Our Blog - Page 2 of 6 - Tracy Walton & Associates

On Not “Charging What You’re Worth” in Oncology Massage Therapy

March 8, 2018 by Tracy Walton 12 Comments

Recently, in a group of oncology massage therapists, I started a discussion about setting fees for massage therapy.

In this particular group, we were all in private practice. They were all participants in my oncology massage therapy mentorship program, and we were talking about money and pricing.

It is a charged topic, this question of what to charge. Massage therapists in private practice are the deciders, but those decisions can be fraught with pressure and confusion.

Our conversation went in several directions and plunged through several layers. How high, how low, whether to discount, how to raise fees when it is time.

But by the time we brought the discussion to a rest, we had focused heavily on one topic:

The Tangible Value of Oncology Massage Therapy

This might not seem like a new or particularly earth-shattering topic. But it is worth revisiting with care. Here is why:

As we talked, we shifted our conversation away from the therapist and toward the therapy. Eventually we did one better and shifted it toward the therapeutic outcomes.

By focusing on outcomes rather than our service, or ourselves, we achieve an important separation. Setting fees requires that we separate ourselves from our work. Even though who we are is a part of what we bring to the session, it is liberating to see our service as separate from ourselves.

Why?

“I Should Charge What I’m Worth**” Can Be a Trap

It’s too easy to fall into the trap of “I should charge what I am worth.” I’ve even encountered MTs who ask each client to pay what the client feels the therapist is worth. Deferring to the client for the final word can be problematic, to say the least.

But equally troubling is the notion that we charge based on what we are worth.

When we do, a simple fee for a simple service becomes gnarled up in self-worth. Add in all the emotional energetics of money and self-esteem, along with the gender wage gap and other social forces, “charging what I’m worth,” is a prescription for confusion. Pile on the intimacy of massage therapy and the therapeutic relationship, and it could take decades to disentangle it all.

Here is an important nugget that can clear things up in a hurry:

The Intrinsic Value of a Human Being is not up for Sale.

It never was. Each person is perfect and sacred, beyond the language of “value.” Not a single person’s worth is affected by their choice of pricing. Not one person’s worth can ever be captured in a $50 or $80 or $150 hourly fee.

No, you’re not for sale.

Even the value of your time is not up for debate. So what are you selling?

Your solutions are for sale.

It’s useful to remember that we work in a service industry. In service industries, we solve problems. We bring expertise and energy to problems that are hard or impossible for people to solve by themselves.

I do not know how to shingle a roof or fix blown plumbing. I cannot cut hair well enough for school picture day. When I hire the roofer, the plumber, or the hair stylist, I pay them for their service. Not because they are “worth” something, but because it is worth something to me have those problems solved. Especially the night before picture day.

The Industry of Solutions

In massage therapy, we would do well to remember our membership in the service industry. It is important to focus on the problems we are known to solve, and those we have the potential to solve.

In oncology massage therapy, that list of problems is compelling. People in cancer treatment and post-treatment deal with pain, nausea, fatigue, stress, trauma, insomnia, isolation, poor body image, stigma, anxiety, and depression.

That’s the short list.

Does Research Back up These “Solved Problems?”

Research on oncology massage therapy is still in a tender place, but there is growing research on massage therapy helping the “Big 5” symptoms in cancer care: pain, nausea, fatigue, anxiety, and depression. From that body of research, the strongest support seems to be for pain relief and easing anxiety.

More generally (across multiple populations, not just oncology), there is compelling evidence that massage therapy is as helpful as psychotherapy for the problems of anxiety and depression.*** That alone is worth celebrating.

We can make clear and accurate claims about massage as follows: “Research suggests massage therapy can help people with cancer and cancer histories with the following: pain, anxiety, fatigue, depression, and nausea,” or, “There is strong research showing massage therapy is as effective as psychotherapy for anxiety and depression.”

Neither of these claims over-promises or overstates what we know. (For a list of claims to avoid because they do overstate and over-promise, download my free e-book, “5 Myths and Truths about Massage Therapy: Letting Go without Losing Heart.”)

Clients Tell Us We Solve Problems

Research aside, we have other reasons to promote our work to oncology clients. These reasons come from the clients themselves.

Over many years, my clients have told me tangible, intangible, and sometimes surprising benefits that they attribute to massage therapy: That massage helps them sleep. With massage therapy they feel less isolated and stigmatized. Massage helps them feel feel cared for and appreciated. They look forward to pleasurable sensations from massage, after months of needle sticks and scans. They tell me that when they receive regular massage therapy, they feel better able to cope.

These benefits are worth money.

Our clients’ observations count for a lot. They are telling us why massage matters to them, with or without rafts of research behind them.

We Solve Other People’s Problems, Too

In addition to the client with cancer, there are others in the circle of care who are helped by our services. Nurses tell us that that massage therapy eases the nursing workload. They notice that when MTs are working with inpatients, the nurses themselves do not have to respond to so many call buttons. This is worth money.

Other people’s burdens are also eased by oncology massage therapy: The out-of-state uncle or daughter who purchases a session for a family member. A group of co-workers who finds a meaningful gift in a package of sessions. An exhausted caregiver who gets an hour off while the MT sees their loved one in the home. The cancer rehab PT who works more effectively when a patient’s muscles are already relaxed.

These things are worth money.

Our clients, client communities, and health care providers tell us that massage is solving problems. With or without research, theirs is an honest truth.

Charge for Solving Problems

Oncology massage therapy has enough of a track record to be well-compensated. We can charge accordingly, without getting ourselves or our self-worth mixed up in it. Oncology massage therapy is well-received. It feels really good.

That sigh of contentment once we’ve bolstered and positioned a client–even that is worth something. (So often, after I’ve set up my client for the session, she’ll sigh and begin to relax deeply. When I suggest I just excuse myself for an hour while she rests on my warm table, she nods…”Whatever.”)

Relaxation is part of the solution. Sometimes it is the entire solution.

“Massage Therapists: The People who Practice Massage Best.”

Zoom out. Look at the field of massage therapy, not just oncology massage therapy. Even massage therapists do not always appreciate the value of basic relaxation massage therapy. Sometimes we search for more powerful techniques, forgetting how highly effective our Swedish massage foundation is.

Years ago, I attended a workshop on breathing problems with Leon Chaitow. He presented the osteopathic view and the PT view and an intricate account of the problems to address with precise manipulations. Then he said something like, “But massage. Don’t forget massage! It’s really helpful.” Gesturing to the crowd, he continued: “And you’re the only ones who can really do it. Or, at least, you are the best at it. Remember to massage!”

It was amusing to have to be reminded of this, but I loved the simplicity of his endorsement. We’re good at massage. Unadorned, un-fancy, effective massage.

When questions of worth enter in, they can confuse matters. Yet all by itself, massage therapy is a compelling service. Our skills are badly needed.

Those Skills are Worth Something

We live in a market economy, where services are exchanged for money to solve problems. Our services should be no exception. We can exchange skilled touch for money, because skilled touch solves problems.

I have more to say about pricing, and our tendencies to over- and undercharge in some cases. There are sometimes special circumstances in force, or a client’s financial need to consider in pricing. I’ll share those thoughts soon.

Meanwhile, remember this important starting point: Pricing does not have to be so personal.

Pricing Does Not Have to be Personal

It is not so much about the problem-solver, or what you, as a therapist or a person are worth. It is more about the results.

Disentangling the self from the service can be freeing. A focus on the service can reveal a much clearer perspective, one where difficult problems demand good solutions.

With that perspective, we are uniquely equipped to provide good solutions.

We can and should be well-compensated for them.

**********

*After I wrote this post, I noticed a Facebook discussion about “charging what you’re worth.” I did not have time to incorporate that discussion here, but if you follow Irene Diamond or Sandy Fritz on Facebook, they tackled this as well. I highly recommend taking a look.

** Do not get me started on the fuzziness of the term, “deep tissue.” That’s a topic for another post.

***Moyer CA. Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004 Jan;130(1):3-18. Every MT should read it.

Cold Caps, Frozen Feet, and Massage during Chemotherapy

February 2, 2018 by Tracy Walton 14 Comments

Two clients come in with interesting stories. The first tells you she received chemotherapy two days ago while wearing an odd-looking cap with a chin strap. It was a special “cold cap” cooled her scalp during the chemotherapy infusion. It made for a chilly session, so the infusion staff took pains to keep the rest of her body warm during the infusion.

The second client tells you about wearing frozen gloves and socks throughout his infusion, also a couple of days go. He didn’t find it comfortable, either, and the staff took extra measures to keep him warm.

As uncomfortable as it seems to add these accessories to the treatment, there were good reasons to cool the scalp, hands and feet in these clients.

Meet the Latest Tool in the Cancer Care Toolbox

A new strategy—cold therapy—is being used on the scalp, hands, and feet to diminish the effects of certain chemotherapy drugs. Massage therapists have questions about how to modify massage therapy for clients using this strategy. The purpose of this post is to answer those questions.

To back up: Most chemotherapy is delivered by infusion directly into the bloodstream. From there, it is distributed throughout the body. Delivery through the bloodstream means that the drug goes to nearly every tissue, not just to the tumor. Delivery through the bloodstream also means that side effects are systemic, rather than selective. In a sense, chemotherapy drugs cannot tell the difference between friend and foe, or the difference between healthy tissue and tumor.

Systemic side effects of chemotherapy, such as hair loss, chemo-induced peripheral neuropathy (CIPN), nausea, and fatigue are caused by this wide, nonselective distribution.

Some side effects of chemotherapy are distressing and uncomfortable, but others can be devastating. Some, like hair loss, are short-term effects. Others, like neuropathy, can last for years or even indefinitely, causing pain and debilitation long after cancer treatment is over.

Freezing out the Medicine

Local cold applications are used to steer chemotherapy away from certain areas by constricting the vessels in that area, minimizing blood flow through them. It doesn’t stop flow entirely (and you wouldn’t want it to. Hypothermia! Tissue damage!), but it narrows the vascular plumbing in the protected area. The goal is to reduce the exposure of local tissues to the drug. To protect the scalp, a cold cap on the head is designed to ease hair loss. To protect the hands and feet, frozen gloves and socks are designed to reduce the amount of drug flowing through their vessels, limiting the injury to local peripheral nerves.

These local cold applications take the form of caps, gloves, and socks. Here are some examples:

“Cold caps” and scalp cooling systems are used immediately before, during, and just after some chemotherapy sessions to diminish hair loss. Cold caps such as Penguin and ElastoGel work similarly to ice packs, and are replaced as they thaw. Scalp cooling has been used in Europe for decades, but is fairly new in the US. Cooling systems made by Paxman or Dignitana offer continuous coolant circulating through the cap. DigniCaps have been approved by the FDA for use in the US since 2015. (Click here for a picture.)

Cold gloves and socks are being applied to lessen chemo-induced peripheral neuropathy. In one study by Hanai et al, reported very recently in the Journal of the National Cancer Institute, participants received cold therapy on one hand and foot, and no cold therapy on the other side. Thus, they served as their own control in the study. Investigators found significant differences in the two sides in subjective experiences of neuropathy symptoms as well as objective performance in manual dexterity tests.

For massage therapists working with clients before, during, or after chemotherapy infusion, how do these new technologies affect your approach? Should you massage the hands or feet? The head? If not now, when?

How to Adapt Massage Therapy to the Scalp?

It’s easy to modify massage for a client receiving scalp cooling therapy. A person attempting to preserve their hair through cryotherapy is not going to want their hair pulled or dragged in any way. They are instructed to brush gently to hang on to as much hair as possible. Massage should honor this goal, throughout treatment, as long as it is vulnerable.

If a client wants touch on the head, we keep it to stationary holding rather than any friction that would pull on the hair. This avoids pulling, and avoids any strokes thought to be circulatory. While we’re at it, avoid getting lotion or oil on the head, if the client prefers.

How to Adapt Massage Therapy to the Hands and Feet?

The key here is also to align with the goals of the health care team. The purpose of cold therapy is to reduce blood circulation to an area. Classical massage strokes—notably effleurage, petrissage, friction, repeated compressions—are thought to increase blood circulation in superficial tissues in the areas worked. As massage therapists whose work is circulatory in intent, we need to work with the purpose of the cryotherapy in mind.

Here is where crystal clear guidelines get fuzzy. How do we avoid raising circulation to the hands and feet?*

You can avoid raising redness, but unfortunately visible hyperemia is only visible after you’ve already raised superficial circulation. So redness is only a reliable indicator of failure to stay within the lines, not of success.
We can avoid the strokes listed above, but then we get into an argument about which pressures make those strokes circulatory. Is it pressure level 3 on this scale? Pressure level 2?

The safest approach would be to avoid contact with the hands and feet altogether. Maybe light holding of each, but only brief. You don’t want to warm the hands or feet if they are supposed to be staying cool.

This guideline is in place just before, during, and just after the infusion. It continues until the drug has been fully eliminated from the body.

How Long is That?

Recall that your client has come to you a two days after the infusion. The cold therapy was applied during the chemotherapy infusion, and for 15-60 minutes beforehand and afterward.

For patients using cold therapy on hands and feet, we avoid circulatory work on the hands and feet as long as the drug is thought to be present in circulation.

Turns out, this length of time can be difficult to determine. The time it takes to completely eliminate a drug from the body is dependent upon the drug, dose, size of the patient, health of the patient’s kidneys and liver, and other factors. The best source of information about a given situation is the hospital pharmacist, but most MTs do not work down the hall from the pharmacist to ask this question.

The Dana-Farber Cancer Institute blog gives a general idea, though. They say that most chemotherapy drugs remain in the body for a matter of hours or a few days. So avoiding circulatory intent at the hands and feet is a good guideline for several days following the infusion.

Massage in the Infusion Room, during Chemotherapy?

Common sense can answer this question: Not on the areas that are cooling. The cap/gloves/socks are in the way! They present a physical obstacle to massage, and a mental reminder of the areas to be careful with afterward.

How about Other Patients at Risk of Neuropathy?

So let’s extend this discussion. Suppose your client has just had chemotherapy with a risk of CIPN, but did not receive cold therapy? What does this mean for the client? Should the client receive hand and foot massage just before, during, or in the hours/days after infusion?

This is a larger question, and one that the oncology massage therapy field should discuss. In the safest approach, we would follow the same guidelines and avoid raising circulation for these clients, as well. We would take care during the hours and perhaps several days after an infusion.

Yet many massage therapists suggest that foot or hand massage can ease neuropathy, and there is at least one published case report of this finding. Given the considerations above, the timing of that hand/foot intervention seems important. I would not do it until several days have elapsed after chemotherapy.

These newer treatments require new discussions: Many MTs are providing hand and foot massage in infusion units. Together, we need to arrive at meaningful standards of practice for the timing of hand and foot massage for people at risk of CIPN.

What Else Do I Need to Know?

This post is devoted to just two issues: hair loss and CIPN. But there are other side effects of chemotherapy, and other guidelines in place for them. During chemotherapy, hands and feet may be at risk of skin breakdown from certain drugs. Nausea and fatigue require a careful approach. Low blood counts require thoughtful interview questions and massage modifications. Even a surgery history can require a complicated array of massage modifications, and massage must be adapted to signs and symptoms of cancer itself.

So it’s important to have training, or at least read the literature on oncology massage therapy before working with a client during chemotherapy. It turns out, there is a lot of literature, and one should be required of all therapists: the 3^rd edition of Gayle MacDonald’s Medicine Hands: Massage Therapy for People with Cancer.

I did not start my career knowing what to do with this question. Cold treatment wasn’t a thing back then. But using a few principles, including aligning my goals with those of the health care team, and looking up some information, asking knowledgeable people, using the best sources in the field, we can adapt to new developments in cancer care.

With thought and care, we can work safely with people during treatment, even as treatments evolve.

*Note

Although a rise in blood flow is assumed to be an effect of Swedish massage techniques, the accuracy and significance of “circulatory massage” is a live question. For the purpose of this post, we’ll assume massage could raise circulation in superficial tissues of the hands and feet, at the site of massage. For more on this topic, see my free downloadable e-book, 5 Myths and Truths about Massage Therapy, below.

Resources

Hanai A, Ishiguro H, Sozu T, Tsuda M, Yano I, Nakagawa T, Imai S, Hamabe Y, Toi M, Arai H, Tsuboyama T; Effects of Cryotherapy on Objective and Subjective Symptoms of Paclitaxel-Induced Neuropathy: Prospective Self-Controlled Trial, JNCI: Journal of the National Cancer Institute, Volume 110, Issue 2, 1 February 2018, djx178.

MacDonald G. Medicine hands: massage therapy for people with cancer (3e). Forres, Scotland: Findhorn Press 2014.

Neighmond P. Cooling Cap May Limit Chemo Hair Loss In Women With Breast Cancer. National Public Radio, February 14, 2017.

Peachman RR. Scalp-Cooling Caps Help Prevent Hair Loss in Chemo. The New York Times, February 14, 2017.

Walton TW. 5 Myths and truths about massage therapy: Letting go without losing heart. Massage Therapy Foundation, 2015.

Save the Date!

August 2, 2017 by Tracy Walton 5 Comments

The Oncology Massage Healing Summit is Scheduled for April 27-29, 2018 in Bloomington, MN at the Northwestern Health Sciences University. The conference schedule will be posted soon, and registration opens this September.

Don’t miss this unique gathering of oncology massage therapy professionals and speakers. The conference is so popular with attendees that the Society for Oncology Massage decided to hold it every two years, rather than every three years.

We plan to be there in force, and plans are shaping up for two of our teaching staff to offer an educational session on bolstering for symptom relief.

Keep an eye on this link for updates.

Growing Up, Getting Real

November 4, 2016 by Tracy Walton 15 Comments

I stand at the side of the bed, looking down long lines of stuffed animals. They form a plush parabola around my sleeping child. For years, they have held all-night, wide-eyed vigils on this bed. By morning they will have been flung at each other in crazy angles.

But now, at 11 PM, they are still.

Standing here, I am seized with the impulse to reach over, lift each tiny ear, and whisper:

“Tomorrow, life as you know it will be over.”

Why? Because the rumors of layoffs are true.

Tomorrow a fluffy little flesh-and-blood animal will crash this scene. As I write, she is crated like fruit in a van, perhaps confused and terrified along with a pile of other street dogs. Her driver is speeding through the night from Houston to New England. Tomorrow we inherit a collar, a chip, a list of shots, a small supply of food, and a dog.

We’ve waited years for this moment. But standing here on the edge of it, my sadness surprises me. It’s ridiculous to be grieving the fate of 30+ stuffed animals, right?

What am I so sad about?

Families grieve transitions, even the joyful ones: Another baby on the way, the start of kindergarten, a new neighborhood. Each new beginning is the end of some old familiar sweater-like norm. The old drops away, as the family is re-made into something new.

Now, as artificial cherubs give way to a real one, something is gained, but something is lost, too.

I grieve the loss of imaginary play

For years, these stuffed animals lined up gamely for music class and divided themselves into reading groups. They followed carefully printed rules. They wore Band-aids and were declared feverish. They ordered complicated meals at restaurants, then went to bed early.

In solitary imaginary play, everyone does your bidding.

Over time, they began singing, hurting, and eating a bit less. Almost imperceptibly, books and extra-curriculars nudged them aside. My dread grew as my daughter’s interest waned.

Then, a few weeks ago, fantasy got a bit of a stay. A doll arrived. The animals re-assembled on their risers as if they had never left. They sang as they were told. I thought, perhaps this is the final flame-out. A last nod to the orderly love of the inner world.

Becoming real

Standing here staring at them, I can’t help but think of the Velveteen Rabbit. How age and love shaped it, how constant companionship wore it out and made a real bunny out of a stuffed one. How, even when its child moved on, it had lived its purpose, and its realness would never again be in doubt.

For me, becoming real means embracing a new seriousness, a closer attention. Things matter more. Looking back at my own long line of defining moments, I see that whatever it was that mattered at the time, it came into sharper relief. I couldn’t ignore it anymore. It called to me.

My training in massage therapy got real when we left the skeleton behind for the flesh and blood practice client. Later, the very real practical exam led to the first real job. I began to grow up, professionally. As I’ve aged, fewer and fewer things submit to my will. Instead, as my focus sharpens, things get way less orderly, way more complicated.

Things haven’t always gone as planned

I feel the focus and the messiness even more now, years later, in my day-to-day work with oncology clients. Reality rules when I meet the real client behind her paper intake form. When someone comes in with the real diagnosis after weeks of tests. When all the side effects they told her about have come true, and cycles of medicine stretch ahead of her into the unknown.

Reality rules when the truth is even worse than predicted.

Reality rules when I sit with someone who admits being buried by depression, even after hitting her 5-year milestone. Post-treatment, this phenomenon is baffling. People observe, “I’m supposed to feel better than this. But I feel worse than before I was diagnosed, before everything fell apart. How did that happen?”

There is no way to rehearse for cancer treatment.

Or, for that matter, its aftermath.

My client and I might linger in conversation for a bit, but eventually we move to the massage table. My hands hover in the air before coming to rest on the living, breathing moment. Below is an aching back, or a head full of distractions and fear. Maybe fatigue, nausea, running down the list. I try a brief rehearsal, or at least a bit of a plan: What matters most? How will my hands make their first contact? How can I possibly help?

As my hands hover, I find myself calling on larger and larger love. Sometimes, I feel as though that is all I have. It’s the only thing that can carry the moment.

Then my hands relax and begin their work.

These quiet conversations and simple exchanges stay with me, long after the work hours are over. They come home with me—not in a “should leave it at the office” way, but in a “must hold it close” way.

Later, my child and I talk about growing up

I tell her, I wish we could reverse it, and I do wish that, as much as I want to dial back the experiences I have just held close in my hands. I want to send us all back to that time before it happened, whatever “it” was. I want my child to return to the simpler ages of one and two that Billy Collins writes about.

Instead, my kid stares down standardized tests and schedules, a sadness and a seriousness. Growing up brings competing demands and chaos, along with the obligation to bring order to it all. Grown up days do not always bend to your will, and you can’t always practice for them ahead of time.

But growing up has plenty to recommend it, too. Even though it tends to come in overwhelming increments, those moments become more manageable. I tell her about plateaus. You gain some agency. New joys, often in surprising places. And yes, there’s more to do, but so much more is possible.

Most importantly, new things come to matter.

In order to hold those new things, love grows proportionally. Because it has to.

I think we come out ahead.

Tomorrow a living, breathing dog will arrive. She will come with quirks, as all of us do. Things will be messy while we learn each others’ rules. They will be messy after we learn each others’ rules.

Eventually she will fold itself into our family. We’ll default to the new configuration. We will not be able to imagine life without her, as we all march inexorably toward life without her. Unlike her polyester predecessors, one day her fluffy little body will give out altogether. Nature is like that.

So tonight, I take a long look at the small, stuffed faces lined up around my daughter. They gave her some good practice, loving and ordering them them around. Now she’s ready for an even larger love.

Perhaps I am, too.

For a moment, I feel silly whispering goodbye to them, but I can’t help myself: I thank them for their service.

Then I close the door.

Ethics in Oncology Massage and Hospice Care

August 4, 2016 by Tracy Walton 12 Comments

My client complained about her doctor, the nurses, and the general care she was receiving during cancer treatment. She went on for some time.

Now and then, she took a breath, then looked at me as though to ask “Do you agree?”

I held her gaze.

It seemed like a challenge to choose sides.

Agree, that she was getting poor care? Disagree? Question her account of her treatment?

I breathed. I wavered. I considered the options.

In the end, I chose reflective listening: “It sounds really hard, what you’re going through.” And a few more questions: “What happened next? Who have you talked to about this? What kind of support are you getting, or do you need?”

I drew her out a bit, and eased the conversation over to the plan for her massage session. Next session I did the same, while encouraging her to vocalize her concerns to her care team.

What would you have said?

This exchange could happen anywhere, with any client, but it is somewhat unique to a massage practice focused on cancer care, hospice care, or people with medically complex conditions.

Why?

In massage therapy, the relationship dynamics are delicate. Clients are typically unclothed and hurting in some way, and are hoping for some sort of help.

Our clients are uniquely vulnerable.

A health crisis compounds that vulnerability. The uncertainty of diagnosis, the transition at end of life, the challenges of treatment–these heighten a client’s needs and sensitivities. Massage therapists navigate trickier waters.

In such situations, my words have as much weight as my touch.

There are countless examples specific to this kind of work: How to manage family dynamics and funerals. How to turn down requests for more pressure when the tissues are frail. How to answer hard questions when the stakes are high.

How to manage professional relationships with physicians, nurses, and PTs I might never meet, but who are lifelines for my client.

In the example above, I knew my client needed moral support, but that I needed to not undermine her care team. Whether or not I agreed with her, I knew the most professional response was to stay supportive, encouraging, and neutral. To let her vent a bit, without joining her on the bandwagon. To support her finding her own, best solution.

These circumstances call on our ethics.

Then I thought of Dianne Polseno

A dear colleague of mine, the late Dianne Polseno, wrote a regular column, “Ethically Speaking” for the Massage Therapy Journal. It was one of a great body of work and service that she left behind.

Over our long, collegial history, I found myself agreeing with Dianne about 50% to 75% of the time. The disagreements did nothing to diminish my admiration for her. Instead, they spawned a rich dialogue.

Recently I dug up an old column of hers and found a great statement.

“Ethics is a verb.”

She explained that it makes itself known through behavior more than belief or commitment.

I loved that, of course. Her writing was always clean and to the point.

Yet reading this, five years after Dianne’s death, I found myself once again agreeing with some parts, but not with everything.

For me, ethics is also profoundly inner process

Yes, it’s a measure of behavior, but the struggles are set in my internal landscape. Reflection and searching are in order. Ethics comes from my relationship with me.

Why? Because tricky situations make me uncomfortable. Uncertainty makes me rush to solutions. Strong feeling gives me…strong feelings.

It’s super easy, when I’m uncomfortable, to act on impulse.

My impulse was to join in my client’s righteous anger.

This needs to stop, to change! She needs to tell them X or Y! Someone should write a letter! Maybe I should write a letter!

Yet I knew that in that particular relationship, my outrage would not serve my client. I needed to control that particular impulse.

Instead, I sensed that the best stance was supportive, but neutral. I knew that doctor-bashing, an all-too-popular sport in my field, would serve no one.

In the pause between stimulus and response, ethics entered in.

Ethics needs a clear invitation, and a little time.

In the moment, I needed to breathe. I needed to notice my body. To acknowledge my strong feelings, and let them know I would get back to them later, but I hit the pause on my righteousness.

Instead, in breathing, I found my compassion for my struggling client, for all of us who struggle to be heard, seen, and understood.

When I finally spoke, I spoke from that compassion.

Charged circumstances, high-stakes conversations, pain and suffering. All can give rise to tender ethical dilemmas for massage therapists.

For decades, I’ve heard and tended these dilemmas in my oncology massage classrooms.

So I made a new course.

Two courses, actually.

A new one, “Ethics in Oncology Massage and Hospice Care.” Launching in September in Boston, it’s 4 CE hours.

Paired with a 3 CE hour course, “Cancer and Massage Therapy: What Does the Research Say?”

I want to address the ongoing needs of massage therapists in cancer care and hospice. I want to support them in the challenges that come up.

Aside from the spectacular convenience of knocking out two common CE requirements in one day, why these two in tandem?

Because of overlap.

The common theme is truth.

Ethical dilemmas present competing truths, and call us to deal with the hard truths. Some truths are liberating, such as the one, “I don’t have to solve this client’s problem, I only have to give them the best massage I can” dangling at the end of the process.

Research is about the search for truth.

There are competing truths about the effects of massage, and competing research results. Some of the massage truths we’ve relied on (Endorphin bursts! Toxin releases!), aren’t really true when lifted up to scrutiny. Yet there are others, underappreciated, that have been waiting in the wings: The potential for massage to help with the worst of anxiety and depression, or ease a distressing symptom or side effect.

In our search for truth, we raise more questions.

What do I do? How do I respond? How does massage help my client with cancer? How do we know? How do I market the effects of massage when we’re not quite sure?

What do I say to my client who complains?

And feelings.

What happens when I feel helpless?

How do I manage my own strong feelings? What if I listen to my pain and it actually speaks? What if it drags me down?

How do I cope, seeing and touching the hardest of human experience, day in and day out?

Do I have a right to complain? Compared to my clients’ struggles, mine are trivial.

And so on, yada.

What about you?

I’m curious about the kinds of challenges MTs face on the front lines of illness. I’m curious how you are handling yours.

I can’t respond to comments here for a couple of weeks, it being August and heading off the grid and all, but I’m grateful for anything you contribute, and I look forward to reading it when I return.

Free resources

Check out the Massage Therapy Foundation for my free eBook, “5 Myths and Truths about Massage Therapy.”

Read everything on massage and ethics in our highly acclaimed texts.

Check out archives of Dianne Polseno’s column in Massage Therapy Journal. Classic, conversational, and on point.

Or come talk to us.

Right? We never talk anymore.

Check out our two new live, face-to-face courses on research and ethics.

« Previous Page