Psychology and Massage: Some Things in Common

My client seemed particularly stressed. Her back and neck was a never-ending patch of bad trigger points and spasms. This client was all wound up.

“How are things going?” I asked. My standard way to get folks to open up when their tissues are slammed shut.

“Work is driving me nuts. Actually, the work is easy. The people I work with are driving me nuts,” the client said.

This client is a psychologist; a psychologist who supervises new psychologists, a requirement of all graduates. My client’s job was supervising and coordinating all that goes with it for an agency that provided psychological help to people in various government aid programs.

My client had a beef. Too many of her newbies were complaining about their pay and paying too little attention to getting their jobs done.

To summarize: Her new psychologists had the attitude that when they graduate, they should immediately be making $250 an hour. Their clients should be movie stars, professional athletes and rich people who pay cash. They shouldn’t have to waste time with boring public fund clients simply to fill an hours requirement. As graduates, they felt entitled to practice unfettered right away.

In feeling that way, they were missing out on a big opportunity to learn what they are doing, she complained. They don’t understand that right out of school they are lucky to be making $25 an hour, with insurance, sick days and vacation, my client said. They often didn’t listen to the sage advice of their supervisor.

My client had been on both sides of the equation. For years she had worked hard on building a private clientele, establishing referral patterns and working the flexible hours – nights and weekends - that go with people’s schedules. If she was sick or took a vacation, she didn’t get paid. Health insurance cost a lot. Some years ago she switched to agency work, glad for regular hours and a quitting time of 4 p.m.

When all this stress came pouring out, I had a reality check myself. These were some of the same issues I had struggled with as a newbie at massage, and later as a massage employer. When I graduated, I assumed I could just go right into private practice, even though I had no experience at finding and keeping clients. When I went to work at a spa, I was surprised at the low pay per massage, with no pay for down time between massages.

Later in my career, as therapist employing other therapists, I saw many an applicant who didn’t like getting one-third the money for “doing all the work.” Besides the pay, they didn’t want to work evenings and or weekends - or massage anybody hairy.

I particularly enjoyed it when they announced their vacations. The idea of asking for vacation time, a tradition at every job I had ever had in my life, seemed like an alien concept.

We talked for a while about the similarities between massage and talk therapists and expectations. Perhaps we all have odd ideas when we start in a field. My client felt better having talked about it, and her massage went well. I felt better having learned that talk therapists and massage therapists perhaps have more in common than one would think.

Hotter? Colder? How Do You Like Your Water?

Love the girl who holds the world in a paper cup, sings the Nitty Gritty Dirt Band. Drink it up. Love her, and she’ll bring you luck. I don’t know about the truth of that, but I adore the image—and goodness knows I’ve served hundreds of Dixie cups full of water to happy, foggy massage clients. Why is water the beverage of choice? I’ve had clients ask me. Why not, say, lemonade or a nice refreshing cocktail before I go home and enjoy a post-massage nap?

Well, many therapists will tell clients to drink their water because it “flushes toxins." However, I was always taught that was something of an over-simplification. My instructors explained that, when you mash on something with fragile parts (like a body made up of cells), you generally break something. And since massage also increases circulation, giving clients water just helps the body process out all the broken stuff faster so that the client’s bloodstream is clear of it sooner. As the reasoning goes, the body is made up of water to a large extent and needs it to function, so give it water. Were the body made up of citrus juice or vodka, then serving screwdrivers would get us to the same place.

I’ve had some interesting new questions, though, lately, on whether the temperature of the water makes a difference. Some clients prefer either hot or cold over the other, and some had heard that if they drank the water at room temperature, or even warmer, it would have greater health benefits and perhaps even increase metabolism.

Most of the information my research turned up was slightly more in favor of cold water. According to many Internet health and sports nutrition sources, cold water is absorbed by the stomach faster and thus can go to work quicker. The evidence on hot water seemed to be less scientifically oriented and joined more to specific diet philosophies such as Ayurveda, where the temperatures of food and water are considered extremely important. But even here, the purists seem to prefer boiled hot water over hot water from a tap, because the latter still has “impurities.” And some of the information I uncovered on Ayurvedic dieting did indeed say that hot water increased digestion and metabolism.

Personally, I go for the simple view: Drink as much water as you can, whatever its temperature. When I’m very hot, I prefer cold water. When I’m not, I prefer it room temperature because I will drink it, not sip at it and forget it’s there. And at no time do I like plain hot water, even if it promises me the metabolism of a hummingbird. Anyone have anything enlightening or interesting to add on this particular hot topic? Or does it just leave you cold? Okay, okay, no more water puns . . .

What Happens When a SOAP Bubble Goes POP!?

A few weeks ago I was asked to do a special blog on SOAP charts, which was rather serendipitous, since the subject of SOAPing has been much on my mind of late.

You see, at Brenneke School of Massage, I received an excellent education concerning SOAPs. We drilled and re-drilled, wrote and re-wrote, using an excellent resource mentioned in an earlier Find Touch blog, Diana L. Thompson’s Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists. By the time I graduated I was doing SOAP charts that almost threatened to become novellas. And even though we were told that our training was “extra thorough” and we would probably not need to produce such exquisite documents in the “real world,” I still expected to immediately transfer my SOAPing skills into the first massage job of my career.

Not so. When I graduated I chose to take a job with a business that was part of a national massage chain, because I reasoned I could get my hands on the maximum amount of tissue in a relatively brief amount of time, gaining a LOT of experience. That part happened in the way I expected. However, the first time I picked up what I thought was a SOAP chart, I realized it was made up of about ten 2x2 inch squares, EACH of which was a SOAP chart. I freaked. There was no way I could get all the information in that square, I fretted to the head therapist. Not to mention the fact that my handwriting has always been an argument for bringing penmanship classes back into the public schools. Any kind of handwriting task makes me look like Michael Jordan heading to the basket back in the day, with his tongue sticking out to the side in total concentration. I had to get it all in PLUS make it really small? I was sunk.

But to my surprise, no one in management seemed upset by the lack of space. In fact, I feel therapists were encouraged to spend as little time as possible writing anything down because it would “take away” from the massage. This kind of attitude is very confusing, especially to newbies who have been trained that SOAP charts are part of what makes us healing professionals.

Recently, I begin working for another such business that DOES encourage SOAP charts, but these are done electronically, after the massage, having no paper to take on-the-spot session notes due to the desire to make it a paperless process. Well, that may be eco-friendly, but it doesn’t help those of us who don’t always have perfect recall. In any case, we are still encouraged to keep even the initial intake under five minutes, and that can be very, very hard to do and produce a chart that reflects any clear and useful record of a session, especially if you need to develop client goals (A: Assessment) for insurance purposes.

The whole issue of SOAPs, then, can become very complex. We know they are important, and we are trained to do them well. Then many of us leave school and work for businesses that don’t give us time or space to do them correctly. Then our SOAP skills atrophy; then we find ourselves, as I find myself at the moment, back with Hands Heal, polishing up because now I’m not just doing good therapeutic work, I’m doing it for insurance purposes. And yet I still may have no more than five minutes to do this. One therapist told me she solves the problem by taking notes during the massage itself. Okay, I know THAT’S out... not only is my hand writing abysmal, I can’t rub my tummy and pat my head at the same time either. Never could. :-)

So in this particular blog, I’d love to have you contribute your own opinions concerning SOAPs... do you have time to do them as well as they should be done? And if you don’t, does this detract from the professional standards you have worked to build for your massage practice? And if so, what can we do, as a community, to change it and still keep everyone involved happy?

Laundry as Therapy... Ommmmmmmmmmm

I do have a thing for nice sheets. They must be flannel, or high-thread count, no see-throughs, and stand up to about 1,000 washings.

I don't have a thing for laundry. I never want to do it.

Yet virtually every night, here I am, slipping into a rhythmic trance as I fold, fold, fold. Most of my career, I have been able to avoid most of this laundry chore, and I'm having trouble adjusting.

A sheet service seems like a great idea, but I learned when I worked at a gym in my last semester at massage school that the services were not what I imagined. The sheets we got were thin, basic hospital/nursing home sheets. One day I opened up a fresh batch of sheets and found a bloody bandage stuck to the top one. What happened? I didn't want to use service sheets ever again. Plus the sheets were thin, revealing and not very comforting.

Later, when I worked at a big spa, sheets became an important commodity. They never had enough, and our spa sampler package - the big seller - featured 25-minute massages. Double the laundry, all day, and the sheets were also used in mud treatments, so they turned a spooky shade of gray.

It took about two years and a new manager to kill the 25-minute spa packages, and by then the sheets were quite dead. Then the spa bought all new sheets - tons of them - and found out they started to unravel after the first wash. Three months later they had the look of old oil, the result of our lead therapist trying to be thrifty and buying plain safflower oil and adding a degreaser that didn't mix well. Nice try, but they were rank and thready in no time. Folding them artfully to cover the shreds or oil glops got tough. I dimmed the lights a lot.

The next time I looked for sheet sources I hit the jackpot. Two hotels needed day spa massage centers, and they did all the linens for you. Let me repeat that. They did all the linens for you. In a big washer that looked like a Peterbuilt truck. The sheets were washed by the hundreds, so a few more a day from massages didn't bother them a bit. They were dried in another Peterbuilt, and then the amazing ironing machine, which looked like a huge conveyor belt with arms. Every day the attendants checked for rips, stains, etc, and tossed the damaged ones into the rag pile.

Next they fed the sheets into a machine ironed and folded them and spit them out the end. Perfect. No one knows how happy you can be until you see how laundry is done efficiently.

Nirvana, it seems, is being able to drop your sheets down a chute and pick up clean ones. I became spoiled, used to the neatly ironed, folded, high-thread-count hotel sheets.

Now, though, I am in private practice and I'm getting a weekly dose of laundry fatigue. The sheets are hauled home with me and get tossed into the washer, then the dryer, sometimes two or three loads a night. I'm often folding while watching the 11 o'clock news. I'm not beating them against a rock or anything, but the laundry is always there!

But I am starting to take the advice I give to clients. Take a mundane task and use it to meditate. I'm not levitating or anything, but I do focus on what I'm doing, folding neatly, drifting into the zen state of hygienic bliss. It doesn't make the laundry disappear, but my crabbiness wasn't helping, either. Ommmmmmmmmm.

Banishing Our Demons

The history of massage includes some interesting twists and fascinating ironies. For example, The History of Massage by Robert Noah Calvert notes that ancient cultures primarily used massage to heal those afflicted by demons or demonic influences. And because pain and disease were believed to be caused by the inhabitation of demons or demonic forces, the direction of massage was downward, toward to the distal parts of the limbs, to force the demons out.

Later, when massage reached the great Greek physicians, massage became much less about spirit, much more about body. So we see the beginnings of what we know as modern massage, with strokes going upward, what the Greeks called anatripsis, toward the heart. And yet when the Greeks fell to the Romans, and then the Roman Empire itself declined, massage almost died away in Western civilization due to the fact that the medieval church considered massage a pagan practice: the same practice that had originally been used for the same type of exorcism that the church upheld. Fascinating, isn’t it?

But of course, the art and science of touch—or massage—did not die away everywhere or for very long even in the Western world, despite any pagan associations. However, like many healing modalities that the Western world “rediscovered,” massage as a healing profession struggled to attain a serious and respectable image as scientific theory and modern medicine were born, grew, and threatened to overshadow anything that did not fit whatever current paradigm they had established.

In my opinion, the whole reason massage did not die, in spite of everything, goes back to its very beginnings. Because we—modern though we are—still have demons, whether they are spirits, or whether they our knots in our emotions and bodily tissues. We call them problems, call them issues, call them needs, call them painful falls in the bathtub, but they are our demons. And we will always have them. And thus the history of massage continues, ironically, much as it first began. Only now, the strokes go both ways.

So Many Lubricants, So Little Time!

Some people think that massage therapists are a perhaps a little too obsessed with lubricants. But you know, lubricants are one of the most important tools of the trade next to linens, liniments, and tables.

In school, they teach you about the Big Four: lotions, crèmes, oils, and gels. Generally, they provide you with a basic, but generous, stock of lubricants and just leave you to find your own way. Soon, you’ve been smeared with just about everything and have heard stories from all the instructors on why they prefer x or y lubricant and how they prefer to x or y apply it. For example, you’ve seen lomi lomi people basically take a handful or oil or crème and just SPLAT! it onto a back, and you’ve seen garden-variety lotion lovers walking around looking confident yet goofy with big dabs of the stuff on their arms because God forbid they should have to reach down and pump a bottle and concentrate on massage at the same time. Eventually, you begin to lean toward a particular lubricant for your own work, and then just when that gets easy, BANG! You’re out of school and have to choose a type and brand of your own. If you want oil, you can certainly have it: but do you want olive, emu, avocado, sesame, sunflower, apricot, or fractionated coconut? Scented or unscented? Organic or non-organic? Blessed-under-a-full-moon-by-a-Peruvian-shaman or non-blessed-under-a-full-moon-by-a-Peruvian-shaman? Biotone, Sacred Earth, Bon Vital, blah, blah, blah, etc ., etc.?? The possibilities can be mind-boggling. The resulting obsessive opinions are really no different than the parallel situations you see with artists (oils, acrylics, pastels, charcoal, pencil, etc.) or rural Southern bass fishermen (frozen corn, chicken livers, anything-you-can mash-together-with-peanut-butter, etc.)

Lately, since I’m even pickier than most, and tend to mix gel and lotion as I work (in different proportions based on skin type), I’ve been working with one that seems to be the best of all possible worlds for me: Soothing Touch Desert Bliss Massage Lotion. It has the “soak” of a lotion with the “glide” of a gel or an oil, perhaps because aloe vera gel is one of the ingredients. Anyone else want to weigh in on your own favorite?

Where to get your Professional Liability Insurance

"What's the best place to get my liability insurance?" I think I have heard this question more often than any other since I graduated from massage school in 2002. Insurance is insurance. Some therapists go with one insurer over another because of additional benefits offered, for example by an AMTA membership. But, some of us are just looking for the best deal.

So, for those that want to do their own shopping, here is a list of masage insurance carriers currently known to me. I hope you find this helpful:

- ABMP
- Affinity Insurance Services
- American Massage Council
- AMTA
- Hands On Trades
- IMA