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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Your Massage Business Plan

I was approached recently by a friend who had a business idea and wanted my take on it. In talking with him, it refreshed for me the importance of developing a solid plan to work with. It occured to me that it is very similar with massage students. In my friend's case, he had a business idea for a product - he had no real expertise in designing it or in marketing it. In massage it is a little bit different, but many of the principles remain the same. Chances are at some point when you are conducting or planning a business, private practice or otherwise, you will need to borrow money from somewhere. And to do that, you'll need a business plan.

It Starts With An Idea

I've mentioned this in prior posts before, but you have to have a firm idea of what it is that you want to do. Form a picture in your mind and abide by Stephen Covey's words, "begin with the end in mind". What is it you are trying to create? The typical answer is "a successful business", but you need more than that. What is successful? A full schedule of regular, loyal clients, or a team of MTs that work for you in your own spa? What clientele are you wanting to work with, what kind of challenges do you want to handle? Pregnancy, cancer, orthopedic surgery, stressed-out executives? In what environment? Describe it all.

Develop it into a mission statement. Then take it down to 3-4 sentences at the most. This will be your pitch (they call it the elevator pitch). It has to describe who you are, what you do, and where in a short, concise statement. Think long and hard on making this perfect - people will decide if they want to know any more based on this statement alone.

What Do You Bring To The Table?

In my friend's case, this was a hurdle. If you want to start a business, you have to have something to offer. I tend to simplify it into three general categories:

1. Expertise
2. Money
3. Connections

Expertise

When it comes to massage, schools quite rightly put a lot of effort into graduating competent massage therapists. Their technical skills are sound. In this conext it means that they have technical expertise - they know how to do the work.

Money

Any business is going to require start-up money. The bigger the business (or dream) the more money it usually takes. For a private practice, we're looking at money to support you unless you have another job, licensing/permit costs, marketing costs, transportation, decor, supplies and equipment, rent, utilities, phone, and any other expenses one has in order to conduct business. This is often a challenge for many new therapists, so it is usually a good idea to have a job or "boot-strap" a business start - starting small and allowing the growing business to pay for it's own growth.

Connections

Deal-maker skills, that's what this is all about. It can be who you know, it can be access, it can be the ability to get the right people together. This is the ability to go out and sell yourself, your idea, your plan, and recruit others to the cause. If you have no money and no expertise, you at least had better have the ability to get people who do on-board.

What About The Idea?

My friend's thought was that the idea was a piece of this equation. The original idea is simply the little nudge that gets the ball rolling. It isn't much in the way of capital all by itself. You have to have one of the other elements to have anything to work with. The idea is the fuel that feeds the business plan, the unifying theme that ties it all together, but is as useless as a fleeting thought all by itself. It needs the plan to become a reality.

Writing The Plan

A key point to remember is that this document is for them, not for you. Leave nothing out and make no assumptions about what the reader knows and does not. For ease of understanding and readability, there is a standard format that you should follow in your plan. There is a good business plan outline available for you to follow online. This has all of the elements that an investor is going to want to see. Remember, although you are trying to promote and sell your vision to the other person, it is your vision and not their's. The prupose of the plan is to demonstrate that you know what you are talking about, you've done your homework, minimized the risks, and maximized the potential for the investor to get their money back and have a return on their investment.

As I was explaining all of this (admittedly in more detail), my friend chuckled and asked if I was trying to scare him into abandoning his idea. "If you can't even put the work into this plan, how can you expect anybody to believe you could actually make this dream into a reality?" was my reply. I consider the business plan an acid test, a rite of passage to see if the entrepreneur has the mettle to get the job done. Have they looked at every angle? They better have, because I'm sure not going to place my money on their faith!

A Closing Word On Doing Business With Friends & Family Members

In my experience, it is always risky to mix business with personal relationships. In the world of business, money, and livelihoods, the decisions and the relationships are often necessarily objective and calculated. You wouldn't think twice about changing banks or insurance companies for the same service at a lower price, would you? You wouldn't expect your credit card company to simply forgive your debt.

The problem is that personal relationships are never so clear-cut. We accept people's faults and forgive them for them. We teach and educate those we care about because we care. We have different boundaries with those we are close to in the same way we have different boundaries with our clients in the therapeutic relationship than with a friend. And because of that, business and personal relationships - with their contrasting boundaries and demands - can be sticky things to mix.

Good luck!

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Recharge Your Batteries

Just a quick note on taking care of yourself.

Some time ago, a healer told me that I needed to get out into nature more often - away from people and civilization - because that's where I recharge my batteries. She told me this unprompted, and to this day I still wonder how she knew, but she was right. When the inevitable stresses of life start to wear me down, I step away and go take a hike, watch the waves at the beach, or head for the mountains. It's amazing how refreshing it is to my mind, body, and spirit.

My wife is different. She needs to socialize and feed off of other people's social energy. She likes to go dance and have a few laughs with friends to recharge.

So how do you recharge your batteries?

You might not have had the benefit of someone telling you how you recharge, but it is important you try to find out. Try thinking of the times when you have felt most at peace and revitalized and then figure out what those times have in common. Is it music, friends, peace & quiet, a getaway, good food...?

Burnout in Massage Therapy

Massage Therapists are subject to the same kind of burnout as other healthcare service providers. It is a phenomenon called Compassion Fatigue, a result of giving so much of yourself to others all of the time. This is a subject we never really talked about in massage school, but it is something of a problem.

Every year, studies by the ABMP and AMTA mention that the average span of time a massage therapist stays in the profession is 7-8 years. Not a very long career. Granted some of them leave the profession to go into physical therapy or other related or complementary health professions, others lack the business skills to succeed, and others practice poor body mechanics and wear themselves down physically. But I contend that a large contribution to many leaving the profession is Compassion Fatigue and lack of Compassion Satisfaction - or Burnout.

As people, we all need to find a balance between giving and receiving. The giving portion of that equation could be called generosity. In my experience, many MTs start their career wanting to give and give and give, but as time passes many become less and less generous, even jaded. For example, an assignment in class is to go out and interview practicing massage therapists. Every time we do it I get students coming back with interesting stories about even trying to ask a person some questions. Some are very giving and generous, others have even asked students to pay for the time of the interview. Ouch. (Who would you want to go to as a client?)

Avoiding Compassion Fatigue

If you want to be successful in this profession, you have to first accept that burnout happens, then understand why, have tools and skills to deal with it, and then act to address it. I'm assuming if you've read this far that you have at least a little acceptance and understanding about why this happens.

A good place to start is to measure your level of burnout, there is a Compassion Fatigue and Satisfaction Survey (here's a more detailed one) available for you to do so. This is a good tool to help to determine if you are at risk. Once you have determined if there is a problem and what it may be, then you'll be in a much better position to do something about it.

Massage Specifics for Burnout

Here are a couple of things that I have noticed that often affect massage therapists:

1. Poor professional boundaries. These all manifest as allowing another to take advantage of you in some way. It could be clients conviincing and MT to give them extra time, overlook their lateness, or pressure them for freebies. It could be a boss or supervisor getting you to wait around without appouintments on the off-chance there will be a walk-in, work more hours than you are comfortable with, or demand your time on-call without the business to back it up.
2. Poor personal boundaries. Letting personal life infiltrate business. Allowing yourself to become personally invested in your clients' outcomes and lives. Allowing business to stray into and interfere with your personal life. Also known as the "I'm cancelling my plans because I have to work" syndrome.
3. Focus. When money is a struggle, it can become easy to start thinking of each client on the table as "1/10 of my rent" or "gas in my car this week". Allowing your personal life to creep into your thoughts when it should be on the client (thinking about the errands you have to run after the appointment is over while you work). Forgetting why you are in the business in the first place.
4. Time. You will never find the time for recharging your batteries if you don't make the time for it. You have to prioritize it and factor it in to your schedule. Bouncing around without a plan means you'll never find the time.
5. Lack of planned generosity. We're in a giving business and you'll struggle if you never want to give anything away. It seems counterintuitive, but give it away to get it. If you factor compassionate giving into your plans then doing it is achieving your goals. Set a quota of what you want to give away, track the results, don't feel bad about giving that part away, but stick to your guns and only give away so much. People will take as much as you will let them.
6. Others. Please post any other issues you've seen lead to burnout in the comments section.

Don't risk losing all that you've worked toward just because of Compassion Fatigue. It's depressing, but it's not the end of the road or the end of your career. Recharge your batteries and take care of yourself. That way you'll be much better able to take care of your clients!

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