Getting Down to Business
December has been a crazy month for me. I’ve been scrambling to get things going so that I will have my own massage practice up and running in January.
I’ve been working especially hard on setting up a web page. Writing content, organizing it effectively, developing a design that I can live with.
I’ve even written some extra content. I meant it to go on the main site, but then I realized it would just be clutter. It was better off going in the blog.
Blog? Crap! I have a blog to attend to!
So if you’re wondering where I’ve been, that’s where. Off in not-quite-panic land, gearing up for a new adventure.
It’s scaring the crap out of me.
But WI’m a scaredy-cat. hat else is new?
(More on what’s new with me after the holidays, I promise. For Christmas, I will hang out with my Jewish relatives, go for a walk in a cemetery, remember how to spout a minimum of six puns a minute, and eat sushi on Boxing Day, because that’s how we roll. You?)
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Nontraditional Approaches to Continuing Education
Continuing education. We talk about it a lot in the massage community. Should it be required? How much? Who should require it? Who should teach? What should “count?”
People seem to fall into two camps: continuing education junkies who are always looking for more classes taught by their favorite instructors or on a subject they’ve been dying to learn about (and there’s always a subject they’ve been dying to learn about) and those who do what they have to in order to stay licensed and insured.
You might be able to deduce that I am one of the former.
But, I’m also hovering valiantly above the poverty line. There are a lot of classes I’d like to take, books I’d like to buy, workshops I’d like to travel to, that are just not going to happen this year.
This doesn’t worry me.
I’ve got more than enough “official” continuing education this year (to be honest, I didn’t need any to begin with: Ohio doesn’t require it and I’m still on my AMTA student membership from before I graduated), which frees me up to learn without messing around with hours or accreditation.
I’ve written about formal continuing education before. I’ve also written about viewing your education as a process of capacity-building. Luckily, lots of other edpunks, autodidacts, and lifelong learners are out and about in the world, and learning what you want with out the BS is being refined into quite the artform.
What do you want to learn?
It seems kind of common-sense, in a way, to have a learning plan. You’ve got a business plan if you’re in business, after all. And since you’re definitely “in learning” even if you’re not in school, a plan for where you’d like to end up with all this learning business seems only sensible. The Edpunk’s Guide to a DIY Credential (a free e-book by Anya Kamenetz) will walk you through this process more thoroughly than I ever could here. It’s hugely helpful for differentiating what you want to accomplish from what you need to know from how you plan to learn it.
How will you get there from here?
- Sign up for the Massage Learning Network.
- Build up a list of useful blogs, and follow them.
- Peruse the International Journal of Therapeutic Massage and Bodywork
- Connect with a mentor.
- Find out whether your public library has any books on massage, wellness, business, or whatever else you want to learn.
- Engage in your own research.
- Keep a journal (especially useful if you’re trying new things).
- About a million other possibilities.
I’m taking a class at Stanford University starting in February. No, I’m not a student there, but they are offering a course on starting a business, The Lean Launchpad online for free.
No, you don’t get actual college credit for it.
No, I have no idea how much of what I learn will be applicable to starting a massage business.
Yeah, I’m doing it anyway, because I think it will be pretty interesting not matter what. But you know what would make it even better?
If there were a small group of new massage therapists (or new/future massage business owners) who were taking this class, who could interact online as a study posse of sorts. And if there were established massage therapists with successful businesses who felt like taking the course, and thought they could contribute to the discussion as mentors.
That would be awesome.
Anybody up for it?
Drop a comment if you want to be a part of this. Or even if you don’t. What’s in your learning plan?
PS- Stanford is also offering a free course on the anatomy of the upper limb. I have no idea if it’s any good, but at the very least it could provide some extra study material for the students out there. Can’t beat free, right?
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Thankful!
I’m so thankful …
for electricity. Because without electricity, there is no internet. And with no internet, there is no fabulous online community. And boy am I ever thankful for that.
for Allissa, in particular. Because she introduced me to just about every person in this aforementioned community. I don’t know what I would have done without her.
for AMTA, ABMP, and all our other awesome massage organizations for doing everything they can to help the community of massage therapists and make sense of all our diverse, sometimes-contradictory desires.
for my husband, who has infinite patience with me when I consistently forget to do the laundry because I got caught up in writing blog entries.
for rainy days that clear up into brilliant sunshine just in time for me to grab the best falafel in Cleveland with said infinitely patient husband.
for my clients, and for the fact that they trust me with their bodies.
for holidays with the family.
for my local public library, which is well-stocked with vegan cookbooks, which makes holidays and everydays so much more edible.
for sufficiency.
for work.
for love.
for you!
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What You Need to Know About Trauma and Massage School
There are some things that I don’t normally talk about much here. Blogs are incredibly public, and while there are some topics I love to talk over with my massage therapy peeps, I don’t necessarily need them plastered all over the internet for the world and my grandma to see. (Not that my grandmother uses the internet, but I’m sure if she did she’d read whatever she could find on me.)
But I was giving some advice to a student on my favorite massage therapy forum, and someone suggested that I really ought to write about it here.
I feel a little squishy about doing this. But because I want the people who NEED this sort of advice to HAVE it, I will.
Let me start by telling a story:
We were approaching psoas from the side-lying position. I was on the table. My amazing friend Matt was working on me. He called over Gary, our instructor, to ask if he were actually doing it properly. Gary put his hands over Matt’s, and moved deeper. Much deeper.
“What does that feel like?” Gary asked me.
“It feels like … crying.” I started to weep.
Poor Matt. He brought me a box of tissues and hovered awkwardly. I kept crying for a while. It felt like forever.
The thing is, I cry every single time I have moderate to deep work done in the side-lying position. Every time, without fail. It’s something I know about myself now, and it’s something my massage therapist needs to know, too.
If you have a history of trauma or abuse–physical, emotional, sexual, disaster-related, war-related, whatever, your massage therapist needs to know before you get on the table. I don’t care whether it’s listed on the medical history form. Circle “anxiety” and write the details in the margins, and make sure you discuss it ahead of time.
Why?
I don’t know about you. Maybe you’re different from me. I’m told we’re all special little snowflakes or something to that effect, so you probably are. But supposing for a moment that you are like me, and you’re on a table, stark naked, and somebody starts hurting you (just a little, unintentionally) then your first reaction isn’t to say calmly, “Hey, that’s a little rough for me, my hamstrings are pretty tight and don’t take a stretch that well.”
If you’re me, your first instinct is to freeze. Hold your breath. Wait for it to stop. Hope the therapist doesn’t notice. Try not to be rude.
And meanwhile, this poor therapist, thinking you’re happy, keeps doing the one thing I can just about guarantee she doesn’t want to do: make you feel worse.
Writing it down on a history form is less scary than bringing it up in conversation out of the blue. And talking about it when you’re one fully-clothed, seated, professional individual having a conversation with another is much easier than talking about it in a dim room while you’re horizontal, next-to-nude, and feeling somebody’s hands doing something that doesn’t feel right.
If you’re a student, you’re going to have to out yourself as a trauma survivor. Whether you do this to the class as a whole (more scary, but sometimes really empowering when you get so much understanding and support in return) or person by person (start with your instructor, then inform each of your partners as you work with them) is up to you. But school is even more likely to include draping mishaps, clumsy technique, miscommunication, and ignorance of trauma-related reactions than a professional setting. You’re much better off playing it safe by speaking up than keeping to yourself.
If anybody, anybody at ALL does not respect this information, tell your instructor, right away. If the person in question is your instructor, tell the director of your program. If those in positions of authority do not crack down on the disrespect, consider switching classes. Consider switching schools. This is no time to put up with people who do not respect your needs, your boundaries, your choices, or your body. Do whatever it takes to put yourself in a caring, supportive environment while you are in massage school.
If you’ve got boundary issues be aware of it. Teach yourself to think, “This feeling is an example of transference. That’s okay. What I’m receiving is a professional massage.” Does that sound clunky to you? It does to me, but the formality of the script helps keep my reactions in line.
If you’ve got negative feelings about your body, be aware of them. If you feel like people must be lying when they say they are happy to work with you, be aware of this. If you’re overeager to please, be aware of this. If you know the smell of sage triggers flashbacks, you REALLY NEED to be aware of this, but you knew that already.
Some people find having a safe word helps. Think that’s just for kinky sex? It’s not. Establishing ahead of time that “stop” or “hold it” or whatever means “I don’t mean to be rude but I need you to stop what you’re doing right now and take your hands off my body because I’m having a reaction at this moment due to prior trauma and we need to communicate before we can continue with this massage,” is SO much easier than trying to formulate a sentence when you’re feeling vulnerable.
If you’re in therapy (the talking kind, not massage), you probably want to discuss massage school with your psychologist. Massage therapy school dredges up challenges, emotions, and issues in the most healthy of us. Your psychologist will probably have all kinds of helpful things to share with you. This person knows her stuff, far more than I do. Listen to what he has to say.
If you’re a massage therapist or a student dealing with trauma: I’m sorry. It sucks. It sucks so much, and it isn’t fair, and you don’t deserve it.
But you also have a gift to offer others. The chance to learn from you. The chance to become better, more responsible, more compassionate, more sensitive, more trustworthy massage therapists.
And you may, as many of us do, find that learning massage is in itself a kind of therapy. Learning to touch other people in ways that heal, without pain, is an extraordinary blessing. Learning to be touched and to allow yourself to heal, without pain, is too.
I know that’s cheesy, but it’s true.
So, we’ve gotten a little up close and personal on LMT or Bust today. That’s how we do things, in the massage therapy world, letting people see all kinds of bits and pieces of ourselves that we normally keep under wraps. I’m not a psychologist. Actually, the only psychology class I ever took, I failed. But this is what I know from experience. And if you know anybody, anybody who might benefit from reading this, please pass it on. Because I wish I’d read something like it when I started school.
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Couples Massage
Here’s a sneaky thing nobody tells you in school:
Couples massage is awesome.
Why? You get to spy on more experienced massage therapists in action with actual clients, AND you get paid for it, AND nobody thinks this is weird. The number of things I’ve learned this way is bordering on unbelievable.
(I’m not saying you shouldn’t give your full attention to your clients. But if your mind is occasionally going to get distracted anyway, it might as well be distracted by something educational.)
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“Instinct”
I got my first job in childcare when I was desperate. I had no experience aside from a brief stint as a babysitter, but I was willing to work for $6.50 an hour and had good references. I looked responsible. I liked kids. They gave me the job.
It didn’t last very long. I didn’t function with the other teachers like a perfect unit. I didn’t make the right split-second decisions. It took me too long to help a kid in the bathroom, or to apply sunscreen, or to contain a temper tantrum. I didn’t hurt anybody, I just wasn’t great. The director told me she’d be happy to keep me if she had a position open with the older kids, since I seemed to do well with them. I just didn’t have the right “instincts” to work with the little ones. I lost that job. I was devastated.
In massage school, it took me longer than others to master the hands-on skills. I could do them, but my body mechanics just seemed off. I wasn’t smooth. I wasn’t intuitive. Some people took to massage like a fish to water. I took to it like a walrus to ice skates. I studied harder, but I was terrified. I was worried I didn’t have the right instincts.
It’s been 6 years since my first childcare job, and I’ve worked almost exclusively with toddlers since then. I know exactly how I want to react to a small child, and I do it without even thinking. I can’t spend more than 20 seconds with a child without slipping into teacher mode, observing their development and testing their abilities. I can quite literally change a diaper with my eyes closed. It appears that I’ve got the instincts after all.
And I give a good massage. I still get compliments on my face and chest work, at which I excelled in school, but now I hear that people like what I do with their necks, their legs. They feel good. Maybe I’m not the best massage therapist they’ve ever had, but it’s enough that a few people are saying, “When I come back for my next massage, I want to schedule it with you.” Just a few. But I’m new. There will be more.
“Instinct” is so often a lie. Instinct is birds flying south in winter, or babies sucking, or newly hatched turtles humping their way to the sea. If you’re getting paid to do something, you can bet it’s not something instinctual. So quit worrying over the instincts you haven’t got for “intuitive” things like massage, or having conversations with people, or writing, or keeping babies amused and safe. Give more massages, talk to more people, write more stories, play with more babies. Because they only way learned behaviors become “instinct” is practice. Lots and lots of practice.
You’ll get there. We all will. Me too.
And in the meantime, we’ll be mediocre, and we’ll learn. The trick is making the effort to realize that that’s okay.
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Why Attend National Convention?
Because you don’t often have the chance to fly to a state you’ve never visited, sit down with a bunch of people you’ve never met in person, and feel perfectly at home.
Because you don’t have to bother explaining to the people around you why shaking Ruth Werner’s hand makes you feel like you just met a rock star.
(Because you get to shake Ruth Werner’s hand and feel like you just met a rock star.)
Because you get introduced to random people who say, “Oh yeah, I read your blog.”
Because you get to see images of the therapist you might want to be in ten years.
Because massage therapists love to boogie.
Because you meet people who say things like, “If you really want to know how your competition is doing, start a laundry service. Then all you have to do is count their sheets.”
Because you’ll take pages and pages of notes, and it still won’t feel like enough.
Because when you tell people on the train you’re going to a massage therapy convention, they always look jealous.
Because of the pins.
Because Chris is pregnant.
Because that’s where your friends are, whether you know them yet or not.
Will I see you in 2012?
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Two Ethical Dilemmas
It’s a crazy place out there in the Real World After School. I thought that knowing exactly what I would and would not do in my practice would keep me out of Crazy Ethical Dilemma Land. No such luck! Now that I’m not just studying my bum off every hour of the day, I get to do things like interact with other people. And other people do things like, say, practice massage therapy illegally without a license. So what’s a law-abiding massage therapist to do? Feel free to chime in with your thoughts. This do-the-right-thing stuff can be downright confusing sometimes.
1st Dilemma: The Student
I saw this ad on craigslist:
I am [NAME] a student of medical massage at [SCHOOL]. I can perform a variety of massages, and work on people ages 13-70. While in training the more experience I can get the better, and that’s why I am offering 50 min relaxation massages for $30. Since I am still in school and have not set up a studio yet, I will be coming to your house to perform the massage. When I came to perform the massage, make sure your home will be calm, quite and free of distractions. Serious inquires only! This is for Medical massage. This offer is good for anyone living within 10 miles of [TOWN], will go further but the price will go up due to the cost of gas. Reserve your relaxing hour of massage today!
Maybe this woman doesn’t know that practicing medicine without a license is a felony.
Maybe she wasn’t taught that if she’s reported to the Medical Board, they could prevent her from receiving her license, ever.
Maybe she doesn’t understand that by saying “this is for Medical massage” she negates her statement that she’s offering “relaxation massage.”
Maybe she hasn’t read that her liability insurance (if she has it) only covers her for school-sponsored activities until she’s licensed.
Maybe she doesn’t realize that non-licensed massage requires an establishment license in most cities in our state.
Or maybe she just doesn’t think she’ll get caught. After all, what are the odds that someone who gives a crap would be searching the massage ads on craigslist?
But I found it, and I DO care.
This woman was very, very close to having her professional dreams crushed. But I decided not to call the Medical Board, or the cops.
I sent her an email, advising her to take the ad down.
And I called her school. I gave the name of the student and explained that they might want to review Ohio law with there students one more time.
And the ad went away.
2nd Dilemma: The Practitioner
A local massage business employs primarily licensed massage therapists, but also one woman who is unlicensed. This is legal in Ohio, but only if she provides ONLY relaxation massage.
I happen to know that she is providing massage therapy to people with minor injuries.
I can’t just call her superior the way I did with the student, because her boss is the one who schedules these people with her, and is therefore already aware of the situation, but chooses to ignore it.
I’m not afraid of this woman hurting people. She’s quite competent (and more experienced than I am, for that matter), and she finished her 750 hours of massage school. She simply has horrible test anxiety and is unable to pass her licensing exams.
Both the practitioner and her employer rely heavily on her income.
What is my legal obligation in this situation?
If I do not report this, and it is later discovered that I was aware of the situation, does that make me an accessory?
How do I bring up my concerns with the practitioner who is doing the work?
How do I bring up my concerns with the employer who is scheduling her with inappropriate clients?
How do I do this in a way that doesn’t make me the evil spy of the massage community, lurking around your business to see if you’re breaking any rules and then threatening to tattle on you?
And if the illegal activity seems to stop and the issue appears resolved … then what? Am I absolved from the necessity of taking further action?
The only person from Ohio that I met at the AMTA National Convention was horrified that I hadn’t already reported this practitioner to the Board. The other massage therapists I’ve met around here are used to working alongside unlicensed folks, and tend to take a more lenient view.
It’s a complicated thing, being a professional in a semi-professional world. What would you do?
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Reflections on Courtesy
I’ve mostly-moved to my new town, keeping my eyes open for new lessons while trying to learn my way from one place to another before starting work. It’s tiny and walkable and filled with bicycles and locally grown produce and idealistic college students who write some terrible poetry and do some very sweet things.
It’s so different from my old city, but I think I could love it here.
Anyhow, I stopped in one of my favorite businesses here, a tiny market where I picked up a carton of unsweetened soymilk and a fistful of kale grown two miles down the road. I sat down with a book and a ginger brew in the cafe, and spied a small, hand-lettered sign taped to the wall.
HELLO tea sippers, readers, and laptop users. We are glad you are enjoying our cozy cafe. Please be aware that between 12pm and 2pm we often need all of our tables for lunch customers.
-O. Market
Hold that thought. Here’s another story from another town:
Jef and I arrive at our favorite coffeeshop around 6:00 pm, whip out the laptops and get to work. He’s working on some graphic and reading the news, I’m studying and then blogging my butt off.
At 7:40 a girl comes up to our table to tell us there will be a band performing that night at 8:00. The cover is $5. We can choose to pay or leave. We leave.
I guess it doesn’t take much effort to see which business made me feel at home. But there are a few specific principles that I’d like to examine a little closer.
1. No Bad Surprises:
Surprises are for marriage proposals and birthdays. If you’ve got a policy about no-shows, bounced checks, illness, or coupons, make sure this information is known before there’s an issue. A little preparation means the difference between “Okay, this is not the best time for a visit,” or “Oops, I’m so sorry I inconvenienced you,” and “That massage business ripped me off.” Bummed and incensed are two very different things.
2. Remember the why:
Why? Of course there needs to be a why. We’re human beings, and we don’t like to be jerked around for no reason. “So that the people who come here for lunch have a place to sit” is a good why. “Because someone else who needs a massage can still schedule an appointment during that open slot if you cancel with sufficient notice,” is another one. “Cuz I said so,” is not. It doesn’t work on children, and it doesn’t work on adults. If we wanted to immerse ourselves in whylessness we’d sit on our butts reading Dilbert all day.
Of course, not all whys are helpful, or even ethical. Assuming you’re the type who has a great set of whys to back you up, though, why not show it? People love having their better natures appealed to. Physicians are more likely to wash their hands when reminded that doing so could help their patients than when reminded that doing so would help themselves. Everyone wants the world to feel fair, to have the Golden Rule apply to things just a little bit more. Why not make people feel not only obliged to follow your policies, but happy to do so?
3. Remember the love:
The people who need to be made aware of your policies aren’t problems, they’re clients. Just because a client showed up late and is only going to receive a 40 minute massage because of it, doesn’t mean that he doesn’t deserve all the care your timely regular does. A little shout-out to the “tea sippers, book readers, and laptop users” does more than make them feel valued, it brings them back. And maybe for lunch. Or a couples massage. Or whatever that special thing is that you do.
4. The magic words:
Please. Thank you. You’re welcome. Excuse me. I’m sorry.
Please use these words. Your clients will thank you. You’re welcome to use them whenever you like. Excuse me for repeating this lesson if you already know it. I’m sorry if this comes across as condescending, it wasn’t intended that way.
And no, “I’m sorry you feel that way” doesn’t count, it’s a cop-out. Honest-to-goodness manners matter. Think about it: if someone cannot keep their words respectful, how can you trust them to keep their hands respectful? How can you trust them to respect your time, money, and information if they aren’t even in control of their own social-conventions-I-learned-in-Kindergarten words?
A third and final story:
We later went back to the same coffeeshop we’d been kicked out of , again with our laptops. (We’d had so many good cups of tea there over the months that we weren’t willing to give them up.) Another band was scheduled to play that night, but they just set up around us. We kept working through the performance, and although they were charging at the door, nobody bothered us about it. There were more than enough seats for everyone, and we weren’t in anybody’s way.
Afterwards, one of the musicians came up to our table and said, “I saw you guys working over there. I’m sorry if we bothered you. I hope we weren’t too loud or anything.”
I melted. It was so sweet. Jef chatted with the guy about music for a while, and we left with their stickers in our computer cases. I tweeted about them the next day. Although they were touring and we might never see them in our area again, we’d become, in a small way, fans.
It’s definitely something I’ll remember as I start my new job in the next few weeks. Stick around for all that excitement, coming soon!
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Developing Organization. Or, My Life in Paper
Today I packed 14 boxes in preparation for our big move up to Oberlin this weekend. More than half of them were books! Massage books, religious books, cookbooks, dictionaries, fake books and books of sheet music, picture books, books of folklore, books of poems, and the handful of science fiction and fantasy novels that survived my original move down to Cincinnati, almost exactly two years ago.
Packing books also meant packing up binders full of paper, which is to say, taking the incredible mess of paper that has grown in my apartment since starting massage school, figuring out what needs to be pitched, organizing the rest, and putting it into binders that can be packed away neatly. I really wish I had done this before hitting a hard deadline like “we’re moving in four days,” but there you have it. I’d be a liar if I didn’t admit to that fact that I’ve struggled with procrastination my entire adult life.
If you’re still in school, please learn from my mistake and organize before you end up in a tight spot. Here’s how I’ve arranged things so far. Thoughts?
Binder 1: Mostly Stuff to Use
Binder 1, Section 1: Status
- Massage therapy license
- Certificate of AMTA membership
- Proof of liability insurance
- Proof of first Aid/CPR certification
- Most recent TB test
- Resume
Binder 1, Section 2: Education
- Diploma
- Continuing education certificates
- Certificates of advanced studies while in school
- Assessments by outreach supervisors, preceptors, etc.
All of these are in reverse chronological order, so I can find the most recent things easily.
Binder 1, Section 3: Laws, Rules, and Ethics
- Scope of practice for massage therapists in Ohio
- AMTA code of ethics
- Oath taken during our graduation ceremony
- Standard precautions and hygiene guidelines
- Information about taxes
Binder 1, Section 4: Forms
- Client intake/medical history forms
- SOAP note forms
While I developed my own forms for these purposes, I always ask for a copy of the massage therapist’s forms when I visit a new place. I put on my best “adorable new therapist” face and they’re always quite sweet about it. I like seeing what other people use.
Binder 1, Section 5: Writing Samples
I’ve only been looking for massage jobs, but I’ve done plenty of writing for different organizations in the past and wouldn’t be averse to doing some for a massage business. And since it seems the #1 complaint employers have about recent massage therapy graduates these days is their lack of communication skills, I figure it’s always better to have proof I can communicate effectively in writing as well as in person.
Binder 2: Mostly Stuff to Learn
Binder 2, Section 1: Technique Handouts
- Thermal modalities
- Iliopelvic dysfunction protocol
- Cranial-Sacral
- TMJ intra-oral
- Etc.
You get the idea. These are handouts for things I might not use every single day, but still want easy access to.
Binder 2, Section 2: Body Stuff Handouts
- Dermatomes
- Common referral patterns
- 100 most-used drugs, their brand names, and their purposes and common side effects
- Cool handout about spinal nerves that I picked up from a local chiropractor at a health fair
- Etc.
Binder 2, Section 3: Marketing Stuff
- Handouts from school
- Marketing materials developed as a school assignment
- Marketing materials from other massage/wellness providers (good and bad)
- Marketing materials I really like from other kinds of businesses
Once I develop more of my own professional materials, they’ll probably go in an additional section in Binder 1.
Binder 3 is full of stuff for my other life, all the community development work I do as a volunteer. And of course, there’s the filing cabinet, which I still need to clean out and reorganize tomorrow. After I clean the bathroom. And pack up the board games. And try and shove my table warmer back in the plastic against its will.
So, yeah. Moving kind of stinks. But I’m excited for the chance to start fresh, and start organized! My top suggestions would be: group things in a way that makes sense to you, and invest in a ton of plastic sheet protectors! Any tips or ideas from the pros (pros at organization, whether you’re a massage therapist or a student) out there?