Navigating the Ethics of Massage Therapy Practice with Pam Fitch

In my conversation with Pam Fitch, a respected RMT and author,  we explore the past and future of massage therapy to reveal its ethical and communicative core.  Pam and I explore the delicate balance between physical relief and psychological comfort, and the potential held within our profession.

We all carry our life stories, and it's through understanding this narrative that wellness begins. Pam and I share personal anecdotes that underscore the significance of recognizing each client's unique touch history. From the intricacies of informed consent to common presentations like neck and shoulder pain, we traverse the human aspect of massage therapy, emphasizing empathy and respect as pillars of our practice. This episode is a tribute to the profound connections we forge in the therapy room, where we treat the person, not just the condition.

Pam and I challenge the profession to elevate its value within the healthcare community by embracing the psychological and emotional support we provide. With Pam's insights, we confront the complexities of treating conditions like obesity and chronic pain, advocating for evidence-based practice over pseudoscientific advice. Every word, every treatment decision carries meaning, and we discuss the responsibility we hold as RMTs to communicate with integrity and to adapt to each client's needs with open minds and informed methods. Tune in to gain a new perspective on the therapist-client relationship and the ethical landscape of massage therapy.

To connect with Pam and/or purchase her book, please visit her website:
https://www.pamelafitch-rmt.com/

Transcript

Speaker 1: 0:08

Hello and welcome to another episode of Purvis Versus. My name is Eric Purvis. I'm a massage therapist course creator, continuing education provider, curriculum advisor and advocate for evidence-based massage therapy. In this episode, we welcome Pam Fitch, who is a well-known RMT author and educator from Ontario. Pam's main area of interest is healthcare ethics. In this episode, we discuss the importance of holding a safe space free of judgment, and how valuable it is to listen and validate people's experiences. We explore evidence-based practice and informed consent and discuss what that looks like in the treatment room for RMTs. And there's two great quotes from this episode 1. We treat people, we don't treat conditions. And 2. Don't be creepy. If you enjoy this episode, please rate it and share it on your favorite social media platforms. You can also support my podcast by making a donation by visiting buymeacoffeecom. Slash helloob and Purvis Versus can also be found on YouTube, so please check us out there and subscribe. Thank you for being here and I hope you enjoy this episode. Hello and welcome to another episode of Purvis Versus.

Speaker 1: 1:15

Today we are here to welcome Pam Fitch from Ottawa, ontario. I'm really excited to have her here today and this is going to be, I think, such a fantastic conversation because we're going to talk about ethics that's going to be our focus and healthcare ethics and how this applies to our wonderful profession of massage therapy. So welcome, pam. Thanks for being here. Thank you, it's my pleasure. It's so happy to be here. Yeah, it'd be great today. So tell us a little bit, the audience, a little bit more about you. You know who are you and where are you and what do you do and why is the things that you do so important for RMTs to know?

Speaker 2: 1:51

Well, I have been a massage therapist for decades.

Speaker 2: 1:56

Like many of your listeners may not have been born when I became a massage therapist a long time ago and in my experience and I don't think things have changed very much since then we were trained very well in manual therapy techniques, but the whole piece around talking to the individuals that we saw as clients was missing somewhat in my training.

Speaker 2: 2:23

I had some things that I was taught. We had a class called Emotional First Aid which was a few hours and we had a few communication conversations, but fundamentally in my experience, massage therapy is taught in silos. So you get knowledge about the jurisprudence what are the laws and the regulations for whatever area that you're in and then maybe there's a little bit about communication and maybe there's a class about informed consent, but nobody's kind of weaving that together and explaining the purposes of that. A long time ago I was faced with a number of clients and situations where I became pretty aware that my communication was going to be the most critical piece of the interaction that I had with my clients, and so it started me on this journey of investigating and interest in communications and the therapeutic relationship. So I've been talking about this, teaching about this, writing about it for literally decades.

Speaker 1: 3:40

So that's me, that's you. Well, I think you. I mean, I've been familiar with your stuff for a long time and I, admittedly, I haven't read like. You have a textbook out there, I believe. Yeah, do you want to do a little plug for your textbook?

Speaker 2: 3:56

Sure, my textbook is called Talking Body, listening. Hands and it's published by Algonquin College Press. So if people go to my website they can find it there.

Speaker 1: 4:07

Perfect, and we'll make sure to include your website in the show notes Okay, yeah.

Speaker 1: 4:12

No, I think it's. I have not. I have seen the textbook, I flipped through it but I have not read it cover to cover. But it is such a this is such an important thing that you, that you have done and that you've made a career out of, really, because the like you said. You said communication is the most important thing. And I don't.

Speaker 1: 4:29

I feel and you know you've been practicing for a lot longer than me, you know I've been around since the early 2000s and it took a long time to realize that what we say and how we interact and the language and the narratives and the communication we use, how impactful that is. But I really I like how you said, that we're, we're, we learn in silos, so we learn all these different things, but there's not a lot of integration of that, like translating that knowledge between you know why, like we learn about anatomy and physiology and all these wonderful hands-on techniques and we learn about you know jurisprudence and stuff. And we learn about informed consent and we learn they talk about. You know ethics of like not doing harm and these kinds of things, but it's not, it's not, it's not really integrated together. Very well, in your career, I guess can you spend a while your time teaching at Algonquin College, if I could remember. Is that right?

Speaker 2: 5:26

I am now retired from my Algonquin gig but yes, I was there for 20 years as teaching just this material.

Speaker 1: 5:34

Just material. Now, did you find, because you were so heavily involved in this that, did you find that in the curriculum and in the program there at Algonquin that there was more of a integration of this material?

Speaker 2: 5:45

Well, we didn't set out to do this but I ended up taking on all the courses that caught communications and jurisprudence and professionalism and entrepreneurship and, you know, financial literacy. So I had all of that stream of the courses. So my students ended up having me in every term for things. So I would actually say do you remember in term one when we talked about X or this is going to be dealt with in detail in term five. So my students in that program had the advantage because I was constantly reminding them about it. But it wasn't necessarily a planned thing, it is just the way the courses landed and I felt incredibly fortunate to have this gig because it really helped me to solidify these principles that I think are so important.

Speaker 2: 6:44

Because you know, what I was going to say at the outset and of course I forgot was we teach people, we work with people. We don't treat conditions. Yes, and people are complicated, as any massage therapist will tell you. You bump up against their touch history. You bump up against their attitudes towards intimacy, like how closely are they comfortable having people stand next to them? So when we instruct our students, for example, in how to fulfill the requirements for informed consent, if we don't give them the bigger picture, then what they're doing is saying I do this and then they do this and then I do that. I did informed consent but there's no sense of I negotiated, I empowered my client to refuse whatever I was doing, because that's important. So unless we get that, what we're doing is very risky. Yeah.

Speaker 1: 7:54

Yeah, no, I love that, and that's something that I wanted to talk to you about. Today was about the informed consent and we're going to come back to that, because I do have some things specific to that I want to kind of unpack with you. But I think that might be. I want to talk with other stuff first before you get that. But I love that. You said that and it's true in that and okay, this is like you know, it's always dangerous to say. In my experience and my experience working with and teaching and working with other RMTs, is that, yeah, the idea of informed consent, it for a lot of people, I feel that it's just more about ticking boxes, of doing what you're supposed to do without the negotiating. I like that you used the word negotiating. I think, if anyone's listening, that's a key, key word.

Speaker 2: 8:40

Yeah, everything should be a negotiation, everything. If touch is the modality, then everything we do should be negotiated, because people are complicated. They have complicated touch histories and you know, in my own life, for example, when I was a child, my big brother used to tease me a lot by tickling me. So as a massage therapy client, I brought that ticklishness into the treatment room. And when people would touch in the areas where my brother would tickle me, I was beside myself.

Speaker 2: 9:21

Well, you know, if you add to that someone's very checkered past or layered trauma that has happened as a result of certain consequences in their life, then the touch becomes kind of it's like kryptonite for their own personal experiences. And the one thing that my experience would suggest is that schools don't fully recognize the client experience. And so on the one hand, we teach our students and we teach our massage therapists to obtain informed consent or check in with a client, but if we don't have permission for what we're doing, the criminal code says we're assaulting people when we touch them without permission. That's basic information that all of our massage therapists should know, and we have a responsibility to negotiate that consent before we ever do anything.

Speaker 1: 10:25

Oh for sure, and that's such a key point too that you made here and this is brilliant, the way this conversation is starting, pam. So thanks for that. Treating the person. And so we learn these techniques. We learn like this stuff we're supposed to do.

Speaker 1: 10:44

But in my massage therapy education, so a long time ago, and in the engagement and then the stuff I do and I interact with other, whether they're students or whether they're RMTs new RMTs or experienced the story is very similar and that we are taught to think in silos, probably because we learn in silos, right? So we think, oh, this person's got shoulder pain, so okay, I'm going to focus on the shoulder and these are the techniques and these are the assessments, and okay, this is what I found, this is what I'm going to do, and you kind of just tell the person but you're not thinking about, well, let's not think about the shoulder pain, let's think about this person, pam, who's here, who's suffering with something going on in their shoulder. So if, flipping that script from, like, we're treating Pam who has shoulder pain rather than shoulder pain in this person in front of me, and I think if we take that mentality into our clinical interactions, it changes everything.

Speaker 2: 11:37

Yes, absolutely. In the textbook I tell a story, which is based slightly on a true story but a little bit adapted, of a person who is caregiving for her husband who has ALS and he is losing function repeatedly, to the point where the two of them are exhausted and crying in terrible grief because the trajectory of ALS is pretty devastating. So in this story the caregiver's husband falls asleep on her shoulder and she feels a lot of pain, but she doesn't want to move him because he slept for the first time in days. Well, imagine she goes to see a massage therapist and she says and my shoulder is kind of sore. She doesn't say any more than that. Well, if somebody immediately pokes in on the shoulder pain, oh, now we've got to do a range of motion. And can you do this? And it's resisted. And all of that without first determining the mechanism of injury. How did the shoulders start hurting in the first place, where the story might spill out?

Speaker 2: 12:56

Well, if we don't do that, we have ignored probably the most essential part of the story, and I am a frustrated novelist. I tell people what's happening by telling stories, and this is an example of that. This is a story that I adapted from something someone shared with me, and as soon as you hear that, you go whoa, if this person is dealing with their partner who's facing end of life circumstances in a very painful way and I haven't asked that question what am I doing as a massage therapist to be treating your shoulder? It's completely wrongheaded to start focusing on the shoulder in this scenario that I've given you. So that's just an example of where I feel so strongly that we treat people. We don't treat conditions. The conditions, if they get better because of what we do, that's golden, but fundamentally, we're dealing with people.

Speaker 1: 14:04

Yes, yes, and that's a fundamental message that is probably missed in large parts of our profession People will talk about the thing that they're treating, not the human that is there, that's suffering.

Speaker 2: 14:20

And I've done it myself. I bet you've done it. I've worked with a lot of frozen shoulders. Yeah, I've said that many, many times. I've worked with a lot of people who experience frozen shoulder for a variety of reasons, and no two cases of the same right. There's always an odd story to go with the condition.

Speaker 1: 14:43

Oh, for sure, One of my we're telling stories, so why not? One of the things that obviously. So I disclaimer like yeah, I started right, it was very orthopedic, very musculoskeletally focused, very like I'm going to do all the things and learn all the techniques and I'm going to be so good at assessment and blah, blah, blah and whatever. I started my career that way and, like a lot of us, we change, we learn, and one of the things that happened to me early on though, speaking of shoulders, was I had this woman who had come in with severe shoulder pain and it kind of presented like a frozen shoulder and she could. She had very limited range of motion, extreme pain, couldn't sleep on it, like just it was off work, and she'd seen numerous other practitioners and she was frustrated like a lot of times right, you're in pain.

Speaker 2: 15:32

No kidding.

Speaker 1: 15:33

And so, and I don't really know what happened, but I just, you know some people you just connect with, yeah, just sitting there and just having a conversation with her, and I asked her, you know what, what happened? You know to like, when did you first start to notice this, this problem? And nobody had asked her that before. They kind of just were like she'd come in shoulder assess you have frozen shoulder, do these exercises like you know, beat the snot out of it or needle it or stretch it, whatever. She had all kinds of things done. And she said oh well, it happened a number of months ago. I left my husband, who is abusive, and he had pulled on her shoulder, you know, and and you know I didn't get a lot more details about this.

Speaker 1: 16:18

Okay, this is. There's a lot of trauma here, so physical trauma, but a lot of emotional, psycho, psycho, social stuff. And I said, oh, okay, well, you know, thanks for sharing that with me. You know, did you want to talk more about that? Or you know, what would you, what would you feel comfortable with? And she just started telling me her story and we had an initial visit. That was scheduled I think it was for 45, maybe 60 minutes, and she talked for the whole time and I said do you want me like to do anything like kind of get you on the table like I'm supposed to put some hands on stuff? She's like no, this feels really good, I need to get this out of the way. So she unloaded all of her stuff on to me and you know I didn't scare her, you know I guess she came back, yeah, but the moral story was, is that, by getting that consistent with what you said, I held that safe space for her to tell me what was going on.

Speaker 1: 17:05

And then after that it was just a series of treatments where we didn't. I felt like I wasn't doing anything. I was just kind of holding her arm and gently massaging it, gently, getting to some gentle range of motion and if you watched from you know, in a soundproof booth, people probably would have thought what is he doing? Is he doing anything? But it wasn't the power of the hands on, it was more about the power of the relationship and the trust and her allowing me to do something that made that shoulder hopefully feel better. That seemed to be the most impactful thing and that was one of those things that just really switched with me. I was like, okay, so this, everything I think I know is now thrown to the side. And this was this one of those early moments in where I really started to shift my thinking, because I was like this doesn't make sense compared to what I've been educated to think. Right, there you go.

Speaker 2: 18:05

Thank you for telling me that story Many, many, many, many times. Most of my practice over the years related to working with people who had some measure of trauma in their life, whether it's personal trauma or there's complex injuries as a result of car accident or whatever. But trauma was a real focus for how I was working with clients and what you described as exactly my experience. Sometimes what people need to do is to get that story out of the way so they don't have to explain it anymore, and the fact that you were able to hear her and validate, just simply by bearing witness to what she was telling you. You're not in any way engaging in psychotherapy, which sometimes the regulatory bodies get alarmed about, right, massage therapist talking about client experience. The fact is, you're getting that stuff out of the way so that you can put your hands on someone and they won't feel like they have to say, oh don't, oh, don't touch there, right? So I feel quite strongly that one of the things we do is to contain, to hold the space for, our clients experience.

Speaker 2: 19:28

And you know, christopher Moyer, back in 2004, published a fascinating study about the effects of massage therapy being akin to equivalent to psychotherapy. It was a very interesting study and it eventually, people who remember that study coming out will recognize it. But we don't talk about it very much anymore, and yet it's just as true now as it was in 2004. And I'm grateful to Chris Moyer for that work because, well, in my own case, it validated my experience as a massage therapist and I went yes, this is what's happening. Right, clients are not coming to see me for psychotherapy, that's not it. They want massage therapy. But there is a need to acknowledge the human experience in that hour in order for us to really see who's in front of us, who's on the table.

Speaker 1: 20:33

I'm glad you brought up that Moyer paper. I love that paper. I use it often, I talk about it often in some of the courses and things I do, because it's and it's 2004. So we're 2023 now it was 20 years ago, almost 20 years, that's right.

Speaker 1: 20:47

And it's talked about, but it's, it seems to give us, as a profession, it kind of gives us some insight into what is it that's happening when we're treating people, when we put our hand, what's happening right, and if that paper talks about, you know, the impacts of massage therapy are very similar to that of having a psychotherapy session in terms of is it anxiety, depression and, yes, capacity is asleep, yeah, and sleep, yeah, sleep capacity, that's right. And so you're like, okay, so people, some people might hear that and think, well, massage is useless, it doesn't do anything.

Speaker 1: 21:25

And I hear that and I think that's fantastic Because we know that anxiety, depression and sleep are three huge factors in a lot of pain and pain-related behaviors and in disability, and if you can provide that safe space for someone to feel better, then that's really powerful.

Speaker 2: 21:42

And how do we heal? We heal by resting. We heal by putting ourselves in that parasympathetic mode. And if what massage therapy is doing is facilitating better mood and improved sleep, wait a minute. That's all about healing. That's what we do. But we have, as a profession, valued the nuts and bolts, the mechanics of what we do, because we can see, we can touch, we can feel the soft tissue changing under our fingers. So we're valuing the impact with our hands but have in some ways been conditioned not to value what we're doing with our hearts or with our minds, and I think that's a great disservice both to the profession and also to the clients. It's terrible.

Speaker 1: 22:36

One thing I felt for a long time is that, in order to be valued or validated as a healthcare profession, massage therapy tried, I think for a long time, to identify as physios, like we were kind of like, and we're kind of like physio light, you know, like you know we wanna be that kind of mechanical, tissue based, you know, orthopedic based profession.

Speaker 1: 23:02

But we know that we have this really powerful impactful effects when we're giving massage and we have the hands on people. But I feel and this is just totally my bias is that by trying to hold on to this very strong kind of physio identity, it's actually stopping our progression from moving forward where we can say, hey, you know what? Yeah, we know orthopedics, we know my scleroscleropathology, but we're really good at this kind of psychosocial stuff. It doesn't involve counseling, it doesn't involve like working out a scope, but we can make people feel better through different avenues that I would say, you know, are probably, depending on the person, just as valuable and maybe even more valuable.

Speaker 2: 23:45

Well, and the irony is, if you talk to physios, they're slightly envious of what art training is, which is so hilarious. You know, physios have master's degrees and they're highly, highly educated in understanding the function of the human body and how to improve it. And then, if you've been in a course with physios, they will sometimes kind of shake their heads at what comes out of the mouth of massage therapists, because the manual therapy skills that we have are exceptionally fine, but it's not the whole picture, and when we don't acknowledge the whole picture, we miss the point of what's really remarkable about what we do. It's hard to talk about it, though, don't you find it's hard for massage therapists to acknowledge that what they did was hold the space for a client. That takes a certain degree of maturity to actually recognize and then acknowledge that that's what you're doing.

Speaker 1: 24:52

It's not my hands my hands right it's holding the space, yeah yeah, and this comes down to the one thing that kind of always drives me a little bit crazy is all the different modality empires out there and all these different ways of selling hands-on techniques. And you think, well, we know that there's not one modality that works better than the other. They all have value. If you're touching somebody in a way that is meaningful and safe, then how can one be right and one be wrong? How can you have eight or 10, maybe more, 1200 different named modalities and they all claim to have effects on people and the people that practice that way. They, you know well, I get results with my clients. Well, of course everybody does, otherwise we wouldn't have a profession, right? So everyone has this different identity and again, it creates these silos of ways of thinking when the commonality is that you're working with the human and you're just using a different way to interact with them.

Speaker 2: 25:59

You know what's really interesting, eric the psychologist, the American Psychological Association acknowledged a similar kind of phenomenon among psychologists, right? So there are hundreds of different techniques or treatments or approaches for psychologists, and so the American Psychological Association I think it was back in 2007 or 2008, published this huge textbook full of evaluating various different kinds of techniques that psychologists use, and what they concluded in the end was the technique that is used makes the practitioner comfortable, but what really is going on is the fact that the client, or, in their case, the patient, felt validated, they felt heard, and this is actually called the common factors model. So the common factors of treatment in healthcare account for I'm going to make up a statistic, but it's like somewhere in the vicinity of 80 to 90% of the progress of a client. You think about the woman you were talking about with the shoulder problem. What she really needed to do was tell her story, feel heard and gradually, like a deer that's been in freeze mode, because they feel like they're frightened gradually her shoulders going to thaw, if you will, so that she can move it more, and then you can deal with the physical trauma. But until somebody can pull themselves out of that frightening mindset is pretty hard to heal.

Speaker 2: 27:59

So what the psychologist figured out was, oh, just sitting and watching people making eye contact, providing compassionate, attentive listening skills. This is therapeutic massage therapists do it. You described exactly what you were doing in your own case, right? Well, that's what I would like our profession to value a little bit more, because for my money, I think that's really essential. And that's probably where Christopher Moyer was realizing that massage therapy was like some of the other psychological treatments, where it's just like one more way for people to feel validated and heard, so that they sleep better, they feel less anxious and they're less depressed. I don't know, I'm maybe extending that research a little bit further, but it makes sense to me that those two realities, the common factors and what he discovered could actually link together.

Speaker 1: 29:00

Yeah, yeah, that would be nice to we had more research or more people doing that kind of research in our profession, and it's too bad that last I'm making probably an assumption here, but I think Chris Moyer I mean he had a lot of papers and he was really involved in this stuff but I think probably 10 or so years ago, I think he probably just got frustrated and kind of did something else, because I have not seen him publish anything anymore.

Speaker 2: 29:24

Yeah, I think he did go in a different direction. I'm not familiar with what it is but there wasn't a lot of future in his research because it wasn't necessarily super well understood. I don't think.

Speaker 1: 29:37

Well, I don't think he's gonna listen to this. But if anybody listens to this, I know I'm telling him to get back on the horse and see if we can, because we do need it. Would be nice to have somebody who PhD that is invested in or understanding of the profession and how to do that would be great. But yeah, he definitely has brought up some great things and I like that you said I've never heard that before the common factors model. I was familiar with the general idea that psychotherapy doesn't really matter which technique you do, or it's all about that.

Speaker 2: 30:13

Who, not the person is like who. It's the connection between the therapist and the client and in massage we all know this. Like finding a massage therapist you relate to is all about who you wanna hang out with without your clothes on and be touched by. It's very intimate.

Speaker 1: 30:33

It's very intimate and it is kind of funny. Our profession is that. It is odd, if you think about it, if you had to describe in one sentence what is it you do for living. You're like a touch-naked stranger, Like it sounds really bad, right, but it's something that we should understand the power balance and the vulnerability that people have.

Speaker 1: 30:55

And I remember very clearly from my first day in massage school. Our instructor in the first day said welcome to the only profession in the world where complete strangers are gonna take off their clothes and turn their back on you. I was like what? And at the time I was kind of shocked. But it's always stuck in my head. That's actually really a power thing to know because, especially being a man, and they're gonna pay you for it.

Speaker 1: 31:18

They're gonna pay you for it, and pay you pretty well too. But it's one thing it's always stuck in my head, being a male too. It's like, okay, there's this like you gotta be like above bar in terms of like communication and consent and all the things, so there's no room for.

Speaker 2: 31:36

Misunderstanding.

Speaker 1: 31:37

Misunderstanding.

Speaker 2: 31:39

And you know, I think that that's really critical, that we need to be after a while. Let me go back when you're first in practice. You kind of remember every client up to about the third month, and then they start to blur and then after three years, you actually can't remember whether you've met certain individuals before. Well, imagine, after 35 years, people will meet me in the grocery store and they say, oh hi, pam, and they want to tell me about their story and I'm thinking who the hang are you? And I have no recollection. So so one of the things that, as massage therapist, is really essential, and especially important for men who are in the profession, is that we need to have our own set of values and principles that we adhere to so that, no matter who we talk to, no matter whether we recognize them or not, if they see us in the grocery store, we are behaving with a level of consistency and integrity so that the person they trusted is still the person in law. Laws at the vegetables right.

Speaker 1: 32:58

Right.

Speaker 2: 33:00

There's something that's really essential and an important about that, because imagine that you treat somebody in your first year of practice and then, five years on, you meet them on the street and you're having a bad day and you're swearing to yourself and the individual comes up and says, eric, is it you? And you think, oh God, what did I just say right? Or you're at a cocktail party, or somebody says something and you bad mouth another individual who we are in the treatment room. That integrity we need to also bring it into our lives and that's a tall order. That's a big tall order to actually instill that value in students. But as massage therapist, that consistency is really, really important. Yeah, and Amanda basketball and some of her colleagues did some work around male massage therapists and did you happen to see the article that?

Speaker 1: 34:04

the no, I know, I know I'm Amanda. I've spoken with her before, but I've never. I have not familiar with that paper, so so part of her.

Speaker 2: 34:12

PhD research was in professional identity, and so one of her chapters was in the experience of male massage therapists, and the conclusion that she drew and made into the title of the paper was just don't be creepy, right.

Speaker 1: 34:32

Yeah.

Speaker 2: 34:34

So for massage therapist it becomes essential that you can both empathize with your clients experience male, female to spirited, gender, queer, non binary, whatever and if you can empathize with that client experience and your male and you demonstrate in your behavior that you can be trusted, that is golden. That is so healing. So my experience with clients who've had a history of trauma, quite often the final frontier for them in healing from trauma especially if there's been any kind of sexualized or physical trauma at the hands of a male is to go see a good male massage therapist so they can acknowledge that that was then and this is now and this person is a good person and I can trust them and I can judge good character. Like all of these things are complicated and our modality is touch, so that's where it becomes really. It's the road, if you will, yeah the hand back.

Speaker 1: 35:44

Yeah, yeah, yeah, that's actually. That's such a great, great point there and I'm gonna have to, I'm gonna have to read that, that paper. That sounds good. Don't be creepy. I mean, which is you know? That's that was kind of my mantra too is like don't be creepy and you know, try and just be, be normal and be thoughtful and be aware and communicate and over communicate and and, yes, don't be creepy, and hopefully nothing bad will happen. So, not good, I'm still here.

Speaker 2: 36:12

So this is a level of emotional intelligence and that is not that is not the case for every person studying massage therapy. So emotional intelligence needs to be born out of your awareness, your perspective. But yeah, that's how you don't be creepy.

Speaker 1: 36:35

So that's a bit of a loaded question, so you can feel free to answer how you wish. Do you feel that? So emotional intelligence usually comes with with maturity, like as you get older you become more, you know better at being a human, hopefully, and better being an adult and recognizing these things. Do you do you see it problematic that you know people can enter this profession that really young ages where they probably don't have that emotional maturity?

Speaker 2: 37:02

I'm generalizing, but you're generalizing, and I certainly generalized. At the beginning of my teaching in a community college setting. I would have students who are 17 and I'd be like how can you do this work? Some of them would never have had intimate sexual relations with anyone, so that I couldn't understand how they could have formulated attitudes towards other people, touching people that were complete strangers.

Speaker 2: 37:33

But over time I realized that there are individuals who are very young, hugely emotionally intelligent, and age is not the issue, it's the capacity to relate in a kind way, in a compassionate, not judgmental way, to another individual and to be able to listen. There might be people who were socially awkward in my classes and those folks really did struggle in massage therapy because quite often didn't understand what the client was saying and the client might be giving them very subtle cues and the cues were going over their head. So that's not necessarily about age, that's more about your capacity to observe or pay attention to the cues that you're getting. So I take your question, certainly felt that way in the beginning, but I think it's more of the emotional intelligence goes across the ages and it is a much more complex kind of phenomenon.

Speaker 1: 38:39

I'm actually glad you said it, because I was saying that to try and load it, just to see how you would answer because in my experience when I was in school, I was 25 when I started massage school, but a good chunk of my classmates were 18, 19, 20, 21. I think almost all of them, 20 through 20 plus years later, are still practicing and they are some of the most fantastic therapists I know. So I had nothing to do with their age, but I remember the time going to school. I remember thinking why, like, just so young, like you know, and this is what you're entering this career right now, and that was my big. I mean, I was, I was only five years older than them, but you know it felt the time right, I was only 25. I'm ancient. I felt like one of the old guys, right, and. But some of the best therapists I knew were and people I know are were young and and. But it was sorry, go ahead.

Speaker 2: 39:34

What makes the absolute best therapist is somebody who's been a client first and knows what they're comfortable with, and they also recognize what they're uncomfortable with, and when they acknowledge that in the treatment room, then they're establishing a level of safety for the client. Sorry, I interrupted you.

Speaker 1: 39:56

No, no, no, no, that's, that's an interjection. Every want, pam, that was, that was a great little thing. You added no, I shouldn't say, but the like what you said to about the social awkwardness and that was the thing is that the people, I think, that tend to struggle where, the ones that people that have trouble with the social, the social interaction, the social cues, or they don't feel comfortable talking to people. But yeah, age I don't think matters. There's, I mean there's people in my class that are quite a bit older than me too and I think they're still practicing. So it's age doesn't matter per se, but anyway, it's a little side track there.

Speaker 1: 40:30

One thing I wanted to ask you about to, one thing I want to talk about is, obviously our focus is kind of on ethics and and and whatnot, but one of my main areas of interest is on evidence based practice and you know, kind of trying to incorporate evidence into what we do, and the more we learn about evidence, more I realize it doesn't give us a lot of answers. Anyway, it kind of gives us more wrong, less wrong ideas, but nothing is for certain, particularly what we do right, I would say evidence based practice is really good medicine, really like you have a heart attack. This is the thing we're going to do. This is the best evidence we help people at hurt. There's a pro, there's a lot of stuff that we don't need to worry about. That's why I think evidence is useful, but I also think it doesn't give us a lot of certainties.

Speaker 1: 41:13

But there's some stuff that I wanted to talk about. Was, you know, like there's? There's, I feel, and I want you to hear your point. Your opinion is this is the relationship between ethical health care and evidence based practice. Do you see there there being a relationship between how those things function together?

Speaker 2: 41:33

100%, absolutely there is. When I first became a massage therapist, there were a lot of people doing colonics. Where they were doing a colonic, irrigation was a big thing back in the early 90s, right. Well, that has been debunked as a form of treatment, but at the time there were many massage therapists who thought, oh, this must be good, so you should go do this If you had abdominal issues. And what I see in massage therapy among practitioners is, if this is the case, then that's the option.

Speaker 2: 42:14

It's kind of like recipe based home care, without a lot of investigation as to the the evidence to support the decision making. We will often tell people things that are completely out of our own opinion and we'll dress it up by saying something like well, there's research to support this idea. Oh yeah, if you read it, do you know what the caveat says? That you know this research is only good if these are the circumstances I think massage therapists are. This is going to sound pejorative. Massage therapists can be somewhat lazy in their willingness to actually investigate the effects of certain actions.

Speaker 2: 43:16

And the other whole piece of this, back to what I was saying earlier is that if we look at the social science research, if we look at qualitative research and we consider client experience, the empirical experience of long standing practitioners. If you've seen 20,000, if you've performed 20,000 treatments, you have a perspective which is there's evidential kind of perspective there. If you've only been in practice for a year and you're telling people that they should do this and that and the other thing, that's not helpful and that's not evidence-based. It's just trying to make us feel better about ourselves, that we know something special, that we're important. That's not evidence-based practice and it puts the clients at risk sometimes. I think so. I think there is an ethical prerogative that we need to carry out if we're a massage therapist yes, that was a very long-awaited story yes, the answer to your question, yes, okay. Next.

Speaker 1: 44:36

Next no, no that's good, I wanted to.

Speaker 1: 44:39

I just wanted to.

Speaker 1: 44:41

I mean, I made an assumption that that would be your answer and that just kind of leads into kind of what we want to talk about, kind of in the last little bit of this conversation.

Speaker 1: 44:49

As you mentioned earlier about things like informed consent, and this is something that I strongly feel needs to be talked about more, and I really strongly feel that the stakeholders in a profession need to understand the implications of the way things are being done and the way, because I feel that, if we're looking at at least how I understand informed consent is, it's not being met. So, and this goes to the thing, like, is it possible, like is it ethical for our entities to make a claim they can't support, which would kind of fit into that evidence-based thing you know, like, what claims can we actually make? If we understand the evidence says you cannot permanently deform tissue with your hands and you don't need to for people to feel better, that doesn't mean what you're doing with your hands is useless, but it means the claims you're making about, oh, I'm interacting with this specific tissue or I'm altering this specific joint, or whatever it is you might wanna claim, if there's not evidence to support that, then is it ethical for you to make those claims?

Speaker 2: 45:55

I don't believe, so I'm gonna make that the short answer.

Speaker 1: 45:58

Yeah, I don't is ethical.

Speaker 2: 46:00

The ethics is the study of right and wrong, the principles by which we form our attitudes in our practice. So if you think about that, then the choices that you make as a professional should land you on the side of principles that support healthy practice. The client feels better. We don't hurt ourselves as massage therapists. We stay within our scope of scopes of practice, whatever they are, however they're described, and if we do all those things, generally speaking, clients are not gonna be injured and our regulatory bodies are not going to feel overwhelmed with the number of complaints against us as professionals. Where we get in trouble is when we make claims that are not supported or we touch people in ways that they didn't anticipate and they feel very uncomfortable and they don't launch, or they feel that they were. You know, on the far end of that spectrum, they were abused by a massage therapist or, worst case scenario, there was predation, like there's a continuum here of care. So if you're working within your scope of practice and you are making good decisions based on what you know about what's available to you, you know that gives you a pretty wide scope of what you can actually perform in the treatment room.

Speaker 2: 47:37

Where I get crazy. I just oh. It makes me crazy is when people use language which is super imprecise. For example, when I hear certain individuals telling me that they're tuning the liver, I want to scream, because what does that mean? In my other life, I'm a musician. What does tuning the liver mean? Applying a tuning fork to the liver? Well, people use tuning forks in some capacity in their work, but hitting the liver with a tuning fork isn't even going to create a sound, because it's going to be kind of a splat. Okay, so what's that mean? So tuning the liver is what you're doing alleviating palpable tension in the structures that are holding the liver in place. Now I can understand what you're talking about.

Speaker 2: 48:31

There's more precision in that language and you've probably had this experience yourself, eric. I've had people tell me oh, my other massage therapist told me that I have this problem, or my doctor has told me I have a degenerative disc, or I have, well, any number of conditions, and I always want to know. So how did they find that out? How was this determined? And when you start to unpack some of the determinations of the impressions that clients have about their conditions, quite often it's because somebody has said oh yeah, it's really common. You got a degenerative disc, oh yeah. You've got this, oh yeah.

Speaker 2: 49:20

And it's just irresponsible because clients are like sponges they hear everything we say and then they interpret what we're saying and then they share what they think their interpretations are with somebody else. And it's like that old game telephone we used to play as kids. So what you may have said to somebody is not gonna bear any relationship to how it's actually reported. Three or four practitioners down the line. It's really essential what we do, that we say carefully what it is. We can do, what our capacities are as practitioners and we're describing what we're doing in a very precise way. It's yeah, that's advanced care.

Speaker 1: 50:06

But I'm so glad you expanded on that, because the way I see it too is that if we don't understand the evidence, then we can speak in these very precise terms and we can say, oh, you hurt, you're back a sore, because you've got a right elevated enomniate on and you're left, as you know, say terms this is whatever, and you can make all these big kind of like things and you say, well, how do you know that?

Speaker 1: 50:31

Well, I can see that, I can feel it, but maybe the person is always like that and they don't have pain and maybe that's not related to pain. And we look at the research, it just says those things, there's not a strong relationship between those things and pain. Anyway, that's just. You know, sometimes that's how people present and maybe it's nothing. We're all different, no one's symmetrical. But we start to make these claims to validate why the person is sore. And then when we make those claims to value the sore it gives us, makes us feel good. And but the way I see it is like, first off you're kind of making something up because it's not evidential, and then you're telling the person this is why you hurt, and then they're giving you consent to treat based on this thing which doesn't exist. So the way I see it is like well, that's not informed consent, Because you're giving consent to something which isn't real or isn't related.

Speaker 2: 51:20

Inform, consent is about negotiating the process. Whatever it is I'm going to do with you is if you're the client, right? So first of all, I have to understand what the purposes, what the circumstances are that created the condition that the client's reporting. And then I need to observe with my eyes, and symmetry is a huge indicator for what we're looking for, right. So I'm looking for asymmetries or postural anomalies, or listening for indications of old injuries or all of those things. That's all true, but then when I'm negotiating with somebody how I'm actually going to put my hands on them, where I'm going to put my hands on them, how they're going to be draped, how long I think the treatment's going to be, and what I would imagine is the time it's going to take for us to do this. Well, that's the information they need to determine whether or not they want to engage with me. Because if I start touching them and they haven't given me permission and they suddenly take offense to what I'm doing, it's possible that they could claim that I've assaulted them because I never told them what I was going to do. Under the criminal code, that is assault. Yeah, I once knew a former police officer and he would come into my classes and talk to my students. One of the most bald statements that he ever said that I've never forgotten is if you put your hands on me and I'm the client and I haven't given you permission, you have assaulted me under the criminal code and I can ask for you to be charged.

Speaker 2: 53:16

My students are went right, because that goes to the heart of what we do as massage therapists. That's why what we do is both so revolutionary healing through touch but also potentially so devastating, because if we touch without permission, we may be reinforcing old traumas. People may be offended, they may be hurt, they may be harmed. So we have a responsibility to make sure that that conversation, that negotiation for consent, is explicit. At the end of that conversation there has to be the question do I have your permission to go ahead? There has to be the statement if, at any time, you feel uncomfortable with what we're doing, let's stop or pause, because I don't want you to feel uncomfortable. If those things are in place, then you're probably getting adequate informed consent from your client. But if they're not there, you're just going through the motions.

Speaker 1: 54:20

Yeah, thanks for clarifying that, ben. That's very helpful, I think, for me and for that.

Speaker 1: 54:26

No, that's okay. I can tell your passion about this. This is why I wanted to have you on for this, because I knew that you would have more experience and knowledge and then this than most. So I appreciate that. So one thing that I want to talk about so when we talk about informed consent, we also can talk about do no harm, which is the first thing that we're always learning.

Speaker 1: 54:44

The way I've interpreted this and correct me if I'm wrong and I'm happy to be wrong is that do no harm. Oftentimes is talked about physical harm. I'm not going to hurt you purposefully. I'm not going to do anything to make you worse. Could we expand that into more some of the psychosocial harms or the unhelpful beliefs and narratives that people have? If, by telling them stories and making things up to try and justify a treatment and maybe, like you said earlier, people go the game of telephone, they're told all these different things Maybe it's true, maybe it's not true, but maybe, if it's not true, but the person believes it is to be true and that impacts their behavior in a negative way, could we include that in that ethical concept of do no harm?

Speaker 2: 55:35

You just set me up right, because of course, of course you can. Of course you can Imagine that you have a client who has a weight issue, so they're morbidly obese. Well, obesity is one of those conditions that lots of people who are not morbidly obese believe can be solved by simply restricting your calories. And that is not the case. After a certain point, when people are morbidly obese, yes, they may be eating more than other individuals, but all of our systems become so pulled out of whack that it's my clinical term pulled out of whack so you're not able to respond to food in the same way. You don't digest it, you hold it in your system and the obesity becomes a full system challenge.

Speaker 2: 56:39

So I've heard massage therapists, for example, say to people well, if Jack would just lose a bit of weight, he'd be so much better, his knees would function better. Yeah, that's not helpful, because obesity may be a factor in the condition of people's knees, but we are also not trained in the particulars of obesity enough to be able to say lose weight, your knees will get better. That's not the way things work. It's very complex and I come back to my earlier point. I think sometimes we look for a very simple. If this, then that kind of response that we can share with our clients to make us feel better, to make us feel knowledgeable, that's not helpful. Our job is to listen to our clients' needs and see where our skills fit in their circumstances, and if they don't fit, we recommend somebody else. We don't hold onto them as clients, we let them go if we're not able to help. It's complicated, but I think that there are a lot of ways you can take your question Again. I could lecture you at length on that one.

Speaker 1: 58:03

No, that's fine, you can lecture if you want. I know you're retired now so you have no pressure to get back in front of the front of the book and lecture. But I just wanted to bring that because it's just in my world of where I first got my focus in terms of advancing my education and the stuff I teach is in the chronic pain and that's where, the more I learn, the more I realize I don't know, but one thing that I have learned about it is that a lot of people, when we're looking at the qualitative literature or the lived experience, a lot of people that suffer and pain and are disabled by it, their disability it's not their level of pain per se but their disability, how much pain impacts their quality life is really influenced strongly by the messages and the narratives that were given to them by well-meaning health care providers who were saying things just making I shouldn't say making stuff up, but they were saying things to try to help, to try and justify why a person hurts. But then the person going gets treated for that thing using said modality or intervention, and they still hurt and then they go and see somebody else who provides a different narrative, a different story and a different rationale for oh, this is why you hurt, is because I found whatever, and they get treated for that and then they don't feel better and it creates a cycle of disability and suffering and I would see that. I see that as extremely harmful because you're trying to help the person but because you might not be aware of the evidence for that condition or you might be unaware of.

Speaker 1: 59:49

Yeah, we know that the evidence for ultrasound is whether the machine's turned on or not. It doesn't matter. Some people might enjoy it, some people might not and some people might feel better. But it probably has nothing to do with the machine going bang or not. It might have something to do with chemical context, but people get sold these ideas to try to fix them and it seems in a lot of cases where the pain persists, that they end up suffering needlessly or longer than they should because of the harm of the stories they're taught. And I see that and this is my opinion I see that as a big ethical dilemma that needs to really be addressed at, I think, a lot of levels in health care and in our profession. I think that needs to be a stakeholder issue because we need to understand we've allowed things like pseudoscience and made up stuff to flourish at all levels, and I don't think it does the public any good.

Speaker 2: 1:00:56

I once knew somebody who lived with Ehlers-Dannells syndrome and the individual had experienced multiple 5, 6, 7 car accidents, a variety of different circumstances over the course of their life and, if you can imagine, combination of the trauma of the motor vehicle. So sudden impact plus a condition of Ehlers-Dannells would result in not only soft tissue damage but neurological challenges as well, because they would not be able to accommodate the force, even if they braced the nerves for going to get stressed. So this individual ended up with, oh my goodness, half a dozen different health care professionals that they were seeing, and each health care professional had a perspective on the circumstance, and not to say that massage therapy is the thing that was the most helpful. But the approach for this client that made a difference was that we just simply stopped trying to figure out is it T6? Is it T7? Is it C1? Where's the TMJ it was how are you doing today and what can we do that will make you feel better at the end of this hour? Because there were so many factors in this individual's healing. I couldn't promise that we were going to get rid of it all, but I have seen this client for many years and what has worked best is presence, observation, a focus on symmetry. Do no harm, don't make things worse, and whatever we do, at the end of the hour I want this client to feel better. That's what we're doing. And can I tell you what hand position is the most helpful? No, because it changes every week, every time I see this person.

Speaker 2: 1:03:14

Well, there, in a nutshell, is the nature of our work. We need to be open to what's possible but, at the same time, contain our skills. We need to pay attention to what we're seeing without making things worse. And you can go on. It's a continuum on a variety of different levels and it is complex. What we do so, ethically, I feel the most important thing I can do for individuals is to just simply listen, pay attention to what I'm seeing and offer something in the hour that we are together and then determine whether that was helpful when I see them the next time. I don't try to go too much further than that because, especially when you see people with complex presentations, it's different every time. There's all kinds of things that have happened between the one day that I saw them the first time and the next time.

Speaker 1: 1:04:23

Yeah, I love that, pam, so much. It's really. The clinical brilliance is in simplicity, yeah, but it's not easy. It would be to say simple, but it's extremely complex. What understanding at all?

Speaker 2: 1:04:41

When I'm teaching my courses, erica, I really have often said like everything you're going to learn here today is context for what you're doing within the treatment room. There's not a lot of. You all have the skills, I have the skills, we all have that stuff in place, but the context, the perspective that we bring in, that rich perspective that comes into the treatment room, is what makes it different for our clients when they feel heard in a new way and recognize to me that's the gift of what Massage Therapy does. I just love it. I think it's one of the most fabulous professions. I love the work but it's complex interacting with people with integrity and ethically.

Speaker 1: 1:05:30

Oh, 100%. The thing is, you have some of these podcasts and stuff. I feel the need to challenge the status quo sometimes, or to try to do things to push our professors forward, because I feel like we're dragging our feet about adopting changes in terms of how we are educated or how we think. I love how you brought this today, really Highlighting the importance of it. May not be sexy, it may not sell courses, it may not make any of us rich. It may be like can you just hold a safe space? Can you listen? Can you communicate in a way that is non-threatening? Can you explore a different touch and different positions and different be curious with your person that comes to see you? That is the clinical brilliance that I feel is not emphasized or understood or appreciated as much as it could be in our profession.

Speaker 1: 1:06:34

I think we do fantastic work. If anyone thinks that I'm saying otherwise, then you're not listening. I think we have such a huge potential impact to change people's lives and we do. I think we could be even better if we just address some of these things that you talked about today and said, yeah, this is where we should be focusing our energy on and you're probably going to have better. We can't produce. We can make better outcomes, but you're probably going to be less wrong. At the very least, you're not going to make anybody worse.

Speaker 2: 1:07:07

If you do that's okay and truthfully, without getting into a rut where you're not being mindful when you're with your client, if you're actually present, moment to moment, to what's happening, present in your hands, what your hands are feeling, but also what you're observing, what you're hearing them say, if they're saying anything, if you're present, then it actually shouldn't feel like a lot of work, because we all have the skills. We're just applying our skills in a thoughtful, mindful way. But if we forget that, we forget that we've got a human being on the table with a story and we don't pay attention to the story, then we get into problems, then the regulator gets involved because complaints happen, right, yeah.

Speaker 1: 1:07:57

That's such a brilliant way to wrap things up today. Pam, thanks for being here. Thanks for sharing your experience, your stories and your knowledge. It's highly valuable. I've really enjoyed the conversation. If anyone wants to get ahold of you, what's the best way for them to get ahold of you?

Speaker 2: 1:08:13

I'll give you my website and you can post it. The link to the textbook is on there as well.

Speaker 1: 1:08:20

Perfect, okay, great Well, thank you, pam. Have a good day.

Speaker 2: 1:08:25

I'm so lovely to chat with you, Eric. I really appreciate it, the conversation. Have a good day to yourself. Bye-bye.

Speaker 1: 1:08:32

Thank you for listening. If you enjoyed this episode, please give it a five-star rating and share it on your favorite social media platform. You can follow me on Instagram or Facebook at EricPervusRMT, and please head over to my website, ericpervuscom to see a full listing of all my live courses, webinars and self-directed course options. Until next time, have a great day and thanks for listening.