Communicating with patients can be hard! And it may be the most important thing we do. Some patients give you one-word answers and always say “fine” when you ask how the pressure is. And on the other hand, there are the patients who narrate their entire week non-stop,filling the space with words and never really tuning into their body.
If we are lucky, we have a decent intake form (not one that says “massage” as the reason for booking the appointment) and reasonable answers to our standard interview, but what we really need is an impactful clinical conversation.
The secret isn't talking more, it’s building rapport through listening well. Here is how to navigate both ends of the spectrum so you can build deep rapport and get better results.
You ask: "How did you feel after our last session?" They answer: "Fine," Hmmm, it would be awesome if they’d expand a little. If they are one-word answerers it may be a sign they feel rushed,guarded, or aren’t comfortable telling you they didn’t feel well, it also might be a sign of a neuro-divergent patient.
Constant chatter often acts as a defense mechanism or nervous system pattern. When a patient talks non stop through the entire session, their brain stays locked in an active, analytical state, preventing the parasympathetic shift they need to release physical tension. This also might be a sign of neuro-divergence.
School teaches us to ask rigid health-history questions, but real patients require therapeutic conversation. The right mix of clinical boundaries and authentic empathy, lets your patient feel understood, and is way less exhausting for you.
Co-regulation starts immediately with your patient. Before you get hands on, your attentive, calm communication starts to down-regulate their nervous system. When a patient feels heard, and believed, their baseline threat perception drops, making their tissues far more receptive to manual work.
Patients don't just want to feel less tight; they want to pick up their kids without pain or get through a workday without a migraine. Listening deeply helps you uncover the real-life goal behind the physical complaint.
Instead of asking, "Does your shoulder hurt when you lift your arm?" try: "Tell me about the moments this week where your shoulder limited you the most." This invites a story rather than a yes-or-no checklist.
If a patient seems hesitant, validate their reality first. A simple, "It makes total sense that you're feeling frustrated with this flare-up," builds trust.
Mirror their words back to them: "So the stiffness is worse in the morning but gets better with movement, right?" Show them you understood the point they were making. Even better, ask a followup question about their goals in relation to this: “Does this stiffness prevent you from doing anything you value in the morning?”
First of all, learn to recognize when the connection is more important to them than the body work. Some people have very few friends or people who will really listen to them, and few places where they don't have to mask. You might be providing exactly what they need by allowing them to talk!
But if you sense they are just filling the space with words and not really seeking connection, then try these below:
I’m an over-talker! Here are things that have worked for me: “I’ve noticed your tissue really softens when you get quiet. I enjoy our conversations, and I’m also wondering if you would get more out of massage if you were able to focus on your body.”
I have one massage therapist that I've asked to enforce "quiet time" for me. I decide how much quiet time I want and when we get to that point in the massage she says: "Ok Alanna, it's quiet time now!" I need the help and I really appreciate her holding this boundary for me.
When small talk spirals mid-session,gently bring them back to sensory awareness. I absolutely interrupt people mid-sentence if I need to. It’s not ideal, but do it kindly and affirm that you care about what they are saying but need to check in with them about their body. I usually pause my hands somewhere that seems significant to me and ask them how it feels. It shows them that I am paying attention to their body and also asks them to pay attention to their body.
Start by timing your strokes to their breathing (if they are breathing quickly, use one stroke for 2 or even 3 breaths.) You can also try timing your strokes to the music. If they don't quiet with this, you may need to interrupt. Then ask them to take 3 slow breaths and describe the sensation you are creating (to themselves is fine, but out loud can be really helpful to you!)
We will spend a whole session on this in my mentorship program At the Table. This is a small group, highly affordable mentorship ($19 per session over 6 months) Our 2026 fall cohort is almost full so sign up on the waitlist today.
Coming soon: Why Telling a Better Story about their Body Matters: Non-Pathologizing Language.
