Difficult issue, but below will help you;
- at the end, its really up to the client. Give client options (without overwhelm them) and help them to decide
- Generally, I will start with a short effleurage, then start focusing on the problematic area. Then, another time effleurage and go again to the problematic area. Then, choose another area, then effleurage, then maybe the problematic area. So...basically, I will alternate between deep technique working on the problematic areas, with the overall flow.
- About your particular question about the shoulder: is the client come more for a treatment or a treat? This is a good realisation. If only for treatment, then you should work more toward 'trying to solve the problem'. If they come more for a 'treat', then just let them relax.
Hope this help!

Gosh, this is hard one Patricia. It brings some thoughts and feeling.
- I would feel that some people are not considerate to my time. That would be difficult at times to keep calm, especially that there is no some sort of recognition or an apology (some people don't have the word 'sorry' in their dictionary).
- Its good to learn from this event, to reduce its happening in the future.
- preventing future similarly issue is best: maybe you would add a sentence to the 'pre-massage email' to say: can you please arrive on time.
- Like most similar situation, communication is a key. For that client, try to explain that you have prepared the session to start and finish on time, etc. Then, ask if its ok to be start on time next time. The challenge here is to do it without resenting this person. If you can do it, then most of the time the problem will go away, and you will grow as a person to feel that you can handle those situations in a much better way in massage and in other life's events.

- Once you are a professional therapist, I would advice you to finish on time. So, if a client book an hour and is late in 15 mins, the whole session will be of 45 mins.