The Psychotherapeutic Relationship in Massage Therapy Background: Psychotherapy and massage therapy (MT) are effective treatments for depression and anxiety. Little is certain about the mechanisms behind these effects in MT, but in psychotherapy they are attributed to a combination of common and specific factors, at the heart of which lies the therapeutic relationship. Research into the psychotherapeutic relationship in MT, therefore, may advance understanding of its impact on depression and anxiety. Purpose: This research seeks to elucidate the components of the psychotherapeutic relationship in MT to inform training, research, and practice. Participants & Setting: Two participants—a therapist and a client—from Melbourne, Australia. Research Design: A qualitative methodology was employed whereby one therapeutic relationship was observed over the course of three massage treatments. After each treatment, the participants commentated recordings of the sessions. The recordings were transcribed and analyzed using Interpretative Phenomenological Analysis (IPA) and Conversation Analysis (CA). Themes and subthemes were extracted from the analysis. Results: Four overarching themes emerged: Separateness, Pleasure, Merging, and Internalization. Separateness is associated with the subthemes of Boundaries, Performance of Roles, and Power. Pleasure is associated with the subthemes of Safety, Comfort and Communication. Merging is associated with the subthemes of Contact and Empathy. Internalization has no subthemes. Conclusions: The results suggest that a clearer conceptualization of the therapeutic relationship in MT may help massage therapists more purposefully treat depressed and anxious clients. A greater emphasis on self-awareness in the professional development of massage therapists may also foster this. Additionally, the role of pleasure in the therapeutic relationship in MT warrants closer examination. KEY WORDS: therapeutic relationship; massage therapy; psychotherapy; phenomenology; selfawareness; pleasure INTRODUCTION While massage therapists typically treat with a biomechanical focus,(1) a substantial body of evidence suggests that massage therapy (MT) can help to address psychological problems, especially depression and anxiety.(2) The mechanisms behind the psychotherapeutic effects of MT are still unclear,(3) so it may be helpful to apply to MT the principles of psychotherapy,(2) where the mechanisms of change are better understood. The current research aims, therefore, to identify psychotherapeutic elements of the therapist-client relationship in MT. It is based on the premise that, if massage practitioners have a better idea of what exists in the therapeutic relationship, they will be better able to apply what works in the relationship. This knowledge may have implications for how massage therapists relate to their clients and address clients’ psychological problems, especially depression and anxiety, which are already known to be responsive to MT. The efficacy of psychotherapy for a variety of psychological conditions, including depression and anxiety, is now accepted by the American Psychological Association(4) and supported by a well-established literature. Wampold(5) cites a mean treatment effect size of .80, which implies that an average client of psychotherapy is “better off than about 79% of untreated clients” (p. 55). By comparison, the widely cited meta-analysis by Moyer et al.(2) suggests that the average recipient of MT experiences a reduction of trait (or characterological) anxiety greater than 77% of people who do not receive MT, and a reduction of depression greater than 73%. While a vast array of psychotherapeutic modalities—such as mindfulness-based, psychodynamic, client-centred and existential approaches—conceptualize the change process, no single mechanism or modality has been proven to hold the key to change. Change is attributable instead to a combination of modality-specific and cross-modality common factors.(6,7) The trans-theoretical, contextual model of change, formulated by Wampold and Imel,(8) helpfully integrates aspects of many theories while emphasizing the importance of the therapeutic context. It suggests that the common factors (including the ‘real Timothy Clark, MCounsPsychthrpy, DipRemMassage Time and Space Therapies, Murrumbeena, Victoria, Australia 23 International Journal of Therapeutic Massage and Bodywork—Volume 12, Number 3, September 2019 nationality, is outside the scope of this research, so these factors did not determine selection of participants. To preserve ecological validity and encourage unbiased responses, it was necessary to select two participants with no prior