Spa Style Massage Add-Ons & Continuing Education

Just a quick post to let you guys know I just put a new NCBTMB approved CE course up on my site

If you need CE hours, cool! They’re super affordable. 

If you don’t need CE hours but you’d like a little add-on inspiration, please feel free to download the course at absolutely no charge and without obligation. 

Thanks for hanging out with us for another year! Here’s to a productive and fulfilling 2016!

Transition

This is a guest post from our friend Michelle Giles, a Phoenix, Arizona based massage therapist and continuing education provider. You can learn more about Michelle here

***

You are a well-oiled machine. Body mechanics spot on. You’ve learned exotic massage techniques from all over the world.  You use many interesting products. Your sacred work space is beautiful. You love your clients. After 10 years you’ve hit your professional stride…or was that a wall?…made of bricks.  

Wait. How many treatments have you been doing a day? Between six and eight. Are you taking breaks in between sessions? Very few, with clients stacked back to back. Since school ended you have been striving, building, advertising, networking and flexing your boundaries and schedule to accommodate clients, never considering how this might impact your body. After all — you love what you do. 

I injured my right arm, shoulder and chest wall simultaneously last January. I didn’t feel it coming — no aches, no warning shot, nothing overtly physical. The signs were there. Subtle things. Things that can be mistaken for general fatigue; a neck ache, headache, or malaise that drifts into life from time to time. It’s easy to get lulled into a feeling of comfort when business is great. It’s also easy to get lazy with self care when you feel good and nothing hurts. 

I tried slowing down, putting more space between clients, getting acupuncture and physical therapy. After a few weeks of that routine, the reality of the situation weighed heavily on me. I was really hurt. Not “get a massage, take a few days and sleep it off” hurt, but “out of commission” hurt. Stubbornly, I still saw a few clients a day for another week. I refused to acknowledge that I was hurt — after all, I had worked so hard to build this. Then a miracle arrived disguised as a disaster — my landlord sold my studio out from under me. I lost my office and was forced to take a break. It was the best thing that could have happened to me.

Once home, I did some research. I read articles about injury and professional burnout.  One fact stood out from the rest: “The burnout rate within the massage industry has been estimated at 50% to 88% within the first 3 to 5 years after graduation according to a study completed by Associated Bodywork and Massage Professionals, a reputable industry organization.” I am not sure how many of us know and absorb that statistic. I have been a full time massage therapist for 15 years, and had no idea it was that high. 

I was depressed for about a week, alternately sleeping and crying.  An MRI revealed severe tendinosis and RSI injuries surrounding the area, and it would take between one and 5 years to heal completely. My PT was very honest with me — no amount of therapy could help at this stage. I felt frenzied, I wanted to will it better with salves and treatments. The simple truth was rest and accept.

Looking for gifts within life’s challenges is tough. My mind wanted to ruminate on loss. I made the conscious choice to use this time to reinvent and rethink my entire approach.  Epiphany: I was in the next stage of my career. I was fortunate enough to be able to take seven months off. This is what I did with that time:

  • Sold most of my belongings from my old office to create a new environment
  • Designed a 200 square foot massage office in the garage behind my house
  • Designed and built (enter my husband’s building skills) 8 large wooden planter boxes to grow herb and plants to make infused oils and salves. Also functions as a courtyard space to separate work and home
  • Learned to use Himalayan salt stones instead of hot stones
  • Learned to use Chinese cups and gua sha tools
  • Bought a product called Armaid to begin rehabbing my arm
  • Learned how to foam roll and use racquet balls for self care
  • Applied for and received my continuing education provider number enabling me to teach continuing education classes out of my new space
  • Learned how to create my own scrubs, soaks, lotions, lip balms and deodorant
  • Created my own website with the free ABMP tool (simplistic, but great)
  • Rested, stretched, soaked, and focused on my new self care needs

I had emailed my client list when I began my sabbatical, emailed them again when the office was done, then emailed a small group of regulars to let them know I was coming back in July…slowly. I began by taking one client a day a few days a week for a month. Then two clients a day a few days a week for two months. After two months, I emailed the rest of my clients announcing I was back to work. It has been seven month since I have been back.  I only see three clients a day. I schedule morning, afternoon and evening- leaving hours in between each. No compromises. My clients have loved the new modalities, the fresh space, and knowing no one is stacked right after them. They take their time, and so do I. What a change. My patience and new approach has paid off, and last week I realized my arm doesn’t hurt at all anymore. I will never return to my old way of doing business; it was outmoded.

Professional transition is inevitable. As our bodies age and change, so should our approach. Self care, exercise and diet need also change as we do. What worked in the beginning of our careers won’t always work. 

Injury is a great teacher.

That Magic Massage Moment (A Poem)

That moment when, 
Your client’s leg begins to stiffen,
There’s a gradual resistance,
And you retreat gently,269001-20150111
Adjusting the technique,
Testing the waters,
Ever cautious,
Ever respectful,
Of their space.

Then you hear it,
The smallest of snores.
Then a glance, 
Feigned casual interest,
Quick to catch a glimpse of the clock,
Or the art on the wall,
Should they catch you peeking,
And think it a stare.

Their head lolls to the side gently,
Their neck has softened,
And they are comfortable in their body,
And comfortable in the moment,
And they begin to expand.

No more shrinking into themselves,
Arms folded over navel,
Abs stiffened,
Ankles turned in,
For a pleasing silhouette.

Just them,
Resting.
With a nice soft jaw and a nice soft snore. 
Suspended in that dream space,
Neither asleep nor awake,
And their bodies expanding,
Unwinding,
Blooming,
Taking up glorious space,
That was always theirs to play in.

The momentary resistance subsides.
You smile a little smile,
Of working hard at work worth doing.

You are doing well.
They are doing well.
All is well and right in the world,
For at least another 42 minutes.

That moment is a feeling of pure joy.

If I could bottle it,
I would. 

 

Interview with an MT: Lauren Cates Talks Oncology Massage

Recently, Lauren Cates was kind enough to answer a few questions about her massage practice. Lauren, who lives in Arlington, VA, runs Lighthold Massage Therapy, a practice that caters to all types of people, but that also specializes in oncology massage and end of life care. She is also the program director of Healwell and the President and Founding Director for the Society of Oncology Massage. Recently, after watching a video of Lauren going around the internet (below) I contacted her to pick her brain. She is incredibly smart, funny, down-to-earth, and doing important work. In short, she is pretty much what I want to be when I grow up.

Click here for a text transcript of the video.

A:  How long have you been a massage therapist, and what led you to pursue oncology massage training and specialization?

L: It was 9 years in February since I graduated from massage therapy school. My pursuit of massage therapy training was a complete accident, if you believe in accidents, but my pursuit of oncology massage specifically has at least some vaguely traceable path. Shortly after I began the 18-month journey that would be my training in massage therapy I had the unique and humbling opportunity to be with my grandfather at the moment of his death.  I actually didn’t know, at the time, that he had cancer.  I was employing my nascent massage skills working with him in his hospital bed when I watched and felt him take his last breath.  Death and I had always had this sweaty palmed, churning guts kind of relationship, so I was surprised by how natural it felt to be a part of this very human, very death-centric moment.   There was no lightning bolt of moment of “Eureka!  I shall go forth and do oncology massage!”, but there was a feeling of wanting to pursue massage in that kind of environment with people who were at these places of physical, spiritual and emotional crossroads.

A: What type of training did you find the greatest benefit to prepare you for working with oncology patients?
L: Honestly, (as if I’ve been lying to you all this time) I have been very lucky to have great technical teachers in the form of massage therapists, nurses, doctors and other healthcare professionals and I couldn’t do what I do without that foundation, but the absolutely most valuable training I have received is the training in how to fully embrace and love myself. Until I was guided by some kind and skillful teachers of mindfulness, compassion and forgiveness, I had never really met myself and that was standing in the way of how useful I could be to the people with whom I worked. When people are faced with a potentially terminal illness, their eyes can become like mirrors of your own soul. You don’t want *that* moment, when you’re at the bedside of a person with cancer, to be first moment you really see yourself. That was happening to me over and over and it was burning me out…until I pulled back from the work for a bit and went deeper into myself. Being at home with myself is, hands down, the most valuable thing I think I bring to my clients.
A: Is there any aspect of the work that you didn’t expect going in? What has been most surprising to you?
L: Working with oncology clients…and all manner of humans with health challenges…has made my life exponentially more joyful. You can’t lie to yourself about how you’re spending your time and if you’re spending it well when you work with people who are faced with being “out of time” and who don’t have a chance to go back and spend it well. Today is truly all we have and my clients remind me that that sentiment is not a bumper sticker…it’s real life. I have seen that I *will* regret it if I work too hard. I *will* wish I had spent more time with family and friends if I don’t do it now…so I do. I do it now…much more than I did before I met so many amazing people who are trying to make sense of how they’ve spent their time.
A: In what ways does Oncology Massage differ from, say, your typical Swedish Massage?
L: There are so many ways in which the internal experience of giving an oncology massage differs from a “typical Swedish Massage”, but on the surface, if you were watching an oncology massage happen, you may not notice most of them. Oncology massage is about cancer. It’s not about massage. If you’re already out in the world doing some type of massage therapy and then you pursue oncology massage training, you will still do the kind of massage you used to do…you’ll just do it with a greater awareness of the effects of cancer treatment on the human body. You’ll be thinking about lymphedema, blood clots, bone fragility, skin changes from radiation, surgical sites and scar tissue, sensation issues from treatment and any number of other considerations that will make you adapt, adjust and alter your work to provide a session that is supremely client centered and so much more than “just working lightly”.
A: How do you connect with the people who need your services?
 L: Shameless self-promotion. In my practice, I actually don’t do any official advertising. I have built my clientele on word of mouth. I do some community education events at cancer support groups and other events where people affected by cancer gather, but mostly I just do what I do and word spreads. The oncology community, in my experience, is an intensely loyal community. If you decrease a person’s neuropathy or nausea or headache or sense of isolation, they become a human billboard for you because they want their friends with cancer to be free of those issues, too.
A: What advice would you give to a therapist interested in pursuing this field of work?

L: Learn your facts. Know the anatomy. Know the physiology. Know the treatments…and then set them down and go get to know yourself. Snuggle up to your sadness, your shame, your humanity, your mortality. The better you know all of those not-so-popular parts of you, the more likely you are to be of service to people in ways you never imagined.

A:  Any further thoughts?

L: If you’re thinking about working with oncology clients, get training. Please, please, please get training and develop a deep sense of humility, curiosity and openness. The illusion of control will be laid bare in front of you if you’re paying attention…and you’ll be grateful for it.

Courses and trainers can be found on the Society for Oncology Massage website,  www.s4om.org. S4OM is also hosting a 4-day conference for the oncology massage community this fall in Sarasota, FL.

vision-image-Key_7e928a603d85468b46482d9a7541d30e

My Client, the White Supremacist and Cross Gender Massage.

(In which I go to bat for clients that have a penis.)

So, ya, you read that right. I wasn’t at a Klan rally.

I do teacher appreciation days at local public schools. It is a great way to advertise to one of my targeted demographics, and I truly enjoy providing this service. I wanted to be a teacher for as long as I could remember, and actually began massage school so that I could have a part-time, high-paying job while I went through a four year university and got my teaching degree…but then, Massage Therapy and I fell in love…and you know the rest of the story. Teachers still have a special little spot in my heart though, since I have been fortunate enough to have so many great ones. At these teacher appreciation days, I raffle off a free 1 hour gift certificate. The person that won this particular gift decided to give it to someone else, which I was ok with.

When I arrived at my client’s house, things went a little differently than planned. Over the phone I was told we would be setting up in the bedroom but when I arrived, he had a worried look on his face and we set up in another room instead(I learned later, upon passing the room in the hallway with the door open, that it was filled with Nazi paraphernalia). At this point, I couldn’t really interpret the vibes I was getting – except that I didn’t feel threatened. I felt comfortable enough to stay. The house was full of people and I wasn’t afraid of him, just a little put off. So I set up, asked the usual questions, he let me know he was a tattoo artist so he has the usual neck/shoulder issues from long work hours,  and excused myself while he clambered up onto the table. (Normal, normal…normal).

Then I came back in and undraped his back.
A giant swastika glared back at me.
I blinked.
It didn’t.

I closed my eyes and centered myself, blinking a few more times to hold back wet eyes. Holy shit. I had a racist on my table. I had a Proud and Out racist on my table. I’m not white, but I pass as white pretty well. They think I might have a little Italian in me, or some Greek, or maybe I just have a good tan. I have a bit of a western twang…in other words, people have said I “sound white”. No one can usually place my racial mutt-ness of Seminole/Creek/Irish. I finally understood his confused and apprehensive behavior. He was trying to figure out whether or not I was white. Apparently he had decided it was worth the gamble for a free massage. Apparently also gambling on the fact that if I were white, that I would be ok with his hateful views. …and I was PISSED.

Then something happened. I heard a little voice inside of me say “First, do no harm.” I clung to it as I breathed steadily and began the massage. It became my quiet mantra, and I performed my best work, while remaining disengaged from the person on the table. Or rather, from the identity the person had imposed on themselves. I felt the human creature beneath my hands. I marveled at the intricacies of his circulatory system, the thought that he had been nurtured and loved as an infant. That he had grown and survived. I filled myself with pleasant thoughts of life and living, and rubbed/pressed/stripped/rolled/rubbed.

I wondered to myself why I didn’t just ask him to get up, or throw the jerk off the table and leave. Something made me stay. Not fear, but a sense of duty. I had work to do, damn it, and I was very well going to do it. I hadn’t finished my work. I thought of the only other line that I knew of the Hippocratic Oath, or at least what I thought was the Hippocratic Oath at the time (It is actually the Oath of Maimonides):

“May I never see in the patient anything but a fellow creature in pain.”

His neck and shoulders were a inflamed hotbed of trigger points and hypertonicity. Years of stress, possibly anger, possibly a great number of life’s other tragedies, failures, heartbreaks, or irritants had lodged there tightly. He was in serious pain. That is why he took the gamble.

I continued to work quietly, as I wondered why I only knew two lines of the Hippocratic Oath, even though I felt like a healthcare worker.

I continued to wonder how anyone in this day and age can actually be a racist.

I had a boyfriend when I was 21, who always wore jeans to the river. We had a summer romance and went to the river, the lake and the pool a lot. One day at the pool he flipped in and on his way down I noticed a swastika tattoo on the backside of his thigh. Naturally, I flipped the hell out. He had managed to hide it from me for the 2 months we had been together. After a day and a half of refusing to speak to him (I’m mature like that) I finally let him in and he explained that he got it in a garage when he was 13, he was part of a little punk group that thought themselves to be racists, and he acted like a complete ass for about 2 years – generally doing a lot of dangerous drugs, messing around with a lot of dangerous people, and spreading around a lot of hate. He wouldn’t tell me exactly what changed his mind, just that “there was this girl.” I asked him why he didn’t have it removed, and he said it was because he never wanted to forget how he felt and he kept it to remind him not only how wrong he could be, but how wrong other people could be. We had a long conversation about empathy and second chances, responsibility and growth. That conversation along with his gentleness and candor was one of the many reasons that I loved him.

This wasn’t the case with my client. It was the first thing I reached for in my attempt at empathy and understanding. An explanation.  His Swastika tattoo was fresh and bright, and if that wasn’t enough to convince me, it had other embellishments with names and was dated 2012. It wasn’t a misunderstanding, this man meant with every pixellated inch of his tattooed skin to convey his message to the world. I would have to reach deeper to find what I would need to get through the next hour.

The truth is I came up with a lot of the same insights as I did when I examined the idea of refusing cross gender massage, which is why I have tied these two posts together.

There is a huge faction of massage therapists that refuse to perform massage therapy on clients of the opposite sex. This really bothers me, the same way that it bothers me that men have such a hard time in our profession. For a lot of the same reasons.

When a client shows up at a spa for a massage, and refuses to see a male therapist, it shows a distrust. They don’t see men as nurturing. Some of them that are male aren’t quite homophobic, but just don’t feel “right” having a man touch them. This is discrimination. It is allowed, because as a consumer, we have the right to decide who touches our body. As therapists, we continue to educate to the best of our ability, but some people just aren’t “there” yet, or are holding on to old ideas of what nurturing means, or are confused about aspects of their sexuality or even the boundaries between sensual and sexual. They might be afraid that men will massage too “deep” or be dealing with a multitude of emotional issues that we can only refrain from guessing at.

Most people hold on to their prejudices. Many don’t care “why” they feel what they feel. They just know that that is the way they feel and that is the end of it. They don’t want to have to explain it to themselves or anyone else. Growth is uncomfortable. People need to do it on their own terms, and the best we can do is educate, in our individual practices and as a profession.

However, this is how I feel: Practitioners don’t get those same rights. Or rather, we seem to, but we shouldn’t.  Please let me clarify. I feel that a massage therapist should have the right to refuse service to someone, on an individual basis. If someone treats you badly, drains you, pushes your buttons, asks you for sexual favors, implies things, or makes you uneasy or afraid, you have the right to refuse service to them at any time. If over the phone you feel like someone poses a potential threat to you, or you get that uneasy feeling about them, you can refuse to see them. There is no reason for them to come in if all of your alarms are going off. Human beings made it pretty far on instinct. It is there for a reason. There is no need to have a mind so open that all of your brains start falling out.

This is different than refusing to service a specific subset of the population such as: “I don’t work on men”, “I don’t work on women”, “I don’t work on black people”,  “I don’t work on white people”, “I only work with healthy people”, “I don’t work on fat people” or “I don’t work on republicans.”

You can also target a specific demographic, no problem, that is different than refusing to work with a specific population (I mention this because recently in Facebook threads there has seemed to be some confusion between these two ideas).

I am of the idea that we should be held to the same standards as healthcare workers in terms of non discriminatory practices and other practices outlined in the following (and pictured below). As I learned more about the Hippocratic Oath, the Oath of Maimonides, and the Declaration of Geneva…I read through them and although I am not religious, I was touched. I got goosebumps. I think there is a reason for that.

When you dedicate your life to service, to taking away the pain of others, there is a certain responsibility that comes with the knowledge and skills. I’m trying to articulate this the best I can…and I keep coming back to this simple sentence:

We can be more.

Therapeutic touch transcends all boundaries. We can be more than what we are. We should always strive to be better human beings and to better serve the rest of humanity. To be of the best possible service. In a culture rife with sexism, misogyny and rape it is all the more necessary that we strive to provide non judgmental, healthy touch. I am of the idea that we are on the front lines of this change, this shift, in the way that people look at human contact, relationships and gender roles.

We are waking up from hundreds of years of imposed religious ideas about female sexuality and the role of women in the hierarchy of civilization. Even today, women continue to fight to be taken seriously in the workplace, to receive a fair wage, to have control over their own bodies, and to hold positions in elected offices. Even today, men in the political spotlight are criticized for their voting history and opinions while women are criticized on the size of their waist, the color of their nail polish, or what they chose to wear that day.

Women today continue to fight (socially, if not legally) for the right to be treated as equals to their male counterparts…and so do our male allies. Many of those women who have fought for our rights, did have men standing next to them, or behind the scenes, who supported them. Many had supportive husbands, fathers, sons, brothers, nephews, grandfathers, cousins and male friends.

No matter how you look at it, when you refuse to serve half of the population because something might go wrong in the session, or you might get hurt, or you might feel uncomfortable – you are perpetuating the idea that all men are potential rapists. Furthermore, you are reinforcing someone else’s idea that the men in your life are potential rapists. This is disingenuous to our profession, disingenuous to good men, and to all of the work human beings are trying to do to collectively improve our perception and understanding of one another and civilization.

Men are not rapists. Rapists are rapists.
Men are not creeps. Creeps are creeps.

People are individual.

As their massage therapist, it is none of my business if they have a penis or a vagina or any amalgamation thereof.

Or what race they are.
Or how old they are.
Or who they voted for.
Or how much money they make.
Or where they come from.
Or who they choose to love.
Or what their religion is (if any).

My job is to relax them, to relieve them of pain. To help them feel better in , and move with, their body. Plain and simple.

Now if a religious person preaches to me and makes me uncomfortable, I have no problem refusing to see them. Or if a man leers or starts wagging around his wally the one eyed wonder, or asks suspicious questions over the phone, or if a right-wing person pressures me about my political views, or if someone is generally just being a rude jerk…then they can be fired. But they are the exception, not the rule.

As I finished up on my racist client and left, I’m not going to lie, I cried a bit in the car. Partially because I was uncomfortable and confused, and partially because I felt truly sorry for the person I was working on. I felt he would lead a life compartmentalized by his belief system,  unable to feel that loving thrum of humanity…that dazzling, rusty, rough hewn, unpolished, vibrating plane of connection we are still working on while reconciling our emotional and rational selves to work harmoniously together…to further our understanding, to be open to new ideas, to connect to one another, learn, engage and grow. It is a beautiful thing.

People can become shackled by their beliefs. ” I mean, you can change an idea, changing a belief is trickier. People die for it, people kill for it.”

I silently thanked him. I had finally sorted out my thoughts and feelings regarding refusing a specific client vs refusing to service a group of people. I won’t be seeing him again…but for the span of an hour, he made me uncomfortable.

Just uncomfortable enough to help me grow.

________________________________________

(Please click on the images to enlarge them)

Declaration of Geneva or Physician's OathOath of MaimonidesThe Hippocratic Oath

Seven things about massage therapy I learned from teaching toddlers.

You think you learned everything you needed in massage school? Forget that. Here’s what six years of working with two-year-olds taught me about being a great massage therapist.

1. Taking turns matters.

You will get your chance to relax, to deal with your personal problems, to break down, to chat about your interests, to cry. But while you’re giving a massage, it’s not your turn. Learn to be patient.

2. It’s mean when you won’t share your toys.

There’s no room for trade secrets in this business. You’ve got two hands, some oil, and a human body in front of you. The rest is just gravy. Playing hard-to-get with your colleagues because you see them as the competition, slapping a trademark on your particular take on deep tissue massage, refusing to mentor students and new therapists for fear they’ll steal your ideas … it’s petty. You’re a special snowflake, okay? Anybody else trying to be you is going to spend a lot of energy and end up with mediocre results.

3. Poop happens.

Also drool, snot, sweat, and period blood. Latex gloves and bleach, my friends. Latex gloves and bleach.

4. Everything can be interesting.

If you’re bored, it’s not the world’s fault, it’s yours. There are ants on the sidewalk, clouds in the sky, and glue sticks have an unusually satisfying flavor. Searching for the causes of a headache is like reading a good mystery novel. Find the wonder. Just because you don’t see it yet doesn’t mean it’s not there.

5. Eventually, somebody’s going to throw a tantrum.

A tantrum is an outsized reaction to a real or imagined problem. If the problem is real, it’s important to fix it. But know that the fixing won’t necessarily stop the tantrum right away. The nice thing about tantrums is that they’re exhausting. They can be scary while they last, but nobody can keep it up for long.

6. Everybody changes.

You will change. You will grow. You will pick up new values and new vocabulary, and learn to do new things on your own. Your body will do things you never anticipated it would do. The same is true of your clients. Expect it.

7. Everybody likes to have their back rubbed before a nap.

Seriously, everybody. Some quiet music, a soft blanket, and a back rub. There’s nothing quite like it. It doesn’t have to be fancy. Any toddler understands the value of regular massage. Maybe it’s time we learned that for ourselves.

Kat Mayerovitch is a licensed massage therapist and recent Midwest transplant to Dallas, Texas. She also works as a copywriter, volunteers like mad in local community development, and plays the ukulele. If you like her writing here, Kat writes more good stuff at LMT or Bust.

Massaging Reality

 

I hope you’ll read this

with an open mind

because love for the skeptic

can be hard to find

 

It’s exceedingly common

to be met with suspicion

when you question “are bodyworkers

really mutant magicians?”

 

Upending secret blockages

releasing them in turn

trumpeting mystical special powers

only initiates can learn

 

Bought skills in aural palpation

in tweaking magnetic fields

full-body cosmic detoxification

and increased psychic yields

 

An ego tripper’s tour bus

on untransmutable lead wheels

a sucker born every minute

breeds bandits poised to steal

 

Past SOAP note notoriety

or “this muscle tissue’s tense”

it’s real world paper dollars

for imaginary sense

 

**************

Andrea Lipomi is a licensed massage therapist and esthetician who lives and works in Las Vegas, Nevada. She also peddles massage therapy ebooks and NCBTMB-approved continuing education courses at ConfidentMassage.com, will travel hundreds of miles for a fantastic spa experience, and craves dark chocolate and Depeche Mode’s upcoming tour dates on an almost daily basis.

 

Research and Approaches to Healing

research

I’ve been thinking a lot about research lately. Rather, I’ve been thinking a lot about how much I used to think about research and how, lately, I seem to do so less and less.

I was a psychology major in college and, as such, had to read lots of research and execute a few studies. Quantitative methods was required for my course, and, as much as I see the place for quantitative research, constructing and executing just one “gold standard” double-blind study in an academic setting with plenty of help and guidance mostly taught me a) that I did not ever want to do it again, and b) that quantitative research is complicated and often imperfect, and as a bonus, it reinforced my belief that many people tend to misread, overgeneralize, and overstate the extent to which studies “prove” things. I do not mean to suggest that it doesn’t matter. Quantitative research matters very much, gives us valuable information and insight into this world of ours, and results in crazy advances for all humankind. I’m just not the girl to carry it out.

Qualitative research, on the other hand? Oh how it makes my heart surge. Qualitative methods was not required for my course, and it was a pretty small class. I understand why. To do it properly requires hours of transcription and coding and analysis, and, at the end, you essentially wind up with a story. It’s a little less sell-able  a little less shiny, a little less likely to turn up in the health section of the Times than quantitative studies with control groups and placebos and scientific method set out to measure the effects of one thing on another (unless, of course, there’s either a quantitative element or a large enough study to detect quantifiable patterns). It doesn’t disprove a hypothesis, and thus it is often sidelined, but I think it is pretty important stuff. It provides new ways of listening, new insights into stories. And stories matter. You can’t extrapolate from them the way you can with quantitative research, can’t say that the experience of a handful of people that you have carefully taken down and parsed and come to understand will predict the experience of another, but that doesn’t mean those experiences don’t matter. They do.

The other day, I saw a post from the marvelous Melissa who administrates Anatomy in Motion’s Facebook page (on the off chance you are not already up on it, Anatomy in Motion is a fantastic app she and her husband created, and they post great content on Facebook that yields many interesting discussions). She was dismayed that someone was posting anti-massage sentiments on some of their infographics in a vaguely troll-like fashion. I had plans to leave the house within a few minutes of seeing her post. Because internet drama bests my feeble time management skills time and again, I chose to forego brushing my hair and packing my bag for yoga in favor of scanning the recent posts to see what this guy had to say. What I found was a fairly straightforward post from Anatomy in Motion citing some information about TMJ (it didn’t mention massage as a treatment), and a response from someone declaring that massage does not ever help this ever, and that no study has ever shown that it does. Ever. He used some language that didn’t sit well with me. It wasn’t foul-mouthed by any stretch, but he suggested that telling people that massage helps with TMJ dysfunction merely adds to the misinformation that “consumers have to wade through.” I felt a little lumped in with snake oil salesmen. I didn’t like it. I left the house as planned, and when I next looked at the discussion, someone with more time than I (OK, it was Melissa/Anatomy in Motion) had hopped onto PubMed and posted four great quantitative studies demonstrating the effectiveness of massage in treating TMJ dysfunction! Problem solved!

But my wheels had been spinning since I’d left the house. The snake oil association had got me thinking about the way that so many people approach healing, about our reliance on research that we take to be cut and dry, but that rarely is, on the reluctance to trust intuition and give complementary care a fair shake. I appreciate the studies that demonstrate that massage helps people who are suffering from TMJ dysfunction. I look for new research fairly regularly, share it when available, write blog posts promoting new information from time to time. I love that stuff. But I was twelve years old when my jaw first slid out of place and started popping every time I opened my mouth. I’ve had TMJ problems longer than I have not. And, when I pin the clavicular attachment of my SCM and tilt my head to the side, I feel the stretch through my neck, up into my masseter, feel a slow and achy opening in the joint itself. And that matters just as much as any study.

Sometimes, it really can feel like we are wading through information. There is so much we don’t know about the human body. For people who don’t “believe in” or use acupuncture, the meridians and elemental associations sound like mumbo jumbo. For people who don’t know about massage, I imagine talk of trigger points can sound similar. But it’s pretty commonly accepted that massage works on muscles, and muscles act on joints, and it has always made sense to me intuitively, long before I ever had a massage, back when I was just a kid with a cranky, painful jaw, that pressing the muscles could help ease the pain.

When I studied qualitative methods in college, in addition to course work and our main study, we had to submit a reflection paper at the end of the term. I remember vividly hand-drawing a cover (a little juvenile, perhaps, for a college paper, but the word “reflection” was in the assignment, so I guess I kind of went for it). I drew a human form, gingerbread-man-style, arms and legs and head, but empty, and I filled in the body with interlocking puzzle pieces. What I loved about my study, which was entirely interview based, was the idea that, rather than looking at people through the lens of an external hypothesis, I started from an open-ended place and let all data arise from interviews, from the individual. I loved my qualitative methods psych class for the same reason I now love massage: all the answers are within the individual, the pieces fit together always, in a unique and fascinating and way that has something to teach us.

The truth is that much massage research usually relies on both quantitative and qualitative measures, and it legitimizes the field, and it informs techniques, and it is fabulous. My issue is not with research itself, but with people like the man commenting on the TMJ post (and other posts, apparently, that I didn’t catch), who insist that the only effective treatments are those that have been pinned down and scrutinized and documented via quantitative methods. I wish that experience and common sense mattered a little bit more, that feeling a change in a joint, however subtle, was enough to demonstrate effectiveness or, at the very least, to not inspire rage. Massage helps me. It helps my clients. As much as I love research and will continue to use it to try and legitimize the field to nonbelievers, the stories I’ve seen of massage working wonders, however few and however undocumented, are just as important to me.

 

Megan Spence is a Licensed Massage Therapist living and working in Brooklyn, NY. She is continually astonished by just how much she loves her work. You can read more about Megan’s adventures in massage and various other things body-related at Bodywork Brooklyn.

Between Science and Woo: My Hospital Adventure

I work in a little-bitty clinic, basically a storefront, filled with donated furniture, ugly carpeting, and a whole lot of love. It’s a casual kind of place. But recently I left work early wearing a suit and heels, to head to the biggest, fanciest, best-known hospital in town: The Cleveland Clinic.

Why was a very junior massage therapist from a very tiny organization visiting a hospital with its own zip code? (44195, I’m not making this up!) I was attending an informational session about their Healing Services program. While the program makes use of massage, it is not organized by massage therapists. Maybe that’s why they’ve managed to sidestep the ongoing battle in the massage world between the forces of Science and Woo.

On one hand, there are the folks who like to talk about evidence, efficacy, and therapeutic outcomes. These are often the same folks who push for massage in he world of healthcare. On the other side of the divide are the people who prefer to base their practice off of their own intuition and experience, and may or may not incorporate energy work into what they do. These folks are perfectly happy to get the results that they get, and aren’t necessarily concerned with whether or not they can chart their results objectively or pass peer review.

As massage therapists, we’re familiar with this dynamic. So what are the factors that allow one of the biggest names in healthcare to incorporate massage, Reiki, guided imagery, aromatherapy, meditation, Healing Touch, counseling, and a hodgepodge of other techniques into one coherent program?

The first is the distinction between Healing Services and other departments. When your work falls under “patient experience” and “spiritual care,” what’s the goal? That the patient feels cared for. In that context, there’s no doubt at all that each of these techniques can be equally valid, depending on the preferences of the patient.

The second is the question of billing. Massage and other offerings available through Healing Services, which are open to patients, families, and staff, are not billed for the way a rehabilitation-focused massage might be. The forms for notetaking are different, so a person offering Reiki, for example, isn’t limited to just checking a box labeled “emotional support.” This allows for greater freedom in modality while still tracking the results that matter most with in the context of the program.

The third has to do with money. The Cleveland Clinic has sufficient funding to offer these services at no charge, because it is only a small piece of what they do. When money is being exchanged for treatment, there are ethical questions about whether or not something  has been shown to have an effect. But in the model being used at the Clinic, the only important factor is the individual’s subjective experience. Given that reimbursement for services will soon be tied to positive patient experiences, this still makes financial sense.

I don’t know whether the various factions in the massage therapy community will manage to find a place of unity anytime in the future. But it is reassuring to know that there is a place where nurses, chaplains, and yes, massage therapists and energy workers of all kinds can come together and find a little patch of common ground. That it’s happening in such a prestigious place is an added bonus. Maybe if we take a step back from wanting our faction to be all things to all people, we can find the niche where we’re most effective, and learn to work together towards a healthier, happier world.

Kat Mayerovitch is a licensed massage therapist practicing in a nonprofit chronic pain management center in Cleveland, Ohio. She also works as a copywriter, volunteers like mad in local community development, and plays the ukulele. If you liked this, Kat writes more good stuff at LMT or Bust.

An Occasional Sliding Scale

Last month, I did my first Sliding Scale Saturday. It was one of those early fall days where the sun is unbelievably golden and the breezes are just getting crisp, the yoga studio where my practice is located was buzzing with weekend classes, some people got massage who otherwise might not be able to afford it, and everyone involved left feeling stellar. It was an all-around spectacular day, and I’m telling you about it in case you want to do it, too.

This is really a post for Sliding Scale novices. There are many who have done far more than I, and I’d love to hear all about it! I have always wanted to offer affordable massage to people who need it, but, as a relatively new therapist slowly building my practice (i.e., not working a ton), I didn’t feel comfortable making sliding scale the foundation of my practice when I started out. I know some people who have offered sliding scale rates full-time from the start of their careers who are absolutely thriving. That’s totally an option, and I think it’s fantastic, but it wasn’t my choice. This little step-by-step is aimed at people like me who aren’t ready (or just plain don’t want) to commit to having a sliding scale practice all the time, but who are interested in increasing access to massage bit by bit. It took me a long time to realize that there are ways to dip a toe in without drastically changing one’s practice. This is how I did it.

Step 1: Determine What You’re Worth.

This is a lengthy discussion for another time. I’m sticking it in as a starting point because I think it’s important, when reducing rates, that we do so for the right reasons. There are a lot of reasons to do this – business promotion and increasing access to massage come to mind for me – but  please don’t do it because you don’t think you’re worth the full rate other people charge. If you think about massage, if you’re passionate about it, if you work hard, then you’re worth a good rate. Lots of people out there have this down pat, but I did a little waffling in the early days of my career, and I’ve seen some talented, well-trained people establish less-than-living wages because they think it’s the only way they’ll get clients, and it makes me a little squirmy. Shoot for the stars, or at least the standard going rate in your town.

Step 2: How Low Can You Go? Establish Your Scale.

Now that you know that you are awesome and totally deserving of the fairest rates in all the land, think about the lowest amount you can make and not feel put out. If that’s totally free, so be it, but if you’re going to be grumpy if you give an amazing massage and your client slips you a tenner as payment, set your scale higher. My base rate was $35/hour, but this will vary quite a bit both regionally and personally. If you have hourly expenses (e.g., space rental), add them to your lowest rate to set the base for your scale. Base rate + hourly expenses = low end of sliding scale. If you have a good relationship with the owner of the space, it is worth mentioning that you are offering reduced rates and ask if your landlord will, in turn, reduce yours.  I rent space in a yoga and movement studio owned by an amazing lady who was offering pay-what-you-want classes that week. She was enthusiastically on board for Sliding Scale Saturday and did not charge me for the space. You might not have the same luck, but you probably won’t know if you don’t ask.

Step 3: Set Your Limits & Book!

Having a day devoted to sliding scale is not the only way to do this. You may choose to offer a set number of sliding scale sessions a month. Lots of people offer sliding scales or reduced rates to certain populations (like students and seniors) on a regular basis. Again, I’m not saying you need to set limits – plenty of people offer sliding scale all the time, and it works out great – but if you’re afraid of feeling broke, or if you feel put out when you are paid less than what you feel you’re worth, be honest about it. I set four sessions on one day. It didn’t seem like much, especially since they went like hotcakes with a waiting list trailing behind, but it was a little something, and I plan to do it again and again.

Step 4: Reflect and Repeat.

I have heard from people who primarily work with sliding scales that the payments even out over time, that some people pay less and some people pay more than the going rate because they can. There’s trust involved. The framework I set, of limiting the discounted sessions, did not allow for such wide fluctuations. I knew it was unlikely that anyone would pay my regular rate or higher, because I wasn’t asking for that, for the generosity of some to make up for dips in the scale over time. I expected little; I got more than I expected. In a way, Sliding Scale Saturday felt like an exercise in generosity for everyone involved. While clients got a big discount, they all thought about what they could give and, in my tiny sample, they all paid more than the minimum I asked. Generosity. I got to offer a very steep discount as my base and feel like I was giving something. Dara at my studio gave the space. Generosity feels good. As does massage. It was a great day, and I’m excited to make Sliding Scale Saturday a staple of my practice.

If you’ve never tried offering a sliding scale, I heartily encourage you to work it into your practice. It’s entirely possible to try it out without overhauling your rates and your practice as a whole. If you’ve done it for years and are brimming with thoughts on the topic, I would love to hear from you. Comment away!

 

Megan Spence is a Licensed Massage Therapist living and working in Brooklyn, NY. She is continually astonished by just how much she loves her work. You can read more about Megan’s adventures in massage and various other things body-related at Bodywork Brooklyn.