February 1, 2024 • 68 mins
In my conversation with Pam Fitch, a respected RMT and author, we explore the past and future of massage therapy to reveal its ethical and communicative core. Pam and I explore the delicate balance between physical relief and psychological comfort, and the potential held within our profession.
We all carry our life stories, and it's through understanding this narrative that wellness begins. Pam and I share personal anecdotes that underscore the significance of recognizing each client's unique touch history. From the intricacies of informed consent to common presentations like neck and shoulder pain, we traverse the human aspect of massage therapy, emphasizing empathy and respect as pillars of our practice. This episode is a tribute to the profound connections we forge in the therapy room, where we treat the person, not just the condition.
Pam and I challenge the profession to elevate its value within the healthcare community by embracing the psychological and emotional support we provide. With Pam's insights, we confront the complexities of treating conditions like obesity and chronic pain, advocating for evidence-based practice over pseudoscientific advice. Every word, every treatment decision carries meaning, and we discuss the responsibility we hold as RMTs to communicate with integrity and to adapt to each client's needs with open minds and informed methods. Tune in to gain a new perspective on the therapist-client relationship and the ethical landscape of massage therapy.
To connect with Pam and/or purchase her book, please visit her website:
https://www.pamelafitch-rmt.com/
Head on over to my website. This includes a list of all my upcoming courses, webinars, self-directed learning opportunities as well as some helpful learning resources.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Hello and welcome to another episode of Purvis Versus
.
My name is Eric Purvis.
I'm a massage therapist coursecreator, continuing education
provider, curriculum advisor andadvocate for evidence-based
massage therapy.
In this episode, we welcome PamFitch, who is a well-known RMT
author and educator from Ontario.
Pam's main area of interest ishealthcare ethics.
(00:28):
In this episode, we discuss theimportance of holding a safe
space free of judgment, and howvaluable it is to listen and
validate people's experiences.
We explore evidence-basedpractice and informed consent
and discuss what that looks likein the treatment room for RMTs.
And there's two great quotesfrom this episode 1.
We treat people, we don't treatconditions.
(00:49):
And 2.
Don't be creepy.
If you enjoy this episode,please rate it and share it on
your favorite social mediaplatforms.
You can also support my podcastby making a donation by
visiting buymeacoffeecom.
Slash helloob and Purvis Versuscan also be found on YouTube,
so please check us out there andsubscribe.
(01:09):
Thank you for being here and Ihope you enjoy this episode.
Hello and welcome to anotherepisode of Purvis Versus.
Today we are here to welcome PamFitch from Ottawa, ontario.
I'm really excited to have herhere today and this is going to
be, I think, such a fantasticconversation because we're going
to talk about ethics that'sgoing to be our focus and
healthcare ethics and how thisapplies to our wonderful
(01:32):
profession of massage therapy.
So welcome, pam.
Thanks for being here.
Thank you, it's my pleasure.
It's so happy to be here.
Yeah, it'd be great today.
So tell us a little bit, theaudience, a little bit more
about you.
You know who are you and whereare you and what do you do and
why is the things that you do soimportant for RMTs to know?
Speaker 2 (01:51):
Well, I have been a massage therapist for decades.
Like many of your listeners maynot have been born when I became
a massage therapist a long timeago and in my experience and I
don't think things have changedvery much since then we were
trained very well in manualtherapy techniques, but the
(02:14):
whole piece around talking tothe individuals that we saw as
clients was missing somewhat inmy training.
I had some things that I wastaught.
We had a class called EmotionalFirst Aid which was a few hours
and we had a few communicationconversations, but fundamentally
(02:37):
in my experience, massagetherapy is taught in silos.
So you get knowledge about thejurisprudence what are the laws
and the regulations for whateverarea that you're in and then
maybe there's a little bit aboutcommunication and maybe there's
a class about informed consent,but nobody's kind of weaving
(02:59):
that together and explaining thepurposes of that.
A long time ago I was facedwith a number of clients and
situations where I became prettyaware that my communication was
going to be the most criticalpiece of the interaction that I
had with my clients, and so itstarted me on this journey of
(03:24):
investigating and interest incommunications and the
therapeutic relationship.
So I've been talking about this, teaching about this, writing
about it for literally decades.
Speaker 1 (03:40):
So that's me, that's you.
Well, I think you.
I mean, I've been familiar withyour stuff for a long time and
I, admittedly, I haven't readlike.
You have a textbook out there,I believe.
Yeah, do you want to do alittle plug for your textbook?
Speaker 2 (03:56):
Sure, my textbook is called Talking Body, listening.
Hands and it's published byAlgonquin College Press.
So if people go to my websitethey can find it there.
Speaker 1 (04:07):
Perfect, and we'll make sure to include your
website in the show notes Okay,yeah.
No, I think it's.
I have not.
I have seen the textbook, Iflipped through it but I have
not read it cover to cover.
But it is such a this is suchan important thing that you,
that you have done and thatyou've made a career out of,
really, because the like yousaid.
You said communication is themost important thing.
(04:27):
And I don't.
I feel and you know you've beenpracticing for a lot longer than
me, you know I've been aroundsince the early 2000s and it
took a long time to realize thatwhat we say and how we interact
and the language and thenarratives and the communication
we use, how impactful that is.
(04:47):
But I really I like how yousaid, that we're, we're, we
learn in silos, so we learn allthese different things, but
there's not a lot of integrationof that, like translating that
knowledge between you know why,like we learn about anatomy and
physiology and all thesewonderful hands-on techniques
and we learn about you knowjurisprudence and stuff.
And we learn about informedconsent and we learn they talk
(05:08):
about.
You know ethics of like notdoing harm and these kinds of
things, but it's not, it's not,it's not really integrated
together.
Very well, in your career, Iguess can you spend a while your
time teaching at AlgonquinCollege, if I could remember.
Is that right?
Speaker 2 (05:26):
I am now retired from my Algonquin gig but yes, I was
there for 20 years as teachingjust this material.
Speaker 1 (05:34):
Just material.
Now, did you find, because youwere so heavily involved in this
that, did you find that in thecurriculum and in the program
there at Algonquin that therewas more of a integration of
this material?
Speaker 2 (05:45):
Well, we didn't set out to do this but I ended up
taking on all the courses thatcaught communications and
jurisprudence andprofessionalism and
entrepreneurship and, you know,financial literacy.
So I had all of that stream ofthe courses.
So my students ended up havingme in every term for things.
(06:07):
So I would actually say do youremember in term one when we
talked about X or this is goingto be dealt with in detail in
term five.
So my students in that programhad the advantage because I was
constantly reminding them aboutit.
But it wasn't necessarily aplanned thing, it is just the
(06:30):
way the courses landed and Ifelt incredibly fortunate to
have this gig because it reallyhelped me to solidify these
principles that I think are soimportant.
Because you know, what I wasgoing to say at the outset and
of course I forgot was we teachpeople, we work with people.
(06:54):
We don't treat conditions.
Yes, and people are complicated, as any massage therapist will
tell you.
You bump up against their touchhistory.
You bump up against theirattitudes towards intimacy, like
how closely are theycomfortable having people stand
(07:15):
next to them?
So when we instruct ourstudents, for example, in how to
fulfill the requirements forinformed consent, if we don't
give them the bigger picture,then what they're doing is
saying I do this and then theydo this and then I do that.
I did informed consent butthere's no sense of I negotiated
(07:39):
, I empowered my client torefuse whatever I was doing,
because that's important.
So unless we get that, whatwe're doing is very risky.
Yeah.
Speaker 1 (07:54):
Yeah, no, I love that , and that's something that I
wanted to talk to you about.
Today was about the informedconsent and we're going to come
back to that, because I do havesome things specific to that I
want to kind of unpack with you.
But I think that might be.
I want to talk with other stufffirst before you get that.
But I love that.
You said that and it's true inthat and okay, this is like you
(08:17):
know, it's always dangerous tosay.
In my experience and myexperience working with and
teaching and working with otherRMTs, is that, yeah, the idea of
informed consent, it for a lotof people, I feel that it's just
more about ticking boxes, ofdoing what you're supposed to do
without the negotiating.
I like that you used the wordnegotiating.
I think, if anyone's listening,that's a key, key word.
Speaker 2 (08:40):
Yeah, everything should be a negotiation,
everything.
If touch is the modality, theneverything we do should be
negotiated, because people arecomplicated.
They have complicated touchhistories and you know, in my
own life, for example, when Iwas a child, my big brother used
(09:03):
to tease me a lot by ticklingme.
So as a massage therapy client,I brought that ticklishness
into the treatment room.
And when people would touch inthe areas where my brother would
tickle me, I was beside myself.
Well, you know, if you add tothat someone's very checkered
(09:25):
past or layered trauma that hashappened as a result of certain
consequences in their life, thenthe touch becomes kind of it's
like kryptonite for their ownpersonal experiences.
And the one thing that myexperience would suggest is that
(09:48):
schools don't fully recognizethe client experience.
And so on the one hand, weteach our students and we teach
our massage therapists to obtaininformed consent or check in
with a client, but if we don'thave permission for what we're
doing, the criminal code sayswe're assaulting people when we
(10:10):
touch them without permission.
That's basic information thatall of our massage therapists
should know, and we have aresponsibility to negotiate that
consent before we ever doanything.
Speaker 1 (10:25):
Oh for sure, and that's such a key point too that
you made here and this isbrilliant, the way this
conversation is starting, pam.
So thanks for that.
Treating the person.
And so we learn thesetechniques.
We learn like this stuff we'resupposed to do.
But in my massage therapyeducation, so a long time ago,
(10:47):
and in the engagement and thenthe stuff I do and I interact
with other, whether they'restudents or whether they're RMTs
new RMTs or experienced thestory is very similar and that
we are taught to think in silos,probably because we learn in
silos, right?
So we think, oh, this person'sgot shoulder pain, so okay, I'm
going to focus on the shoulderand these are the techniques and
(11:09):
these are the assessments, andokay, this is what I found, this
is what I'm going to do, andyou kind of just tell the person
but you're not thinking about,well, let's not think about the
shoulder pain, let's think aboutthis person, pam, who's here,
who's suffering with somethinggoing on in their shoulder.
So if, flipping that scriptfrom, like, we're treating Pam
who has shoulder pain ratherthan shoulder pain in this
(11:29):
person in front of me, and Ithink if we take that mentality
into our clinical interactions,it changes everything.
Speaker 2 (11:37):
Yes, absolutely.
In the textbook I tell a story,which is based slightly on a
true story but a little bitadapted, of a person who is
caregiving for her husband whohas ALS and he is losing
(11:59):
function repeatedly, to thepoint where the two of them are
exhausted and crying in terriblegrief because the trajectory of
ALS is pretty devastating.
So in this story thecaregiver's husband falls asleep
on her shoulder and she feels alot of pain, but she doesn't
(12:23):
want to move him because heslept for the first time in days
.
Well, imagine she goes to see amassage therapist and she says
and my shoulder is kind of sore.
She doesn't say any more thanthat.
Well, if somebody immediatelypokes in on the shoulder pain,
oh, now we've got to do a rangeof motion.
And can you do this?
And it's resisted.
(12:43):
And all of that without firstdetermining the mechanism of
injury.
How did the shoulders starthurting in the first place,
where the story might spill out?
Well, if we don't do that, wehave ignored probably the most
essential part of the story, andI am a frustrated novelist.
(13:08):
I tell people what's happeningby telling stories, and this is
an example of that.
This is a story that I adaptedfrom something someone shared
with me, and as soon as you hearthat, you go whoa, if this
person is dealing with theirpartner who's facing end of life
(13:31):
circumstances in a very painfulway and I haven't asked that
question what am I doing as amassage therapist to be treating
your shoulder?
It's completely wrongheaded tostart focusing on the shoulder
in this scenario that I've givenyou.
So that's just an example ofwhere I feel so strongly that we
(13:53):
treat people.
We don't treat conditions.
The conditions, if they getbetter because of what we do,
that's golden, but fundamentally, we're dealing with people.
Speaker 1 (14:04):
Yes, yes, and that's a fundamental message that is
probably missed in large partsof our profession People will
talk about the thing thatthey're treating, not the human
that is there, that's suffering.
Speaker 2 (14:20):
And I've done it myself.
I bet you've done it.
I've worked with a lot offrozen shoulders.
Yeah, I've said that many, manytimes.
I've worked with a lot ofpeople who experience frozen
shoulder for a variety ofreasons, and no two cases of the
same right.
There's always an odd story togo with the condition.
Speaker 1 (14:43):
Oh, for sure, One of my we're telling stories, so why
not?
One of the things thatobviously.
So I disclaimer like yeah, Istarted right, it was very
orthopedic, verymusculoskeletally focused, very
like I'm going to do all thethings and learn all the
techniques and I'm going to beso good at assessment and blah,
blah, blah and whatever.
I started my career that wayand, like a lot of us, we change
(15:04):
, we learn, and one of thethings that happened to me early
on though, speaking ofshoulders, was I had this woman
who had come in with severeshoulder pain and it kind of
presented like a frozen shoulderand she could.
She had very limited range ofmotion, extreme pain, couldn't
sleep on it, like just it wasoff work, and she'd seen
(15:27):
numerous other practitioners andshe was frustrated like a lot
of times right, you're in pain.
Speaker 2 (15:32):
No kidding.
Speaker 1 (15:33):
And so, and I don't really know what happened, but I
just, you know some people youjust connect with, yeah, just
sitting there and just having aconversation with her, and I
asked her, you know what, whathappened?
You know to like, when did youfirst start to notice this, this
problem?
And nobody had asked her thatbefore.
They kind of just were likeshe'd come in shoulder assess
(15:56):
you have frozen shoulder, dothese exercises like you know,
beat the snot out of it orneedle it or stretch it,
whatever.
She had all kinds of thingsdone.
And she said oh well, ithappened a number of months ago.
I left my husband, who isabusive, and he had pulled on
her shoulder, you know, and andyou know I didn't get a lot more
(16:17):
details about this.
Okay, this is.
There's a lot of trauma here,so physical trauma, but a lot of
emotional, psycho, psycho,social stuff.
And I said, oh, okay, well, youknow, thanks for sharing that
with me.
You know, did you want to talkmore about that?
Or you know, what would you,what would you feel comfortable
with?
And she just started telling meher story and we had an initial
visit.
(16:37):
That was scheduled I think itwas for 45, maybe 60 minutes,
and she talked for the wholetime and I said do you want me
like to do anything like kind ofget you on the table like I'm
supposed to put some hands onstuff?
She's like no, this feelsreally good, I need to get this
out of the way.
So she unloaded all of herstuff on to me and you know I
didn't scare her, you know Iguess she came back, yeah, but
(16:58):
the moral story was, is that, bygetting that consistent with
what you said, I held that safespace for her to tell me what
was going on.
And then after that it was justa series of treatments where we
didn't.
I felt like I wasn't doinganything.
I was just kind of holding herarm and gently massaging it,
gently, getting to some gentlerange of motion and if you
watched from you know, in asoundproof booth, people
(17:20):
probably would have thought whatis he doing?
Is he doing anything?
But it wasn't the power of thehands on, it was more about the
power of the relationship andthe trust and her allowing me to
do something that made thatshoulder hopefully feel better.
That seemed to be the mostimpactful thing and that was one
(17:42):
of those things that justreally switched with me.
I was like, okay, so this,everything I think I know is now
thrown to the side.
And this was this one of thoseearly moments in where I really
started to shift my thinking,because I was like this doesn't
make sense compared to what I'vebeen educated to think.
Right, there you go.
Speaker 2 (18:05):
Thank you for telling me that story Many, many, many,
many times.
Most of my practice over theyears related to working with
people who had some measure oftrauma in their life, whether
it's personal trauma or there'scomplex injuries as a result of
car accident or whatever.
But trauma was a real focus forhow I was working with clients
(18:30):
and what you described asexactly my experience.
Sometimes what people need todo is to get that story out of
the way so they don't have toexplain it anymore, and the fact
that you were able to hear herand validate, just simply by
bearing witness to what she wastelling you.
You're not in any way engagingin psychotherapy, which
(18:56):
sometimes the regulatory bodiesget alarmed about, right,
massage therapist talking aboutclient experience.
The fact is, you're gettingthat stuff out of the way so
that you can put your hands onsomeone and they won't feel like
they have to say, oh don't, oh,don't touch there, right?
(19:17):
So I feel quite strongly thatone of the things we do is to
contain, to hold the space for,our clients experience.
And you know, christopher Moyer,back in 2004, published a
fascinating study about theeffects of massage therapy being
(19:37):
akin to equivalent topsychotherapy.
It was a very interesting studyand it eventually, people who
remember that study coming outwill recognize it.
But we don't talk about it verymuch anymore, and yet it's just
as true now as it was in 2004.
(19:58):
And I'm grateful to Chris Moyerfor that work because, well, in
my own case, it validated myexperience as a massage
therapist and I went yes, thisis what's happening.
Right, clients are not comingto see me for psychotherapy,
(20:18):
that's not it.
They want massage therapy.
But there is a need toacknowledge the human experience
in that hour in order for us toreally see who's in front of us
, who's on the table.
Speaker 1 (20:33):
I'm glad you brought up that Moyer paper.
I love that paper.
I use it often, I talk about itoften in some of the courses
and things I do, because it'sand it's 2004.
So we're 2023 now it was 20years ago, almost 20 years,
that's right.
And it's talked about, but it's,it seems to give us, as a
(20:56):
profession, it kind of gives ussome insight into what is it
that's happening when we'retreating people, when we put our
hand, what's happening right,and if that paper talks about,
you know, the impacts of massagetherapy are very similar to
that of having a psychotherapysession in terms of is it
anxiety, depression and, yes,capacity is asleep, yeah, and
sleep, yeah, sleep capacity,that's right.
(21:17):
And so you're like, okay, sopeople, some people might hear
that and think, well, massage isuseless, it doesn't do anything
.
And I hear that and I thinkthat's fantastic Because we know
that anxiety, depression andsleep are three huge factors in
a lot of pain and pain-relatedbehaviors and in disability, and
if you can provide that safespace for someone to feel better
(21:40):
, then that's really powerful.
Speaker 2 (21:42):
And how do we heal?
We heal by resting.
We heal by putting ourselves inthat parasympathetic mode.
And if what massage therapy isdoing is facilitating better
mood and improved sleep, wait aminute.
That's all about healing.
That's what we do.
But we have, as a profession,valued the nuts and bolts, the
(22:07):
mechanics of what we do, becausewe can see, we can touch, we
can feel the soft tissuechanging under our fingers.
So we're valuing the impactwith our hands but have in some
ways been conditioned not tovalue what we're doing with our
hearts or with our minds, and Ithink that's a great disservice
(22:30):
both to the profession and alsoto the clients.
It's terrible.
Speaker 1 (22:36):
One thing I felt for a long time is that, in order to
be valued or validated as ahealthcare profession, massage
therapy tried, I think for along time, to identify as
physios, like we were kind oflike, and we're kind of like
physio light, you know, like youknow we wanna be that kind of
(22:56):
mechanical, tissue based, youknow, orthopedic based
profession.
But we know that we have thisreally powerful impactful
effects when we're givingmassage and we have the hands on
people.
But I feel and this is justtotally my bias is that by
trying to hold on to this verystrong kind of physio identity,
(23:17):
it's actually stopping ourprogression from moving forward
where we can say, hey, you knowwhat?
Yeah, we know orthopedics, weknow my scleroscleropathology,
but we're really good at thiskind of psychosocial stuff.
It doesn't involve counseling,it doesn't involve like working
out a scope, but we can makepeople feel better through
different avenues that I wouldsay, you know, are probably,
(23:42):
depending on the person, just asvaluable and maybe even more
valuable.
Speaker 2 (23:45):
Well, and the irony is, if you talk to physios,
they're slightly envious of whatart training is, which is so
hilarious.
You know, physios have master'sdegrees and they're highly,
highly educated in understandingthe function of the human body
and how to improve it.
And then, if you've been in acourse with physios, they will
(24:13):
sometimes kind of shake theirheads at what comes out of the
mouth of massage therapists,because the manual therapy
skills that we have areexceptionally fine, but it's not
the whole picture, and when wedon't acknowledge the whole
picture, we miss the point ofwhat's really remarkable about
what we do.
It's hard to talk about it,though, don't you find it's hard
(24:37):
for massage therapists toacknowledge that what they did
was hold the space for a client.
That takes a certain degree ofmaturity to actually recognize
and then acknowledge that that'swhat you're doing.
Speaker 1 (24:52):
It's not my hands my hands right it's holding the
space, yeah yeah, and this comesdown to the one thing that kind
of always drives me a littlebit crazy is all the different
modality empires out there andall these different ways of
selling hands-on techniques.
And you think, well, we knowthat there's not one modality
(25:15):
that works better than the other.
They all have value.
If you're touching somebody ina way that is meaningful and
safe, then how can one be rightand one be wrong?
How can you have eight or 10,maybe more, 1200 different named
modalities and they all claimto have effects on people and
(25:36):
the people that practice thatway.
They, you know well, I getresults with my clients.
Well, of course everybody does,otherwise we wouldn't have a
profession, right?
So everyone has this differentidentity and again, it creates
these silos of ways of thinkingwhen the commonality is that
you're working with the humanand you're just using a
different way to interact withthem.
Speaker 2 (25:59):
You know what's really interesting, eric the
psychologist, the AmericanPsychological Association
acknowledged a similar kind ofphenomenon among psychologists,
right?
So there are hundreds ofdifferent techniques or
treatments or approaches forpsychologists, and so the
(26:22):
American PsychologicalAssociation I think it was back
in 2007 or 2008, published thishuge textbook full of evaluating
various different kinds oftechniques that psychologists
use, and what they concluded inthe end was the technique that
(26:44):
is used makes the practitionercomfortable, but what really is
going on is the fact that theclient, or, in their case, the
patient, felt validated, theyfelt heard, and this is actually
called the common factors model.
So the common factors oftreatment in healthcare account
(27:14):
for I'm going to make up astatistic, but it's like
somewhere in the vicinity of 80to 90% of the progress of a
client.
You think about the woman youwere talking about with the
shoulder problem.
What she really needed to dowas tell her story, feel heard
and gradually, like a deerthat's been in freeze mode,
(27:39):
because they feel like they'refrightened gradually her
shoulders going to thaw, if youwill, so that she can move it
more, and then you can deal withthe physical trauma.
But until somebody can pullthemselves out of that
frightening mindset is prettyhard to heal.
(27:59):
So what the psychologist figuredout was, oh, just sitting and
watching people making eyecontact, providing compassionate
, attentive listening skills.
This is therapeutic massagetherapists do it.
You described exactly what youwere doing in your own case,
right?
Well, that's what I would likeour profession to value a little
(28:22):
bit more, because for my money,I think that's really essential
.
And that's probably whereChristopher Moyer was realizing
that massage therapy was likesome of the other psychological
treatments, where it's just likeone more way for people to feel
validated and heard, so thatthey sleep better, they feel
(28:44):
less anxious and they're lessdepressed.
I don't know, I'm maybeextending that research a little
bit further, but it makes senseto me that those two realities,
the common factors and what hediscovered could actually link
together.
Speaker 1 (29:00):
Yeah, yeah, that would be nice to we had more
research or more people doingthat kind of research in our
profession, and it's too badthat last I'm making probably an
assumption here, but I thinkChris Moyer I mean he had a lot
of papers and he was reallyinvolved in this stuff but I
think probably 10 or so yearsago, I think he probably just
got frustrated and kind of didsomething else, because I have
(29:22):
not seen him publish anythinganymore.
Speaker 2 (29:24):
Yeah, I think he did go in a different direction.
I'm not familiar with what itis but there wasn't a lot of
future in his research becauseit wasn't necessarily super well
understood.
I don't think.
Speaker 1 (29:37):
Well, I don't think he's gonna listen to this.
But if anybody listens to this,I know I'm telling him to get
back on the horse and see if wecan, because we do need it.
Would be nice to have somebodywho PhD that is invested in or
understanding of the professionand how to do that would be
great.
But yeah, he definitely hasbrought up some great things and
I like that you said I've neverheard that before the common
(29:59):
factors model.
I was familiar with the generalidea that psychotherapy doesn't
really matter which techniqueyou do, or it's all about that.
Speaker 2 (30:13):
Who, not the person is like who.
It's the connection between thetherapist and the client and in
massage we all know this.
Like finding a massagetherapist you relate to is all
about who you wanna hang outwith without your clothes on and
be touched by.
It's very intimate.
Speaker 1 (30:33):
It's very intimate and it is kind of funny.
Our profession is that.
It is odd, if you think aboutit, if you had to describe in
one sentence what is it you dofor living.
You're like a touch-nakedstranger, Like it sounds really
bad, right, but it's somethingthat we should understand the
power balance and thevulnerability that people have.
(30:55):
And I remember very clearly frommy first day in massage school.
Our instructor in the first daysaid welcome to the only
profession in the world wherecomplete strangers are gonna
take off their clothes and turntheir back on you.
I was like what?
And at the time I was kind ofshocked.
But it's always stuck in myhead.
That's actually really a powerthing to know because,
(31:16):
especially being a man, andthey're gonna pay you for it.
They're gonna pay you for it,and pay you pretty well too.
But it's one thing it's alwaysstuck in my head, being a male
too.
It's like, okay, there's thislike you gotta be like above bar
in terms of like communicationand consent and all the things,
so there's no room for.
Speaker 2 (31:36):
Misunderstanding.
Speaker 1 (31:37):
Misunderstanding.
Speaker 2 (31:39):
And you know, I think that that's really critical,
that we need to be after a while.
Let me go back when you'refirst in practice.
You kind of remember everyclient up to about the third
month, and then they start toblur and then after three years,
(32:01):
you actually can't rememberwhether you've met certain
individuals before.
Well, imagine, after 35 years,people will meet me in the
grocery store and they say, ohhi, pam, and they want to tell
me about their story and I'mthinking who the hang are you?
And I have no recollection.
(32:23):
So so one of the things that,as massage therapist, is really
essential, and especiallyimportant for men who are in the
profession, is that we need tohave our own set of values and
principles that we adhere to sothat, no matter who we talk to,
no matter whether we recognizethem or not, if they see us in
(32:45):
the grocery store, we arebehaving with a level of
consistency and integrity sothat the person they trusted is
still the person in law.
Laws at the vegetables right.
Speaker 1 (32:58):
Right.
Speaker 2 (33:00):
There's something that's really essential and an
important about that, becauseimagine that you treat somebody
in your first year of practiceand then, five years on, you
meet them on the street andyou're having a bad day and
you're swearing to yourself andthe individual comes up and says
(33:20):
, eric, is it you?
And you think, oh God, what didI just say right?
Or you're at a cocktail party,or somebody says something and
you bad mouth another individualwho we are in the treatment
room.
That integrity we need to alsobring it into our lives and
(33:40):
that's a tall order.
That's a big tall order toactually instill that value in
students.
But as massage therapist, thatconsistency is really, really
important.
Yeah, and Amanda basketball andsome of her colleagues did some
work around male massagetherapists and did you happen to
(34:02):
see the article that?
Speaker 1 (34:04):
the no, I know, I know I'm Amanda.
I've spoken with her before,but I've never.
I have not familiar with thatpaper, so so part of her.
Speaker 2 (34:12):
PhD research was in professional identity, and so
one of her chapters was in theexperience of male massage
therapists, and the conclusionthat she drew and made into the
title of the paper was justdon't be creepy, right.
Speaker 1 (34:32):
Yeah.
Speaker 2 (34:34):
So for massage therapist it becomes essential
that you can both empathize withyour clients experience male,
female to spirited, gender,queer, non binary, whatever and
if you can empathize with thatclient experience and your male
(34:55):
and you demonstrate in yourbehavior that you can be trusted
, that is golden.
That is so healing.
So my experience with clientswho've had a history of trauma,
quite often the final frontierfor them in healing from trauma
especially if there's been anykind of sexualized or physical
(35:18):
trauma at the hands of a male isto go see a good male massage
therapist so they canacknowledge that that was then
and this is now and this personis a good person and I can trust
them and I can judge goodcharacter.
Like all of these things arecomplicated and our modality is
touch, so that's where itbecomes really.
(35:39):
It's the road, if you will,yeah the hand back.
Speaker 1 (35:44):
Yeah, yeah, yeah, that's actually.
That's such a great, greatpoint there and I'm gonna have
to, I'm gonna have to read that,that paper.
That sounds good.
Don't be creepy.
I mean, which is you know?
That's that was kind of mymantra too is like don't be
creepy and you know, try andjust be, be normal and be
thoughtful and be aware andcommunicate and over communicate
and and, yes, don't be creepy,and hopefully nothing bad will
(36:06):
happen.
So, not good, I'm still here.
Speaker 2 (36:12):
So this is a level of emotional intelligence and that
is not that is not the case forevery person studying massage
therapy.
So emotional intelligence needsto be born out of your
awareness, your perspective.
But yeah, that's how you don'tbe creepy.
Speaker 1 (36:35):
So that's a bit of a loaded question, so you can feel
free to answer how you wish.
Do you feel that?
So emotional intelligenceusually comes with with maturity
, like as you get older youbecome more, you know better at
being a human, hopefully, andbetter being an adult and
recognizing these things.
Do you do you see itproblematic that you know people
(36:57):
can enter this profession thatreally young ages where they
probably don't have thatemotional maturity?
Speaker 2 (37:02):
I'm generalizing, but you're generalizing, and I
certainly generalized.
At the beginning of my teachingin a community college setting.
I would have students who are17 and I'd be like how can you
do this work?
Some of them would never havehad intimate sexual relations
with anyone, so that I couldn'tunderstand how they could have
(37:26):
formulated attitudes towardsother people, touching people
that were complete strangers.
But over time I realized thatthere are individuals who are
very young, hugely emotionallyintelligent, and age is not the
issue, it's the capacity torelate in a kind way, in a
(37:51):
compassionate, not judgmentalway, to another individual and
to be able to listen.
There might be people who weresocially awkward in my classes
and those folks really didstruggle in massage therapy
because quite often didn'tunderstand what the client was
saying and the client might begiving them very subtle cues and
(38:13):
the cues were going over theirhead.
So that's not necessarily aboutage, that's more about your
capacity to observe or payattention to the cues that
you're getting.
So I take your question,certainly felt that way in the
beginning, but I think it's moreof the emotional intelligence
goes across the ages and it is amuch more complex kind of
(38:38):
phenomenon.
Speaker 1 (38:39):
I'm actually glad you said it, because I was saying
that to try and load it, just tosee how you would answer
because in my experience when Iwas in school, I was 25 when I
started massage school, but agood chunk of my classmates were
18, 19, 20, 21.
I think almost all of them, 20through 20 plus years later, are
(39:01):
still practicing and they aresome of the most fantastic
therapists I know.
So I had nothing to do withtheir age, but I remember the
time going to school.
I remember thinking why, like,just so young, like you know,
and this is what you're enteringthis career right now, and that
was my big.
I mean, I was, I was only fiveyears older than them, but you
know it felt the time right, Iwas only 25.
I'm ancient.
I felt like one of the old guys, right, and.
(39:22):
But some of the best therapistsI knew were and people I know
are were young and and.
But it was sorry, go ahead.
Speaker 2 (39:34):
What makes the absolute best therapist is
somebody who's been a clientfirst and knows what they're
comfortable with, and they alsorecognize what they're
uncomfortable with, and whenthey acknowledge that in the
treatment room, then they'reestablishing a level of safety
for the client.
Sorry, I interrupted you.
Speaker 1 (39:56):
No, no, no, no, that's, that's an interjection.
Every want, pam, that was, thatwas a great little thing.
You added no, I shouldn't say,but the like what you said to
about the social awkwardness andthat was the thing is that the
people, I think, that tend tostruggle where, the ones that
people that have trouble withthe social, the social
interaction, the social cues, orthey don't feel comfortable
talking to people.
(40:17):
But yeah, age I don't thinkmatters.
There's, I mean there's peoplein my class that are quite a bit
older than me too and I thinkthey're still practicing.
So it's age doesn't matter perse, but anyway, it's a little
side track there.
One thing I wanted to ask youabout to, one thing I want to
talk about is, obviously ourfocus is kind of on ethics and
and and whatnot, but one of mymain areas of interest is on
(40:38):
evidence based practice and youknow, kind of trying to
incorporate evidence into whatwe do, and the more we learn
about evidence, more I realizeit doesn't give us a lot of
answers.
Anyway, it kind of gives usmore wrong, less wrong ideas,
but nothing is for certain,particularly what we do right, I
would say evidence basedpractice is really good medicine
, really like you have a heartattack.
(40:59):
This is the thing we're goingto do.
This is the best evidence wehelp people at hurt.
There's a pro, there's a lot ofstuff that we don't need to
worry about.
That's why I think evidence isuseful, but I also think it
doesn't give us a lot ofcertainties.
But there's some stuff that Iwanted to talk about.
Was, you know, like there's?
(41:20):
There's, I feel, and I want youto hear your point.
Your opinion is this is therelationship between ethical
health care and evidence basedpractice.
Do you see there there being arelationship between how those
things function together?
Speaker 2 (41:33):
100%, absolutely there is.
When I first became a massagetherapist, there were a lot of
people doing colonics.
Where they were doing a colonic, irrigation was a big thing
back in the early 90s, right.
Well, that has been debunked asa form of treatment, but at the
(41:57):
time there were many massagetherapists who thought, oh, this
must be good, so you should godo this If you had abdominal
issues.
And what I see in massagetherapy among practitioners is,
if this is the case, then that'sthe option.
It's kind of like recipe basedhome care, without a lot of
(42:20):
investigation as to the theevidence to support the decision
making.
We will often tell peoplethings that are completely out
of our own opinion and we'lldress it up by saying something
like well, there's research tosupport this idea.
(42:41):
Oh yeah, if you read it, do youknow what the caveat says?
That you know this research isonly good if these are the
circumstances I think massagetherapists are.
This is going to soundpejorative.
Massage therapists can besomewhat lazy in their
(43:05):
willingness to actuallyinvestigate the effects of
certain actions.
And the other whole piece ofthis, back to what I was saying
earlier is that if we look atthe social science research, if
we look at qualitative researchand we consider client
(43:28):
experience, the empiricalexperience of long standing
practitioners.
If you've seen 20,000, ifyou've performed 20,000
treatments, you have aperspective which is there's
evidential kind of perspectivethere.
If you've only been in practicefor a year and you're telling
(43:50):
people that they should do thisand that and the other thing,
that's not helpful and that'snot evidence-based.
It's just trying to make usfeel better about ourselves,
that we know something special,that we're important.
(44:10):
That's not evidence-basedpractice and it puts the clients
at risk sometimes.
I think so.
I think there is an ethicalprerogative that we need to
carry out if we're a massagetherapist yes, that was a very
long-awaited story yes, theanswer to your question, yes,
(44:35):
okay.
Next.
Speaker 1 (44:36):
Next no, no that's good, I wanted to.
I just wanted to.
I mean, I made an assumptionthat that would be your answer
and that just kind of leads intokind of what we want to talk
about, kind of in the lastlittle bit of this conversation.
As you mentioned earlier aboutthings like informed consent,
and this is something that Istrongly feel needs to be talked
(44:57):
about more, and I reallystrongly feel that the
stakeholders in a professionneed to understand the
implications of the way thingsare being done and the way,
because I feel that, if we'relooking at at least how I
understand informed consent is,it's not being met.
So, and this goes to the thing,like, is it possible, like is
(45:21):
it ethical for our entities tomake a claim they can't support,
which would kind of fit intothat evidence-based thing you
know, like, what claims can weactually make?
If we understand the evidencesays you cannot permanently
deform tissue with your handsand you don't need to for people
to feel better, that doesn'tmean what you're doing with your
hands is useless, but it meansthe claims you're making about,
(45:42):
oh, I'm interacting with thisspecific tissue or I'm altering
this specific joint, or whateverit is you might wanna claim, if
there's not evidence to supportthat, then is it ethical for
you to make those claims?
Speaker 2 (45:55):
I don't believe, so I'm gonna make that the short
answer.
Speaker 1 (45:58):
Yeah, I don't is ethical.
Speaker 2 (46:00):
The ethics is the study of right and wrong, the
principles by which we form ourattitudes in our practice.
So if you think about that,then the choices that you make
as a professional should landyou on the side of principles
(46:20):
that support healthy practice.
The client feels better.
We don't hurt ourselves asmassage therapists.
We stay within our scope ofscopes of practice, whatever
they are, however they'redescribed, and if we do all
those things, generally speaking, clients are not gonna be
injured and our regulatorybodies are not going to feel
(46:46):
overwhelmed with the number ofcomplaints against us as
professionals.
Where we get in trouble is whenwe make claims that are not
supported or we touch people inways that they didn't anticipate
and they feel veryuncomfortable and they don't
launch, or they feel that theywere.
You know, on the far end ofthat spectrum, they were abused
(47:10):
by a massage therapist or, worstcase scenario, there was
predation, like there's acontinuum here of care.
So if you're working withinyour scope of practice and you
are making good decisions basedon what you know about what's
available to you, you know thatgives you a pretty wide scope of
(47:34):
what you can actually performin the treatment room.
Where I get crazy.
I just oh.
It makes me crazy is whenpeople use language which is
super imprecise.
For example, when I hearcertain individuals telling me
that they're tuning the liver, Iwant to scream, because what
(47:57):
does that mean?
In my other life, I'm amusician.
What does tuning the liver mean?
Applying a tuning fork to theliver?
Well, people use tuning forksin some capacity in their work,
but hitting the liver with atuning fork isn't even going to
create a sound, because it'sgoing to be kind of a splat.
Okay, so what's that mean?
(48:18):
So tuning the liver is whatyou're doing alleviating
palpable tension in thestructures that are holding the
liver in place.
Now I can understand whatyou're talking about.
There's more precision in thatlanguage and you've probably had
this experience yourself, eric.
I've had people tell me oh, myother massage therapist told me
(48:43):
that I have this problem, or mydoctor has told me I have a
degenerative disc, or I have,well, any number of conditions,
and I always want to know.
So how did they find that out?
How was this determined?
And when you start to unpacksome of the determinations of
(49:09):
the impressions that clientshave about their conditions,
quite often it's becausesomebody has said oh yeah, it's
really common.
You got a degenerative disc, ohyeah.
You've got this, oh yeah.
And it's just irresponsiblebecause clients are like sponges
they hear everything we say andthen they interpret what we're
saying and then they share whatthey think their interpretations
(49:32):
are with somebody else.
And it's like that old gametelephone we used to play as
kids.
So what you may have said tosomebody is not gonna bear any
relationship to how it'sactually reported.
Three or four practitionersdown the line.
It's really essential what wedo, that we say carefully what
(49:53):
it is.
We can do, what our capacitiesare as practitioners and we're
describing what we're doing in avery precise way.
It's yeah, that's advanced care.
Speaker 1 (50:06):
But I'm so glad you expanded on that, because the
way I see it too is that if wedon't understand the evidence,
then we can speak in these veryprecise terms and we can say, oh
, you hurt, you're back a sore,because you've got a right
elevated enomniate on and you'releft, as you know, say terms
(50:26):
this is whatever, and you canmake all these big kind of like
things and you say, well, how doyou know that?
Well, I can see that, I can feelit, but maybe the person is
always like that and they don'thave pain and maybe that's not
related to pain.
And we look at the research, itjust says those things, there's
not a strong relationshipbetween those things and pain.
Anyway, that's just.
You know, sometimes that's howpeople present and maybe it's
nothing.
We're all different, no one'ssymmetrical.
(50:47):
But we start to make theseclaims to validate why the
person is sore.
And then when we make thoseclaims to value the sore it
gives us, makes us feel good.
And but the way I see it islike, first off you're kind of
making something up because it'snot evidential, and then you're
telling the person this is whyyou hurt, and then they're
giving you consent to treatbased on this thing which
(51:08):
doesn't exist.
So the way I see it is likewell, that's not informed
consent, Because you're givingconsent to something which isn't
real or isn't related.
Speaker 2 (51:20):
Inform, consent is about negotiating the process.
Whatever it is I'm going to dowith you is if you're the client
, right?
So first of all, I have tounderstand what the purposes,
what the circumstances are thatcreated the condition that the
client's reporting.
And then I need to observe withmy eyes, and symmetry is a huge
(51:45):
indicator for what we'relooking for, right.
So I'm looking for asymmetriesor postural anomalies, or
listening for indications of oldinjuries or all of those things
.
That's all true, but then whenI'm negotiating with somebody
how I'm actually going to put myhands on them, where I'm going
(52:09):
to put my hands on them, howthey're going to be draped, how
long I think the treatment'sgoing to be, and what I would
imagine is the time it's goingto take for us to do this.
Well, that's the informationthey need to determine whether
or not they want to engage withme.
Because if I start touchingthem and they haven't given me
(52:29):
permission and they suddenlytake offense to what I'm doing,
it's possible that they couldclaim that I've assaulted them
because I never told them what Iwas going to do.
Under the criminal code, thatis assault.
Yeah, I once knew a formerpolice officer and he would come
(52:53):
into my classes and talk to mystudents.
One of the most bald statementsthat he ever said that I've
never forgotten is if you putyour hands on me and I'm the
client and I haven't given youpermission, you have assaulted
me under the criminal code and Ican ask for you to be charged.
(53:16):
My students are went right,because that goes to the heart
of what we do as massagetherapists.
That's why what we do is bothso revolutionary healing through
touch but also potentially sodevastating, because if we touch
without permission, we may bereinforcing old traumas.
(53:38):
People may be offended, theymay be hurt, they may be harmed.
So we have a responsibility tomake sure that that conversation
, that negotiation for consent,is explicit.
At the end of that conversationthere has to be the question do
I have your permission to goahead?
There has to be the statementif, at any time, you feel
(54:02):
uncomfortable with what we'redoing, let's stop or pause,
because I don't want you to feeluncomfortable.
If those things are in place,then you're probably getting
adequate informed consent fromyour client.
But if they're not there,you're just going through the
motions.
Speaker 1 (54:20):
Yeah, thanks for clarifying that, ben.
That's very helpful, I think,for me and for that.
No, that's okay.
I can tell your passion aboutthis.
This is why I wanted to haveyou on for this, because I knew
that you would have moreexperience and knowledge and
then this than most.
So I appreciate that.
So one thing that I want totalk about so when we talk about
informed consent, we also cantalk about do no harm, which is
(54:42):
the first thing that we'realways learning.
The way I've interpreted thisand correct me if I'm wrong and
I'm happy to be wrong is that dono harm.
Oftentimes is talked aboutphysical harm.
I'm not going to hurt youpurposefully.
I'm not going to do anything tomake you worse.
Could we expand that into moresome of the psychosocial harms
(55:02):
or the unhelpful beliefs andnarratives that people have?
If, by telling them stories andmaking things up to try and
justify a treatment and maybe,like you said earlier, people go
the game of telephone, they'retold all these different things
Maybe it's true, maybe it's nottrue, but maybe, if it's not
(55:24):
true, but the person believes itis to be true and that impacts
their behavior in a negative way, could we include that in that
ethical concept of do no harm?
Speaker 2 (55:35):
You just set me up right, because of course, of
course you can.
Of course you can Imagine thatyou have a client who has a
weight issue, so they'remorbidly obese.
Well, obesity is one of thoseconditions that lots of people
(55:55):
who are not morbidly obesebelieve can be solved by simply
restricting your calories.
And that is not the case.
After a certain point, whenpeople are morbidly obese, yes,
they may be eating more thanother individuals, but all of
our systems become so pulled outof whack that it's my clinical
(56:21):
term pulled out of whack soyou're not able to respond to
food in the same way.
You don't digest it, you holdit in your system and the
obesity becomes a full systemchallenge.
So I've heard massage therapists, for example, say to people
(56:44):
well, if Jack would just lose abit of weight, he'd be so much
better, his knees would functionbetter.
Yeah, that's not helpful,because obesity may be a factor
in the condition of people'sknees, but we are also not
trained in the particulars ofobesity enough to be able to say
(57:07):
lose weight, your knees willget better.
That's not the way things work.
It's very complex and I comeback to my earlier point.
I think sometimes we look for avery simple.
If this, then that kind ofresponse that we can share with
our clients to make us feelbetter, to make us feel
(57:28):
knowledgeable, that's nothelpful.
Our job is to listen to ourclients' needs and see where our
skills fit in theircircumstances, and if they don't
fit, we recommend somebody else.
We don't hold onto them asclients, we let them go if we're
(57:49):
not able to help.
It's complicated, but I thinkthat there are a lot of ways you
can take your question Again.
I could lecture you at lengthon that one.
Speaker 1 (58:03):
No, that's fine, you can lecture if you want.
I know you're retired now soyou have no pressure to get back
in front of the front of thebook and lecture.
But I just wanted to bring thatbecause it's just in my world
of where I first got my focus interms of advancing my education
and the stuff I teach is in thechronic pain and that's where,
(58:28):
the more I learn, the more Irealize I don't know, but one
thing that I have learned aboutit is that a lot of people, when
we're looking at thequalitative literature or the
lived experience, a lot ofpeople that suffer and pain and
are disabled by it, theirdisability it's not their level
of pain per se but theirdisability, how much pain
(58:48):
impacts their quality life isreally influenced strongly by
the messages and the narrativesthat were given to them by
well-meaning health careproviders who were saying things
just making I shouldn't saymaking stuff up, but they were
saying things to try to help, totry and justify why a person
hurts.
But then the person going getstreated for that thing using
(59:11):
said modality or intervention,and they still hurt and then
they go and see somebody elsewho provides a different
narrative, a different story anda different rationale for oh,
this is why you hurt, is becauseI found whatever, and they get
treated for that and then theydon't feel better and it creates
a cycle of disability andsuffering and I would see that.
(59:34):
I see that as extremely harmfulbecause you're trying to help
the person but because you mightnot be aware of the evidence
for that condition or you mightbe unaware of.
Yeah, we know that the evidencefor ultrasound is whether the
(59:56):
machine's turned on or not.
It doesn't matter.
Some people might enjoy it,some people might not and some
people might feel better.
But it probably has nothing todo with the machine going bang
or not.
It might have something to dowith chemical context, but
people get sold these ideas totry to fix them and it seems in
a lot of cases where the painpersists, that they end up
suffering needlessly or longerthan they should because of the
(01:00:22):
harm of the stories they'retaught.
And I see that and this is myopinion I see that as a big
ethical dilemma that needs toreally be addressed at, I think,
a lot of levels in health careand in our profession.
I think that needs to be astakeholder issue because we
need to understand we've allowedthings like pseudoscience and
(01:00:46):
made up stuff to flourish at alllevels, and I don't think it
does the public any good.
Speaker 2 (01:00:56):
I once knew somebody who lived with Ehlers-Dannells
syndrome and the individual hadexperienced multiple 5, 6, 7 car
accidents, a variety ofdifferent circumstances over the
course of their life and, ifyou can imagine, combination of
(01:01:16):
the trauma of the motor vehicle.
So sudden impact plus acondition of Ehlers-Dannells
would result in not only softtissue damage but neurological
challenges as well, because theywould not be able to
accommodate the force, even ifthey braced the nerves for going
(01:01:39):
to get stressed.
So this individual ended upwith, oh my goodness, half a
dozen different health careprofessionals that they were
seeing, and each health careprofessional had a perspective
on the circumstance, and not tosay that massage therapy is the
thing that was the most helpful.
(01:02:00):
But the approach for thisclient that made a difference
was that we just simply stoppedtrying to figure out is it T6?
Is it T7?
Is it C1?
Where's the TMJ it was how areyou doing today and what can we
(01:02:25):
do that will make you feelbetter at the end of this hour?
Because there were so manyfactors in this individual's
healing.
I couldn't promise that we weregoing to get rid of it all, but
I have seen this client formany years and what has worked
best is presence, observation, afocus on symmetry.
(01:02:51):
Do no harm, don't make thingsworse, and whatever we do, at
the end of the hour I want thisclient to feel better.
That's what we're doing.
And can I tell you what handposition is the most helpful?
No, because it changes everyweek, every time I see this
(01:03:13):
person.
Well, there, in a nutshell, isthe nature of our work.
We need to be open to what'spossible but, at the same time,
contain our skills.
We need to pay attention towhat we're seeing without making
(01:03:37):
things worse.
And you can go on.
It's a continuum on a varietyof different levels and it is
complex.
What we do so, ethically, Ifeel the most important thing I
can do for individuals is tojust simply listen, pay
(01:03:58):
attention to what I'm seeing andoffer something in the hour
that we are together and thendetermine whether that was
helpful when I see them the nexttime.
I don't try to go too muchfurther than that because,
especially when you see peoplewith complex presentations, it's
different every time.
There's all kinds of thingsthat have happened between the
(01:04:20):
one day that I saw them thefirst time and the next time.
Speaker 1 (01:04:23):
Yeah, I love that, pam, so much.
It's really.
The clinical brilliance is insimplicity, yeah, but it's not
easy.
It would be to say simple, butit's extremely complex.
What understanding at all?
Speaker 2 (01:04:41):
When I'm teaching my courses, erica, I really have
often said like everythingyou're going to learn here today
is context for what you'redoing within the treatment room.
There's not a lot of.
You all have the skills, I havethe skills, we all have that
stuff in place, but the context,the perspective that we bring
in, that rich perspective thatcomes into the treatment room,
(01:05:05):
is what makes it different forour clients when they feel heard
in a new way and recognize tome that's the gift of what
Massage Therapy does.
I just love it.
I think it's one of the mostfabulous professions.
I love the work but it'scomplex interacting with people
(01:05:28):
with integrity and ethically.
Speaker 1 (01:05:30):
Oh, 100%.
The thing is, you have some ofthese podcasts and stuff.
I feel the need to challengethe status quo sometimes, or to
try to do things to push ourprofessors forward, because I
feel like we're dragging ourfeet about adopting changes in
terms of how we are educated orhow we think.
I love how you brought thistoday, really Highlighting the
(01:05:56):
importance of it.
May not be sexy, it may notsell courses, it may not make
any of us rich.
It may be like can you justhold a safe space?
Can you listen?
Can you communicate in a waythat is non-threatening?
Can you explore a differenttouch and different positions
and different be curious withyour person that comes to see
(01:06:19):
you?
That is the clinical brilliancethat I feel is not emphasized
or understood or appreciated asmuch as it could be in our
profession.
I think we do fantastic work.
If anyone thinks that I'msaying otherwise, then you're
(01:06:39):
not listening.
I think we have such a hugepotential impact to change
people's lives and we do.
I think we could be even betterif we just address some of
these things that you talkedabout today and said, yeah, this
is where we should be focusingour energy on and you're
probably going to have better.
We can't produce.
(01:07:00):
We can make better outcomes,but you're probably going to be
less wrong.
At the very least, you're notgoing to make anybody worse.
Speaker 2 (01:07:07):
If you do that's okay and truthfully, without getting
into a rut where you're notbeing mindful when you're with
your client, if you're actuallypresent, moment to moment, to
what's happening, present inyour hands, what your hands are
feeling, but also what you'reobserving, what you're hearing
them say, if they're sayinganything, if you're present,
(01:07:32):
then it actually shouldn't feellike a lot of work, because we
all have the skills.
We're just applying our skillsin a thoughtful, mindful way.
But if we forget that, weforget that we've got a human
being on the table with a storyand we don't pay attention to
the story, then we get intoproblems, then the regulator
(01:07:52):
gets involved because complaintshappen, right, yeah.
Speaker 1 (01:07:57):
That's such a brilliant way to wrap things up
today.
Pam, thanks for being here.
Thanks for sharing yourexperience, your stories and
your knowledge.
It's highly valuable.
I've really enjoyed theconversation.
If anyone wants to get ahold ofyou, what's the best way for
them to get ahold of you?
Speaker 2 (01:08:13):
I'll give you my website and you can post it.
The link to the textbook is onthere as well.
Speaker 1 (01:08:20):
Perfect, okay, great Well, thank you, pam.
Have a good day.
Speaker 2 (01:08:25):
I'm so lovely to chat with you, Eric.
I really appreciate it, theconversation.
Have a good day to yourself.
Bye-bye.
Speaker 1 (01:08:32):
Thank you for listening.
If you enjoyed this episode,please give it a five-star
rating and share it on yourfavorite social media platform.
You can follow me on Instagramor Facebook at EricPervusRMT,
and please head over to mywebsite, ericpervuscom to see a
full listing of all my livecourses, webinars and
self-directed course options.
Until next time, have a greatday and thanks for listening.
Hello and welcome to another episode of Purvis Versus
.
My name is Eric Purvis.
I'm a massage therapist coursecreator, continuing education
provider, curriculum advisor andadvocate for evidence-based
massage therapy.
In this episode, we welcome PamFitch, who is a well-known RMT
author and educator from Ontario.
Pam's main area of interest ishealthcare ethics.
(00:28):
In this episode, we discuss theimportance of holding a safe
space free of judgment, and howvaluable it is to listen and
validate people's experiences.
We explore evidence-basedpractice and informed consent
and discuss what that looks likein the treatment room for RMTs.
And there's two great quotesfrom this episode 1.
We treat people, we don't treatconditions.
(00:49):
And 2.
Don't be creepy.
If you enjoy this episode,please rate it and share it on
your favorite social mediaplatforms.
You can also support my podcastby making a donation by
visiting buymeacoffeecom.
Slash helloob and Purvis Versuscan also be found on YouTube,
so please check us out there andsubscribe.
(01:09):
Thank you for being here and Ihope you enjoy this episode.
Hello and welcome to anotherepisode of Purvis Versus.
Today we are here to welcome PamFitch from Ottawa, ontario.
I'm really excited to have herhere today and this is going to
be, I think, such a fantasticconversation because we're going
to talk about ethics that'sgoing to be our focus and
healthcare ethics and how thisapplies to our wonderful
(01:32):
profession of massage therapy.
So welcome, pam.
Thanks for being here.
Thank you, it's my pleasure.
It's so happy to be here.
Yeah, it'd be great today.
So tell us a little bit, theaudience, a little bit more
about you.
You know who are you and whereare you and what do you do and
why is the things that you do soimportant for RMTs to know?
Speaker 2 (01:51):
Well, I have been a massage therapist for decades.
Like many of your listeners maynot have been born when I became
a massage therapist a long timeago and in my experience and I
don't think things have changedvery much since then we were
trained very well in manualtherapy techniques, but the
(02:14):
whole piece around talking tothe individuals that we saw as
clients was missing somewhat inmy training.
I had some things that I wastaught.
We had a class called EmotionalFirst Aid which was a few hours
and we had a few communicationconversations, but fundamentally
(02:37):
in my experience, massagetherapy is taught in silos.
So you get knowledge about thejurisprudence what are the laws
and the regulations for whateverarea that you're in and then
maybe there's a little bit aboutcommunication and maybe there's
a class about informed consent,but nobody's kind of weaving
(02:59):
that together and explaining thepurposes of that.
A long time ago I was facedwith a number of clients and
situations where I became prettyaware that my communication was
going to be the most criticalpiece of the interaction that I
had with my clients, and so itstarted me on this journey of
(03:24):
investigating and interest incommunications and the
therapeutic relationship.
So I've been talking about this, teaching about this, writing
about it for literally decades.
Speaker 1 (03:40):
So that's me, that's you.
Well, I think you.
I mean, I've been familiar withyour stuff for a long time and
I, admittedly, I haven't readlike.
You have a textbook out there,I believe.
Yeah, do you want to do alittle plug for your textbook?
Speaker 2 (03:56):
Sure, my textbook is called Talking Body, listening.
Hands and it's published byAlgonquin College Press.
So if people go to my websitethey can find it there.
Speaker 1 (04:07):
Perfect, and we'll make sure to include your
website in the show notes Okay,yeah.
No, I think it's.
I have not.
I have seen the textbook, Iflipped through it but I have
not read it cover to cover.
But it is such a this is suchan important thing that you,
that you have done and thatyou've made a career out of,
really, because the like yousaid.
You said communication is themost important thing.
(04:27):
And I don't.
I feel and you know you've beenpracticing for a lot longer than
me, you know I've been aroundsince the early 2000s and it
took a long time to realize thatwhat we say and how we interact
and the language and thenarratives and the communication
we use, how impactful that is.
(04:47):
But I really I like how yousaid, that we're, we're, we
learn in silos, so we learn allthese different things, but
there's not a lot of integrationof that, like translating that
knowledge between you know why,like we learn about anatomy and
physiology and all thesewonderful hands-on techniques
and we learn about you knowjurisprudence and stuff.
And we learn about informedconsent and we learn they talk
(05:08):
about.
You know ethics of like notdoing harm and these kinds of
things, but it's not, it's not,it's not really integrated
together.
Very well, in your career, Iguess can you spend a while your
time teaching at AlgonquinCollege, if I could remember.
Is that right?
Speaker 2 (05:26):
I am now retired from my Algonquin gig but yes, I was
there for 20 years as teachingjust this material.
Speaker 1 (05:34):
Just material.
Now, did you find, because youwere so heavily involved in this
that, did you find that in thecurriculum and in the program
there at Algonquin that therewas more of a integration of
this material?
Speaker 2 (05:45):
Well, we didn't set out to do this but I ended up
taking on all the courses thatcaught communications and
jurisprudence andprofessionalism and
entrepreneurship and, you know,financial literacy.
So I had all of that stream ofthe courses.
So my students ended up havingme in every term for things.
(06:07):
So I would actually say do youremember in term one when we
talked about X or this is goingto be dealt with in detail in
term five.
So my students in that programhad the advantage because I was
constantly reminding them aboutit.
But it wasn't necessarily aplanned thing, it is just the
(06:30):
way the courses landed and Ifelt incredibly fortunate to
have this gig because it reallyhelped me to solidify these
principles that I think are soimportant.
Because you know, what I wasgoing to say at the outset and
of course I forgot was we teachpeople, we work with people.
(06:54):
We don't treat conditions.
Yes, and people are complicated, as any massage therapist will
tell you.
You bump up against their touchhistory.
You bump up against theirattitudes towards intimacy, like
how closely are theycomfortable having people stand
(07:15):
next to them?
So when we instruct ourstudents, for example, in how to
fulfill the requirements forinformed consent, if we don't
give them the bigger picture,then what they're doing is
saying I do this and then theydo this and then I do that.
I did informed consent butthere's no sense of I negotiated
(07:39):
, I empowered my client torefuse whatever I was doing,
because that's important.
So unless we get that, whatwe're doing is very risky.
Yeah.
Speaker 1 (07:54):
Yeah, no, I love that , and that's something that I
wanted to talk to you about.
Today was about the informedconsent and we're going to come
back to that, because I do havesome things specific to that I
want to kind of unpack with you.
But I think that might be.
I want to talk with other stufffirst before you get that.
But I love that.
You said that and it's true inthat and okay, this is like you
(08:17):
know, it's always dangerous tosay.
In my experience and myexperience working with and
teaching and working with otherRMTs, is that, yeah, the idea of
informed consent, it for a lotof people, I feel that it's just
more about ticking boxes, ofdoing what you're supposed to do
without the negotiating.
I like that you used the wordnegotiating.
I think, if anyone's listening,that's a key, key word.
Speaker 2 (08:40):
Yeah, everything should be a negotiation,
everything.
If touch is the modality, theneverything we do should be
negotiated, because people arecomplicated.
They have complicated touchhistories and you know, in my
own life, for example, when Iwas a child, my big brother used
(09:03):
to tease me a lot by ticklingme.
So as a massage therapy client,I brought that ticklishness
into the treatment room.
And when people would touch inthe areas where my brother would
tickle me, I was beside myself.
Well, you know, if you add tothat someone's very checkered
(09:25):
past or layered trauma that hashappened as a result of certain
consequences in their life, thenthe touch becomes kind of it's
like kryptonite for their ownpersonal experiences.
And the one thing that myexperience would suggest is that
(09:48):
schools don't fully recognizethe client experience.
And so on the one hand, weteach our students and we teach
our massage therapists to obtaininformed consent or check in
with a client, but if we don'thave permission for what we're
doing, the criminal code sayswe're assaulting people when we
(10:10):
touch them without permission.
That's basic information thatall of our massage therapists
should know, and we have aresponsibility to negotiate that
consent before we ever doanything.
Speaker 1 (10:25):
Oh for sure, and that's such a key point too that
you made here and this isbrilliant, the way this
conversation is starting, pam.
So thanks for that.
Treating the person.
And so we learn thesetechniques.
We learn like this stuff we'resupposed to do.
But in my massage therapyeducation, so a long time ago,
(10:47):
and in the engagement and thenthe stuff I do and I interact
with other, whether they'restudents or whether they're RMTs
new RMTs or experienced thestory is very similar and that
we are taught to think in silos,probably because we learn in
silos, right?
So we think, oh, this person'sgot shoulder pain, so okay, I'm
going to focus on the shoulderand these are the techniques and
(11:09):
these are the assessments, andokay, this is what I found, this
is what I'm going to do, andyou kind of just tell the person
but you're not thinking about,well, let's not think about the
shoulder pain, let's think aboutthis person, pam, who's here,
who's suffering with somethinggoing on in their shoulder.
So if, flipping that scriptfrom, like, we're treating Pam
who has shoulder pain ratherthan shoulder pain in this
(11:29):
person in front of me, and Ithink if we take that mentality
into our clinical interactions,it changes everything.
Speaker 2 (11:37):
Yes, absolutely.
In the textbook I tell a story,which is based slightly on a
true story but a little bitadapted, of a person who is
caregiving for her husband whohas ALS and he is losing
(11:59):
function repeatedly, to thepoint where the two of them are
exhausted and crying in terriblegrief because the trajectory of
ALS is pretty devastating.
So in this story thecaregiver's husband falls asleep
on her shoulder and she feels alot of pain, but she doesn't
(12:23):
want to move him because heslept for the first time in days
.
Well, imagine she goes to see amassage therapist and she says
and my shoulder is kind of sore.
She doesn't say any more thanthat.
Well, if somebody immediatelypokes in on the shoulder pain,
oh, now we've got to do a rangeof motion.
And can you do this?
And it's resisted.
(12:43):
And all of that without firstdetermining the mechanism of
injury.
How did the shoulders starthurting in the first place,
where the story might spill out?
Well, if we don't do that, wehave ignored probably the most
essential part of the story, andI am a frustrated novelist.
(13:08):
I tell people what's happeningby telling stories, and this is
an example of that.
This is a story that I adaptedfrom something someone shared
with me, and as soon as you hearthat, you go whoa, if this
person is dealing with theirpartner who's facing end of life
(13:31):
circumstances in a very painfulway and I haven't asked that
question what am I doing as amassage therapist to be treating
your shoulder?
It's completely wrongheaded tostart focusing on the shoulder
in this scenario that I've givenyou.
So that's just an example ofwhere I feel so strongly that we
(13:53):
treat people.
We don't treat conditions.
The conditions, if they getbetter because of what we do,
that's golden, but fundamentally, we're dealing with people.
Speaker 1 (14:04):
Yes, yes, and that's a fundamental message that is
probably missed in large partsof our profession People will
talk about the thing thatthey're treating, not the human
that is there, that's suffering.
Speaker 2 (14:20):
And I've done it myself.
I bet you've done it.
I've worked with a lot offrozen shoulders.
Yeah, I've said that many, manytimes.
I've worked with a lot ofpeople who experience frozen
shoulder for a variety ofreasons, and no two cases of the
same right.
There's always an odd story togo with the condition.
Speaker 1 (14:43):
Oh, for sure, One of my we're telling stories, so why
not?
One of the things thatobviously.
So I disclaimer like yeah, Istarted right, it was very
orthopedic, verymusculoskeletally focused, very
like I'm going to do all thethings and learn all the
techniques and I'm going to beso good at assessment and blah,
blah, blah and whatever.
I started my career that wayand, like a lot of us, we change
(15:04):
, we learn, and one of thethings that happened to me early
on though, speaking ofshoulders, was I had this woman
who had come in with severeshoulder pain and it kind of
presented like a frozen shoulderand she could.
She had very limited range ofmotion, extreme pain, couldn't
sleep on it, like just it wasoff work, and she'd seen
(15:27):
numerous other practitioners andshe was frustrated like a lot
of times right, you're in pain.
Speaker 2 (15:32):
No kidding.
Speaker 1 (15:33):
And so, and I don't really know what happened, but I
just, you know some people youjust connect with, yeah, just
sitting there and just having aconversation with her, and I
asked her, you know what, whathappened?
You know to like, when did youfirst start to notice this, this
problem?
And nobody had asked her thatbefore.
They kind of just were likeshe'd come in shoulder assess
(15:56):
you have frozen shoulder, dothese exercises like you know,
beat the snot out of it orneedle it or stretch it,
whatever.
She had all kinds of thingsdone.
And she said oh well, ithappened a number of months ago.
I left my husband, who isabusive, and he had pulled on
her shoulder, you know, and andyou know I didn't get a lot more
(16:17):
details about this.
Okay, this is.
There's a lot of trauma here,so physical trauma, but a lot of
emotional, psycho, psycho,social stuff.
And I said, oh, okay, well, youknow, thanks for sharing that
with me.
You know, did you want to talkmore about that?
Or you know, what would you,what would you feel comfortable
with?
And she just started telling meher story and we had an initial
visit.
(16:37):
That was scheduled I think itwas for 45, maybe 60 minutes,
and she talked for the wholetime and I said do you want me
like to do anything like kind ofget you on the table like I'm
supposed to put some hands onstuff?
She's like no, this feelsreally good, I need to get this
out of the way.
So she unloaded all of herstuff on to me and you know I
didn't scare her, you know Iguess she came back, yeah, but
(16:58):
the moral story was, is that, bygetting that consistent with
what you said, I held that safespace for her to tell me what
was going on.
And then after that it was justa series of treatments where we
didn't.
I felt like I wasn't doinganything.
I was just kind of holding herarm and gently massaging it,
gently, getting to some gentlerange of motion and if you
watched from you know, in asoundproof booth, people
(17:20):
probably would have thought whatis he doing?
Is he doing anything?
But it wasn't the power of thehands on, it was more about the
power of the relationship andthe trust and her allowing me to
do something that made thatshoulder hopefully feel better.
That seemed to be the mostimpactful thing and that was one
(17:42):
of those things that justreally switched with me.
I was like, okay, so this,everything I think I know is now
thrown to the side.
And this was this one of thoseearly moments in where I really
started to shift my thinking,because I was like this doesn't
make sense compared to what I'vebeen educated to think.
Right, there you go.
Speaker 2 (18:05):
Thank you for telling me that story Many, many, many,
many times.
Most of my practice over theyears related to working with
people who had some measure oftrauma in their life, whether
it's personal trauma or there'scomplex injuries as a result of
car accident or whatever.
But trauma was a real focus forhow I was working with clients
(18:30):
and what you described asexactly my experience.
Sometimes what people need todo is to get that story out of
the way so they don't have toexplain it anymore, and the fact
that you were able to hear herand validate, just simply by
bearing witness to what she wastelling you.
You're not in any way engagingin psychotherapy, which
(18:56):
sometimes the regulatory bodiesget alarmed about, right,
massage therapist talking aboutclient experience.
The fact is, you're gettingthat stuff out of the way so
that you can put your hands onsomeone and they won't feel like
they have to say, oh don't, oh,don't touch there, right?
(19:17):
So I feel quite strongly thatone of the things we do is to
contain, to hold the space for,our clients experience.
And you know, christopher Moyer,back in 2004, published a
fascinating study about theeffects of massage therapy being
(19:37):
akin to equivalent topsychotherapy.
It was a very interesting studyand it eventually, people who
remember that study coming outwill recognize it.
But we don't talk about it verymuch anymore, and yet it's just
as true now as it was in 2004.
(19:58):
And I'm grateful to Chris Moyerfor that work because, well, in
my own case, it validated myexperience as a massage
therapist and I went yes, thisis what's happening.
Right, clients are not comingto see me for psychotherapy,
(20:18):
that's not it.
They want massage therapy.
But there is a need toacknowledge the human experience
in that hour in order for us toreally see who's in front of us
, who's on the table.
Speaker 1 (20:33):
I'm glad you brought up that Moyer paper.
I love that paper.
I use it often, I talk about itoften in some of the courses
and things I do, because it'sand it's 2004.
So we're 2023 now it was 20years ago, almost 20 years,
that's right.
And it's talked about, but it's,it seems to give us, as a
(20:56):
profession, it kind of gives ussome insight into what is it
that's happening when we'retreating people, when we put our
hand, what's happening right,and if that paper talks about,
you know, the impacts of massagetherapy are very similar to
that of having a psychotherapysession in terms of is it
anxiety, depression and, yes,capacity is asleep, yeah, and
sleep, yeah, sleep capacity,that's right.
(21:17):
And so you're like, okay, sopeople, some people might hear
that and think, well, massage isuseless, it doesn't do anything
.
And I hear that and I thinkthat's fantastic Because we know
that anxiety, depression andsleep are three huge factors in
a lot of pain and pain-relatedbehaviors and in disability, and
if you can provide that safespace for someone to feel better
(21:40):
, then that's really powerful.
Speaker 2 (21:42):
And how do we heal?
We heal by resting.
We heal by putting ourselves inthat parasympathetic mode.
And if what massage therapy isdoing is facilitating better
mood and improved sleep, wait aminute.
That's all about healing.
That's what we do.
But we have, as a profession,valued the nuts and bolts, the
(22:07):
mechanics of what we do, becausewe can see, we can touch, we
can feel the soft tissuechanging under our fingers.
So we're valuing the impactwith our hands but have in some
ways been conditioned not tovalue what we're doing with our
hearts or with our minds, and Ithink that's a great disservice
(22:30):
both to the profession and alsoto the clients.
It's terrible.
Speaker 1 (22:36):
One thing I felt for a long time is that, in order to
be valued or validated as ahealthcare profession, massage
therapy tried, I think for along time, to identify as
physios, like we were kind oflike, and we're kind of like
physio light, you know, like youknow we wanna be that kind of
(22:56):
mechanical, tissue based, youknow, orthopedic based
profession.
But we know that we have thisreally powerful impactful
effects when we're givingmassage and we have the hands on
people.
But I feel and this is justtotally my bias is that by
trying to hold on to this verystrong kind of physio identity,
(23:17):
it's actually stopping ourprogression from moving forward
where we can say, hey, you knowwhat?
Yeah, we know orthopedics, weknow my scleroscleropathology,
but we're really good at thiskind of psychosocial stuff.
It doesn't involve counseling,it doesn't involve like working
out a scope, but we can makepeople feel better through
different avenues that I wouldsay, you know, are probably,
(23:42):
depending on the person, just asvaluable and maybe even more
valuable.
Speaker 2 (23:45):
Well, and the irony is, if you talk to physios,
they're slightly envious of whatart training is, which is so
hilarious.
You know, physios have master'sdegrees and they're highly,
highly educated in understandingthe function of the human body
and how to improve it.
And then, if you've been in acourse with physios, they will
(24:13):
sometimes kind of shake theirheads at what comes out of the
mouth of massage therapists,because the manual therapy
skills that we have areexceptionally fine, but it's not
the whole picture, and when wedon't acknowledge the whole
picture, we miss the point ofwhat's really remarkable about
what we do.
It's hard to talk about it,though, don't you find it's hard
(24:37):
for massage therapists toacknowledge that what they did
was hold the space for a client.
That takes a certain degree ofmaturity to actually recognize
and then acknowledge that that'swhat you're doing.
Speaker 1 (24:52):
It's not my hands my hands right it's holding the
space, yeah yeah, and this comesdown to the one thing that kind
of always drives me a littlebit crazy is all the different
modality empires out there andall these different ways of
selling hands-on techniques.
And you think, well, we knowthat there's not one modality
(25:15):
that works better than the other.
They all have value.
If you're touching somebody ina way that is meaningful and
safe, then how can one be rightand one be wrong?
How can you have eight or 10,maybe more, 1200 different named
modalities and they all claimto have effects on people and
(25:36):
the people that practice thatway.
They, you know well, I getresults with my clients.
Well, of course everybody does,otherwise we wouldn't have a
profession, right?
So everyone has this differentidentity and again, it creates
these silos of ways of thinkingwhen the commonality is that
you're working with the humanand you're just using a
different way to interact withthem.
Speaker 2 (25:59):
You know what's really interesting, eric the
psychologist, the AmericanPsychological Association
acknowledged a similar kind ofphenomenon among psychologists,
right?
So there are hundreds ofdifferent techniques or
treatments or approaches forpsychologists, and so the
(26:22):
American PsychologicalAssociation I think it was back
in 2007 or 2008, published thishuge textbook full of evaluating
various different kinds oftechniques that psychologists
use, and what they concluded inthe end was the technique that
(26:44):
is used makes the practitionercomfortable, but what really is
going on is the fact that theclient, or, in their case, the
patient, felt validated, theyfelt heard, and this is actually
called the common factors model.
So the common factors oftreatment in healthcare account
(27:14):
for I'm going to make up astatistic, but it's like
somewhere in the vicinity of 80to 90% of the progress of a
client.
You think about the woman youwere talking about with the
shoulder problem.
What she really needed to dowas tell her story, feel heard
and gradually, like a deerthat's been in freeze mode,
(27:39):
because they feel like they'refrightened gradually her
shoulders going to thaw, if youwill, so that she can move it
more, and then you can deal withthe physical trauma.
But until somebody can pullthemselves out of that
frightening mindset is prettyhard to heal.
(27:59):
So what the psychologist figuredout was, oh, just sitting and
watching people making eyecontact, providing compassionate
, attentive listening skills.
This is therapeutic massagetherapists do it.
You described exactly what youwere doing in your own case,
right?
Well, that's what I would likeour profession to value a little
(28:22):
bit more, because for my money,I think that's really essential
.
And that's probably whereChristopher Moyer was realizing
that massage therapy was likesome of the other psychological
treatments, where it's just likeone more way for people to feel
validated and heard, so thatthey sleep better, they feel
(28:44):
less anxious and they're lessdepressed.
I don't know, I'm maybeextending that research a little
bit further, but it makes senseto me that those two realities,
the common factors and what hediscovered could actually link
together.
Speaker 1 (29:00):
Yeah, yeah, that would be nice to we had more
research or more people doingthat kind of research in our
profession, and it's too badthat last I'm making probably an
assumption here, but I thinkChris Moyer I mean he had a lot
of papers and he was reallyinvolved in this stuff but I
think probably 10 or so yearsago, I think he probably just
got frustrated and kind of didsomething else, because I have
(29:22):
not seen him publish anythinganymore.
Speaker 2 (29:24):
Yeah, I think he did go in a different direction.
I'm not familiar with what itis but there wasn't a lot of
future in his research becauseit wasn't necessarily super well
understood.
I don't think.
Speaker 1 (29:37):
Well, I don't think he's gonna listen to this.
But if anybody listens to this,I know I'm telling him to get
back on the horse and see if wecan, because we do need it.
Would be nice to have somebodywho PhD that is invested in or
understanding of the professionand how to do that would be
great.
But yeah, he definitely hasbrought up some great things and
I like that you said I've neverheard that before the common
(29:59):
factors model.
I was familiar with the generalidea that psychotherapy doesn't
really matter which techniqueyou do, or it's all about that.
Speaker 2 (30:13):
Who, not the person is like who.
It's the connection between thetherapist and the client and in
massage we all know this.
Like finding a massagetherapist you relate to is all
about who you wanna hang outwith without your clothes on and
be touched by.
It's very intimate.
Speaker 1 (30:33):
It's very intimate and it is kind of funny.
Our profession is that.
It is odd, if you think aboutit, if you had to describe in
one sentence what is it you dofor living.
You're like a touch-nakedstranger, Like it sounds really
bad, right, but it's somethingthat we should understand the
power balance and thevulnerability that people have.
(30:55):
And I remember very clearly frommy first day in massage school.
Our instructor in the first daysaid welcome to the only
profession in the world wherecomplete strangers are gonna
take off their clothes and turntheir back on you.
I was like what?
And at the time I was kind ofshocked.
But it's always stuck in myhead.
That's actually really a powerthing to know because,
(31:16):
especially being a man, andthey're gonna pay you for it.
They're gonna pay you for it,and pay you pretty well too.
But it's one thing it's alwaysstuck in my head, being a male
too.
It's like, okay, there's thislike you gotta be like above bar
in terms of like communicationand consent and all the things,
so there's no room for.
Speaker 2 (31:36):
Misunderstanding.
Speaker 1 (31:37):
Misunderstanding.
Speaker 2 (31:39):
And you know, I think that that's really critical,
that we need to be after a while.
Let me go back when you'refirst in practice.
You kind of remember everyclient up to about the third
month, and then they start toblur and then after three years,
(32:01):
you actually can't rememberwhether you've met certain
individuals before.
Well, imagine, after 35 years,people will meet me in the
grocery store and they say, ohhi, pam, and they want to tell
me about their story and I'mthinking who the hang are you?
And I have no recollection.
(32:23):
So so one of the things that,as massage therapist, is really
essential, and especiallyimportant for men who are in the
profession, is that we need tohave our own set of values and
principles that we adhere to sothat, no matter who we talk to,
no matter whether we recognizethem or not, if they see us in
(32:45):
the grocery store, we arebehaving with a level of
consistency and integrity sothat the person they trusted is
still the person in law.
Laws at the vegetables right.
Speaker 1 (32:58):
Right.
Speaker 2 (33:00):
There's something that's really essential and an
important about that, becauseimagine that you treat somebody
in your first year of practiceand then, five years on, you
meet them on the street andyou're having a bad day and
you're swearing to yourself andthe individual comes up and says
(33:20):
, eric, is it you?
And you think, oh God, what didI just say right?
Or you're at a cocktail party,or somebody says something and
you bad mouth another individualwho we are in the treatment
room.
That integrity we need to alsobring it into our lives and
(33:40):
that's a tall order.
That's a big tall order toactually instill that value in
students.
But as massage therapist, thatconsistency is really, really
important.
Yeah, and Amanda basketball andsome of her colleagues did some
work around male massagetherapists and did you happen to
(34:02):
see the article that?
Speaker 1 (34:04):
the no, I know, I know I'm Amanda.
I've spoken with her before,but I've never.
I have not familiar with thatpaper, so so part of her.
Speaker 2 (34:12):
PhD research was in professional identity, and so
one of her chapters was in theexperience of male massage
therapists, and the conclusionthat she drew and made into the
title of the paper was justdon't be creepy, right.
Speaker 1 (34:32):
Yeah.
Speaker 2 (34:34):
So for massage therapist it becomes essential
that you can both empathize withyour clients experience male,
female to spirited, gender,queer, non binary, whatever and
if you can empathize with thatclient experience and your male
(34:55):
and you demonstrate in yourbehavior that you can be trusted
, that is golden.
That is so healing.
So my experience with clientswho've had a history of trauma,
quite often the final frontierfor them in healing from trauma
especially if there's been anykind of sexualized or physical
(35:18):
trauma at the hands of a male isto go see a good male massage
therapist so they canacknowledge that that was then
and this is now and this personis a good person and I can trust
them and I can judge goodcharacter.
Like all of these things arecomplicated and our modality is
touch, so that's where itbecomes really.
(35:39):
It's the road, if you will,yeah the hand back.
Speaker 1 (35:44):
Yeah, yeah, yeah, that's actually.
That's such a great, greatpoint there and I'm gonna have
to, I'm gonna have to read that,that paper.
That sounds good.
Don't be creepy.
I mean, which is you know?
That's that was kind of mymantra too is like don't be
creepy and you know, try andjust be, be normal and be
thoughtful and be aware andcommunicate and over communicate
and and, yes, don't be creepy,and hopefully nothing bad will
(36:06):
happen.
So, not good, I'm still here.
Speaker 2 (36:12):
So this is a level of emotional intelligence and that
is not that is not the case forevery person studying massage
therapy.
So emotional intelligence needsto be born out of your
awareness, your perspective.
But yeah, that's how you don'tbe creepy.
Speaker 1 (36:35):
So that's a bit of a loaded question, so you can feel
free to answer how you wish.
Do you feel that?
So emotional intelligenceusually comes with with maturity
, like as you get older youbecome more, you know better at
being a human, hopefully, andbetter being an adult and
recognizing these things.
Do you do you see itproblematic that you know people
(36:57):
can enter this profession thatreally young ages where they
probably don't have thatemotional maturity?
Speaker 2 (37:02):
I'm generalizing, but you're generalizing, and I
certainly generalized.
At the beginning of my teachingin a community college setting.
I would have students who are17 and I'd be like how can you
do this work?
Some of them would never havehad intimate sexual relations
with anyone, so that I couldn'tunderstand how they could have
(37:26):
formulated attitudes towardsother people, touching people
that were complete strangers.
But over time I realized thatthere are individuals who are
very young, hugely emotionallyintelligent, and age is not the
issue, it's the capacity torelate in a kind way, in a
(37:51):
compassionate, not judgmentalway, to another individual and
to be able to listen.
There might be people who weresocially awkward in my classes
and those folks really didstruggle in massage therapy
because quite often didn'tunderstand what the client was
saying and the client might begiving them very subtle cues and
(38:13):
the cues were going over theirhead.
So that's not necessarily aboutage, that's more about your
capacity to observe or payattention to the cues that
you're getting.
So I take your question,certainly felt that way in the
beginning, but I think it's moreof the emotional intelligence
goes across the ages and it is amuch more complex kind of
(38:38):
phenomenon.
Speaker 1 (38:39):
I'm actually glad you said it, because I was saying
that to try and load it, just tosee how you would answer
because in my experience when Iwas in school, I was 25 when I
started massage school, but agood chunk of my classmates were
18, 19, 20, 21.
I think almost all of them, 20through 20 plus years later, are
(39:01):
still practicing and they aresome of the most fantastic
therapists I know.
So I had nothing to do withtheir age, but I remember the
time going to school.
I remember thinking why, like,just so young, like you know,
and this is what you're enteringthis career right now, and that
was my big.
I mean, I was, I was only fiveyears older than them, but you
know it felt the time right, Iwas only 25.
I'm ancient.
I felt like one of the old guys, right, and.
(39:22):
But some of the best therapistsI knew were and people I know
are were young and and.
But it was sorry, go ahead.
Speaker 2 (39:34):
What makes the absolute best therapist is
somebody who's been a clientfirst and knows what they're
comfortable with, and they alsorecognize what they're
uncomfortable with, and whenthey acknowledge that in the
treatment room, then they'reestablishing a level of safety
for the client.
Sorry, I interrupted you.
Speaker 1 (39:56):
No, no, no, no, that's, that's an interjection.
Every want, pam, that was, thatwas a great little thing.
You added no, I shouldn't say,but the like what you said to
about the social awkwardness andthat was the thing is that the
people, I think, that tend tostruggle where, the ones that
people that have trouble withthe social, the social
interaction, the social cues, orthey don't feel comfortable
talking to people.
(40:17):
But yeah, age I don't thinkmatters.
There's, I mean there's peoplein my class that are quite a bit
older than me too and I thinkthey're still practicing.
So it's age doesn't matter perse, but anyway, it's a little
side track there.
One thing I wanted to ask youabout to, one thing I want to
talk about is, obviously ourfocus is kind of on ethics and
and and whatnot, but one of mymain areas of interest is on
(40:38):
evidence based practice and youknow, kind of trying to
incorporate evidence into whatwe do, and the more we learn
about evidence, more I realizeit doesn't give us a lot of
answers.
Anyway, it kind of gives usmore wrong, less wrong ideas,
but nothing is for certain,particularly what we do right, I
would say evidence basedpractice is really good medicine
, really like you have a heartattack.
(40:59):
This is the thing we're goingto do.
This is the best evidence wehelp people at hurt.
There's a pro, there's a lot ofstuff that we don't need to
worry about.
That's why I think evidence isuseful, but I also think it
doesn't give us a lot ofcertainties.
But there's some stuff that Iwanted to talk about.
Was, you know, like there's?
(41:20):
There's, I feel, and I want youto hear your point.
Your opinion is this is therelationship between ethical
health care and evidence basedpractice.
Do you see there there being arelationship between how those
things function together?
Speaker 2 (41:33):
100%, absolutely there is.
When I first became a massagetherapist, there were a lot of
people doing colonics.
Where they were doing a colonic, irrigation was a big thing
back in the early 90s, right.
Well, that has been debunked asa form of treatment, but at the
(41:57):
time there were many massagetherapists who thought, oh, this
must be good, so you should godo this If you had abdominal
issues.
And what I see in massagetherapy among practitioners is,
if this is the case, then that'sthe option.
It's kind of like recipe basedhome care, without a lot of
(42:20):
investigation as to the theevidence to support the decision
making.
We will often tell peoplethings that are completely out
of our own opinion and we'lldress it up by saying something
like well, there's research tosupport this idea.
(42:41):
Oh yeah, if you read it, do youknow what the caveat says?
That you know this research isonly good if these are the
circumstances I think massagetherapists are.
This is going to soundpejorative.
Massage therapists can besomewhat lazy in their
(43:05):
willingness to actuallyinvestigate the effects of
certain actions.
And the other whole piece ofthis, back to what I was saying
earlier is that if we look atthe social science research, if
we look at qualitative researchand we consider client
(43:28):
experience, the empiricalexperience of long standing
practitioners.
If you've seen 20,000, ifyou've performed 20,000
treatments, you have aperspective which is there's
evidential kind of perspectivethere.
If you've only been in practicefor a year and you're telling
(43:50):
people that they should do thisand that and the other thing,
that's not helpful and that'snot evidence-based.
It's just trying to make usfeel better about ourselves,
that we know something special,that we're important.
(44:10):
That's not evidence-basedpractice and it puts the clients
at risk sometimes.
I think so.
I think there is an ethicalprerogative that we need to
carry out if we're a massagetherapist yes, that was a very
long-awaited story yes, theanswer to your question, yes,
(44:35):
okay.
Next.
Speaker 1 (44:36):
Next no, no that's good, I wanted to.
I just wanted to.
I mean, I made an assumptionthat that would be your answer
and that just kind of leads intokind of what we want to talk
about, kind of in the lastlittle bit of this conversation.
As you mentioned earlier aboutthings like informed consent,
and this is something that Istrongly feel needs to be talked
(44:57):
about more, and I reallystrongly feel that the
stakeholders in a professionneed to understand the
implications of the way thingsare being done and the way,
because I feel that, if we'relooking at at least how I
understand informed consent is,it's not being met.
So, and this goes to the thing,like, is it possible, like is
(45:21):
it ethical for our entities tomake a claim they can't support,
which would kind of fit intothat evidence-based thing you
know, like, what claims can weactually make?
If we understand the evidencesays you cannot permanently
deform tissue with your handsand you don't need to for people
to feel better, that doesn'tmean what you're doing with your
hands is useless, but it meansthe claims you're making about,
(45:42):
oh, I'm interacting with thisspecific tissue or I'm altering
this specific joint, or whateverit is you might wanna claim, if
there's not evidence to supportthat, then is it ethical for
you to make those claims?
Speaker 2 (45:55):
I don't believe, so I'm gonna make that the short
answer.
Speaker 1 (45:58):
Yeah, I don't is ethical.
Speaker 2 (46:00):
The ethics is the study of right and wrong, the
principles by which we form ourattitudes in our practice.
So if you think about that,then the choices that you make
as a professional should landyou on the side of principles
(46:20):
that support healthy practice.
The client feels better.
We don't hurt ourselves asmassage therapists.
We stay within our scope ofscopes of practice, whatever
they are, however they'redescribed, and if we do all
those things, generally speaking, clients are not gonna be
injured and our regulatorybodies are not going to feel
(46:46):
overwhelmed with the number ofcomplaints against us as
professionals.
Where we get in trouble is whenwe make claims that are not
supported or we touch people inways that they didn't anticipate
and they feel veryuncomfortable and they don't
launch, or they feel that theywere.
You know, on the far end ofthat spectrum, they were abused
(47:10):
by a massage therapist or, worstcase scenario, there was
predation, like there's acontinuum here of care.
So if you're working withinyour scope of practice and you
are making good decisions basedon what you know about what's
available to you, you know thatgives you a pretty wide scope of
(47:34):
what you can actually performin the treatment room.
Where I get crazy.
I just oh.
It makes me crazy is whenpeople use language which is
super imprecise.
For example, when I hearcertain individuals telling me
that they're tuning the liver, Iwant to scream, because what
(47:57):
does that mean?
In my other life, I'm amusician.
What does tuning the liver mean?
Applying a tuning fork to theliver?
Well, people use tuning forksin some capacity in their work,
but hitting the liver with atuning fork isn't even going to
create a sound, because it'sgoing to be kind of a splat.
Okay, so what's that mean?
(48:18):
So tuning the liver is whatyou're doing alleviating
palpable tension in thestructures that are holding the
liver in place.
Now I can understand whatyou're talking about.
There's more precision in thatlanguage and you've probably had
this experience yourself, eric.
I've had people tell me oh, myother massage therapist told me
(48:43):
that I have this problem, or mydoctor has told me I have a
degenerative disc, or I have,well, any number of conditions,
and I always want to know.
So how did they find that out?
How was this determined?
And when you start to unpacksome of the determinations of
(49:09):
the impressions that clientshave about their conditions,
quite often it's becausesomebody has said oh yeah, it's
really common.
You got a degenerative disc, ohyeah.
You've got this, oh yeah.
And it's just irresponsiblebecause clients are like sponges
they hear everything we say andthen they interpret what we're
saying and then they share whatthey think their interpretations
(49:32):
are with somebody else.
And it's like that old gametelephone we used to play as
kids.
So what you may have said tosomebody is not gonna bear any
relationship to how it'sactually reported.
Three or four practitionersdown the line.
It's really essential what wedo, that we say carefully what
(49:53):
it is.
We can do, what our capacitiesare as practitioners and we're
describing what we're doing in avery precise way.
It's yeah, that's advanced care.
Speaker 1 (50:06):
But I'm so glad you expanded on that, because the
way I see it too is that if wedon't understand the evidence,
then we can speak in these veryprecise terms and we can say, oh
, you hurt, you're back a sore,because you've got a right
elevated enomniate on and you'releft, as you know, say terms
(50:26):
this is whatever, and you canmake all these big kind of like
things and you say, well, how doyou know that?
Well, I can see that, I can feelit, but maybe the person is
always like that and they don'thave pain and maybe that's not
related to pain.
And we look at the research, itjust says those things, there's
not a strong relationshipbetween those things and pain.
Anyway, that's just.
You know, sometimes that's howpeople present and maybe it's
nothing.
We're all different, no one'ssymmetrical.
(50:47):
But we start to make theseclaims to validate why the
person is sore.
And then when we make thoseclaims to value the sore it
gives us, makes us feel good.
And but the way I see it islike, first off you're kind of
making something up because it'snot evidential, and then you're
telling the person this is whyyou hurt, and then they're
giving you consent to treatbased on this thing which
(51:08):
doesn't exist.
So the way I see it is likewell, that's not informed
consent, Because you're givingconsent to something which isn't
real or isn't related.
Speaker 2 (51:20):
Inform, consent is about negotiating the process.
Whatever it is I'm going to dowith you is if you're the client
, right?
So first of all, I have tounderstand what the purposes,
what the circumstances are thatcreated the condition that the
client's reporting.
And then I need to observe withmy eyes, and symmetry is a huge
(51:45):
indicator for what we'relooking for, right.
So I'm looking for asymmetriesor postural anomalies, or
listening for indications of oldinjuries or all of those things
.
That's all true, but then whenI'm negotiating with somebody
how I'm actually going to put myhands on them, where I'm going
(52:09):
to put my hands on them, howthey're going to be draped, how
long I think the treatment'sgoing to be, and what I would
imagine is the time it's goingto take for us to do this.
Well, that's the informationthey need to determine whether
or not they want to engage withme.
Because if I start touchingthem and they haven't given me
(52:29):
permission and they suddenlytake offense to what I'm doing,
it's possible that they couldclaim that I've assaulted them
because I never told them what Iwas going to do.
Under the criminal code, thatis assault.
Yeah, I once knew a formerpolice officer and he would come
(52:53):
into my classes and talk to mystudents.
One of the most bald statementsthat he ever said that I've
never forgotten is if you putyour hands on me and I'm the
client and I haven't given youpermission, you have assaulted
me under the criminal code and Ican ask for you to be charged.
(53:16):
My students are went right,because that goes to the heart
of what we do as massagetherapists.
That's why what we do is bothso revolutionary healing through
touch but also potentially sodevastating, because if we touch
without permission, we may bereinforcing old traumas.
(53:38):
People may be offended, theymay be hurt, they may be harmed.
So we have a responsibility tomake sure that that conversation
, that negotiation for consent,is explicit.
At the end of that conversationthere has to be the question do
I have your permission to goahead?
There has to be the statementif, at any time, you feel
(54:02):
uncomfortable with what we'redoing, let's stop or pause,
because I don't want you to feeluncomfortable.
If those things are in place,then you're probably getting
adequate informed consent fromyour client.
But if they're not there,you're just going through the
motions.
Speaker 1 (54:20):
Yeah, thanks for clarifying that, ben.
That's very helpful, I think,for me and for that.
No, that's okay.
I can tell your passion aboutthis.
This is why I wanted to haveyou on for this, because I knew
that you would have moreexperience and knowledge and
then this than most.
So I appreciate that.
So one thing that I want totalk about so when we talk about
informed consent, we also cantalk about do no harm, which is
(54:42):
the first thing that we'realways learning.
The way I've interpreted thisand correct me if I'm wrong and
I'm happy to be wrong is that dono harm.
Oftentimes is talked aboutphysical harm.
I'm not going to hurt youpurposefully.
I'm not going to do anything tomake you worse.
Could we expand that into moresome of the psychosocial harms
(55:02):
or the unhelpful beliefs andnarratives that people have?
If, by telling them stories andmaking things up to try and
justify a treatment and maybe,like you said earlier, people go
the game of telephone, they'retold all these different things
Maybe it's true, maybe it's nottrue, but maybe, if it's not
(55:24):
true, but the person believes itis to be true and that impacts
their behavior in a negative way, could we include that in that
ethical concept of do no harm?
Speaker 2 (55:35):
You just set me up right, because of course, of
course you can.
Of course you can Imagine thatyou have a client who has a
weight issue, so they'remorbidly obese.
Well, obesity is one of thoseconditions that lots of people
(55:55):
who are not morbidly obesebelieve can be solved by simply
restricting your calories.
And that is not the case.
After a certain point, whenpeople are morbidly obese, yes,
they may be eating more thanother individuals, but all of
our systems become so pulled outof whack that it's my clinical
(56:21):
term pulled out of whack soyou're not able to respond to
food in the same way.
You don't digest it, you holdit in your system and the
obesity becomes a full systemchallenge.
So I've heard massage therapists, for example, say to people
(56:44):
well, if Jack would just lose abit of weight, he'd be so much
better, his knees would functionbetter.
Yeah, that's not helpful,because obesity may be a factor
in the condition of people'sknees, but we are also not
trained in the particulars ofobesity enough to be able to say
(57:07):
lose weight, your knees willget better.
That's not the way things work.
It's very complex and I comeback to my earlier point.
I think sometimes we look for avery simple.
If this, then that kind ofresponse that we can share with
our clients to make us feelbetter, to make us feel
(57:28):
knowledgeable, that's nothelpful.
Our job is to listen to ourclients' needs and see where our
skills fit in theircircumstances, and if they don't
fit, we recommend somebody else.
We don't hold onto them asclients, we let them go if we're
(57:49):
not able to help.
It's complicated, but I thinkthat there are a lot of ways you
can take your question Again.
I could lecture you at lengthon that one.
Speaker 1 (58:03):
No, that's fine, you can lecture if you want.
I know you're retired now soyou have no pressure to get back
in front of the front of thebook and lecture.
But I just wanted to bring thatbecause it's just in my world
of where I first got my focus interms of advancing my education
and the stuff I teach is in thechronic pain and that's where,
(58:28):
the more I learn, the more Irealize I don't know, but one
thing that I have learned aboutit is that a lot of people, when
we're looking at thequalitative literature or the
lived experience, a lot ofpeople that suffer and pain and
are disabled by it, theirdisability it's not their level
of pain per se but theirdisability, how much pain
(58:48):
impacts their quality life isreally influenced strongly by
the messages and the narrativesthat were given to them by
well-meaning health careproviders who were saying things
just making I shouldn't saymaking stuff up, but they were
saying things to try to help, totry and justify why a person
hurts.
But then the person going getstreated for that thing using
(59:11):
said modality or intervention,and they still hurt and then
they go and see somebody elsewho provides a different
narrative, a different story anda different rationale for oh,
this is why you hurt, is becauseI found whatever, and they get
treated for that and then theydon't feel better and it creates
a cycle of disability andsuffering and I would see that.
(59:34):
I see that as extremely harmfulbecause you're trying to help
the person but because you mightnot be aware of the evidence
for that condition or you mightbe unaware of.
Yeah, we know that the evidencefor ultrasound is whether the
(59:56):
machine's turned on or not.
It doesn't matter.
Some people might enjoy it,some people might not and some
people might feel better.
But it probably has nothing todo with the machine going bang
or not.
It might have something to dowith chemical context, but
people get sold these ideas totry to fix them and it seems in
a lot of cases where the painpersists, that they end up
suffering needlessly or longerthan they should because of the
(01:00:22):
harm of the stories they'retaught.
And I see that and this is myopinion I see that as a big
ethical dilemma that needs toreally be addressed at, I think,
a lot of levels in health careand in our profession.
I think that needs to be astakeholder issue because we
need to understand we've allowedthings like pseudoscience and
(01:00:46):
made up stuff to flourish at alllevels, and I don't think it
does the public any good.
Speaker 2 (01:00:56):
I once knew somebody who lived with Ehlers-Dannells
syndrome and the individual hadexperienced multiple 5, 6, 7 car
accidents, a variety ofdifferent circumstances over the
course of their life and, ifyou can imagine, combination of
(01:01:16):
the trauma of the motor vehicle.
So sudden impact plus acondition of Ehlers-Dannells
would result in not only softtissue damage but neurological
challenges as well, because theywould not be able to
accommodate the force, even ifthey braced the nerves for going
(01:01:39):
to get stressed.
So this individual ended upwith, oh my goodness, half a
dozen different health careprofessionals that they were
seeing, and each health careprofessional had a perspective
on the circumstance, and not tosay that massage therapy is the
thing that was the most helpful.
(01:02:00):
But the approach for thisclient that made a difference
was that we just simply stoppedtrying to figure out is it T6?
Is it T7?
Is it C1?
Where's the TMJ it was how areyou doing today and what can we
(01:02:25):
do that will make you feelbetter at the end of this hour?
Because there were so manyfactors in this individual's
healing.
I couldn't promise that we weregoing to get rid of it all, but
I have seen this client formany years and what has worked
best is presence, observation, afocus on symmetry.
(01:02:51):
Do no harm, don't make thingsworse, and whatever we do, at
the end of the hour I want thisclient to feel better.
That's what we're doing.
And can I tell you what handposition is the most helpful?
No, because it changes everyweek, every time I see this
(01:03:13):
person.
Well, there, in a nutshell, isthe nature of our work.
We need to be open to what'spossible but, at the same time,
contain our skills.
We need to pay attention towhat we're seeing without making
(01:03:37):
things worse.
And you can go on.
It's a continuum on a varietyof different levels and it is
complex.
What we do so, ethically, Ifeel the most important thing I
can do for individuals is tojust simply listen, pay
(01:03:58):
attention to what I'm seeing andoffer something in the hour
that we are together and thendetermine whether that was
helpful when I see them the nexttime.
I don't try to go too muchfurther than that because,
especially when you see peoplewith complex presentations, it's
different every time.
There's all kinds of thingsthat have happened between the
(01:04:20):
one day that I saw them thefirst time and the next time.
Speaker 1 (01:04:23):
Yeah, I love that, pam, so much.
It's really.
The clinical brilliance is insimplicity, yeah, but it's not
easy.
It would be to say simple, butit's extremely complex.
What understanding at all?
Speaker 2 (01:04:41):
When I'm teaching my courses, erica, I really have
often said like everythingyou're going to learn here today
is context for what you'redoing within the treatment room.
There's not a lot of.
You all have the skills, I havethe skills, we all have that
stuff in place, but the context,the perspective that we bring
in, that rich perspective thatcomes into the treatment room,
(01:05:05):
is what makes it different forour clients when they feel heard
in a new way and recognize tome that's the gift of what
Massage Therapy does.
I just love it.
I think it's one of the mostfabulous professions.
I love the work but it'scomplex interacting with people
(01:05:28):
with integrity and ethically.
Speaker 1 (01:05:30):
Oh, 100%.
The thing is, you have some ofthese podcasts and stuff.
I feel the need to challengethe status quo sometimes, or to
try to do things to push ourprofessors forward, because I
feel like we're dragging ourfeet about adopting changes in
terms of how we are educated orhow we think.
I love how you brought thistoday, really Highlighting the
(01:05:56):
importance of it.
May not be sexy, it may notsell courses, it may not make
any of us rich.
It may be like can you justhold a safe space?
Can you listen?
Can you communicate in a waythat is non-threatening?
Can you explore a differenttouch and different positions
and different be curious withyour person that comes to see
(01:06:19):
you?
That is the clinical brilliancethat I feel is not emphasized
or understood or appreciated asmuch as it could be in our
profession.
I think we do fantastic work.
If anyone thinks that I'msaying otherwise, then you're
(01:06:39):
not listening.
I think we have such a hugepotential impact to change
people's lives and we do.
I think we could be even betterif we just address some of
these things that you talkedabout today and said, yeah, this
is where we should be focusingour energy on and you're
probably going to have better.
We can't produce.
(01:07:00):
We can make better outcomes,but you're probably going to be
less wrong.
At the very least, you're notgoing to make anybody worse.
Speaker 2 (01:07:07):
If you do that's okay and truthfully, without getting
into a rut where you're notbeing mindful when you're with
your client, if you're actuallypresent, moment to moment, to
what's happening, present inyour hands, what your hands are
feeling, but also what you'reobserving, what you're hearing
them say, if they're sayinganything, if you're present,
(01:07:32):
then it actually shouldn't feellike a lot of work, because we
all have the skills.
We're just applying our skillsin a thoughtful, mindful way.
But if we forget that, weforget that we've got a human
being on the table with a storyand we don't pay attention to
the story, then we get intoproblems, then the regulator
(01:07:52):
gets involved because complaintshappen, right, yeah.
Speaker 1 (01:07:57):
That's such a brilliant way to wrap things up
today.
Pam, thanks for being here.
Thanks for sharing yourexperience, your stories and
your knowledge.
It's highly valuable.
I've really enjoyed theconversation.
If anyone wants to get ahold ofyou, what's the best way for
them to get ahold of you?
Speaker 2 (01:08:13):
I'll give you my website and you can post it.
The link to the textbook is onthere as well.
Speaker 1 (01:08:20):
Perfect, okay, great Well, thank you, pam.
Have a good day.
Speaker 2 (01:08:25):
I'm so lovely to chat with you, Eric.
I really appreciate it, theconversation.
Have a good day to yourself.
Bye-bye.
Speaker 1 (01:08:32):
Thank you for listening.
If you enjoyed this episode,please give it a five-star
rating and share it on yourfavorite social media platform.
You can follow me on Instagramor Facebook at EricPervusRMT,
and please head over to mywebsite, ericpervuscom to see a
full listing of all my livecourses, webinars and
self-directed course options.
Until next time, have a greatday and thanks for listening.
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