I’ve got a confession to make, every time I walk into a new class room I feel nervous. There, I’ve said it. Not the breath crushing type, that was years ago, but still a tingle of what I call ‘nerves’.Read More
Someday, somehow those of you reading this are going to die. In fact everyone not reading this is going to die as well. Everyone you know or have ever met will also be dying. Indeed what a great and final equalizer death is for there is not one person on this planet, rich or poor, privileged or downtrodden who will not be dying once their 'living' is done. And if it is the ONLY thing beside birth we know we will ALL be doing why it is so hard to talk about, read about, think about and deal with, particularly in this westernized world that most of you readers are living in? Perhaps it could be suggested that because of this westernized world we live in death has become hidden, never talked about and rarely celebrated. Both as human beings and massage therapists this fact is certainly food for thought.
Every day when we open our clinic doors we are greeted with a day of clients who are moving through life just as we are, all of us at the 'awkward' stage between birth and death, otherwise known as life. Often we are put into situations that require us to use all of our skill, expertise and training to develop a treatment protocol that will assist our clients to lead happier and more healthy, pain free lives. But what happens when we encounter those clients who by their own admission are not much longer for this mortal coil? Those clients who have been diagnosed with a terminal illness meaning their days of living are almost over. As professional therapists how do we deal not only with our clients but also our own feelings? How do we understand and accept not only treating them through this time, but also saying goodbye in the not too distant future? A client we know we cannot 'save' but who we may be able to offer assistance to through our touch. How do we offer comfort, connection and warmth as their lives are ending?
To be completely honest this topic puts me outside my comfort zone as well. What got me thinking about the need to understand this and be able to explore and discuss this area of client connection was an experience I had many years ago with a client who was dying. Even though during the course of my life I had experienced the concept and reality of death several times, I was still caught off guard when this client showed up in my treatment room. She was referred to me by another client whom I had been treating for quite a while, using MLD as a post mastectomy treatment for first one and then a second breast removal a few years later. She told me that this lady had been fighting cancer for many years having tried many treatments from both the eastern and western traditions. One of the first things that struck me was her bubbly, vivacious, active and spirited personality. From her very first treatment with me she put her situation quite simply, "I don't want to die".
Over the course of the next six months her cancer worsened despite her positive and upbeat approach. Towards the end of her life I was seeing her weekly and then visiting her in palliative care. By this stage her cancer had spread to her lungs, throughout her organs and eventually into her lymphatic system. It became not a question of if she would die, but when? During the course of my interaction with her I was personally challenged to face my feelings about death, I was so hurt for her because I knew she didn't want to die. I had to dig deep and really question what it was I could do for her or help her with in her final weeks. She insisted that MLD made her life and pain more bearable. Although the cancer had spread to her lymph nodes and MLD was technically contraindicated, she absolved me from any misconduct and asked that I remain her therapist until the end. How could I say no? Until her last breath she was still living and so I felt that the least I could do for her was bring the bright spark of life and humanity to her through my touch and treatment. I learned to really hold space and be present during this intense, heartbreaking and yet somehow beautiful transition. Although she fought the notion of her existence being over towards the final days there was an acceptance and a kind of peace found within her. The funny things was I never felt like I was in the presence of someone dying, I was in the presence of someone still living, until they weren't anymore. Even our last session together didn't feel like the end. She was still conversational yet with a quiet stillness that really moved me. I suppose the most difficult part of the whole experience was the day she died because it felt to me like one minute she was there, living and fighting her illness, and then in an instant she was gone.
I grieved her death for both of us. I grieved for the loss of my 'innocence'. The truth hit me hard. That experience showed me the way it will be for all of us and everyone we know, in a nutshell - here one minute, gone the next.
The way I see it there are two ways we can choose to deal with death. The first is to stick our heads in the proverbial sand and pretend that death won't come for us. That death won't appear in our clients' lives, on our tables and in our treatment rooms. Pretend that we are immune to the passage of time and the scourge of illness. In our western world we have managed to package death up into neat boxes where families usually make a call to a group of professional strangers so that the body and final details of those they loved most in the world can be handled by someone else. Very rarely does the family involve themselves in direct preparations for the cleansing of the body or the actual mechanics of the funeral.
The other direction that we can choose as human beings and massage therapists is to step forward and accept death as a natural part of life. In order to prepare ourselves for the most probable eventuality that during the course of our professional lives we will come into contact with a client who has a terminal diagnosis, or a client who is in palliative care, we need address our own feelings about death and dying and come to a kind of peace with it. The reality is that when clients are in palliative care they are waiting and while they wait we can help them with our touch. This opportunity could be seen as a privilege afforded to those of us brave enough to stand up and be of service to a fellow human being, possibly when they need it most. Holding space during that time means we are willing to walk alongside another person in whatever journey they are on without judgement or trying to fix them or impact the outcome. As a body-worker we can hold space for our palliative care clients by opening our hearts, offering unconditional support and letting go of judgement and control.
Death is the truth of life and there is little to say about it because dying and living are two sides of the same coin. How difficult it is in our culture and time to die well. As Stephen Jenkinson said in his remarkable documentary "Griefwalker", "The cradle of your love of life is death, the fact that it all ends" It took me hearing that many times to fully understand his sentiment but it all comes down to knowing that someday we will die. Shouldn't that be the inspiration to take this thing we call 'life' and do a good job of it while we still can? Again in Griefwalker Jenkinson asks the question, "If you cannot befriend your own death then how strongly in your life are you?"
Finally for those of you working in palliative care or working with terminally ill clients open your hearts and accept this moment your life has presented to you with gratitude and humility. By offering massage therapy as a physical comfort for palliative care we can honor the experience of the client and find solidarity and connection in our common human condition. What a gift clients give by allowing you to share their journey towards death. As a massage therapist make the palliative connection, learn from it and be inspired to a fuller life while you are still gifted the opportunity to do so.
("The Palliative Connection" a 3 part webinar series by Rhythm Massage Development will commence in 2018. Keep an eye out on the website or FB page for details.)
"No man is an island, entire of itself, every man is a piece of the continent, a part of the main"
And so this brings me to the topic of my next offering. Human beings do not thrive when isolated from each other, so shouldn't the same be true for massage therapists? Massage is often times a pretty lonely profession. This is not something that will come up in your training, nor will it really be discussed in the class room. This is true because around 70% of 'learning' happens through experience (Charles Jennings, Founder 70:20:10 forum), on the job, in the massage room. It will dawn upon you once you are out of school and in the massage world, behind closed doors treating your clients, assessing their conditions, listening to their problems and stories, feeling pain some where in your own body and wondering what to do next?
This is one of the massage truths that school does not and cannot prepare you for.
No one really talks about it, the nerves that you feel when you are assessing your client and having applied all the 'special tests' that you can, written the most comprehensive notes that you ever have and still not knowing which way to go with your treatment.
Nothing really prepares you for the boundaries that will often be crossed by clients, who are not only allowing you to work on their bodies, but wanting to offload all their concerns and issues onto you in the hope that you will be able to relieve the aches of not only their physical selves but of their hearts and minds as well.
And then there are the days when you know that you have a full day of massage ahead of you and you wake up with pain in your thumbs, shoulders, neck or lower back. The feeling of panic that you try to squash, the pain that you try to ignore and work through, the terror that creeps into your mind, knowing that unless you work no one is going to be paying you sick leave or any other sort of remuneration, until you are fit to work again. I know about all of these because I have been there, in each one of them and at those times I have felt alone. I feel qualified to share my experiences with you because they are just that, experiences I have had. And the odds are that for most of you reading this, you have had at least one of them as well.
And so the big question is, where do you go from here? How do you deal with these realities? Who do you talk to? Who do you share with? Who do you listen to? Three words my friends, another massage therapist!
Another massage therapist will not only listen, but really hear you. They will relate to your feelings. This will give you the feeling of validation that so often comes from sharing something that has been on your mind. The relief that comes when you have finally gotten it off your chest. First there will be that enormous weight lifted. And then will come their own stories, their wisdom, their advice.
From sharing you are likely to gain confidence, new skills and ideas, strategies and advice about how to manage these professional tests. You will feel less alone, less like that lonely island and more like part of the archipelago of the massage profession. This sharing between therapists is when 'didactic moments can occur and allow seeds to fall on fertile ground'. This will in turn make you a far better therapist than you ever dreamed of being while studying. And the added bonus is that the experiences of the profession will inform not only your working but your personal lives as well. Many times I have commented that I wish I could be as calm, assured and relaxed in the rest of my life as I am when treating clients in my massage room.
The experiences of my work and the stories of others including my friends who are massage therapists, my teachers and mentors, my peers and my students are helping to make both my professional world and my personal world so much better.
And so to you MT's reading this, reach out to each other. Share you stories, open your hearts and minds to allowing someone else to listen, guide or advise you. Most of the time you will not be disappointed. By virtue of the fact that we are massage therapists we are for the most part caring people. What a wonderful idea it would be if we could care just as much for ourselves and each other as we do for our clients?
I have been teaching research literacy for over ten years. For some reason the word 'research' is still often associated with nerdy guys in white polyester knee highs and sandals who live with their mums. For most of us the word research conjures up images of white coats, labs and incomprehensible mathematical calculations that only those brightest and best amongst us could possibly understand or be interested in. Well I am here to paint you a different picture.
Let's start with the big revelation, as a massage therapist you are conducting research EVERY TIME you step up to your massage table to treat your client. You are conducting research every time you take down a client history. You are conducting research every time you question your clients about their past medical history or their current medical concerns. And every time you decide on a treatment protocol, most likely you are using it because someone, somewhere conducted research which has led you to the conclusion that this course of action is the most beneficial to your client, because current research suggests it is. Think RICE protocol just for one example.
On the other side of this equation as massage therapists there are often questions that we need answers to. More
complex musculo-skeletal pathologies which we need to seek help with. Sometimes we need to search for an alternative way of treating something which is not responding to the usual treatment regime. Where can we find this help? Where can we access the latest data about massage therapy and make sense of it? How can we know what others are doing and saying about a particular treatment protocol or
Again the answer to these questions is Research.
As Dianna Thompson stated in her keynote address at the AAMT conference in 2008 in Adelaide “Information is the first step to knowledge, wisdom and foresight. Information is often what feeds our intuition about clients and treatment plans. Part of the essence of science is in not taking someone else's word for it. Questioning is cool. Curiosity is cool”. Research allows us to question authority and debate theories which you may not accept as fact. Research allows us to be open to new ideas and understand that things are generally only tentatively true until someone comes along and creates research which increases its validity, or disproves it.
The good news for students and MT's is that you don't have to go out and get a research grant and write 'official research' at a university level to really understand research. What you do need to do however is become 'research literate'. The Massage Therapy Research Curriculum Kit (Dryden and Achilles, 2003, p.1) defines research literacy as “…the ability to find, understand and critically evaluate research evidence for
application in professional practice” We need research to define us as a profession rather than an industry.
Carolyn M Hicks in “Research Methods for Clinical Therapists” sums up the need for research literacy among massage therapists very well, “In a climate of increasing accountability… it is becoming imperative for professionals to justify their
clinical decisions and actions and to increase their
effectiveness and efficiency… as a result massage therapists are turning increasingly to published research in order to inform their practice… (and so) they need to be able to evaluate and make properly informed judgments concerning other peoples research work” (p4)
And so to all the massage students out there who are doing their remedial massage diplomas and have to complete the 'research' subject, try to go into those classes with a new view point. An understanding that what you are learning will enhance your massage career in so many ways. You will be able to find and use those research articles that can help you comprehend your profession better. Most of all approach this subject with an open mind and heart. After all, don't you want to know why what you do works? Be curious, in this subject, curiosity is the key to success.
Let's not sugar coat anything here, you should know that being a massage therapist is physically demanding. The burn out rate within the industry has been estimated at 50 to 88% within the first 3 to 5 years after graduation according to a study completed by Associated Bodywork and Massage Professionals, a reputable industry organization.
Training for your massage career should seem like something that would be obvious to anyone aspiring to be an MT, but the truth is that it isn't. Many times I have stood in front of a soon to be graduating class of massage students and asked how many are 'training' for their jobs? The number of blank stares and puzzled expressions says it all, massage therapy students don't really know that they are going to have to do some work on their physical bodies and minds to make a career out of massage.
So where do we go from here? Obviously the current climate in massage education does not allow for a thorough examination of all the elements that make up the massage therapists self care matrix. Everything from post massage stretching which is the most 'common' self care technique, eating the right mix of nutritional elements to support our working bodies and negotiating the demands of our clients and schedule, such as setting appropriate boundaries to allow us to have real 'time out' from our clients needs and our work, needs to be worked into massage therapists training. As massage therapy educators it is our responsibility to share our knowledge and understanding of what constitutes a holistic and thorough approach to self care.
The way I see it there are at least eight key elements that are necessary to focus on in any massage therapists self care routine with a view to long term working 'career longevity' for massage therapists. They are:
1. Exercise, make a commitment to train for your job.
2. Become aware of your physical advantages and disadvantages and tailor your training appropriately.
3. Perform both pre and post massage stretching, dynamic and static.
4. Come to understand the physiology and warning signs of injury and inflammation and deal with them
5. Develop an awareness of body dynamics and mechanics for correct movement and stance around
the massage table.
6. Know how to ‘eat right’ for the work that you do with your body by understanding more about nutrition
and its relationship to inflammation.
7. Understand more about energy transference between ourselves and our clients and how this can be
exhausting for you as a therapist.
8. Learn how to safely manage your workspace and client schedule.
If you are a student of massage therapy think about how you might incorporate these elements into your massage training and create a routine before you start to increase your work load upon graduation.
If you are a practicing massage therapist look at this list and think about how many you are already incorporating and those which you need to include.
And finally if you are a massage educator how much do you know about each of these topics and how can you pass this onto the next generation of massage professionals so that they might be better trained and able to have pain free satisfying long term careers as massage therapists?
The way I see it performing massage is an art. The Oxford dictionary defines art as "ability in skilful execution”. A great massage could be defined therefore as the skilful execution and fusion of creativity, knowledge, technique and intuition.
All the above take time and practice to develop in any therapist. However all the practice in the world won't make a master of someone if they lack the motivation and dedication to excel. These qualities are what sets apart the massage artist from a regular masseuse. In this way as a massage therapist practices, learns and dedicates themselves to their work they become more of an artist. Each time the therapist steps up to the table the analogy could be made that they are the artist and the body of the client is the canvas. As they gain understanding through the melding together the many skills they have studied, they will start to see the development of their own individual style. If you were to have the experience of ten different massages from ten different therapists you would notice that each massage is completely different. What makes each experience different is the therapist. Just as each person has a different personality so too do massage therapists have their own individual style. This is made up of their own system of beliefs and unique understanding of the world. It informs everything from the confidence of their touch, the comfort during their work and the ease of their client interactions.
Each therapist brings their own set of life experiences to their work. This assists them to be able to interpret the clients' body and create the healing space for the client accordingly. As a massage therapist my understanding comes from a sense of rhythm, movement and flow, coupled with the intention to be creative and open to allowing the massage to develop, with both conscious and unconscious thought processes taking place. During the course of a treatment the conscious mind of both the practitioner and the client interact with each other. They talk, exchange information, express needs and expectations. What they also bring with them is their unconscious process, both from personal and collective human experience. It is the awareness of these deeper elements that both parties bring to the treatment room that changes a static therapeutic encounter into a deep and dynamic creative experience.
There is no right way of doing a massage. The massage therapist needs to develop their particular personal style which allows them to enjoy the work they do as well as create an environment in which the client is completely satisfied with their treatment. The art of massage is in tailoring the work to the needs of the individual client. To be optimally effective the massage practitioner needs to tune into the client to know what needs to be done from both the physical and energetic perspective.
In order to create this for ourselves and our clients the massage therapist needs to be able to integrate the two things that make them who they are, namely the mind and the body. The mind part of the therapist needs information to be supplied, information such as which types of techniques would be appropriate to use with this particular client. The body of the therapist needs awareness of its physical state in order that the body can be utilised with the most efficiency while at the same time allowing the therapist freedom of movement throughout the treatment. If one of these is compromised the massage will invariably be lacking, and both the therapist and the client will feel this. It will be nothing more than a 'rub' which often leaves the client feeling bruised and sore and the therapist grumpy with sore wrists, discomfort in their bodies and resentment towards their work.
The client also has an important role to play in the creation of the massage. If the client comes to the massage with a closed mind and uptight attitude about what they expect it will be a less than pleasant experience for both parties. If the client is willing to be a participant in the massage rather than a casual observer they will benefit greatly. What I mean by participant is someone who approaches the massage with a clear sense of what they hope to gain by having the experience. If they have particular physical complaints they will most probably be hoping to have those addressed. However if they are willing to open their minds a little further they may be able to gain a sense of not only physical but also mental relief from the massage. The quiet time can allow them time to release the cares that they carry around with them in their everyday lives. It can offer them the space for a mental daydream or a deeper place where their breathing becomes the focus. Deep breathing releases stress and allow the muscles to relax. More oxygenated blood is delivered to the muscles and the heart rate slows down. Breathing deeply with full conscious awareness permits them to enter into the massage without tension and allows the client to fully experience the art of massage.
There are many layers to explore within the bodywork field for both the therapist and the client. As therapists we need to be passionate about what we do because if we are realizing our passions we will be creative and artistic in our dealings with the bodies of our clients. As a client we need to be open to receiving and in doing so allow ourselves, both in mind and body to truly experience the magic of massage therapy.
As a teacher of massage therapy I feel a great responsibility to assist my students to ignite their passion for learning new material and for helping them along their massage education journey. The way that I like to think about this is that behind the 'door' of my subject lies knowledge and material which will not only enhance the students understanding of the particular field but will also empower them to search further and find out more about that area of massage for themselves.
The teacher of the subject does not however hold all the answers, and neither should they or the interaction between student and teacher would indeed be a one way street. Rather it is the role of the teacher to pass out the 'key' to the knowledge door, it is a matter entirely up to the student whether or not they actually choose to open the door and pass through onto the next part of their learning or whether they decided that there is no reason to move forward because they feel that the particular teaching being offered will not be of interest or benefit to them.
The fulfillment as a teacher comes when a student who has chosen to use the key, unlock the door and absorb the knowledge, comes back to you after you have parted ways to share with you what their experiences with that new knowledge have been. In effect they are inviting you to take a peak through their particular door. One such door way was opened up for me just the other day by a past student. She studied manual lymph drainage with me and not only embraced the material but excelled in the practice of the technique to such a degree that she is now using it in a professional sports setting on a daily basis. She stopped me in the hallway to share her story and to tell me that the results of her work not only amazed her but all the other medical staff and clients of that particular department. She was so pleased, grateful and excited that she was able to learn and use this technique in her professional practice. As her teacher and now her peer the golden moment for me was in knowing that not only had I done my job by empowering and informing her, but that she had taken the learning and made it here own, forging ahead and creating a successful niche for herself. You could say that she didn't just walk through that knowledge door, she ran! What better reward as a teacher than to see her smile, hear her story and know that by sharing my knowledge of a topic I was able to help her on her way. In a nutshell that is what makes teaching such an inspiring career choice for me.
What we hear in the classroom is often not one hundred percent related to the exact topic of discussion scheduled in the class notes for that day. Sometimes a discussion will be struck up from a seemingly unrelated question or comment. This can lead the student to learn some golden piece of insight that will not be examined in the classroom, but will be useful once they are in the massage room alone with their client....