Direct vs. Indirect—Working With the Body Rather Than Against It
When I was a new therapist, I thought my job was to fix things. Find the knot, push on it until it gives up. Find the stuck joint, push it back. Find the tight muscle, and stretch it until it relents. It was satisfying… until it wasn’t. Some clients just didn’t respond, no matter how skilled my techniques were or how hard I worked.
That’s when I learned there’s another way. I had to learn to work with the body, not against it.
Direct Work (Therapist-Led)
This is the traditional “I’m going to fix this for you” model. It is therapist-based, bossy, and relies on the therapist’s wisdom and skill set.
It often involves moving tissues where we think they should go. The hamstrings are tight? Stretch them. Oh, here’s a trigger point! Let me push on it until it melts. The arm won’t rotate externally? Let’s stretch those internal rotators!
It can be helpful—but it also assumes the therapist knows better than the client’s body. I don’t know every inflammatory response this client has ever had in his/her life—every injury, every illness that caused a fever, every meal that caused indigestion and derailed the gut biome for God only knows how long. Only the client’s body knows all of those things.
Homeostasis has happened for their entire life, because their body knew how to keep their blood pressure stable, their temperature stable, their pH within a very narrow range. It knew how to keep them in a position that allowed blood to get into the brain, into the kidneys and liver, air to get into the lungs, and feces to come out where it should. The body remembers each and every insult that it has ever suffered, and has systems in place to compensate for the lack of adaptability caused by each insult. Who am I to assume that I know what the body needs? Just because I graduated from massage school and passed a course on Anatomy and Physiology does not mean that I know better than anyone’s body how to keep them alive.
Sometimes, if I assume I know better, the body fights back. The person gets off the table and within an hour goes back to the same patterns they had before. Not because I didn’t get that one muscle to relent, but rather because I didn’t get the brain on board. Getting the brain on board continues to be something I learn more and more about, but just recognizing that, as a beginner of learning what would become Dynamic Integrative Therapies, made a huge difference in the results I achieved with my clients, and how long those results lasted.
Indirect Work (Client-Led)
Indirect work is more like a conversation than a correction. When you’re trying to reason with a stubborn teenager, how hard do you push? If you push, you might get what you want in the moment, but just wait until that kid gets out on their own—they’re going to try all the things you didn’t allow them to.
But what if you started a conversation with a little curiosity? What do you like about…? How do you feel when you…?, etc. If you can get the teenager talking, often you can discover why they had their heels dug in in the first place, and help them to see a better way forward.
It’s the same with the body. If I push and manipulate and, do I daresay force, the body to submit to my will, it’s just a matter of time before the brain says, nope, I wanted it that way, I put it there on purpose so I could keep functioning and breathing and pumping blood, so I’m putting it back now, and you get an F for… that’s right—FAILURE.
Instead of pushing tissues where I think they should go, I follow where the body wants to lead. How do I do that? First I listen. There are many different methods of listening to the body. In massage school we started listening by taking a postural assessment, a gait assessment, and then assessing the tissues to see where they were tight, loose, taut, inflamed, etc. This is entry level listening.
Once you get into deeper models of study, you can learn to access a deeper listening. In osteopathy there are many ways to put your hands on and assess where you should treat first. Lately I have been using the one I learned from the Barral Institute, and then mixing in a little Upledger style listening, or another form of osteopathic listening. I like listening a few ways, because if I get the same answer from more than one style of listening, then I know I’m on to something important. Once I figure out where to start, I usually start with indirect work.
Did you notice that the assessment is a question to the body? Rather than taking the stance that if this is asymmetrical, or their gait is not even, then I must do this or that, because it is wrong to be asymmetrical, I ask a question, what would you like to do? My osteopathic mentor would say, “Don’t worship the false god Symmetricus.” We didn’t actually grow symmetrically. Ever see a liver and how it is situated in the body? Check it out and you will see why we are not symmetrical.
Once I start working in an area, I am asking the tissues, would you like to go this way or that way or another way? Then rather than taking them where they don’t want to go, I give them what they want. You gotta give a little to get a little. By taking the tissues where they want to go, exaggerating their “dysfunctional” pattern (because I have decided it’s dysfunctional, although the brain knows exactly how that pattern is keeping the organism functional), I can give the body what it’s trying to get. Once it gets what it has been wanting all this time, it can let go of at least part of that pattern, and find a new way to be functional.
Sometimes the releases don’t happen as quickly as they would with a trigger point release, or a pin and stretch, or stripping strokes, but the results will last longer, because you showed respect for the brain and took its wisdom into account.
Here’s a fun (and humbling) study project to drive this point home. Sometime when you have a few minutes, sit down and write as many things as you can that the brain is tracking in any given moment of time. Start with breath rate, heart rate, blood pressure, pH. Sounds pretty easy. What about the hormones? How many can you name off the top of your head? Just start with groups of hormones: adrenal hormones, reproductive hormones, glucose-regulating hormones, neurotransmitters (yes those are hormones, too), and the list goes on.
The hypothalamus is tasting all of these and more, and making small adjustments whenever needed to keep the body balanced and alive. So many parts of the nervous and endocrine systems are at play to keep the musicians in the orchestra playing in tune and in time with each other.
I can’t possibly track all of those things, nor would I want to, even in my own body, let alone someone else’s. I would much rather trust that their body knows what it is doing, and go with that, enhance it a little, wake something up a little bit, and see what the body can do with a few extra options.
A Simple Analogy:
Direct work is like forcing a tight lid open. Indirect work is like running it under warm water and waiting for it to loosen on its own.
Why This Matters for Therapists
If you’re burning out trying to “fix” people, it’s time to learn some more subtle ways to work under the radar and get the nervous and endocrine systems on your side… or rather just get on their side—they know what they’re doing.
If you’ve hit a wall with certain clients, it’s time to up your game. That was always my cue that it was time to take a class. And once I got out of the traditional massage and therapeutic applications and deep tissue classes, I started getting a deeper understanding of how the body actually works.
If you’re curious how to get better, longer-lasting results without pushing harder, come learn with me how to work with the body, not against it.
I teach these approaches in all of my classes, but Balancing the Diaphragm is a great place to start. We learn to listen, follow, and support the body—not fight it. Plust you get to learn about a super important muscle that got skimmed over in massage school, perhaps THE most important muscle.
Curious? I’d love to have you join me. Go to my courses page to choose where you will jump on board.
