It took me a while this year to acknowledge and accept the fact that most fitness and massage clients don’t really care what technique, tool, or modality I use, and what I use just aren’t that important to them. What matters more to my clients are my abilities to listen, provide and receive feedback, and adapt to address their problems. Thus, this is my journey of transition from the operator model to interactor model.
First, in my early years as a personal trainer at a box gym, I learned how to teach clients certain “corrective exercises” to “improve” their posture and body asymmetries, hoping that this would help them move better or be in less pain. I also learned how to use certain modalities of exercise, such as the BOSU (a new toy in 2002), cable machines, foam rollers, and other equipment that promised clients and trainers that they will get stronger, be more balanced, or burn more calories. Even as recent as 2011, I was still very convinced that the Functional Movement Screen (FMS) and posture assessments were the Holy Grail to improve clients’ daily function, sports performance, and pain relief.
Let’s fast forward to early 2013 when I first enrolled in massage school. The 700-plus hour course for a standard massage therapy education and training in California also followed a similar pattern and philosophy that I had experienced in my fitness career. We were taught different modalities of massage: Swedish, “deep tissue sculpting,” NMT, etc. In Asian Healing Arts, I learned to follow a recipe for tui na massage that is supposed to alleviate symptoms in certain internal organ problems. In NMT, I learned to palpate certain areas on the body to find “trigger points” that is supposed to cause pain. The experience overall is the emphasis of the modality to “treat” certain problems by addressing the problem from outside to within.
In short, if so-and-so has this problem, use XYZ or DEF method to treat it. If the problem is resolved, the therapist or trainer gets most of the credit. If it is not resolved, then, well, I see two possible outcomes: The therapist or trainer gets most of the blame, or the case is ignored and only the cases that “worked” are confirmed and lauded.
Eventually, it took me some time to realize that most clients don’t really care what method I used or what toys I have. They didn’t care much whether I used certain type of deep tissue work, kettlebells, or rice bags. What mattered more to them is that they want their problem resolved and have somebody listen and understand their problem. Today, I find the latter a much more effective way to help them: Work with them, not just work on them.
This “novel” idea stemmed from a Facebook group discussion about two years ago when a gentleman named Will Stewart, who is a fellow massage therapist and fitness professional, brought up the terms “operator” and “interactor.” Originally published in the May 2011 issue of The Journal of Manual & Manipulatve Therapy by physical therapists Diane Jacobs and Jason Silvernail, the operator model of client care or patient treatment involves the health professional doing most of the work while the client or patient plays mostly a passive role. The operator also focuses more on the structural aspects of the body (e.g., muscles, fasciae).
For example, a massage therapist performs deep tissue compressions upon a client’s lumbar region with chronic low back pain. The client may or may not feel better after the work, and the outcome is based on the quality of the work.
In the interactor model, other factors are taken into context beyond the technique, such as the relationship and interaction between the practitioner and the client, the environment they are in, the client’s mindset, and each person’s cultural background. These factors interact with each other and play a role in the client’s outcome and the practitioner’s work.
For example, an interactive massage therapist might use a lighter and slower work to ease muscle tension instead of just grabbing the meat and mush it. He or she would also consider not only the clients’ biological factors (e.g. anatomy, physiology) but also their psychological, social life, and environment that may affect their problem. Thus, the biopsycholosocial model is what the interactor model is based on.
“An ‘interactor’ stance would be to remind oneself that that patient’s/client’s nervous system is responding to mechanical forces, and softening is occurring as a desirable result,” Diane Jacobs said in a Facebook chat. “No heuristics. No shortcuts in the breadcrumb trail between what the therapist is doing, and the outcome achieved. If the nervous system of the patient isn’t ready to reshape its sensory input or motor output representations, that muscle isn’t going to soften the way the therapist would like.”
Enabling clients to develop their own sense of control of their problems is the greatest gift I can offer to them. While there is still much to learn to apply this relatively new paradigm with my practice, I think this is something most medical, fitness, and allied health professionals should adopt in their practice. Wouldn’t you want to be in control of your own health rather than relying on someone or a product constantly?