Cause-Related Marketing in Your Massage Practice

(Sorry it's been a while. I've been a busy bee...)

The economy isn't so hot right now, as if you need me to tell you. Unfortunately, that has a lot of implications for massage therapy. As a teacher, I get asked a lot about what the job prospects for massage therapists are these days. "Is there a market?", "Will I be able to find a job when I'm done with school?" I get asked a lot. From what I have seen, my graduates have still been able to find jobs, but the current state of the economy has created a bit of turmoil in our industry. What I've seen lately is that businesses that were on shaky footing may be closing their doors, laying off workers, or cutting hours and wages. Others seem to be experiencing an increase in business. There are many experienced therapists out looking right now. I haven't seen a drop in demand for massage therapy, but I have seen some shaking up as MTs move around. What gives?

Massage As a Luxury
Unfortunately, there are many people out there who still see massage therapy as a luxury service and not a necessary one. When the economy turns south, discretionary spending on luxuries is the first thing to go. Yesterday on NPR's Marketplace there was an item about shopper's guilt. It's a phenomenon in which in a down economy, people feel guilty about spending money on things that aren't seen as necessary. It kind of feels like you're rubbing it in on the less fortunate. So what can a massage therapist do to overcome shopper's guilt?

Cause-Related Marketing
This is a practice in which when a consumer makes a purchase, a part of the sale is donated to a charity. It can assuage the guilt associated with the purchase in hard times. The nice thing is that the donation is actually tied to a sale instead of just asking for money. You might even consider matching the client's contribution up to a limited dollar amount. You could support a cause that is dear to your heart or allow the client to select a charity of their choice. Both have advantages, some of which are discussed in the next section. Allowing the clients to choose their favorite charity can add value to your service and make it more personal.

Working with a Charity
Another option is to actually partner with a charity for mutual benefit. This can be practiced in a variety of forms, including the following:

• providing complimentary services to the charity for them to use in their marketing efforts, gift certificates work well because they are easily transferrable
  
• offer your services at their events with half or more of the proceeds supporting the cause
• health education - teach the organization or the groups they serve. You may just pick up some clients

In this season of giving amidst a backdrop of economic uncertainty, give your clients a way to feel better about the money they spend while helping to make the world a better place. What could be better?

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Using Movies to Teach

I love introducing films into the classroom to illustrate topics. Educational video is great, but I'm talking about Hollywood. Nothing pulls in a student like a good story and the nice thing about a movie is that it wraps it all up in a tidy, 2-hour package. It is something that a student can relate to and it will engage them in their learning.

Prepare the Student

The important thing about using movies as instructional tools is to set the stage appropriately and follow up after. Typically, I show a film after I've had a lesson or series of lessons about the themes I want the film to illustrate. That way the class has already had a discussion about the theory and the film can demonstrate a "real life" application, albeit a dramatized one. To set the stage right, you need to give the student some information to look for while watching. This will change the viewing experience from a passive role to an active one. They will be searching the material for information and they will be comparing it to what they already know.

Follow It Up

Just as important as setting the stage is the follw up. The film should be followed by an activity to integrate the learning; ideally an activity that will allow the students to come together in their understanding. A good method is to have the students write a reaction paper to the film, giving them some guidelines for their discussion and tying their own emotional reactions to the material. Then bringing the students together in a discussion will emphasis the themes. Many students will come to the same conclusions, but they will all have different takes and some students will surprise you with what they find.

The Legend of Bagger Vance

I'm going to use this movie as an example of one of the films I use in class. In one particular class, we discuss the theory behind many topics vital to a massage therapist's success - ethics, boundaries, relationships, communication, thinking vs. feeling... all of which are addressed in this film.

Other Films:

1. Contact - Beliefs, values, persistence, communication, relationships
2. Pay It Forward - Ethics, values, social responsibility

The great thing is that the film brings the "real world" into the classroom. It gives the students a break from listening to a lecture from their regular instructor (students always love guest speakers). But the main advantage of using film to illustrate a point is that it gets the students thinking situationally - outside the classroom.

What films can you think of that could be used to teach?

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Life, Outsourcing, and Massage Therapy – Part 2

In part 1, we discussed general busy-ness in our clients’ lives and the reason people outsource. I also introduced the idea that we as massage therapists are contracted as outsourced wellness providers. So what can we do with this?

Extend Our Reach (and Role)

So what is your role? As a massage therapist, most people would give the simple answer of “giving massage to my clients”. Close, but too vague. Sure, that is how we go about it, but really we provide wellness, stress-reduction, and all of the other benefits that our clients experience out of our work. When I say that we need to extend our reach, I mean that we need to fulfill our wellness contract. If our clients have put it into our hands to be responsible for a part of their wellness, then we better see that it gets done!

First off, communicate what it is that you are doing. “I provide wellness”, “I improve athletic performance”, whatever your mission is. Make sure your clients know it, and then let your clients know what it is that you do to get them there – that you will proactively help them with their well-being.

Being a proactive partner in your client’s health implies action on your part. I see far too many therapists that sit back and wait for clients to come to them, wait for clients to rebook, or wait for clients to respond to their marketing. Although marketing might seem to be a proactive approach, really you do something and then you have to wait for the client to respond. Gaining clients proactively is a whole new discussion, but what about the clients you already have? What can you do for the clients you already have a wellness contract with?

Be An Active Partner

Let me paint a picture for you. You enroll in a class. You show up for your first day, excited about all the great things you are going to learn. The teacher sits you down, hands you a textbook and says, “I’ll be over there if you have any questions”. How would you feel about that?

Figure out what role you can play in helping their wellness goals to become a reality. One answer is to take on some of the responsibility yourself. And I mean the responsibility for making the massage session even happen. Make sure that for every client you have, you have a plan. Make sure that that plan is well communicated and understood by both you and the client. Make sure that the plan is as much the clients as it is yours. Maybe even have them sign it (not a binding contract!) to give it a little more weight. Then help them to fulfill it. That may mean telling them straight out that if you haven’t heard from them for two weeks, you’ll call to check in with how they are doing. It may mean sitting down and planning out their session schedule so you can have a number of appointments set up and in both of your calendars. It means following up with them by phone, email, text-messaging, and smoke signals. Get the client’s agreement of course from the start. We don’t want to harass them!

This approach may seem pushy to you. However, I have found that clients appreciate the concern. I’ve called clients that I haven’t seen in a while and it’s like they’re reading from a script every time – “Oh, hi! Has it really been that long? I really need a massage! I’ve just been really busy. Thank you so much for calling! Can I come in…?”. I think it’s because they outsourced this part of theiw wellness to you in the first place and they are happy to have you do it for them.

Reminder cards can work, but it is still putting the task of remembering on them. Don’t forget, they have to remember, it has to be at a convenient time, and it has to be urgent for them to pick up the phone. Make it as easy as possible by remembering and picking up the phone for them! I know I’ve found services like Genbook (a free online scheduling service) to be great boosts, because it makes it so easy for them to get an appointment AND it sends reminder emails (or text messages too if you pay for the upgrade). Remember, it isn’t their job to keep you in business, so do the remembering for them!

Outsourcing Wellness = Opportunity

I haven’t seen many therapists take this approach to their practice. However, if you look at it this way, you could expand it to include business wellness programs, government health programs, and more. The important thing there is to demonstrate benefit, and that means a lot more than your clients walking out saying they “feel better”. You need some proof. Use research from the Massage Therapy Foundation, the Touch Research Institute, or the International Journal of Therapeutic Massage & Bodywork to back up your claims. You want to translate those studies into something meaningful to your clients. Stress-reduction may not mean much to them, but maybe helping with insomnia might.

The key is to remember that people outsource work to people who can do it better and more efficiently than they can. I would start taking a look at the different programs out there to promote wellness, pain reduction, sports performance, or whatever your specialty is and develop a program to compare and compete. Ask yourself, “how can I make this easier, more effective, and more time efficient for my clients?” and “What can I do to help my clients take advantage of massage work and stay on track?”

My money is on the fact that if you start being more proactive about your clients’ wellness it’s really a win-win for everybody.

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Life, Outsourcing, and Massage Therapy – Part 1

Just reading the title, you may be wondering what the heck I’m talking about. Well, you may have noticed that it’s been a while since I’ve posted to this blog. Life happened. Life is still happening. I teach, I have a family, car repairs, sports massage events, I’m in school taking classes, and I’m working on setting up a business. I just got busy.

The thing is, so do our clients. Often, as massage therapists, we wonder where our clients go. The truth is that many times it has nothing to do with the client not wanting to come back. Life just got in the way. Very few people I know have large blocks of time in their schedules to do with what they wish. MTs often fall prey to thinking that they are only competing against other massage therapists. Some who see a little bit more realize that they are also competing against other niche products like chiropractic, pain relief, and stress-reduction activities. But in the broader scheme of things, we are fighting tooth and claw with almost every other business (and even person) out there for one thing. Time.

Time and Our Service Economy

We are competing with sports events, TiVo, concerts, charity events, kids’ recitals, theme parks, you name it. Time is our clients’ most precious commodity. It seems that all too often, even when you want to get together with a friend, they have to check their schedule and pencil you in in three weeks. More and more, people are just so busy they can’t get away for anything.

What does that have to do with the service economy? Few would deny that massage therapy is a profession that rests firmly in the service sector. Whether you look at it as health care or a luxury, it is still a service. In one of my business classes recently, I learned that the rise of the service economy in the U.S. really began after World War II. What ended up happening is that incomes rose so that people had more to spend. At the same time, a counter-trend was occurring in that people had more demands on their time. The result was this, people began to pay others to do time-consuming services that they didn’t wish to do. Things like dry cleaning, painting the house, dining out increased. People began outsourcing more of their needs to others.

Outsourcing

The way I see it is that our clients have outsourced some of their care needs to us. We provide a therapeutic service and can rattle off all kinds of therapeutic benefits for massage therapy. We’ve been contracted to provide something that our clients want or need, but either can’t or don’t want to do themselves.

Think for a minute about the things that you want or need and can’t/won’t do for yourself. A person could get in shape without a personal trainer or a gym membership, but isn’t it easier to pay the membership or have somebody else guide you? Massage is kind of the same. People could reduce their own stress, there are many forms of massage that people really could do for themselves. But that isn’t really the issue. It’s time and focus.

General Busy-ness

A month ago, I wrote about my TFL and my plan for addressing it. I was going to chart the progress and write about it here. I know this stuff. I teach this stuff. I recommend it to my clients. Did I do it? Nope. It wasn’t important enough to me at any given moment to do much. Oh, I worked on it a few times. I got some massages at my school. But did I do the entire protocol that I laid out for myself? Sorry.

The point is that our clients are the same way. It’s not that they’re lazy, or uncommitted, or that they don’t want to be healthy. It’s that they have a gazillion priorities and their health is only one of them. Proper nutrition requires a lifetime commitment while McDonald’s only requires a commitment of $5, right now. When so many people demand so many things, something has to give. Unfortunately for us, for many people that seems to be massage and taking care of themselves.

And Back to Outsourcing

The answer to busy-ness for most people is one of two things. Put it on the back burner to be ignored or forgotten OR… outsource it. Our clients are outsourcing part of the wellbeing to us. We just need to know the best way to go about it for our particular group of customers. So what can we do to fulfill our contract as outsourced wellness providers? I’ll save that for part 2… (nice teaser, eh?)

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The Wolnick Trigger Point Protocol

OK, lame name, I know. I’ll come up with something better soon.

Over the years, I’ve dealt with a lot of trigger points. I just talked about a few of my own in my last post. Now some of these trigger points are just plain nasty. They exhibit the kind of pain that simply wants to make you cry – the “exquisite tenderness” described by Travell & Simons. I’ve seen what’s out there as far as techniques for addressing trigger points and have developed a protocol for deactivating them that has worked very well. Surprisingly enough, I’ve never seen any one source that puts all of these techniques together into a single protocol. If you have, let me know, and I’ll give them credit! This is what I teach my students and use myself. Works like a charm!

Here’s a simple version of my protocol:

1. MET
2. Cross-Fiber Friction
3. Static Compression

In that order!

MET, aka Muscle Energy Technique

MET has to be one of my favorite styles. It has some great advantages, not the least of which that it can address a trigger point without the same kind of excruciating pain as the other techniques. Simply described, MET is a technique that you can use to reset the communication between the brain and the muscle. Often, at least part of the irritation is that the nervous system is maintaining a negative feedback loop that reinforces the dysfunction in the muscle. In my experience, using MET nearly always reduces the irritation of the trigger point before you start using any more painful techniques. This decreases the discomfort of the client, and some trigger points may even disappear entirely without any pain! I love the look of confusion on a client’s face when you do a simple exercise and then their pain has disappeared. They always ask “Are you pressing in the same spot?”

MET involves a thorough knowledge of kinesiology and the ability to apply very slight resistance in precise planes of movement. You establish a clear signal between the brain and the muscle and take advantage of innate reflexes to obtain specific effects. Sounds complicated, and the reasoning behind it is, but in practice it’s fairly simple to actually perform. You can learn more about MET here, a few videos here (1 and 2), and a technical paper here.

Cross-Fiber Friction (CF)

The favored technique of Clair Davies, author of the Trigger Point Workbook, this technique has seen a rise in popularity over the years. While it is still painful to the client, the pain is in short bursts rather than a sustained pressure. This allows the client to tolerate more, but also allows for more of a pumping action in restoring circulation to the area. Davies recommends that only 6-12 good, firm strokes over the trigger point constitutes a treatment – a guideline I agree with. This prevents you from overworking the point and causing the trigger point to go active on you. Ouch.

This technique is one that you can do easily on yourself as well. This is good, since it is better to work frequently and in short bursts on a trigger point than rarely but for a long time. It is something that your clients can do at home. Often, the cross-fiber friction will take care of the trigger point aggravation. If not…

Static (Ischemic) Compression (SC)

Ahh, the good old standby of Neuromuscular Therapy (video here). This technique involves holding sustained pressure directly over the trigger point. This has the effect of increasing the pain sensation and “overloading” the neurological circuit so that it shuts down, kind of like tripping the circuit breaker. The analogy that I like to use is that of a rain bucket. The water in the bucket is the amount of irritability in the trigger point. As it fills, eventually the bucket overflows (the TrP goes active) and starts sending pain elsewhere. SC is like tossing bricks in the bucket. It causes it to overflow, but after you’ve drained some water, when you pull the bricks out there is less water in the bucket.

This is certainly the most uncomfortable of the trigger point techniques – which is precisely why I save it for last. However, there are some trigger points that don’t seem to respond to anything else. The good news is that by the time you get to static compression, the other techniques should have reduced the irritability so that this one isn’t so bad.

To perform this technique, locate the precise point of the pain, sink in to the point until you get to a pain of 7 on a scale of ten (the point where if you go past you’ll need to tense up to resist it), and hold it. If the pain is increasing, release and try something else, if it is staying the same, hold for 8-15 seconds then repeat, if it is decreasing, ride it home until it levels off.

I recommend that you only combine up to 3 treatments of either CF or SC at one time to avoid overworking the point and sending the client home in pain. It is a very common mistake to overwork a point and it is very easy to do.

Happy Trigger Point Hunting!

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Getting in Touch with Your TFL

Your Tensor Fasciae Latae (pronounced Tensor Fah-sha Lotta), or TFL, is a small, upside-down teardrop-shaped muscle in your hip. While the muscle isn’t large, it certainly has a large role in how your hips function. You can see a picture here from Gray’s Anatomy and some interactive anatomy here. The TFL helps to abduct, flex, and medially rotate your hip as well as extend your knee (or prevent it from collapsing while walking). Of course it helps to regulate the opposite of those actions too. In short, TFL is involved in every motion of the hip and the major actions of the knee! The insertion for this important little muscle is on the Iliotibial Band (ITB), that taut strip of connective tissue going down the outside of your thigh. TFL can be responsible for some considerable tenderness and tightness on the outside of the thigh.

My Connection

I think it’s funny that I teach this stuff, and I pass it along to my client’s all the time about what is good for them, and yet I have problems with my own TFLs. I had reconstructive surgery on my ACL 12 years ago and I have to say that my hips and legs haven’t been the same since. Over time, I have slowly realized that it’s not so much the surgery as how my body responded to the surgery – and the protective mechanisms I developed. Don’t ask me why it took me so long to realize this; I guess it’s easier to look objectively at somebody else’s body.

How it manifests for me is a massive trigger point in my left TFL. It’s bothered me on and off over the years – some little stress sets it off and it will make my entire leg ache. Over the past few years however, I’ve found a new pattern of periodically tweaking my hip when I carry something awkward (like a massage table) on one shoulder. Invariably it causes my left piriformis to go into spasm so that I can hardly walk – limping for several days. Only just recently have I realized a direct connection between the two pains. I have the same problems mirrored on my right side, just not as severely.

Lifting something awkwardly for a Memorial Day picnic, my piriformis went into spasm again. In working on the area myself, I probed around the rest of my hip to try to see what else was contributing. When I pressed on the latent trigger point in my TFL, my piriformis began pulsating for as long as I help the pressure. When I dug in a little further, I felt a sharp pain in the middle of my anterior shin (Tibialis Anterior) – another common site of pain for me. AHA! Paradigm shift!

Bodywork

IN my next post, I’ll go into a little more detail over the treatment protocols I intend to use to get rid of these things. I’m a massage teacher, and I can receive bodywork on a fairly regular basis. Still, I’ve been receiving bodywork regularly for years and it hasn’t done much for these trigger points. Nothing short of direct, focused efforts will do it. So here’s my plan.

First, I will make sure that I get at least one massage per week with at least some special emphasis specifically on my hips and these trigger points. Good, but that won’t be enough. Clair Davies recommends that you work on them with 6-12 good strokes multiple times per day and that you’ll see improvement in less than 2 weeks, even for the really bad ones. Well it’s proving time! I’m going to work them at least three times per day for at least two weeks and gauge the results.

I’ll keep you posted!

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Your Perception Is Your Reality

“Your perception is your reality”

I recently heard someone say this and I thought it would make a great critical thinking question, especially when applied in context to massage and our client relationships. This is a pretty deep statement and has implications that affect all aspects of our lives. Many times people perceive what they want to perceive. In class, we identified five areas of impact – personally, professionally, communication, your clients, and your work.

Personal Perceptions

Your personal perceptions dramatically affect your own self-esteem and relationships. In essence, your own self-perception is actually the basis of self-esteem. Relationships also have a large element of perception. I know that I have seen people that when they state “I’m not happy in my relationship” it is less of an observation and more of a decision. They have decided that they are not happy and that nothing about it ever will. Others seem to be able to make it through hard times by having the faith that it is only a temporary struggle and that brighter times are ahead. We call these kinds of perceptions a person’s character and we describe it in terms of being optimistic or pessimistic or cheerful or sarcastic. These personal perceptions can really color a person’s world. Stereotypes are an example of this too.

Professional Perceptions

Let’s talk about ethics first. When it comes to ethics, there are times when perceptions can matter almost more than the substance. Were you to socialize with a client, another client or professional could easily perceive the relationship as being improper. Really any interaction is open to interpretation about motives and you only have any kind of control over the impression that you present (I call it impression management). While you can’t control the thoughts of another person, you want to avoid anything that could give the “appearance of impropriety”.

Professional perceptions are also exemplified in job interviews. Your performance in that interview is dependent on how that interviewer perceives you. In this case the perception can quite literally create the reality in that you will never really be that employee unless they perceive you to be.

Communication

Since communication takes two, and the two can never completely know each other’s mind, there is an aspect of interpretation. How many times have we discovered a miscommunication because one person perceived a meaning the other never intended? Sometimes perceptions can also relate to selectivity – only seeing or hearing what one wants to see or hear. Different perspectives will also place different priorities on different things. You may intend emphasis on one thing, but someone else prioritizes another.

Your Clients

I know I’ve seen many clients who say that they are stressed. Sometimes I have to wonder how much of that is a symptom and how much is a self-fulfilling prophecy. Are they stressed, or does believing that they are stressed just allow them to accept it and not find a way to get rid of it? If a client resigns themself to a life of chronic pain, does the perception create or contribute to that reality? There is a connection.

Another aspect is the “I can’t” mentality. You know what I’m talking about. A child is working on their math homework and is saying “I can’t do it” and then after a lot of frustration and agony they do in 30 seconds what they’ve been “unable” to do for half an hour. They’re just trapped in a mindset and convinced their self that it is too hard. They can’t do it as long as they believe that they can’t. Other examples can be clients stating that they can’t function without a steady stream of caffeine, that they don’t have time to take care of their self, or eating right is impossible.

In Your Work

Perceptions here can create some conflict when you perceive something to be beneficial to a client and others may disagree. A huge example of this is I have heard of some spas prohibiting their MTs from working on clients’ gluteal areas because of the perception that it is sexual. These clients miss out on an important integrative region of their body because of a perception (I’d say misconception, but that is my perception! :D). You may perceive that a client needs more pressure to achieve the results they seek, but they perceive that the pressure is already too hard. You perceive that trigger points are to blame for the agonizing pain they are in, but they perceive that trigger point work is simply increasing the pain they are experiencing.

So What To Do About Perceptions?

The good news is that you do have control over your perceptions and, to a lesser degree, others’ perceptions as well. Even a phrase like “look on the bright side” indicates that there is a choice about how you choose to perceive something. An important thing is to do some periodic self-evaluation and see (pun intended) if there are any perceptions that hold you back. Do you have any self-fulfilling prophecies? “I think, therefore I am” could be changed to “I think ______, therefore I am _______.” To a degree, when you think certain thoughts, you start behaving in a way to start to bring those thoughts into reality. Affirmations work this way. You choose something you want to be (a perception), and through repetition you change your thought processes to make it a reality.

Another simple strategy is to just do it. How many times have you thought something was hard or impossible only to realize it wasn’t all that bad? When an event occurs that dramatically changes our entire world view, we call it a paradigm shift. We can cause these to happen intentionally by opening ourselves up to new experience.

I certainly hope that you’ve perceived this to be helpful!

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Diversity in Your Practice

Jack of all trades, master of none - or so they say.

While there is a lot of merit in specialization and becoming a master of your chosen niche, it is important not to become overly limited and specialized as well. And in that respect, I'll use another old cliche - moderation is key.

Why Diversify?

In investments, you diversify to minimize risk. In the workplace to capitalize on different cultures and viewpoints. In massage, it's both.

Risks?

What risks, you might ask? In massage school, we all should have learned (and hopefully learned well) the risks associated with improper body mechanics and repetitive strain injuries. We learn how to help our clients deal with and prevent these things in their lives. But what about ours? Massage is physical work, and even using the best body mechanics isn't going to eliminate all potential problems. We all come into this work with a different history, a different accumulation of life's wear and tear on our bodies, and different genetic predispositions. Some can certainly last longer than others, and proper body mechanics employed consistently and habitually should allow any therapist to (as I always say in class) "let you work for as long as you choose to, not for as long as your body will let you." So, performing the same movements over and over again in your work can create the potential for RSIs.

Let's not forget that we are holistic beings here, so we can't neglect emotional, mental, and spiritual aspects of specialization as well. Personally, I thrive on novelty. I love new projects, getting things kicked off, establishing procedures and efficiencies, building businesses, and starting careers (that's why I love teaching). Doing the same darn thing day in and day out is torture for me. For me, psychological burnout is a bigger concern than physical problems. There is a real danger to the client-centeredness of your practice when things become so habitual you stop asking questions and start running on autopilot. Work becomes less fulfilling, monotonous, and a chore. I'd venture to suggest that just as many, if not more, MTs leave the profession because of this as for physical reasons. It can also lead down the slippery slope of focusing on what you're getting out of it (aka $). Not a good road to go down.

Specialization has its rewards too, but I don't hear too often any discussion about the downside. A healthy MT/practice/career strikes a balance.

Diversify

OK, so over-concentration in a single area can be risky. What do I do about it? How do I diversify?

Well for starters, it may mean using some different techniques. I'm sure there are a lot of things you learned in massage school that you haven't used in a while. Or you could watch a massage DVD, even search on YouTube so you could see some different techniques. Trade massage with an MT that uses a different style than you do or purchase one. Read a book. Even learn something from a discipline that is similar but different like PT, emotional healing, yoga, breath-work... You could also just make the effort to change up the emphasis in your sessions - do a lot more stretching, try some techniques that require client participation, mix zen shiatsu into your Swedish.

Another way is to provide some complementary services. Body wraps, exfoliations, hot stone, aromatherapy, and others are all great ways to mix things up. They can use your body in a different way or potentially use your body in the same way but with an entirely different thought process. It helps to keep you (and your client) engaged in the process.

It might also mean diversifying your work environment. Getting out of a rut means breaking routine. Try working in different environments - a spa, chiropractice office, a pain clinic, a law firm, a house call, outdoors at the charity 10K... Try working with some different clients that have different challenges for you to work with.

Got some ideas on how to diversify? Let me know!

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Raising Your Rates

A touchy subject for all massage therapists. When do you do it? How? What do you say? This question was recently posted on LinkedIn's Massage Therapists & Bodyworkers group:

I would like to hear what other therapists tell their clients when they ask why you've raised prices. (or if they complain about it). I raised my prices last year from $70 to $80/hour. I was underpriced for my area, now I'm competitive. I own the business so about 30% of my clients tip but I don't count on it and it isn't expected or considered in my financing. We all know why we have to raise our prices: 1) To stay competitive and not under-value our work. 2) To pay for the increases in the cost of doing business so that our profit margin remains the same. People who are employed get annual 'cost of living' raises. we don't unless we raise our prices. I am resentful of people who don't understand this, and have a hard time coming up with a concise, professional way to explain. I certainly think I'm worth the raise, so that is not the issue, and I'm not defending that. Thanks!

Cass Vertefeuille Garrett of Greenleaf Therapies, LLC

First off, Cass has it right. When we're self-employed, we are the ones who have to give ourselves a cost-of-living adjustment. I think that Cass has already presented some good reasons why we need to raise prices, but let's take a look at the thought process behind it and the when and how of increasing rates.

Why Raise Rates?

The thought process here is a simple one. Our prices aren't static, as our clients often seem to think they are, and like we MTs can even fall into the trap of believing. There are lots of factors that drive our pricing, some of the most obvious being: inflation, increased cost-of-living, increased costs of doing business, having increased experience, training, or specialized skills, and so forth.

Because these expenses aren't static, neither can our prices. We need to build that mentality into our business plans and practices. Ideally, we should also build this into our clients' expectations. Think about the example of a client who wasn't informed that they might be sore following a massage who then becomes sore afterwards. The are upset because it was a surprise and worried that something might be wrong. The same can happen with your business practices. Build in the expectation that prices will change periodically to reflect the current economic environment and it won't be such a nasty surprise when it happens. I'd include this expectation in your policies from the very first appointment with your client.

When to Raise Rates?

The knee-jerk response to this question is "when you need to" and that is a valid answer. But it is also an answer that implies a lack of planning or control. While you do need to be responsive to factors such as rent increases and the like, that shouldn't necessarily be the only reason to look at your rates.

My recommendation is to develop a process to systematically examine your pricing structure. Earlier, I used the word "periodically" to describe when rates would change (nice foreshadowing, eh?). That means that there is some kind of established and regular time-frame for when the rate changes occur. I go with a yearly period, but you could go shorter or longer if you'd like.

This evaluation should take into account all of the changes to your personal business climate over the course of that period. Some examples:

1. Taxes - increase or decrease?
2. Expenses - personal and business
3. Inflation - don't overlook this one!
4. Local changes in the market - competition, new regulations...

Inflation alone means a pay-cut every year if you don't adjust your rates. A 3% inflation rate means you essentially earn that much less in spending power that year. Over a couple of years of static pricing, that really adds up!

Generally, I would suggest that you factor all of the cost increases in and figure out the percentage that impacts your real income (not dollar amount, but buying power). If it's not too big, you can hold off tacking on another $5 onto your rates, but then plan on it for the following year. Just make sure that you establish a schedule - a fiscal year, if you will.

How?

This is probably the one most MTs have the problem with. How do I actually break it to my clients? Won't they be resentful? Will I lose clients? These are common fears.

As far as resentment from your clients, nobody likes to have prices go up, but it's a fact of life and if you have prepared they way with client expectations it won't be as big of a deal. And losing clients? Maybe. But if a client leaves because of a small and realistic price increase, they weren't there for you, the health of your business, or the results you deliver; they were there for price alone and you won't miss them. That's a reason why I only use low introductory rates with caution - it fosters an relationship where the most important factor is your low price relative to the competition. If you do have some clients that truly cannot afford your new rates but you want to keep in your practice and they need the work - try including these clients in part of your planned charitable giving. All individuals and businesses should plan on giving some of it all away, either for free or at cost. It's good for everybody. Set aside a certain number of appointments a week (I shoot for 10%) that you can either give away or perform at a reduced price. That way the cost to you is limited, accounted for, and planned on. Everybody wins.

Breaking the news is not the most pleasant of tasks, but like other forms of boundary enforcement, it is necessary. It should be done in the spirit of both acceptance of the fact it must be done and compassion for how it affects your clients. It should be delivered firmly and clearly, with compassion but not regret or apology. Some suggestions that I posted on the LinkedIn forum:

You might try something along the lines of:
"Dear valued client, As I'm sure that you are well aware, the current economic environment has placed additional pressures on all businesses. Unfortunately, my practice has not remained isolated from these pressures and in order to continue to operate soundly I need to increase my rates to (insert your new rate schedule). These new rates are effective on (date). Thank you for your continued support."
Or...
"Periodically, I must adjust my rates to reflect changes in inflation, cost of living, and operational expenses. As a result, I will be increasing my rates to... on (date)."

Promote It

As a teacher, I've had to deal with from time to time is change - curriculum changes, textbook changes, procedural changes - and times of change can be stressful to students (and clients). The important thing when you are implementing a change, even a rate change, is to promote the positives. Sometimes it icludes an explanation about why, sometimes you just emphasize the improvements. With rates, it could be as simple as "to continue to provide the same level of service in the face of rising costs". Your students, and you clients, will pick up on your attitude about it and it does influence how they feel about it. If you are positive, it will move their feelings about it in a more positive direction. If you are negative, they will fight you on it. And if you are wishy washy about it, they will feel they can get you to make exceptions and special allowances.

One thing that can turn the change more positive is to tie in the rate increase with a promotional period. Give a date for when the new pricing takes effect and allow your clients to take advantage of getting in some more appointments at your current rate. Even allow them to buy packages or gift certificates at your current rates up until a certain date. This can have the effect of increasing both the amount of business and having money in your pocket up front. If you worry that things might get tight, you could restrict the discounted certificates to certain times or days so it doesn't interfere with your full-priced business.

So to summarize, make sure you regularly evaluate your pricing and make sure that your pricing is optimal for your business climate and meeting your needs. Be positive, firm, clear, and compassionate about how you communicate a rate increase to your clients. Expect you may lose a few, but most will understand and the ones that leave aren't the healthiest clients for your practice anyway.

Good luck!

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Harmony

I recently returned from a road trip to Sedona, AZ and back. Something about the scenery along the way got me thinking about harmony. Maybe it was the way I saw so much land that man has bent to his will mixed in with the practical realities of having to work with it. Dictionary.com defines harmony as follows:

1. concord, unity, peace, amity, friendship
2. agreement; accord
3. a consistent, orderly, or pleasing arrangement of parts
4. a pleasing combination of elements in a whole
5. things intended to form a connected whole

I could wax on with old cliches about how we're all in this together, there's only one Earth, and so on, but let me bring this back to bodywork.

Harmony in Massage Therapy

I've been teaching for years now and of course I have seen many student struggles. One that is common is when students seem to hit a wall where they aren't seeing the kind of results they'd like, or they're working too hard, or their clients aren't falling asleep and raving about how wonderful their bodywork is like they do their classmates'. A common theme that I have noticed is the need for a very subtle, yet very profound, shift in their way of thinking. This is what I say...

"You need to work with the body, not on the body."

Simple, eh? For some, this idea comes naturally. Others must learn it. I don't necessarily advertise it, but I make it an objective that every student leaves my program with this concept. And for some that means that I need to teach it to them.

So what does it mean, with it not on it? It's subtle, but makes a big difference. For one, studies have shown that the intent behind your touch has a dramatic impact on the outcome (Got that from Salvo). But what is that intent?

Working ON the Body

When you work ON a person, you are coming at it with your own agenda. In a very real way it is assuming that you know what their body needs better than they do. It is attempting to inflict healing upon somebody. It is an attempt to make healing an event rather than a process. It is attempting to control the outcome in a prescribed way. It is neglectful of where the client is in their healing process. In short, it is just wrong.

Working WITH the Body

Fortunately, there is a better way. When you work WITH the body, you are a partner, a facilitator, a coach, an encourager. You become a part of the process. You assist and help rather than trying to hijack the process. It allows for adaptation and accommodation to what they want, what they need, and what they are prepared to receive. It allows for the reception of the subtle information that the client is giving you through their body. It is humble. It is harmonious.

There is an old saying that when the student is ready, the teacher appears. The teacher was really there all along, but the student wasn't ready to learn anything. Healing is much the same way - when the one who is hurt is ready, healing will happen. You can't force someone into the process, they must be ready and willing to accept it. Of course, you encourage them to push their limits, but that is what spurs positive change.

The point is that when you work WITH the body, you are working from a place of respect, not one of assumed superiority. Working WITH the body, you build trust with your client and they can begin to allow the healing process to begin in your presence and with your help. Working ON the body shuts down this process and can even reinforce defensive patterns that make the client feel even worse.

The Pain of Dis-harmony

It's a shame that not all massagers out there know this. I use the term massager because a massage therapist really should know this in my book. We've probably all had clients or potential clients tell us some horror story about a massage session where they were worked "on". Often you could equate this to being "worked over". Usually it accompanies complaints that the practitioner didn't listen, didn't care, hurt them, ignored their needs, and many other gripes that really amount to boundary issues centered around an improper intent.

The best massage comes from a place of proper intent, a sense of the sacredness of the soma (or the body-mind), a place of wisdom, and a sense of harmony.

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Embodiment, Disembodiment, and Stress

I'm busy working my way through Teaching Massage when I make the time and I came across the section in Chapter 2 on embodiment in hands-on training. I found it quite interesting, especially since I had never really seen this before (At least put in this way).

Embodiment

Essentially, your presence and awareness within your body. It is a very holistic concept - relating to your mental, emotional, physical, and spiritual connection to your own being. As massage therapists, you could say that our practice is all about facilitating and enhancing our client's embodiment.

Disembodiment

Even before I'd read this section in the book, I discussed these concepts in class. Our modern world has the effect of drawing our presence out of our bodies, with our consciousness out in the story we're watching on TV, on the conversation we're having with the person on the other end of the phone, on the information we see on the computer screen, on all of the tasks we have to do at work. The work that we do has the effect of drawing the recipient back into their body.

Stress

The book identifies a number of things that have a disembodying effect - all stressors. Technology was cited as a primary factor here. Most of what I mentioned in the previous section were based on technology. It makes sense to me since the technology encourages us to focus on things outside of our body. I suppose on a certain level, we could say that the stress response is a cry for attention to draw us back into our body - like a petulant child acting out for attention. Our society shows no signs of becoming any more embodying, in fact it shows just the opposite - a culture of people growing more and more disconnected with their selves.

Massage, meditation, Tai Chi, yoga, exercise, biofeedback - there are many methods for enhancing embodiment. Stress is a disconnection and all of these techniques reconnect.

Any discussion about stress should also include mention of coping strategies. One of the best methods that I have discovered is to determine your stress type. Once you've done that, you can employ coping strategies that help you to deal with your stress more effectively.

Personally, I began working out at the gym again about 6 weeks ago after a long hiatus. Now, I have more energy, a lot more patience, and have restored some of what I think of as my normal sense of calm. Embodiment at it's best!

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Bad Experiences

Another Critical Thinking Exercise from class...

The Question:

Think of a really bad experience you had with a “professional”, a business, or a service provider.

1. What went wrong – with the circumstance and the resolution process?
2. What happened after? Was it resolved?
3. If you were them, what could you do to have prevented or dealt with this situation?

The Ugly

The students had some fun with this one. I mean, who doesn't like to tell their horror stories about something like this. Statistically, if someone has a bad experience with a business, they will go and tell at least 10 other people about it. Why? Because people love to gossip about this stuff and see people's reactions ("They did what?!"). If only they did the same thing when they have a good experience.

These stories ranged from a hotel room paid for a month in advance with a bug infestation and the fight to get their money back, to a dentist that started drilling without anesthesia or permission, to auto sales, to insurance claims, to omnipresent and dastardly telecom companies, to a doctor that assumed everybody that he saw was filing a fraudulent workman's compensation claim and refusing to actually do his job and diagnose their pain, to a landlord taking a complaint about an authorized cat to the level of screaming that their tenant was a bad mother and a worthless human being. Man! Everybody has one of these stories to tell.

We've all had these ugly experiences. Getting shuffled from department to department and having to explain the same thing over and over to an army of people, none of whom are equipped to help you with your problem. Skepticism or outright disbelief that you, the customer, are actually telling them the truth!

The Bad

In these student stories, we identified a number of common themes that make for a bad experience:

1. Rude, abrasive, aggressive, or insulting: This one was common. Resorting to insults and attacks will never turn the conversation in a positive direction. In fact, it will almost inevitably escalate the hostility in the conflict. If a client does this to you, it still isn't right to return the favor.
2. Assumptions: We all know the old saying here about assume and "u and me". There is a distinction between using experience to make an educated guess in anticipating the needs of another and making an assumption that you already know what they're thinking or want.
3. "Own Agendas": One of the biggest problems I see with unsuccessful MTs/sessions is that the therapist thought they knew better than the client about what was right. That way the needs were ignored. You use your knowledge to inform your work, but we don't dictate to the client what is right for them (and it is unethical to do anything that benefits you at their expense!)
4. Conflicts of Interest: Who are they really working for? You or their shareholders? This goes hand in hand with having your own agenda. Client-centered practices require that you do what is best for your client. It should for all business!
5. Bait & Switch: Of course this is illegal as well as unethical. Misleading clients into getting something other than what they expected won't win any hearts.
6. Lack of Concern: They just don't care about you and your life, only about your customer number, payment history, profitability. Massage is a people business, so caring is our business. Don't make this mistake.
7. Incompetence: There's no excuse for not knowing what you're doing or what you're selling. One student had an experience where the sales clerk didn't even know the most basic things that they sold in their store, before copping an attitude about it!
8. NOT LISTENING: Big one, this, and common. It goes along with agendas, rudeness, and others. When customers get angry, it's most often because they aren't being heard (of course this is set off by something). You can't solve the problem if you don't listen to what it is.

The Good

Whew! A lot went wrong, didn't it? On the other hand, the class identified a number of themes as being essential to the relationship either to begin with... or to repair it when things have gone wrong.

1. Boundaries: Know what you are willing to give and take and stick to it. Communicate it clearly and firmly and keep things "in bounds". Limit discussions to the matter at hand. That landlord was way out of line for calling her a bad mother simply because she had a cat!
2. Respect: We've all heard of the Golden Rule - treat other the way you would want to be treated - but the platinum rule takes it to the next level - treat others the way that they would want to be treated. Not everybody wants to be treated like you would. This automatically rules out aggression, insults, and dismissal.
3. Follow Through: If you say you're going to do something, do it. No excuses. You should always operate this way, but when you are trying to mend a relationship, it is an absolute must. Don't make promises you can't keep.
4. Accomodation: Know what you are willing to part with or what you are willing to do to placate this customer. Figure this out ahead of time so that you don't make a mistake in the moment. It may include bending the rules a little - like coming in on your day off or staying late for them, or comping a service or gift certificate. Remember - a customer who had a problem that was resolved to their satisfaction is more loyal than a customer who never had a problem at all.
5. Communication: Honestly, most conflicts are the result of mis-communication. Don't make it worse by continuing the mistake. Make sure that you take extra efforts to ensure that both parties are clear on the message. Listen. Listen. Listen. Often, when people are angry, it is mostly out of frustration that they are not being heard. Allow them to speak. Make sure you pay close attention not just to the words, but to the meaning behind them.
   
6. Informed Consent: They want to know what their in for and it is your job to let them know. Build realistic expectations with your clients and make sure you give them all of the information they need in order to make an educated decision about what is right for them.
7. Professionalism: Conduct yourself appropriately and diplomatically. Make sure you maintain your client-centered attitude throughout. Professionalism is a skill and a habit. Make sure you think about these kinds of situations ahead of time and figure out how you would like to handle them to create and ideal resolution.
8. Deliver: Make sure they get what they pay for. Don't overstep your bounds (and scope of practice), but make sure you live up to your billing. Make sure you bring your A-game to the table every time, for every client, without fail.

Once again, an excellent discussion. Mind you, I helped to frame some of these terms, but my students came up with all of this on their own, simply by relating their own stories. Kudos!

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Missing Beauty

A former student of mine sent me this and I used it in class as a Critical Thinking Exercise.

What do you see?

Washington DC Metro Station on a cold January morning in 2007. He played six Bach pieces for about 45 minutes. During that time approx 2 thousand people went through the station, most of them on their way to work. After 3 minutes a middle aged man noticed there was a musician playing. He slowed his pace and stopped for a few seconds and then hurried to meet his schedule.

Four minutes later the violinist received his first dollar: a woman threw the money in the till and, without stopping, continued to walk.

6 minutes, a young man leaned against the wall to listen to him, then looked at his watch and started to walk again.

10 minutes: a 3 year old boy stopped but his mother tugged him along hurriedly, as the kid stopped to look at the violinist. Finally the mother pushed hard and the child continued to walk, turning his head all the time. This action was repeated by several other children. Every parent, without exception, forced them to move on.

45 minutes; the musician played. Only 6 people stopped and stayed for a while. About 20 gave him money but continued to walk their normal pace.

One hour; he finished playing and silence took over. No one noticed. No one applauded, nor was there any recognition. He collected $3.

Not too surprising, don't you think? We've probably all seen something like this happen before, right? Maybe...

No one knew this but the violinist was Joshua Bell, one of the best musicians in the world. He played one of the most intricate pieces ever written, with a violin worth $3.5 million dollars. Two days before Joshua Bell sold out a theater in Boston where the seats averaged $100.

This is a real story. Joshua Bell playing incognito in the metro station was organized by the Washington Post as part of a social experiment about perception, taste and peoples priorities. The questions raised: in a common place environment at an inappropriate hour, do we perceive beauty? Do we stop to appreciate it? Do we recognize talent in an unexpected context?

One possible conclusion reached from this experiment could be:

If we do not have a moment to stop and listen to one of the best musicians in the world playing some of the finest music ever written, with one of the most beautiful instruments.... how many other things are we missing?

What we pay attention to isn’t always deserving of it. We could be missing the blossom of a wild rose.

Interesting, isn't it? I broadened the discussion to include what happens to we MTs if we neglect to pay attention. What do we miss? I've known many MTs that never have time to take a vacation, or work seven days a week, or go in to work on a single client on a day they were supposed to be off. Are we too busy?

It's important to take the time out to recharge your batteries or you'll burnout quick. Massage therapy is a demanding profession, one in which we must don our professional mask and play the part for our clients. We create a client-centered practice, but what about us? Do we get too drained from giving that we have no more to give? Are we too focused on what we need to do to make our practice thrive that we forget who we are, why we're doing it, or what is really important? Maybe that is related to the change in motivation I discussed last week.

How many of us have experienced something wonderful, something beautiful that happened spontaneously? I'm sure all of us. In our rush to create our practices, our futures, and to control our world, we can also unintentionally plan "out" the room for spontanaiety and appreciation of the unexpected. Don't be so present in your practise that you cease to be present in the moment!

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Effects and Benefits of Massage Therapy

This is the first in my Critical Thinking Series of questions from class discussions.

Question:

How does understanding the effects and benefits of massage or massage techniques make you a better massage therapist and/or more successful?

As we discussed this topic as a class, several themes emerged:

1. Effectiveness & Outcomes
2. Contraindications
3. Professionalism
4. Marketing
5. Communication & Education

Effectiveness & Outcomes

The very first student comment to this question was in selecting treatment. We examined the adage "If all you have is a hammer, everything looks like a nail" and how it applied to this idea. In understanding how a massage technique will affect the body, we also can determine whether or not it is appropriate or effective for a given problem. Selecting more effective techniques leads to better outcomes.

Contraindications

Naturally, the prior discussion led right into the discussion of what to do when massage is not appropriate. Understanding the effects is a large part of the "do no harm" mantra. It can prevent possible harm, but sometimes it can serve another positive function in practice - positive regard for the client. This overlaps into the next theme, but it demonstrates a positive regard for the client's well-being to help them find the help they need, even if it isn't with you.

Professionalism

As part of this discussion, I asked the students how many of them had had a client who had asked them about a particular massage style or technique and what it did. Of course they all had. The follow up was "what did you say?". It was quickly determined that many hadn't felt they had provided the best answer, or that they had to think about how to condense an entire class down into a simple, understandable statement. The consensus was that you look like an idiot when you are unable to give an answer to those questions. Who should know better what a technique does, you or your client? Understanding these effects makes you appear more professional in the eyes of the client - more competent, more knowledgeable, more credible.

Marketing

Why should they buy what you're selling if you can't even give them a reason? Understanding effects is the foundation of what you need to communicate to your clients. But it doesn't stop there. A discussion of effects seldom means a whole lot to the client. Enter benefits.

Effects vs. Benefits

Effects are what happens in the body - mechanical, physiological, reflex... increased circulation, parasympathetic stimulation, enhanced lymphatic flow, and many, many more. Benefits are what the client experiences because of those effects - they sleep better, experience reduced pain, improved body image... Clients for the most part don't care about the effects (in marketing we call them features) because it doesn't really mean much to them. Benefits, on the other hand, are the things they care about - that register on their consciousness.

Back to Marketing

When a student learns the effects of massage techniques, the next step is to be able to translate those effects into why it is a good thing for the client, aka the benefit. Often this is a very different way to frame it and it is also highly dependent on the audience. It doesn't do a whole lot of good to discuss with an athlete how massage will help them sleep better when they are really concerned with performance improvement. Likewise an insomniac won't care about increased rang of motion and power out of their throwing shoulder. A thorough understanding of effects and benefits allows you to speak in your client's language about their problems. Not grasping this is like trying to speak a foreign language with only half the alphabet.

Communication & Education

Effective marketing is honest education - education about why your service is valuable to your client. Communicating and educating about effects/benefits effectively increases the value that you offer to your clients. You can't teach someone why what you do is important if you don't already know it yourself! To be honest, this category encompasses all of the ones we've talked about so far because education and communication are such an integral part of what we do.

Anything we missed? Please add it to the comments below. Happy massaging!

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Critical Thinking Exercises

Lately I've introduced regular critical thinking exercises into the classroom. I take a question that may or may not have a correct answer, but at the very least draws together various concepts that we've looked at in class, come from the media or current events, or are items that should be part of the students' burgeoning awareness. This has been more successful than I could have imagined.

Originally, I started the practice simply to get my students to think on a higher level than brute memorization, but the effect has been more dramatic. The students are engaged in the topic more, taking more ownership of the concepts, and participating as individuals and a group more heavily. Seeing the impact, I have decided to include this as a daily exercise. I write the question on the board, along with any additional points or lines of thought I'd like the student to consider in their response. Then I give them about 5 minutes to organize their thoughts and write some notes. Then we discuss it as a class and see where it goes. Everybody participates.

Almost invariably so far, I've been impressed. While the students don't necessarily pick up on all of the lines of thinking that I had in mind, they often pull out some ideas that I hadn't considered, or they bring in a different perspective.

Ah, such is the power of collaborative learning!

Enough Rope to...

One thing that I have noticed above all is that given the opportunity, students will usually impress. It makes me think back to the old saying "give them enough rope to hang themselves" and turn it on its head. In this case it seems like I am giving them enough rope to build a bridge. With more or less guidance from me, the students take on the task and pursue the subject - usually with some excitement. It's amazing to see how the students are more engaged - and no wonder, they get to say something instead of just sit back and be talked at.

The reason I chose the rope-bridge analogy is because I have seen this exercise drawing the class closer together as well. The sharing of ideas and group effort to find solutions has had the result of the students participating more as a team than before.

The Future

I'm thinking of turning this into a slightly more formal exercise and have the students note this discussion in a log. That way it won't be some here-and-gone discussion, but there will be a record - something for each student to look back on about all of these important subjects. I know I wish I'd had more detailed notes to reflect back on from when I was in school. Many things become clearer when you talk about them in school, gain some experience, and them come back to ponder them again with new perspective.

I'll post at least some of these discussions here in this forum - as many as I have time for. I hope they help you as much as I've observed!

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A question from the LinkedIn Massage Instructor's Forum involving the creating of a program curriculum. I thought it would be good to add here as well...

Thank you Michael for the opportunity to expand the conversation. We are looking at about a 750 hour course. The intention is to create a program that is at the forefront of massage education, equipping students with what they will need to be effective and successful in the coming years in a new economy.

Some of the specs... I'd like to create a bridge for the graduates to understand the language and relate with doctors and other mainstream medical professionals in the care of people who are already being treated within the western medical model -- that would be most of the population. Along with that, students will graduate with the technical training to treat clients who present with a variety of clinical diagnoses and be able to refer to others when they have reached the limit of their scope of practice. To equip them, I want to integrate training in Neuromuscular Therapy, Myofasical Release, MET, PNF, orthopedic assessments, and other modalities

During the past ten years, I have seen a trend continually moving toward a more integrated medical model that includes what we talk about as "alternative" along side the "western". It wasn't too long ago that chiropractic care was where massage therapy is now. Unless a massage therapist is only interested in doing stress-relief massage, they will need a greater understanding of and ability to relate within the larger medical system in the United States. So, they need their bearings in that world.

I also want the training to encompass an appreciation for and competence in a variety of energetic modalities as well. It really is apparent that all bodywork is energy work, regardless of how "clinical" or "medical" the approach. Cultivating intuition and creativity I think will go a long way to put graduates in a strategic place to do well and meet some of the needs that other medical professionals don't have the training to address.

So Michael, considering this perspective, yes, I do want to develop a broad eastern-western program. I wonder how others who have existing programs might be adapting or altering what they teach to be relevant within our changing world. That is the basis of this conversation. Thank you all for contributing.

Here was my response:

In my experience teaching programs of 720 and 620 hours ranges, you will be a little hard-pressed to fit all of that in and still cover it at the depth you would probably like. Have you taught and developed curriculum before?

It sounds to me that you have a focus on western massage styles and integration with health care. I think that you will have time to cover most of what you mention there at sufficient depth in a fundamental program. An initial question I might ask is are you taking students from zero to hero? Will they have a background in massage already or are they starting from scratch?

For the moment, I'm assuming you are talking about a fundamental program and not an advanced one.

I think the challenge you will find is that orthopedic assessment is certainly a process for students and one that takes a long time to develop. It certainly is in the upper levels of Bloom's Taxonomy and you have to lay a strong foundation of the fundamentals before they can even begin to synthesize them and apply them in this process. Question. Are you looking at a sequential program or a modular one? That can make a difference in how you choose to address this challenge.

With everything that you are talking about, another big challenge that you mention is the language to relate with other medical professionals. Learning all of this language and vocabulary is a huge mountain for most students to climb - it quite literally is a new language for most students. Try to be realistic about how you balance all of the new terms with the expectation that they also understand the concepts, how to use the word, and eventually being able to relate that word/concept to the others that they have learned as well.

I teach a modular program that includes 5 classes that a student can start at any point and take in any order. We have swedish, zen shiatsu, deep tissue, sports, and a chair/business development module.

From experience, the more you emphasize the western clinical model, the more time it seems to take away from eastern/energetic. I find that spending time with the zen shiatsu is incredibly beneficial - but it is an entirely different language and mode of thinking than the western medical model.

Business as well is a large skill-set that many students don't have and need to be successful. You have to know how much time you will need to spend on professionalism skills. It won't do any good if they have amazing technical skills if they don't know the professional mind-set to be a team-member, how to manage money, or even dress/speak on the job. Just teaching the medical terminology isn't enough if they don't know how to put a sentence together in plain english.

I know that this is a lot, but I can probably narrow it down to:

1. What is the starting level of your students - technically, educationally, and professionally?
2. You have a limited amount of time to accomplish your goals, what are the most important things you'd like them to be able to do when they walk out the door?

Mike

I'll continue to follow this discussion here, so stay tuned!

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Massage Student Motivation - Part 4

Continuing my discussion of International Journal of Therapeutic Massage and Bodywork's article A Qualitative Investigation into Why the Motivation of Massage Therapy Students Changes over the Course of Their Professional Education from parts 1, 2, and 3...

So What Does It All Mean?

So far we've established that over the course of a massage program, intrinsic motivation decreases and extrinsic motivation increases in students (see the article above for the study). To summarize:

1. Students become more aware of financial responsibilities (debt load)
2. Students grow to understand the contributions and limitations of their work (effectiveness)
3. Students place more value on their skills as they realize the commitments required in their education
4. Students begin to make associations between professionalism and their career. They identify with being a professional and what that implies.
5. Interaction with seasoned professionals (faculty) moderates students' idealism with "realistic altruism"

How Can Massage Educators Use This Information?

So it is a fact that students experience decreased intrinsic motivation and increased extrinsic motivation over the course of their program. Dr. Finch concludes that this isn't actually a problem, but a natural progression and reflects a healthy change in attitude. They learn a more balanced perspective.

As educators, we need to be conscious of this shift, and address it appropriately as we bring our students along. We need to be cautious about not injecting the realities to quickly, which may disillusion new students at the outset. At the same time, we need to make sure that students recieve the realities "on schedule" to achieve the balance necessary by the end of their training. We must ensure that we include this transformational process as part of the training, not a side-effect. It deserves some focused attention and even to be raised to a conscious level in the students as well.

It requires also a conscious effort to maintain the altruism through the end. Instructors must be careful to moderate the realities so that the ideals of their students aren't shattered. The idealism should be fostered and molded into something tangible that the students can use. In my classes, I teach my students to build their altruism into an intentional plan. It helps to have a target, or quota for their altruism - I teach 10%. It helps the students to have that target - that way they don't feel guilty about not giving anything away, have it as part of their plan to give something away, but don't give away the farm. This principle can also help to stave off the problem of viewing clients as numbers, or as a means to an end - becoming too extrinsically motivated.

As teachers, we have to be conscious of giving our students what they need in its proper time. This study shows that their exposure to us is a part of this process. We have to bring our students along as they are ready and not introduce them to all of our "realities" too soon. We also need to make sure that as we teach professionalism, we cultivate their altruism as part of the process.

Happy teaching!

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Massage Student Motivation - Part 3

Continuing my discussion of International Journal of Therapeutic Massage and Bodywork's article A Qualitative Investigation into Why the Motivation of Massage Therapy Students Changes over the Course of Their Professional Education from part 1 and part 2...

The Evolving Self Image As a Health Care Professional

Again, Dr. Finch broke this theme down into parts:

1. Rigor/Intensity of the Educational Program
2. Developing Perspective of Massage Therapy As a Career
3. Interaction with Faculty

Let's discuss these themes individually (summarized from the article).

Rigor/Intensity of the Educational Program

Dr. Finch describes this theme as the students expectation of commitment to the program. Most students "were largely unaware of the commitment it would take to successfully complete the program". This had the effect of increasing extrinsic expectations because of acceptance of implied level of expertise. It kind of makes me wonder if some of the problems we face in our field comes from the fact that many people aren't aware of just how much we massage therapists know! As the student becomes more aware of the level of knowledge required, they also place more value on their skill and with it the expectation of more rewards. It fits well with the risk/reward paradigm, in that the more you risk, the more you typically expect to receive in return. When the student makes those sacrifices, they look for "a return on all that investment".

As much as I try, it is nearly impossible for my incoming students to fully comprehend what they are signing on to. It is invariably more involved, more work, more homework, more reading, more massage, more, more, more, than the students expect. This leads to Dr. Finch's last point on the theme, that the amount of focus on the details of the work can draw focus from the why behind it - that students quickly run out of time for even thinking about the intrinsic rewards to what they do.

Developing Perspective of Massage Therapy As a Career

As a student progresses through the massage program, they increasingly identify with being part of health care. They realize that they can and often are expected to assist with clients' health problems and that accompanies a level of responsibility.

In addition, students learn about what it means to be a professional and the thought processes, behaviors, and "things" that go along with it. Often there is an association between being successful as a professional and the freedom that goes along with having more money. Personally, I include it as part of my program the entire thought process behind making massage therapy work as a career. The students must think about how they are going to support themselves and their business, pay the bills and enjoy life too. I see it as part of my job to help them figure out how to get there.

Interaction with Faculty

Of course, faculty have been through massage school already. They have experience working as a massage therapist. They have been through the struggles and triumphs of being a practicing massage therapist. They've had their naivete stripped away already. While of course many things must really be experienced before they are truly learned, the instructors begin the process of creating more realistic expectations for the students. It's a part of the process. Altruism is taught as well, but from the tempered perspective of the seasoned professional, and as the students look up to their instructors as role models, the attitudes begin to have an impact.

I've met some very jaded massage therapists in my time - the kind that won't lift a finger for anybody else (figuratively!) unless they're paid for it (can you believe I've had MTs ask to be paid for their time when students asked them for a 10-minute interview?! Talk about a learning experience for the students!). Who'd want a person like that as a teacher? So a good teacher will still maintain some of the altruistic, idealistic spirit to impart to their students - albeit with a realistic and experienced frame of reference.

I love the term that Dr. Finch uses for this - "Realistic Altruism". Boy am I going to start using that!

So what does this all mean? On to part 4...

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Massage Student Motivation - Part 2

Continuing my discussion of International Journal of Therapeutic Massage and Bodywork's article A Qualitative Investigation into Why the Motivation of Massage Therapy Students Changes over the Course of Their Professional Education from part 1...

The Reality of Life in Practice

This is what Dr. Paul Finch decided to name the first theme that his study identified. I think it is a very appropriate title. He further breaks this theme down into two parts:

1. Debt Load
2. Effectiveness in Achieving Positive Health Outcomes

Let's examine each of these sub-themes and before discussion (I summarize from the article).

Debt Load

This one seems fairly self-explanatory. When the student first begins their studies, their loan repayments are generally a long way off. As they progress through their program, the reality that they will soon begin to have payments due, coupled with a mandated financial aid exit workshop and discussion in class about business, making a living, and other financial education means that the students become more financially savvy. As the end of the program approaches, and students face the prospect of being out on their own, responsible and independent professionals, without the crutch that being a student offers. Looking for a job also heightens awareness of the importance of financial acumen to their future.

Effectiveness in Achieving Positive Health Outcomes

Dr. Finch describes this one as a growing awareness that what the student can do can make a real difference in people's lives. Students become aware of the contribution that they can make to a person's well-being and health. They also obtain an understanding about the knowledge that is behind what they do. That might lead you to think that intrinsic motivation increases with this, but it is tempered by the fact that students also learn that massage isn't the answer to every problem and "you are not going to help everyone with everything". To me that indicates a loss of idealism, which isn't an entirely bad thing if their idealism is now balanced with realistic expectations.

Discussion

The reality of life certainly does have a moderating effect on idealism and naivete. To me, I feel it is an instructor's duty to assist the students' growth through this process into a mature professional. It is a disservice to move students through a program without educating them about these realities. Of course, as Dr. Finch mentions, it is also the instructor's job to balance this fact with maintaining support for the "humanistic mission of the profession". I believe that in essence it is a teacher's job to take a dream and turn it into a reality. Part of that process is to help the student to have more realistic expectations about what those dreams really are.

Both of these are a natural part of the process of education. In school, we discuss the practical realities and real-life situations that our students will face. But still, I believe that for me, the value of this discussion is in raising the awareness of the need to keep the realities from crushing the ideals. It is important to find the healthy balance.

On to part 3...

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Massage Student Motivation - Part 1

The second issue of the International Journal of Therapeutic Massage and Bodywork came out today and there was a very interesting article about the changes that massage students experience in motivation over the course of their program. I found it fascinating and it reflected a phenomenon that I have observed over the years in the classroom and in practice - particularly with the "jaded" massage therapists that are just in it for the money.

Here's the article:
A Qualitative Investigation into Why Massage Therapy Students’ Motivation Changes over the Course of Their Professional Education (and their license)

To summarize, the study is about why massage students' motivation changes from more intrinsic to more extrinsic over the course of their education. It takes place at only one school, with a small sample size, but the author recognizes this weakness, and from my observations in my classes the findings are accurate. Please note that I am commenting on this article and adding my observations - Paul Finch, PhD (the author) deserves all of the credit for the article and the pieces I quote from it.

Intrinsic vs. Extrinsic Motivations

First off, many massage students enter their massage programs with some "naive expectations", as Dr. Finch puts it. These expectations manifest as a desire to help others, an altruistic ideal about the work they are about to learn to do. The naivete isn't so much in the altruism as in that it isn't balanced by the realities of the profession they have yet to learn. Intrinsic motivation also comes from things like the satisfaction in the work being done and the self-esteem derived from being skilled and appreciated. IN-trinsic motivation is IN-ternal and given to yourself.

By extension, EX-trinsic motivation comes from rewards from EX-ternal sources. Of course those include compensation, the praise and recognition they get from happy clients, prestige, and more.

Past studies have shown that as a massage student progresses through their program intrinsic motivation decreases and extrinsic motivation increases. This study looked at why.

So Why?

Dr. Finch identified several themes prevalent in the study participants' responses. He describes them as follows:

Reality of Life in Practice

1. Debt Load
2. Effectiveness in Achieving Positive Health Outcomes

An Evolving Self-Image As a Health Care Professional

1. Rigor/Intensity of the Educational Program
2. Developing Perspective of Massage Therapy as a Career
3. Interaction with Faculty

Don't worry, I'll discuss each one of these in more depth in this series. I'll also introduce my perspective on how we as educators could use this information to foster this development appropriately and help our students leave our programs best prepared for a vibrant, healthy career. So let's get started!

On to part 2...

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Other Massage Bloggers

There are some amazing blogs out there discussing different topics on massage therapy. I thought I'd put some links down here to some of my favorites (in no particular order). I tried to place links to some of the interesting articles, but this is by no means exhaustive for everything available. Enjoy!

Fingertips:

1. Tendinosis
2. How Inflammation Causes Fatigue
3. Shin Splints
4. Therapeutic Communication
5. Silence as Communication
6. Buying a Massage Table
7. 100 Best Foods
8. Client Comfort
9. Knees
10. Manipulative Behavior
11. MBLEx
12. Anatomy Clothes
13. What's the Point?
14. Valuable Customers
15. Creating a Professional Appearance

Massage, Mind, and Body:

1. Which Massage for Which Aches?
2. Say No to Splenda
3. Cancer Fighting Tips
4. Old injury, New Pain

The Bodyworker:

1. Recession Proof Your Massage Business

Massage Therapy Benefits Blog:

1. Start a Massage Business
2. Index of Benefits, Techniques

Massage Success Tips:

1. Attending Massage Conferences

Massage Geek Blog:

1. What CEUs to Take?

The AromaConnection Blog

Massage Marketing Rebellion

Creating a Prosperous Practice

The Enlightened Body Blog

Massage Therapy Online

Free Massage Video Blog

Massage Nerd Blog

Please feel free to comment and add your own blogs or favorites to this list. Thanks!

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