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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Standards for Massage Education and Educators

Whew... it's been a while. But at least it's because I've been busy!

There was an interesting question posted in the "Massage Instructors" group on LinkedIn.

How much education does a massage therapist need?
We all know that different states have different clock hour requirements for entry into the profession (where there are requirements at all). What do you think is the minimum education for an entry-level therapist? Is there a need for an associate's level degree? What about for educators?

Here was my reply:

Minimum Requirements

I think the entry-level requirement varies with the intent of the work. I think that a 2-tier system for licensing requirements is appropriate and wish they'd keep it here in CA instead of eventually switching to a single 500-hour requirement.

In general, I am in favor of higher standards, but I also know that there are many good relaxation-massage practitioners out there. They don't have a corrective intent, can't do a SOAP chart to save their life, but they do have a role in simple relaxation massage. I think that the 250-hour "massage practioner" requirement just passed in CA is appropriate for this level of practice. I know of a school or two that under the current system only teaches a 100-hour program; enough to learn a set sequence, but very little in the way of pathology, anatomy, physiology, ethics, or professionalism.

Advanced Training?

On the other hand, for a corrective intent, I think that 500-hours might still not be enough. At least for a broad, fundamental program that teaches the basics. 100 hours is enough for teaching chair massage or a basic swedish sequence, but a student can't become proficient in deep tissue or sports massage in such a short time. Unless they have prior training of course. I think it might be more effective to categorize programs as fundamental or advanced training programs. Although standardization across all curriculum can have it's problems, I think it could be valuable to establish some levels of training this way.

Degree Programs

As for Associates Degrees, I think it is a good move. A post-secondary degree is becoming more and more necessary in today's work-force. Heck, I see ads for receptionist positions these days that require a Bachelor's! I can see that in the future an AS or BS will be the new minimum standard instead of a high school diploma. I always encourage my students to take advantage of their opportunity to get their AS (it is optional at my school) as it opens a lot of doors for them in the future.

Educator Standards

And finally, as for educators, I think there is a real need for high standards here. I kind of got thrown into teaching and was fortunate that I had prior teaching experience in martial arts. But I now know that there is a significant difference between being a good massage therapist and being a good massage instructor. Teaching material and using it are not the same beast. I am really glad that the ABMP now has a course in Teaching Massage. It is an awesome resource and I'm happy that somebody recognized the need for teacher training.

I do think that as a profession, we need to do a better job of defining what the essential knowledge that a massage therapist needs to be effective. As it stands now the most we have is some requirements for some accreditations that say we need to spend a certain number of hours on a particular subject, not what needs to be taught during those hours. I personally am in favor of educators being held to a higher standard than just practitioners - they should have had at least as much training as they are teaching and experience to boot AND they should have (or get) some training in how to teach as well.

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