title: Creating integrative work: a qualitative study of how massage therapists work with existing clients.
abstract: BACKGROUND
  As one of the most often used complementary treatments, massage is increasingly positioned as an essential component of integrative medicine. Recent studies evaluate the clinical efficacy of massage therapy, but few studies explore how massage therapists (MTs) execute their work and exercise clinical reasoning in natural settings.
  
  
  OBJECTIVE
  To gain foundational knowledge about clinical reasoning and applied knowledge, this study examined how 10 MTs executed an entire session with established clients. Results support translational research design and inform educators.
  
  
  METHODS
  Ethnomethodology and phenomenology informed the qualitative design. Data were collected by videotaping actual sessions and interviewing the participants immediately afterward while viewing the videos. Computer-aided analysis identified data patterns for thematic interpretation.
  
  
  RESULTS
  The MTs shared tacit knowledge that directed their work: a) maintaining a primarily biomechanical focus, b) prerequisite safe touch, c) multitasking not allowed, d) MTs assume physical risk, and e) the work affects multiple bodily systems. The MTs sensed effectiveness experientially by adopting common tactics: a) visualizing the manual engagement points, b) assuming the client controlled the physiological release, and c) educating the client. Within these commonalities, they operationalized their work in complex and singular ways, with the particular client relationship critical to structuring the session and evaluating the outcome.
  
  
  CONCLUSIONS
  MTs viewed their work primarily as a biomechanical intervention, but understood therapeutic massage as serving multiple functions. Process-oriented clinical reasoning mirrored models found in psychotherapy and was informed by experience, intuition, and training, which resulted in an intentionally holistic approach.
authors.affiliation: School of Mind-Body Medicine, Saybrook University, San Francisco, CA, USA; Fellow, Institute of Social Innovation, Fielding University, Santa Barbara, CA, USA. Electronic address: lfortune@saybrook.edu.
authors.forename: Luann Drolc
authors.initials: LD
authors.lastname: Fortune
authors.affiliation: Department of Psychology, Loyal University, New Orleans, LA, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Hymel
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage / Q000379:methods* / Q000523:psychology*; D017060:Patient Satisfaction; D036301:Qualitative Research
keywords: Bodywork; Client-centered; Clinical reasoning; Complementary and alternative medicine (CAM); Health care; Holistic; Integrative healthcare; Manual therapy; Qualitative research; Somatic awareness; Therapeutic relationship; Wellness