The Chronically Depleted Client

Touch for Systems Under Stress


by Eric Moya Cst-D, Ms/Mfct

(Article originally published in Massage Magazine, December 2015)


     Sometimes clients can seem so complex, so hypersensitive, so...depleted. Thinking over the past 18 years of practice, I find these complex clients seem to be more numerous now than they used to, both in my practice and in conversations with other practitioners.

     Earlier this year, I had a new client, Jamie*, referred to me by a local psychotherapist. They were doing some wonderful therapeutic work together for a variety of physical and psychotherapeutic concerns. The psychotherapist referred the client because she had heard that CranioSacral Therapy might be able to help with some of the physical symptoms related to severe exhaustion, muscle fatigue, eye sensitivity, and emotional depression.

     When the client called me, he understandably had questions about CranioSacral Therapy and whether it would be helpful for him. He wanted to know what the technique was about and how it worked. He wanted to know what the likelihood might be that this type of work might help him. Jamie also wanted to know what my previous experience was with clients similar to him.

     I should mention, of course, that by profession, the client is a well-trained and practicing physician’s assistant. Understandably, part of the discussion involved letting me know that he had been through the full battery of tests and differential diagnoses for his symptoms, yet, his particular symptoms continued to evade an easy path of treatment.

     As we talked, it was clear that Jamie had many symptoms across multiple body systems, as well as many ongoing stressors in his life. Wonderfully, he was also fully committed to turning around his own health and regaining a sense of resilience in his life. The work he was doing with his psychotherapist was helping tremendously. He was also engaged in regular meditation practices and was truly open to anything that might help.

     As we talked, I was able to describe a little bit of how a CranioSacral Therapist might view chronic depletion, and I was able to give him a sense of how previous clients have progressed through treatments. I was also able to give him a good sense of how the first session might look.

     My overall message was meant to convey that it was worth a first session to see if CranioSacral Therapy might benefit him, to reinforce that his full professional experience as a physician’s assistant was welcome in the session, and to reassure him we would work together to empower him to make his own best decisions about his health and treatment plans.


     Clients like this are much more common these days than when I first began practice 18 years ago. Sometimes clients come in seeking relaxation or general well-being, but more often than not, clients seem to present with a myriad of complex problems
that seem unrelated to each other, having traversed a medical system that works to treat the various symptoms individually.

     Additionally, clients with this host of problems can sometimes have adverse treatment reactions. It’s as if their systems are hypersensitive and over-reactive, and that what would normally be considered a very gentle treatment might result in several days of discomfort. It’s common in bodywork circles to talk about a healing crisis, but that explanation alone is rarely satisfactory for someone in distress—and it does little to solve the problem.

     In worst-case scenarios, the healing crisis explanation really only functions to absolve a well-intentioned practitioner of responsibility for a treatment that actually pushed an overly sensitive system a bit too far. Basically, it is time for manual therapists to rework our understanding of what is happening and adapt our skills to match what appears to be an increasing problem.


     The world around us is continuing to grow in complexity. In the modern world, innovations in the areas of mobility, travel, communication, technology, and information are exposing us to an increasingly complex landscape that is changing more quickly than we can easily adapt to. In the recent past or even the last century, people may not have traveled or been exposed to ideas, people, and cultures outside of their immediate community. Individuals were not exposed to the same level of interdependence, connection, diversity, or need for adaptation that we consider normal now. The world is simply growing in its complexity—economically, socially, ecologically, politically, and biologically.

     We have to evolve—but evolution is a slow process that puts our system under stress. The system is then either able to adapt or not. The gap between our stressors and our capacity for compensation is growing with each year at an accelerating rate. Our body-mind-spirits are showing the effects of this complexity and stress.

     As manual therapists, we are privileged to be at that intersection of the individual and the world as our clients present with a variety of stress-related challenges: TMJ problems, digestive disorders, sleep difficulty, muscle tension, pain disorders, emotional difficulties, environmental sensitivities, and autoimmune difficulties among them. Most of these problems defy single-session answers, and too much time can be wasted looking for a cause of what is really a much more global problem of a system burdened by patterned and chronic stressors. Our clients are looking for help.


     One of John Upledger, D.O., O.M.M.’s greatest gifts in his development of CranioSacral Therapy was the deep core belief that the client is the best teacher; the idea that when we listen and are present with a client’s body-mind-spirit system, it will show and guide the practitioner how to work with it.

     Now, on a systemic level, practitioners have to learn new skillsets for working with chronic depletion. CranioSacral Therapy, with its philosophy and core beliefs of a person having the inner resources, or inner wisdom, necessary for healing, as well as a chosen value of using the least amount of influence necessary to get the job done, is a perfect approach to both conceptualize and work with the problem of chronic depletion.

     To begin with, depletion or resilience is understood as the gap between stressors and the capacity for compensation. Pretty easy, really. If a person’s stressors are greater than her ability to compensate, she is in a depletion phase. If the opposite is true, then she would be gaining resilience.

     It is natural in the course of life for us to flow from resilience to depletion and back as we adjust accordingly. When stressors are too great, too patterned, or ongoing, however, sometimes a person can end up severely depleted in body, mind, and spirit. Eventually, a system becomes so severely depleted that any new stressor basically causes a new crash. The colloquial phrase, the straw that breaks the camel’s back, conveys that sentiment a bit.

     I’m reminded of a different client many years ago, Susan*, when asked to describe her experience of what general adaptation syndrome or severe adrenal burnout was like, she described sitting on the couch and being unable to do anything, and then the phone would ring and she would just break down in tears. Once a person’s system has achieved this level of hypersensitivity, we would definitely call him chronically depleted.

     It’s possible to assess and evaluate this condition with CranioSacral Therapy. From a CranioSacral point of view, the vitality and quality of the system become almost nonexistent, and the resource for healing becomes so diminished that little is available to correct even the most basic of tissue restrictions. Also, any minute stressor—even that of normally gentle bodywork—can easily send the system into a hyper-reactive state.

     Basically, with a chronically depleted client, releases are slow, adverse treatment reactions are common, and a lot of factors come together that make it likely for the therapist to feel unsuccessful and, perhaps, the client to terminate early—even while these clients represent a population in great need of support.


     To work with chronic depletion, we have developed a different dimension to blending with the body-mind-spirit so as to begin to palpate the qualities of chronic depletion. We have also developed different processes of treating a hypersensitive system. These processes are based more on identifying patterns of restriction as opposed to finding individual restrictions, and on processes of treating relationships between restrictions rather than the restrictions themselves. This process is called working with epicenter and is a very gentle way of working with great specificity without sacrificing the global view of how the system is reorganizing itself for better health.

     Imagine a mobile hanging from the ceiling, a beautiful mobile with many different parts all in an exquisite, balanced relationship with each other. When you pick up the mobile from its core attachment, the entire pattern becomes apparent and balanced. If you try to pick up the mobile from anywhere else, however, the pattern collapses and isn’t accessible any longer.

     Working with the epicenter is similar, in that it is kind of like identifying a pattern of restrictions and contacting them at the balance point for the network.

     When working with chronic depletion, we must take a multi-session and multi-factorial approach to improvement. Good client education, tracking progress across multiple sessions, and thinking in terms of a contributing factor approach rather than causes are all part of the picture when working with a chronically depleted client.

     In other words, working with chronic depletion is usually a marathon, not a sprint. It’s a gentle and holistic way of working with a complex situation while supporting the body’s innate healing capability and using the least amount of influence necessary to get the job done.

     Most importantly, people get helped.


     When Jamie, the client mentioned at the start of this article, came in for his first session, his system did show signs of being chronically depleted, both in whole-body evaluations and in the story he told about his experiences. In the treatment process, we were able to find a way to work with his patterns of dysfunction rather than focus on individual restrictions. The result was a gentle but powerful session that did not throw his system into chaos but instead helped his system resources reorganize more functionally.

     Thus far, we have had eight sessions together over three months. Over the course of those eight sessions, Jamie’s system has begun returning to resilience, his sleep patterns and digestion have improved, his level of physical fatigue and eye sensitivity has diminished, and he has a deep sense of returning back to himself. Jamie is also tapering off his sessions and no longer sees the same need for sessions that he did at the beginning of the therapeutic relationship.

     There may very likely be more work to be done, but recognizing that tapering off of sessions is possible is a great sign of progress in the client’s health and well-being.

     Our world will likely not become less complex in the future. Massage and bodywork offer people a respite from the stress and demands of the modern world and could help shape a more peaceful and connected future.

*Client names have been changed.

Eric Moya, C.S.T.-D., is a lecturer and instructor on manual therapy and CranioSacral Therapy for the Upledger Institute, and former director of education at the Esalen Institute. His professional backgrounds are in massage therapy and psychotherapy. He lives in Monterey, California, and has private practices in Carmel and San Francisco. For more about Eric, link to his contributor bio.M