional communication through touch.
References
1. Montagu, A, 1986, Touch, The Human Significance of the Skin, New York, Harper & Collins
2. Chaitow L & Frit S, 2006, A Massage Therapist?s Guide to Understanding, Locating and Treating Myofascial Trigger Points, Edinburgh, Churchill Livingstone
3. Hungerford M, 1999, Lecture Notes
4. Myers T, 2001, Anatomy Trains, Edinburgh, Churchill Livingstone
5. Nelson-Jones R, 1995, The Theory and Practice of Counselling, New York, Cassell
6. Maupin E, 2005, A Dynamic relation to Gravity Volume 1 ? The Elements of Structural Integration, Dawn Eve Press.
7. Schwind P, 2006, Fascial and Membrane Technique. A manual for comprehensive treatment of the connective tissue system, Edinburgh, Churchill Livingstone
8. Schleip R, 2003, ?Fascial Plasticity ? a new neurobiological explanation: Parts 1 & 2?, Journal of Bodywork and Movement Therapies, Edinburgh, Elsevier, Jan;7(1) 11-19 and 2003 Apr;7(2) 104-116
9. Aston J, 2006, Lecture Notes
James Earls holds a BA in Psychology, certified in Structural Integration at KMI, and has trained widely in other bodywork professions. He is the founder/director of Ultimate Massage Solutions and is on the faculty of Kinesis, Inc. and Kinesis UK, teaching Structural Integration training and workshops. He teaches extensively throughout the UK, Ireland, Europe and the USA. He lives in Belfast, North Ireland, and can be reached at +44 (0)2890 481267 or [email protected][:]D.A.S.I.E
As you register, you allow [email protected] to send you emails with information
The language of this site is in English, but you can navigate through the pages using the Google Translate. Just select the flag of the language you want to browse. Automatic translation may contain errors, so if you prefer, go back to the original language, English.
Developed with 
by Empreiteira Digital
To have full access to the content of this article you need to be registered on the site. Sign up or Register.