Critical Thinking And Planning Your CECs

April 3, 2017/in Business, Massage Clinic, Massage Therapist, Massage Therapy/by Sarah Haag

I’m coming up on my 15th year as a physical therapist. It’s hard to believe, as I still feel so young and I still have so much to learn!

Over the years, I’ve spent many weekends in courses, trying to become a better physical therapist. Earlier in my career, I would walk in, wide-eyed and hopeful that I was going to learn the ‘one thing’ that I was missing from my skill set…another tool for my toolkit.

Over the years, I’d like to think I was more helpful than harmful , but I don’t have any data to support that. I can recall smooshing on ‘trigger points’, trying to release very specific muscles, and giving ridiculously long home programs. I followed protocols, and made a very organized binder of Muscle Energy Techniques.

I would often go home a bit tired, because I spent the day trying to figure out what I was doing wrong, trying to figure out why some people got better and some didn’t. I spent lots of time, energy, and money hoping my next class would be the one where I’d walk out with the skills that would let me help more people.

Then I started hanging out with Sandy Hilton. And reading more research. And talking about what we know vs. what we do vs. what we say we’re doing with researchers and clinicians from all over the world.

It was discussions like these that really made me reconsider how I was looking at continuing education.

How To Start Critically Thinking About Your Continuing Education.

Below is a list of four methods I like to use when picking my next CEC. While it can be tough making these choices at the start, it has been a really beneficial way to start changing my outlook and my practice for the better.

1. Look for courses that teach you principles, not protocols.

Recipes are wonderful when you’re baking. However, people are not all the same. Trying to make everyone fit the same box results in lots of ‘non-responders’ or ‘non-compliance’

2. Look for instructors who don’t mind being questioned, and question them.

It’s often said that if you’d really like to learn about something, teach about it. I believe this is true, and it’s not just the research to teach a topic! I learn so much from people asking me questions, or asking me to further clarify something I’ve said. None of us know everything, so instructors who rely on people just following instruction are actually just looking for followers. Which takes us to the next point…

3. Question what you’re doing and why!

Sometimes it pays to act like a three year old: ask why, a lot. To yourself or out loud. Or a slightly more mature approach that I learned from Sandy Hilton is, “can you walk me through that?”. There should be answers as to why people do what they do. There can be discussions as to why what they are doing may work. You should be able to discuss, defend or explain what you’re doing.

4. Choose courses that challenge your beliefs.

Having people agree with you can feel fantastic! But if you constantly surround yourself with people who agree with you, it’s not likely you’ll come to have a deeper or broader understanding of much. Move out of that comfort zone, and at least consider alternatives to your usual way of doing things.

Photo by: qimono

A New Perspective

Any class or lecture I was attending was no longer a quest for an answer, but rather gathering more information to review and question my current practice.

I embraced that I could walk out of a class and think ‘Nope, I’m not going to do that’. The most wonderful part about realizing I was allowed to critically think about why I was choosing to do (or not do) things in the clinic. I realized I was allowed to respectfully disagree and question ideas. I finally realized that there were no magic answers, and the best we can do is strive to be less wrong.

It was so freeing to say ‘I don’t know’! To embrace the unknown, to acknowledge that I would have to actively work to know more, and even then I would get it wrong.

One thing these realizations did was make me start to question the people I was learning from.

What’s interesting, is that some people embraced my questions and my challenges! And that’s when it hit me: I didn’t need to learn any specific technique! I needed to be a better critical thinker!

A large majority of the continuing education for Physical Therapists (at least in the United States) seems to focus on specific techniques, some involving expensive trademarked tools. Some ‘techniques’ require several levels of training to become ‘competent’. Other courses seem to promise the impossible (or at lease biologically implausible).

The purpose of this post is not to discourage any technique or school of thought. It is to encourage questioning! And thinking! And discussion! And to challenge your biases. (Because we all have them!)

Now when I go to courses, I don’t plan on learning anything to actually do. I plan on listening with an open mind, gathering information, and looking at my entire practice. I’m much more vocal asking questions when points don’t seem to be supported by science or seem to contradict what is commonly accepted. As healthcare providers, we feel a need to do things, to help our patients or clients feel better and be healthier. So on the quest to be better (and we can all be better), acknowledge that the next technique you learn won’t be any more magical than the last one you learned. However, if you reflect and think critically, you may just be able to use what you already know to be better.

What Do Massage Therapy Associations Do For You?

March 27, 2017/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jill Haig

“What do massage therapy associations even do?” I get this question all the time.

We’re not an insurance company, although we do offer insurance, and we’re not a union, although we do represent Massage Therapists. We’re not lobbyists, although we do promote massage therapy to government and stakeholders, and we’re not a money grab because we put every single penny back towards working for you.

We’re an association.

We’re a group of like-minded individuals with a common goal.

So why would you want to give your hard earned money to your professional association? What’s the benefit for you? What do you get for your money? In addition to the obvious benefits like preferred rates for insurance, continuing education opportunities, networking opportunities, access to research, and referral services, we provide insight and guidance, programs and services, tools and resources. But there is a much larger long-term benefit.

We Advocate For You

Advocacy, in its most basic form, means to speak in favour of something.

So, your association speaks in favour of the profession of massage therapy. We promote massage therapy as a part of primary health care to government, the insurance industry, the general public, and other stakeholders. We make people aware of what it is that massage therapists can do, how well you do it, and why it works. We make sure that massage therapy is an important part of the healthcare landscape.

We work for you.

Advocacy is often seen as “big picture work”. Sometimes it’s complicated and often takes a long time, but it also has a direct and practical impact on your career as an RMT. It impacts how you practice, how patients find you, and how you’re viewed. It’s not only your professional association that can make a difference – you can too.

There are really two ‘yous’ when it comes to advocacy. There is the ‘smaller you’ and the ‘larger you’. The ‘smaller you’ is each individual health professional (that’s you!). You demonstrate a commitment to professional practice, ongoing education and continuous improvement. You are the health professional that people point to and say “they are the reason that massage therapy is a valuable health care profession”. You are dedicated to your profession and are able to easily articulate why you have chosen massage therapy and why it works.

The day-to-day interactions with patients and the way you present yourself professionally are ways that you advocate for the profession – perhaps without even knowing you’re doing it. This is advocacy on an individual level and is incredibly important.

It is, in fact, the basis of all advocacy.

The ‘larger you’ is all Massage Therapists combined. It is a “coming together” as an association with a common purpose. It is team work, co-operation and collaboration combined, and that team work has the power to make a real difference. A large group with a common goal can do things that individuals can’t. Doors are open for associations that are not open for individuals. Together, the ‘larger you’ has a louder voice.

The “larger you”, the association, amplifies that voice and directs it towards the appropriate people and organizations. We get the right message to the people who are in a position to make change happen. There’s power in numbers, and numbers get people in a position of power to take notice.

A rising tide lifts all boats. Whatever the association achieves for Massage Therapists will affect you whether you’re a member of the association or not. I get it – it’s easier to save your money, put your head down, and do your job. But as part of the association, you get a say in the way the wind is blowing and how the boat is steered. When you’re not a part of the association, you’re along for the ride whether you like it or not.

Associations reach out to their members to get feedback. We want to know what you need, when you need it and how we can make it happen.

Most, if not all, RMTs think we should have access to extended healthcare benefits. They want to be respected as a primary health care provider. They expect and deserve to earn a suitable income.

Massage therapy associations are the groups that make sure massage therapy is a viable, respected and accessible profession. We want to make it easier for Massage Therapists to do their jobs. You already know how to get a patient back to optimal health. Our job is to make sure that you can provide your professional healthcare services and earn a living so that you can continue to do so.

Photo by: RMTBC

Increasing Credibility Of Our Profession

Massage therapy associations are run by a board of your peers, chosen by you, who identify the issues and trends that will impact the profession and what we should do about it.

The board does extensive research to ensure they are representing the profession and the issues that are current to the day. They talk with members – the people these decisions will directly affect – and determine the way to position the profession for maximum success and the steps that should be taken in order to achieve the vision for the profession.

Massage therapy associations are run by Massage Therapists, for Massage Therapists. We keep a finger on the pulse of the profession and the landscape in which it operates.

Massage therapy associations work for the profession, and massage therapy regulatory bodies are primarily concerned with the public interest. Although these two groups may seem to be opposites, they are really two sides of the same coin. We both work in the best interest of the patient by making sure they are able to access massage therapy receive proper and appropriate care from Massage Therapists.

Both the association and the college must communicate with each other to work towards our separate mandates and our common goals. We both want Massage Therapists to be able to positively contribute to the health of Canadians.

RMTs are working with doctors, physiotherapists and chiropractors, in palliative care, and in hospitals – situations that may not have seemed possible in the early years of the profession. Massage therapy is now seen more often as a valuable healthcare option, which was made possible through years of advocacy undertaken by associations.

I suppose that provides an example of the answer to that frequently asked question ‘what do massage therapy associations even do?’ Associations determine the direction this profession should be heading, determine what we need to do to get it there, and then we actually do it.

The credibility of the profession has increased dramatically over the past few decades, thanks in part to the work of associations. Massage therapy remains the most utilized paramedical benefit in Canada behind drugs and vision care.

But we still have work to do.

Advocacy takes time. To make a significant change takes time. Developing the argument with the inescapable conclusion that massage therapy is an effective and critical piece of the healthcare puzzle is how we spend a large part of our time.

But this is time well spent.

It will ensure that massage therapy is and remains a solid and respected part of the health care landscape. It will ensure that you are appropriately rewarded for your time and effort. It will bring new patients to you because they will be aware of what massage therapy is and how it can help them, and it will ensure that you remain valued as a healthcare professional.

Canada is searching for solutions to the impending healthcare crisis. Massage Therapists are a part of that solution. It is the dedication and passion of Massage Therapists, which can be amplified by professional associations, which ensures massage therapy can remain an important part of health care. In your own community, and through your day-to-day professional life, you can advocate for the profession by the way you practice and the way you communicate that practice.As the larger you, your professional association is part of the important conversations, the important decisions, and the necessary actions now and in the future. Check out what your association is doing about the issues that affect you and your profession. It’s your profession and your association.

Taking Advancement Of The Profession Into Our Own Hands

March 20, 2017/9 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

What do you get when you have a group of PT’s, MT’s and Trainers from the US, Canada, New Zealand and Australia drinking beer in a hot tub?

A lengthy discussion on what’s wrong with our profession.

And I use the term “our” profession even though all of us have a different scope of practice, because to my surprise, we’re all facing the same issues. At every level there is an issue with education, regulatory bodies, our peers and even some associations.

You see the problem in all of these industries is a lack of change.

The schools have too much invested within themselves to make changes that would help improve the profession. They are still stuck in research from 20-30 years ago, and well, change is difficult.

The regulatory bodies are concerned (as well they should be, as it’s their role) about protecting the public. All too often they err on the side of caution and ignore new developments in research and practice, which in turn harms the profession. And when I say harms the profession, I find it shocking just how badly it can harm the profession. This is exactly what I love to hear.

Little did I know the extent it was happening in our industry until the above conversation.

When regulatory bodies ignore things like mental health and the biopsychosocial approach, but still promote and teach research and science that is long outdated, not only do we suffer as therapists but unfortunately so does the public, which these regulatory bodies are supposed to be protecting. By their very definition they need to adopt new standards or they are strongly in breach of their core duty.

As the frustration grows among therapists who are trying to do right by their patients (and their profession), it is beginning to become apparent that we have no choice.

It’s time to take things into our own hands.

Creating CEC’s

Where this can be a bit of a problem, is the lack of therapists who want to get involved. Like it or not we are a fairly apathetic group. We tend to get lost in just going to work doing our treatments and shutting down at the end of the day. Then we are usually scrambling at the end of the year to fulfill our CECs.

I’m not saying there is anything wrong with that (well actually I guess I am), I used to be one of those therapists. I wouldn’t bother going to a college or an association AGM, wouldn’t bother to vote on anything, and would take whatever CEC’s came to town, just to fill the quota. But as time went on, started to realize change was needed, not only in myself but also in the profession.

Since it’s apparent that nothing is going to change when it comes to entry to practice standards, if we want change it’s going to be up to us. The best way to change our profession and influence practice standards is to have a critical mass of therapists lobbying and demanding change.

This can be a bit tricky.

Since entry to practice won’t change, we look to continuing education to help shape our careers. Tania Velasque z wrote a great piece on Modalities vs Concepts and not getting caught up in the modality empires. Now, there’s nothing wrong with learning a new modality, in fact through most regulatory bodies it’s encouraged. However what we need to do, is be careful not to get caught up in the bias’ that usually go with some of those classes and make sure they’re backed by sound research and encourage critical thinking. Part of the problem is that there aren’t a lot of courses that encourage this.

So, what do we do in cases like this?

It’s time to start developing our own. If we truly care about the advancement of our profession, it’s high time we start breaking the mold of what is being offered and rely on each other to develop continuing education. Over the past couple of years (and I’ve wrote about it on here) I’ve started attending more conferences for my CECs instead of just hands on manual courses. For each conference I’ve been to, it has been amazing to meet like minded therapists from, not only different countries, but also different backgrounds and certification levels who all want to improve their profession.

And the beauty of it all…they’re all willing to work together.

We all have different strengths that would lend itself to quality CEC courses. In the last two weeks alone I’ve had discussions with other therapists on possibilities for courses on motivational interviewing, pain science introduction, DNM, assessment and of course first aid. The more we can collaborate and work together to develop the education happening after college, the bigger change we can make in bettering ourselves and the profession.

Photo by: Unsplash

Mentorship

There are a few ways we can make this happen.

Typically when we think of a mentor, we think of a one on one coaching type dynamic. While this is a great option and should be highly sought after, it can also be difficult to find an agreement that works for both parties.

Our local association encourages a mentorship program in which a more experienced therapist takes a less experienced practitioner and gives them tips and advice when starting out. This is a great way for a new grad to learn the ropes and build confidence. However if this is something you’re thinking of, there should be compensation (I don’t know if our association encourages that or not) given to the mentor. Years of experience and of course their time should only be given away if they choose to allow that, but it would be a wise investment on the part of a new grad.

Online there are several ways to gain mentorship. Joining several of the Facebook groups out there, you can learn a ton just by watching the comments and interaction among other therapists. But just like anything else, you have to choose wisely. Just like when choosing your CEC course, make sure the group(s) you decide to follow are quality and backed by research and science, or at least promote those two topics.

You can also create meet-ups in your area, to see if other therapists would like to get together and just talk shop. I’ve learned more from going out for a couple pints with other practitioners to pick their brain about what they’re good at (and probably forgot a lot of it) than I can ever pay back to them. You’d be amazed if you just put a request out how many therapists would be willing to do this. But don’t keep it to just Massage Therapists, meet up with ATs, Chiros, Physios and Personal Trainers, they all have knowledge you can learn from.

Blogs. Start following some good quality blogs, there are a ton out there! However the same caution I talked about earlier should be applied when deciding which ones to follow. Find the ones who cite quality research, give advice and focus on patient centred care. I’ve been fortunate enough to meet some of the bloggers that I follow and every time have been amazed at their humility. While some of them charge for products on their sites, they are usually quite willing to give away lots of free content. If you can use some of their paid content as CECs all the better (and easier) for you to learn from.

As therapists, there is no end to the amount of things we can learn. But we do have a choice in what we learn. Shaping your career and profession is all of our responsibility, not to be left up to the regulatory bodies. When you go take new courses that give you quality information, there is also a responsibility on your part to share that information in your community with other practitioners. There are some therapists out there doing some pretty amazing things, but we can make greater change as a group than we can flying solo.

Free Massage!

March 13, 2017/3 Comments/in Business, Massage Clinic, Massage Therapist, Massage Therapy/by Laura Allen

Do you ever feel like you have a sign on your forehead that says “Free Massage?”

Every day on my social networks, I see massage therapists talking about being asked to do free massage. “Come and do free chair massage at our event and it will get your name out there….” never mind that you’ve been practicing for 15 years and your name is already out there.

I recently saw on FB post where a chiropractor wanted someone to come to his office and do a week’s worth of free massage so he could get the client feedback and decide whether or not he would hire the person…I guess he thought she just wouldn’t need any rent money or groceries that week. If he’s located near a massage school that’s turning out graduates or an area that’s saturated with massage therapists, he could feasibly keep the “audition week” going for a long time–and quite probably billing insurance for the massage that he’s not even paying the therapist to perform.

At the massage school I attended, back in the day, we were required to perform 25 hours of community service…free massage on a deserving population. 15 years later, I still don’t mind performing free massage on a deserving population. I occasionally volunteer time to what I think is a worthy cause.

I once gave weekly massage to someone for almost a year because he had spent nearly a year in the hospital, his medical bills were in the millions of dollars, and he just plain needed the work and couldn’t pay. One of my staff members has given a lot of massage at an abused women’s shelter. Another did deeply discounted work on someone who was seriously injured and didn’t have any insurance, and many of us have done that kind of thing at one time or another, for nothing other than the warm fuzzy feeling of having helped someone.

If there is an event going on that I think we need to have a presence at, I will pay staff members to do chair massage; I don’t expect people to work for free. We just can’t and/or won’t go everywhere we are asked to go. If the event is more than ten miles away from my office, I’m not really inclined to go there. There are plenty of massage therapists in our county, and if there’s a health fair that’s all the way at the other end of the county and plenty of practicing therapists between here and there, I’d rather let one of them have it.

I have recently been receiving invites to an event in Shelby, NC. That’s 25 miles away from here and I know at least half a dozen therapists that practice there, so I’m not going to go encroach on their territory. The last time the organizer called, I told him he was wasting time by continuing to call me about it and suggested he contact therapists from that area. I also turned one down that was relatively close, but on a holiday. When the woman called me, I said, “thank you, but our staff members want to spend the holiday with their own families that day.” Not only do they want us to do free massage, they also want us to pay them for a booth to do it in.

Sometimes MTs are distressed or hesitant about saying “no,” because “it’s at my mother-in-law’s church,” or “one of my clients asked me to do it, but it’s 30 miles away,” and that kind of thing. If you’re a new therapist, or an old one who’s feeling torn on this issue, then here’s the answer: “Thank you for thinking of me, but I already have clients booked for that day.” Or you can say “Thanks, but I don’t give my services away,” with no excuse. You don’t need an excuse.

If you have the time, and so much money you don’t have to worry about paying your bills, then feel free to give away all the massage you want to. Say yes to everyone who asks. You’ll probably get some business out of it, but keep these thoughts in mind: Some people will do anything just because it’s free, that they would never think of actually spending money on. Some people who are already consumers of massage and already have their own therapist of choice will sit down and get the massage, again, just because it’s free. And many times, people don’t place much value on something they get for free.

If you need an actual return on investment for your time, then you need to pick and choose what you’re going to participate in. Realistically, you stand a much better chance of getting business from an event that’s 5 miles away from your office than one that’s 25 miles away from your office. Some events, like an annual festival, attract a lot of people from out of town that are never going to become clients, but you’ll have to massage them along with any locals who might potentially become clients.

Your dentist isn’t going to do your root canal for free. Your doctor isn’t going to do your appendectomy or deliver your baby for free. The plumber, the electrician, the washing machine repairman isn’t coming to your home for free. You can’t walk into Walmart and load up on free goods, but for some reason, many people seem to expect that massage therapists are always available to give it away.

Here’s the reality check: most of us have overhead directly related to our work. It also costs money to get educated, to get licensed, and to keep up with continuing education requirements. It costs money to run our homes and our lives–just the same as it does for the people who are soliciting us to come and do free massage. We have mortgages, car payments, student loans, and debts to pay. We need food and utilities and medicine and school tuition and child care just like everyone else.

Doing free massage is sometimes a good marketing opportunity. It’s always providing a public service, and you should do it only when you genuinely want to. Don’t allow yourself to be talked into doing it when you don’t want to, and don’t allow yourself to feel guilty for turning anyone down.

5 Habits To Start Your Work Week!

February 13, 2017/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Robert Libbey

1: Reviewing This Week’s Calendar

This is similar to how we end our week. It’s good to have this as a habit at the beginning and ending or the week.

Make note of any business contacts you need to meet with or contact this week. Make a short list of who needs to be contacted and set tentative dates and times to do so.

Photo by: Dafne Cholet

2: Arriving At The Office 30 Minutes Earlier

“But I don’t have time to have the time to get into the office earlier!”

Time Management is Life Management!

The biggest problem most people have is “Time Poverty!”

We perceive that we are short of time in almost all areas of our lives. The truth is, is that everyone has the exact same amount to time to do things within each and every day. It’s what you do with that time that is of most importance!

Developing Time Management Habits enables you to work smarter, not harder.

Managing time for a successful practice goes beyond your practice. It must include all facets of your personal and professional life.

Personal and business lives have a symbiotic relationship. When one suffers or prospers, so does the other.

Getting into the office affords you time to gather your patients files for the day. Review each file and reflect on what was treated, accomplished previously and formulate a game plan for today’s appointment. Even though that plan can be thrown out the window if the patient arrives with new complaints, at least you went through the process of planning and reflecting.

Performing these on a regular basis develops within you the ability to become faster at it.

3: Planning Your Weekly Errands.

Staying with the Time Management topic, reflecting on your weekly calendar allows you the opportunity to best attempt to balance work and life schedules.

Groceries need to be bought, kiddlets need to be picked up and taken to various activities, food needs to be planned and then there is your clinic and all the aspects that go along with it.

Supply runs, and so on all need to be scheduled.

Life can seem overwhelming.

What has been shown to work best is to sit down and plan the week. Sometimes it’s a great way to get the family involved. Everyone gets to plan out the “Family Schedule”. It’s a great bonding time for everyone to come together and recognize each other’s contributions to the family.

Option 1:
Get a big calendar desktop paper that can be posted on the way and start filling it in. Everyone gets a colour.

Option 2:
These days, everyone seems to “Be Connected” through technology. Technology has made it simple to have everyone’s calendars synced to each other. Have a Family Calendar that everyone contributes to and receives updates on.

We all know that “Life Happens” and unplanned events can happen.

Your Stress level during these time will be far less knowing that you have effectively planned your time for the week and altering the planned events will be easier.

Photo by: StartupStockPhotos

4: Planning Your Meals! Meal Plan

Nutrition is more important for manual therapists due to the fact that we have a very physically demanding profession.

Some days it really feels as if we are endurance athletes!

Planning good daily nutritional intake to support our athletic activities (treating patients) is imperative to our performance, our ability to serve our patients to our highest ability!

It’s quite easy to get into the habit of stopping for some quick food somewhere only once. But as the “only once” time happens again and again, before you know it, it’s everyday. NOT the habit we want!

Planning food can be incredibly easy as long as you keep it simple. Plan out your daily eating habits for each day of the week. Copy and past that week into the next week and so on. You have just created your grocery-shopping list for the week.

5: Look Ahead To Your Weekend!

Think about something fun to arrange.

Something that gets you out of your routine.

Something that surrounds you with positive people and activities.

Too often we do not effectively plan our weeks, work becomes all-consuming and by the time the weekend roles around, we are exhausted. By planning your week efficiently, you create a life where you are energized throughout each and every day and when the weekend is reached, you have planned exciting events and activities to look forward to and positive people to spend time with.

Remember that sometimes we all need some down time and taking a weekend to relax, reflect and re-energize is prescribed. Take those times and enjoy them.

Be sure to include some outdoors activities just to keep you moving!

Don’t feel bad if you don’t get through all of these. This exercise is to get you into the habit of beginning your week productively and positively!

How Can You Change Client Expectations In Order To Be Most Effective?

January 17, 2017/2 Comments/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Walt Fritz

As a physical therapist, I face certain expectations when a client first comes to see me for treatment.

When they walk in my treatment room, a few may look around, wondering where the exercise equipment is hidden, as my room is a 9’ X 13” room with a massage table and little else. But most have been prepared in advance that their experience at my clinic, the Pain Relief Center, may be quite different than what they may have experienced in the past with other physical therapists.

How did I prepare them before they walked in my door?

I set the tone before they ever met me, both through the information contained on my website and through the packet of information they downloaded from my website (or I emailed to them prior to their first visit).

I long ago changed my client’s expectations for what physical therapy can look like, as I had already changed that expectation for myself.

People are referred to me due to my skill set; I am quite good at reducing/eliminating pain.

My business name sets that intention and my website reinforces that fact.

My referral sources speak of my skills and clients typically come to see me showing little shock at the altered nature of my physical therapy practice model.

But what about you and your practice; is it time to change the rules so that client expectations are realistic?

Massage therapists make up a good percentage of the folks who take my Foundations in Myofascial Release Seminars and many of these therapists speak to the expectations that their clients hold.

Expectations include; using oil/lotion during sessions, being relatively undressed under a drape sheet, and having the entire body attended to during a session.

These expectations are valid, as this is the mindset of many when they think of massage therapy.

But are your clients (or you!) so rigid that they are not willing to bend these expectations?

If they are coming to you for relief from pain in an isolated area, does the elimination of pain in this area take precedence over the desire/expectation to have the entire body addressed in a single session?

Is it you, the massage therapist, who is feeding these expectations? Are you simply unwilling to change the rules?

Myofascial release (MFR) tends to be considered a “dry modality”, contrasted with wet modalities where a lubricant is used. While there are exceptions to this generalization, most forms of MFR are performed on dry skin. MFR happens to be one of many very good modalities for the relief of pain and the improvement of function.

Your license, as a massage therapist (or PT/OT/SLP), allows you to utilize a wide range of modalities and techniques, all which fall under the category of having a “license to touch”.

My clients come to me to rid themselves of pain, no matter my choice of modalities. If you have skills and tools at your disposal to help meet your client’s goals, it may be up to you to change their expectations.

Education is the key to all of this and it is your duty to educate your clients.

Here are some things you can do to start changing the expectations of your clients:

1. I am a strong advocate of having a website to allow potential clients to find you and learn about you and your practice/goals. I began my do-it-yourself website in 2005 and allowed it to develop over the course of a few years. In 2010 I paid a website designer to craft me a more professional looking site that links together my private practice, my seminars, and my blog.

My website begins to lay out the expectations for my clients, whether they are interested in becoming a client or interested in taking one of my seminars.

If you don’t have a website, get one, even if it a free one-page site provided by the various professional organizations. Your website’s message should not be about what modalities you use or who you trained with; it should be about what you can do for a client.

My original website was a painful attempt at trying to convert the masses into believing that MFR was the greatest modality out there, and I went into great detail discussing why I thought it was so, including old worn out explanations of how fascia is the primary culprit responsible for most pain.

People don’t care about this.

Most, including myself, are somewhat selfish. I care about what you can do for me, not how you will go about doing it. I care that if I have a problem, you are the person to see for this problem. Later, I may ask about how you go about doing this (the modality), but not at the onset. If I cannot find out what you can do for me in the first few seconds of reading your website, I will move on to the next person’s website. What is seen when they first land on your website is key. For more information on this, please check out a post I made titled Above The E-Fold™.

2. If someone is coming to see you for your expertise, then tell/teach them what they will need to do to allow you to be most effective. With MFR, I am best able to work when a client is wearing shorts and a tank top or T-shirt, rather than them being fully clothed or undressed under a drape sheet.

My introductory materials outline this need, as well as why it is important.

I tell them to bring along an appropriate change of clothing to facilitate receiving the maximum benefit from my services. Additionally, I keep a drawer full of shorts and tank tops of various sizes, in case someone forgets their “uniform”.

Educating your clients that having a drape sheet to maneuver around/over their undressed body may not be in their best interest is important to set expectations, both with MFR treatment and similar modalities.

I tell them what I need in order to do my job and best meet their goals and that these are my expectations. If the person is seeing me based on my reputation, etc., they typically have no trouble working within these expectations.

3. Opinions vary widely as to how best accomplish pain relief, as is evident by the large number of named modalities available to each of us as manual therapists.

With the type of myofascial release I practice and teach it is not necessary to treat the entire body or both sides of the body in order to reduce/eliminate an issue. However, if the commonly held expectation is that a client will receive a full-body treatment, then this expectations needs to be addressed before treatment is commenced.

You can actually take care of this issue before you ever meet this person by including the information on your website and new client handouts.

My handouts have a number of purposes.

They collect the basic demographics I need in order to treat a person. They also set the rules in terms of my cancellation policy/No-Show policy.

New clients read and sign a release, stating that they will abide by these rules.

Set your expectations early on, through your website or handouts, so that there are no surprises or disappointments. If someone comes to you for a longstanding issue, neck pain for example, and after you have performed your evaluation, take a moment and ask them how they would like the session to flow.

If the neck is their primary concern, ask if they have any objection with you spending the entire session working the neck issue. If they have issues with this, they need to let you know and not be mad when the session time is up and you have not gotten to the rest of their body.

Set the expectation.

4. I am very punctual with my sessions. I start on-time 99% of the time and I finish promptly at the originally scheduled time. In my new client handouts, I state:

An appointment is a commitment to our work and a contract between us. On rare occasions we may not be able to start on time. This is usually because a treatment is taking slightly longer than expected. For this we ask for your understanding and assure you that you will receive a full treatment. Also be assured that at some point if you need a longer session, you will always be afforded the same consideration. In order for all of this to work, you need to be on time for your appointment. If you arrive late, your session will need to end at its originally scheduled time with the fee equal to the original length of the scheduled session. If you need to cancel, please call as soon as possible so that I can attempt to fill the vacant appointment. A 24-hour notice is required for cancellations to avoid payment of a $50 fee.

We teach people how we wish to be treated, both professionally and personally. I believe in firm, clear boundaries in all aspects of my practice.

I expect you to be on time.

If you are late, I will not extend the session to give you the “extra” time. I expect the full payment, whether or not you received the full session. If I am late starting, you will receive your full session length. Some may feel this is harsh.

I feel that it is about having good boundaries.

5. Be clear with your intentions and always get verbal permission.

At times I will wish to place a hand in areas of the body that may be misconstrued by someone not knowing my intentions.

If I need to place my hand in any area where there may be questions, I will always:

Tell them what I am hoping to accomplish
Tell them where I will need to place my hand(s).
Ask for verbal permission and wait for the reply.
I use simple language and layman’s terms. My client may not know what the sacrum or sternum is, so I will both use layman’s terms (tailbone/breast bone) as well as point to the area on myself or them.
I speak clearly and with confidence. Client’s easily pick up if you sound shy or timid.

I speak at length to this topic in a blog post (here).

During any of my Foundations in Myofascial Release Seminars, I ask therapists to practice wording these concepts with their lab partners throughout the seminar, in order to take the awkwardness out of the interaction.

“In order to try to reduce the tightness/pain in your lower back, I would like to be able to place a hand directly under your sacrum/tailbone. It is not necessary for me to be directly on your skin. Are you OK with this?”

This interaction becomes quite easy, once you have done it a few times. It takes any ambiguity out of the situation, protecting both you as well as your client.

If you work for someone else, many of these topics may be non-negotiable. But if clients come to you for your expertise, you may have a say in these matters. If that expertise includes MFR, you need to change the rules that your client believes exist. It is in their best interest to change their expectations, if they are interested in being helped by you. Don’t be shy about changing the rules. It may take some time before you are confident enough with MFR (or any other new modality) but act now to change the rules/expectations. It is your practice; treat it as such.

How do you set expectations?

Do you state the “rules” of your practice upfront?