Energetically speaking, there are two main approaches to a reflexology treatment, and it's down to the skill of the therapist to ascertain which one is best. One can choose to act according to a non-interference principle, as simple 'catalyst': this is when there isn't really an interaction between patient and therapist. The therapist 'lends' his/her energy as a medium to support healing. The mere 'presence' of the therapist is enough to help the healing process, the treatment being the medium. A second avenue is the one of active release, where the therapist actively stimulates or seeks to modify energy patterns, having identified an imbalance.
The thought of an intelligent, sentient Moon Bear being locked in a cage no bigger than itself for 20 years with a dirty, metal catheter crudely inserted in to the gall bladder while bile is endlessly and painfully extracted sounds like a torturous experience beyond the capabilities of any living being. But it happens.