The Health Intake Interview

Having completed this lesson, you will be able to:

• Define the term client interview.
• Describe the purpose of a pre-session client interview.
• Outline the school-selected steps in a client interview process (e.g., establish rapport with the client, communicate clinic policies, clarify written information on the health form, determine client session goals and expectations, identify body regions where the client wishes to receive massage, identify body regions where the client does not wish to receive massage, determine the types of techniques and depth the client would like, determine the client’s preferences for music or lubricants, etc.).
• List three pieces of information a therapist can learn from a pre-session client interview (e.g., the client’s expectations for the session, the quality of the client’s experience of pain, functional limitations, etc.).
• Define the term session adaptations.
• List three session adaptations a therapist might use to make a massage session more comfortable or safer for a client (e.g., changes in positioning, shorten the session, choice of application methods, etc.).

A health intake interview is a conversation that occurs between the therapist and the client to gather information that will be used to plan the session. An interview conducted before a wellness session is usually less detailed than an intake interview for a health care session. It should be managed efficiently and not cut into the time allocated for the client’s massage. In Chapter 7 (The Therapeutic Relationship), you learned about the therapeutic relationship. In Chapter 8 (Professional Communication) you learned about active professional communication practices. Both of these topics directly influence the quality of the health intake interview. If you are uncertain about how to set up and maintain a therapeutic relationship, or if you have not started practicing professional communication skills, a review of these chapters is recommended. Without first understanding these core skills it will be difficult to conduct an efficient and meaningful health intake interview.

The goals of the interview include:

• Put the client at ease and establish rapport: Rapport is defined as a friendly bond between people based on mutual liking, trust, and a sense that they understand and share each other’s concerns. While you don’t want to overstep the boundaries of the therapeutic relationship and treat clients like buddies, you will want to greet them warmly and treat them with respect, friendliness, and compassion. One of the first questions to review on the health intake form is “Have you ever received a massage before?” If the client answers “yes” ask him or her about the experience and what they liked about the massage. This can clue you into the client’s expectations for the session and help you meet these expectations. If the client answers “no” you will probably want to spend additional time orienting the client to the way a session is conducted. New clients may be very apprehensive and clear descriptions of the draping policy and client’s rights often help them relax and develop feelings of trust.
• Communicate the policies of the clinic to establish the therapeutic relationship: Review the informed consent form with the client. Don’t assume that the client has read it just because it is signed. Briefly verbalize each section of the form and ensure the client understands all of the clinic policies and his or her rights as a client to stop the session at anytime, or to control the massage experience by providing feedback, or asking for adaptations to the massage. Discussing the information on the informed consent form helps you establish the therapeutic relationship because it outlines the role of the therapist and the role of the client. It clarifies the scope of practice and limitations of massage, and defines massage as a health care profession. This structure often makes clients feel safer about receiving massage and builds their trust that your business is a professional establishment.
• Clarify information written on the health intake form to rule out contraindications: Review the health intake form with the client and question the client for more detail in the event that the client has pre-existing conditions or is taking medications that require adaptations be made to the massage. It is appropriate to ask clients to describe the types of side effects they experience from medications and to talk over ways to adapt the massage to better meet their needs. For example, one client experienced increased urination as a side effect of a medication. She needed to take a break and run to the restroom at the halfway point in her session. The therapist provided the client with a robe and slippers so she could move between the treatment room and the restroom without the need to fully dress and undress again.
• Physician’s Release: In some cases the therapist may need to contact the client’s physician to obtain a physician’s release. This takes time that can cut into the massage and frustrate the client. If possible, list conditions that require a physician’s release during the booking phone call so the client can bring the release to the massage. Never proceed with a massage if you feel the client is contraindicated, or if you feel the client’s condition requires a release from a physician. Err on the side of caution. Even if the client is frustrated, you uphold good ethical principles when you make choices that ensure the client’s safety. Chapter 5 (Massage Cautions and Contraindications) discusses contraindications, medications, and massage adaptations in depth. It provides a critical thinking model to help new therapists work through whether or not it is safe for a client to receive massage.
• Determine the client’s expectations and goals for the session: Clients most often seek out wellness massage to relax, reduce minor physical tension, or because massage is soothing and pleasurable to receive. Sometimes a client will over-do it and request a massage to relive intense muscle stiffness or the pain from a minor injury. Ask the client to share his or her expectations of the session with questions like, “How would you like to feel at the end of the session today?” Sometimes clients are very clear about what they want and sometimes they need the therapist to present some options. For example, you might say, “It sounds like you have no areas that are particularly tense. Would you like me to focus on providing a deeply relaxing and soothing massage? If not, we could go for an invigorating, faster paced massage to get you energized. What do you think would work best for you today?”
• Identify the body regions where the client would like focused massage work: Most often clients hold tension in particular areas and need focused work during the wellness massage. Sometimes other body areas are left out of the session to provide more time for areas that need the most massage. Ask clients to explain where they would like you to focus, or review the Today’s Session form with the client to ensure you understand his or her needs.
• Identify the body regions the client does not want massaged: It is important to explain to clients the concept of a full body massage. Some get nervous, “You’re going to massage… everything!?” Clarify the areas that are massaged and the areas that are never massaged so clients can relax. Many clients feel nervous about having their gluteal muscles and abdominal muscles massaged. Often times they relax when the importance of these muscles in back tension, posture, and free graceful movement are explained. Still, this is the client’s choice. Remind clients that they have the right to choose which areas receive massage and which do not.
• Determine the types of techniques the client likes: Some clients like deep work while others like a very light touch. Some want the therapist to dig in, even if they experience a bit of discomfort, to work out adhesions and strip muscles. Others want a completely soothing massage and find deep work disruptive to their relaxing session. It is helpful to get an indication of these preferences up front and to share with the client specialized techniques you are trained in. If you are a reflexologist you might mention that you do skilled foot massage and ask if the client would like to have some extra time on the feet. If you are an expert in energetic bodywork practices it is important to let the client decide if such techniques are used in the session. Many clients don’t believe in such practices and expect their massages to take a more traditional form. Using energetic techniques without the client’s permission crosses an ethical boundary. A client who has never had a massage will not know what to ask for or what to expect. Spend extra time checking in with the client during the massage to ensure that the techniques feel comfortable.
• Determine the client’s preferences for music and lubricants: Present the client with some options for music (i.e., classical piano, world rhythms, Japanese flute, even soft rock or contemporary music), or arrange during the booking phone call for the client to bring a CD he or she particularly enjoys. Allow clients to see and smell some lubricant options and explain the differences between them. Some clients don’t want any scents while others enjoy aromas. Usually clients respond more positively to natural aromas like those of herbs or essential oils as compared to synthetic fragrances and dyes.

By the conclusion of the health intake interview the therapist is likely to have plan forming for how the treatment will begin and progress. Palpation findings during the massage will influence the plan and may require the therapist to make adaptations. These considerations are discussed later in this chapter.