further borne out in the way the Client rejects any suggestions that the Therapist may not be completely attuned to the Client’s needs. She lavishes praise on the Therapist’s strengths, but glosses over a number of uncomfortable moments, ‘taking in’ the good and rejecting the bad. The Therapist’s language, too, with its “blankie”, “puppy” and “loosey goosey”, reinforces the comparison, as does her wiping away of excess oil, upon which she reflects: Therapist: I’m just wiping off the excess and…it’s like the cloth when they swaddle babies, the extra support of the cloth and it’s that cloth against the body and also that hand on top of it is a very caring movement… Further exploration of how infant–caregiver roles play out in MT may help to shed more light on how the relationship works. DISCUSSION As might be expected with research of this type and scale, the findings are not generalizable, and may be of greatest utility as springboards for further research across qualitative and quantitative domains. In shaping future approaches, Wampold and Imel’s contextual model(8) may provide a useful framework for conceptualizing psychotherapeutic processes in MT, largely because the therapeutic relationship underpins its every aspect. Its central tenets of trust, understanding, and expertise are echoed in the themes and subthemes identified in this research. In addition to these common factors, an awareness of psychotherapeutic modality-specific factors may offer MT researchers useful paradigms, and allow massage therapists to conceptualize a wider range of client problems and customize their treatment to clients’ specific needs and communication styles. Approaches invoked in the analysis include mindfulness, psychoanalytic, and client-centred and existential principles, but numerous others may be apposite. That the Client in this research showed signs of internalizing the caring, maternal figure of the Therapist suggests that the relationship in MT can be psychotherapeutic, even if the therapist does not intend it to be. There may be no need, therefore, for a formalized integration of MT and psychotherapy. As Barnett & Shale(22) imply, the potential for boundary violations and the risks associated with dual relationships render highly problematic an approach where MT and psychotherapy are given by the same practitioner. What may be more helpful is a psychotherapeutically informed approach to MT, in which the therapist is highly selfaware, their role is clearly defined, and the client has a clear understanding of the purpose and relevance of any interventions used that may be seen to be outside the practitioner’s scope of practice, and furthermore permits their use explicitly and autonomously. The results also suggest that therapists’ awareness of their own psychology and behavioural patterns may help them to avoid rupturing their relationships with clients. Because the act of giving a massage does not permit therapists to give their full attention to the content of conversation during treatment, the likelihood of unconscious material rupturing the relationship in MT may be greater than in purely talk-based therapies. The therapeutic use of rupture-repair, which is commonplace in psychotherapy,(23) may be difficult to implement in MT, as evinced in this study by the Therapist’s failure to initiate this repair herself, although the data did not make clear how this failure impacted the Client, if at all. This is in line with Moyer’s(9) finding that talk-restricted, high-therapeutic bond conditions are optimal for reducing psychological distress. Future research examining the effects of the therapeutic relationship in MT across time could help address questions around the therapeutic use of talk in MT, especially with depressed and anxious clients. 29 International Journal of Therapeutic Massage and Bodywork—Volume 12, Number 3, September 2019 CONFLICT OF INTEREST NOTIFICATION The author declares there are no conflicts of interest. COPYRIGHT Published under the CreativeCommons AttributionNonCommercial-NoDerivs 3.0 License. REFERENCES 1. Fortune LD, Hymel GM. 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