Congratulations! You have taken the first step on the path to a successful and rewarding career in therapeutic massage.
The workbook you are about to read was first published in 1996, but the principles still hold true today—nearly 26 years later at the time of this writing in 2022.
Good luck in your quest!
Douglas Helmer and David Lemke
Focus. Just another buzzword? No!
The fact is, clarity of purpose in any endeavor is always more efficient and rewarding than an unfocussed approach, be it in massage or life in general. Having focus means getting what you want—not settling for whatever comes along or for that which seems most expedient at the time. Unfortunately, massage is a vast industry which, unlike most other professions, virtually defies all attempts at career focus. Until now, that is.
If you have just started your training in massage you stand to reap the most benefit from these principles. This is because you haven't already spent any of your valuable time and money learning techniques or investing in business opportunities that don't meet your career focus. If you are already a practicing therapist, we assume you are reading this because your career locomotive has jumped its track. In your case, these principles will help you to get your career locomotive back on track toward a practice which is not only enjoyable but also rewarding. If you are a school or clinic administrator, these principles will give you greater insight into what courses to offer or therapists to hire.
However, before we let you rush onward to figure out your exact massage career focus, we need to explain a few things. First, we want to explain the situation and reasoning which lead to the development of these principles. Why is this? you ask. It's just that solutions are always better appreciated when one understands the full extent of the problems and circumstances which lead to the solution. Second, we will explain the benefits of these career focus principles. And third, we will give you some insight into the layout of this workbook and some tips on how to get the most out of it.
Around about 1995, while writing the script for a ten-minute-long promotional video on massage therapy, we tried to answer a seemingly innocuous question: What is massage and why is it valuable? Our intuitive response was: Massage therapy is the manipulation of muscles and soft tissues and it is valuable because it makes people feel better. But that answer just didn't seem to do the profession any justice. What kind of touch was it? How did it make people feel better?
We pondered these questions awhile and came up with dozens of possible answers. We realized the answer to What is massage and why is it valuable? depended upon many things. It depended on the individual therapist, his or her training and objectives, the nature of the practice, and the needs of the clients. We also realized, given the terminology extant at the time, that no two therapists described massage or its value in the same way. We knew right then we were in trouble; we couldn't possibly explain all these answers in a ten-minute video.
In the end, we limited the video's scope to educating the public about common, everyday activities which could lead to muscle and soft tissue complaints. We then simply added the assertion that massage was uniquely suited to relieving such complaints. This approach, although not our original one, deftly skirted the entire issue of defining the nature of massage. But we weren't ones to skirt an issue, especially when it came to something as important to us as massage. We resolved to do more intellectual ruminating starting with why the public should value massage.
Value is a highly subjective term. Were we talking about monetary value or just the intrinsic value of human touch? Or, were we talking about the value of good health? Because of this uncertainty, we decided to go back to the basics. We asked ourselves the following: What motivates a person to go to a therapist of any sort? We came up with another list of answers, most of which had to do with improved wellness. So, we surmised, massage's ability to improve wellness made it valuable. But wellness was another one of those subjective terms; we still hadn't discovered anything concrete. Finally, we asked ourselves, Why is wellness valuable? That's when we had it ...Wellness allows people to do what they want, how they want.
Perhaps that sounds overly simplistic, but if you think about it, you will realize, as we did, that most people only seek health care services when they actually experience or fear the loss of a desired activity such as running, walking, or typing at a computer. Therefore, it wasn't pain relief, stress reduction, or even good health per se that made massage (or any other health service) valuable to the public, it was its ability to help individuals regain or maintain the ability to do certain, chosen activities without pain, stress, dysfunction, or limitation. However, desired activities were not simply limited to those conscious activities people cared about, it could also include unconscious activities like breathing, digestion, and growing healthy skin. Furthermore, because every person has different activity desires and needs, wellness could not be defined as a single thing for all people.
What we needed was a simple method of determining a person's activity needs and hence, their wellness. So, based on the assertion that activity was synonymous with wellness, we developed a model which divided all the activities humans perform into three wellness areas. We then used this model to create a massage practice building manual which exploited this phenomenon and called it The Active Wellness System.
At this point, we knew why massage was valuable, but we still hadn't been able to describe massage. Being professional communicators (in addition to being massage persons) it was readily apparent to us that a significant factor contributing to the difficulty lay in the terms therapists were using; most were obscure, unfamiliar words to the public. Once again, back to the drawing board. What came out of that research was a plain-English guide for massage consumers we called The Massage Treatment Objectives and Preferences Guide or TOP Guide for short.
The objectives portion of the TOP Guide drew upon our previous discoveries revealed in the Active Wellness System. The Preferences portion of the guide were those optional factors we felt were common throughout all massage practices. What happened next was totally unexpected.
Therapists who ordered TOP Guides for their clients started telling us that the information (originally intended for the massage consumer) had helped them to focus their careers. Until the TOP guide, these therapists had never seen such a succinct, yet comprehensive, explanation of the range of possible choices available through massage. That's when the penny dropped.
It became clear to us that it wasn't the consumer who needed educating, it was the therapists. So we got out our pencils and paper (again) and revamped the entire format of the TOP Guide for use by therapists. It was only later, after we and some willing volunteers had a chance to test and implement these principles, that we discovered the range of benefits this approach to career focus afforded.
Now you know about the problems and circumstances which led to this workbook. Let's now take a closer look at those benefits we just mentioned.
The first benefit these principles offer is that they drastically reduce the amount of time required to find a career focus. Until now, even the most determined therapist would still probably require from five to ten years to find his or her chosen career focus. That is because it is basically a trial and error process (i.e., you just keep taking this course and that seminar until you finally latch onto a preferred career focus). This approach may have been fine in the good ol' days when massage certification only required a hundred (or fewer) hours of training. Nowadays, however, massage certification can take up to 3,500 hours and cost thousands of dollars. Therefore, today's new therapists just don't have the resources to support themselves or the luxury of time to spend finding themselves. With these principles you can reduce the time from five or ten years down to a few hours of reading and practicing. Not a bad way to spend a few afternoons, wouldn't you say?
The second benefit afforded by these principles is their user-friendliness. User-friendly not just because they incorporate terms which are easily understood by the public, but they are also specific enough to communicate the real-world value your massage practice offers. The self-explanatory nature inherent in these terms will help you to overcome the limitations of descriptions such as Shiatsu, Manual Lymphatic Drainage, or even Swedish Massage.
The third benefit is in the way our theory of wellness areas from the Active Wellness System reveal how every style or technique has its own unique and valuable place within massage. Until now, you really could not defend yourself if someone said their method or technique was better or truer than your method or technique. We are truly hopeful that this aspect of these principles for career focus will bring peace and harmony o'er the land of massage.
The fourth benefit is actually an extension of the third, but it is one of the most exciting. Because our model of wellness areas is non-massage specific, we find these career focus principles apply to virtually every form of health care. So, not only will you understand where your particular massage practice fits within massage, but you will also understand where it fits in relation to the entire health care system. And, if you can see where your practice fits within health care, it doesn't take a great leap of intellect to realize that other health care practitioners and organizations will see where you fit.
Lest you not fully appreciate this benefit, let us explain further. Almost since the day massage became an organized profession it has struggled to justify its existence within the conventional health care system. Even the fact that we have to refer to the conventional health care system illustrates this point. Ipso facto, the conventional practitioners see massage as alternative. But now, with these principles, there is no need for phrases like conventional or alternative health care. Wellness is wellness, the only difference now is the degree and scope of the therapy.
The fifth and final benefit (so far) that these principles provide is that they allow you to do away with all the demographic, cultural, tradename, and symptom-specific modifiers of the word massage. Examples of these are Sports Massage, Thai Massage, Cayce-Reilly Massage, or Stress-Relief Massage, respectively. Granted, from a marketing standpoint, these may be useful, but they will no longer be necessary for describing or focussing your career.
Now that we have brought you up to speed on the development and benefits of these principles, we would just like to spend a moment telling you about the design and structure of the workbook.
First, there is the cover …
Some people have asked us why we chose the image of a prism. It wasn't because we are big Pink Floyd fans; rather, it was because prisms are simple yet powerful tools for revealing a complex phenomenon. That's how we like to think of these career focus principles—simple yet powerful. And since there are three main sections (analogous to the three sides of a prism) from which seven focus principles emerge (like the seven colors within white light) we thought the image was a natural fit.
Now, we know we have been going on about how critical career focus is for success, and that's true, but career focus is really only half the equation. The other half is effective communication. If we were not to give you the ability to communicate your career focus, we would be guilty of wasting your valuable time. That is why we have divided the seven career focus principles into those three sections we just mentioned in the preceding paragraph. Each section represents a portion of an effective communications statement you will use to tell others about your existing practice, school, or clinic, or to talk about your future schooling or professional development needs.
Specifically, the three main parts of the workbook which represent the three components of a communications statement are: Part One - Service Provided, Part Two - Service Method, and Part Three - Service Context. These are just fancy titles which reflect the fact that if you want to tell somebody about your practice you have to convey what you will provide, how you will provide it, and finally, where you will provide it. Within these three sections you will find the seven career focus principles. Each focus principle is further divided into four sections as follows:
At the end of this workbook, you will find an appendix containing additional resources designed to help you put these principles into action.
If you want to get the most from this workbook, please be aware that each section builds on the information in the preceding sections. If you skip a section, the following sections may not make sense to you. Above all, discuss with others the focus decisions you have made about your training, career, practice, and professional development. This will further solidify your understanding and facilitate your ability to employ these fundamental principles, which in order to be effective, must become second nature.
One final bit of advice before you begin. Over time, your own objectives may change to some degree. If this occurs, you may find your career focus has become somewhat blurred. Therefore, use this workbook as a tool (just as a prism is a tool for dividing light) for splitting up your own jumble of thoughts and aspirations into its component parts. This will allow you to see if your career focus is still the same or if a new, more focussed career path has emerged.
That said, you may now rush forth and start focussing your career.
As the name implies, Service Provided refers to what you intend to provide your existing or future clients. Or, in the words of a client "If I give you money for a massage, what do I get?" In the introduction we mentioned that we had a theory that people only sought health care in order to keep doing those activities they wanted or had to do. That theory nicely addresses the what do I get? (i.e., to keep doing the desired activities) aspect of why people go for massage. But if life were that simple we would never have written this workbook. There is another aspect to massage, however, which makes it unlike any other service industry in that What do I get? is often just as important as How do I get it?
For example, people don't care how accountants add up the numbers on tax returns so long as everything is correct and balances in the end. In massage, however, how you go about providing a customer with the service is often just as important as the actual result of such service. In fact, sometimes the means are all that the client values. No end is even expected. To put this in a more ridiculous, yet illustrative light; would you pay an accountant just to be nice to you while he did your taxes and then just walk out without taking your tax return? Of course not. But people will go for a massage just for the sake of the experience. But now we have a problem. When a customer just comes for the experience, then the experience becomes the What do I get? and not the How do I get it? It's all so very confusing, but that's what makes massage so wonderful in its own right.
So, in order to address this dichotomy, we must break up your career focus into sections. This first section defines the What do I get? aspect of your massage career. The focus principles are:
The choices you make within each of these three focus principles will establish what your clients can expect to receive when they come to you for a massage.
Specifically, Wellness Area is not something your clients will get but the region of wellness (as defined by activity) in which they get it. What they actually get will be found in your choices of Therapeutic Outcome and Documentation. Therapeutic Outcome, if you are a massage therapist, represents why you do massage and why clients come to you. To say that it is important would be an understatement. It is also here, within Therapeutic Outcome, where we address that dichotomy of massage being valuable for the sheer experience and for what it can produce at some later date. Which leaves us with Documentation.
Documentation is truly the only tangible thing a massage service can provide its clients (Don't confuse tangible with quantifiable. For example, improving a client's range of motion is not tangible, it is quantifiable). And, depending on your choices of Wellness Area and Treatment Outcome, documentation may be of little or of great importance to your clients.
At the end of Section One you will find an example and exercise for combining your focus choices into the first part of an effective communications statement. Section Two, Service Method, will help you to define the How do I get it? aspect of your career focus.
FOCUS 1 Wellness Area
Wellness Area Concept:
Human be-ings. To be or not to be. See a pattern here? In order for humans to exist they must be. A rock can be, but it can't be a being. Being implies doing something. Doing something like breathing, thinking, walking, growing healthy cells, or digesting food, to name a few. We call doing something an activity. And if you recall from the introduction, we found that people value their ability to be doing things; that is, to perform those activities they desire. We also know that when a person's activities become impaired or threatened, he or she will seek health care. Therefore, if health care is about improving or maintaining wellness, then we could also say that health care is for improving or maintaining activities.
So, it makes intuitive sense that if we divide all human activities into handy categories (or areas), we will have some insight into why people go to health care professionals. Hence the term Wellness Area. Then, we as therapists, can choose which area we want to focus in ourselves. Fortunately, we have already made such a list of all the activities humans perform in order to be and then found the minimum number of categories into which they all fit. Here's what we came up with: Psychosocial, Biochemical, Biomechanical.
Wellness Area Options:
OPTION 1) Psychosocial Wellness Area
Psychosocial wellness is highly dynamic and represents the ultimate wellness area. It is where the sensory information from the other wellness areas (including itself) are perceived and interpreted. It encompasses activities such as thinking, feeling, interpreting, reacting and interacting. But every person perceives, interprets and acts upon stimuli differently. What makes one person feel terrible, either physically or emotionally, may only be a minor irritant to another. Therefore, what you learn about someone's psychosocial wellness area is entirely dependent upon his or her subjective interpretations.
There is also another factor which makes psychosocial wellness somewhat unique. Therapists who specialize in this wellness area are as much a part of the treatment themselves as are their massage skills. That is to say personality and empathetic skills are very important. If you have a caring, sympathetic nature, plus a fundamental desire to improve the relative quality of people's thoughts, feelings, interpretations, and reactions to internal and external stimuli, you would focus in this wellness area.
OPTION 2) Biochemical Wellness Area
The biochemical wellness area refers to those activities performed by a person's circulatory, lymphatic, endocrine, immune, reproductive and digestive systems. A number of these could be grouped under the term metabolic activity. It is most directly affected by a person's diet, environment, and hygiene. Sure, there are genetic influences, but we are only concerned with those things we can readily identify and influence within the scope of massage. If you want to help clients suffering the effects of a poor diet, unhealthy work environment, or improper hygiene (including the inability to efficiently transport or expel metabolic waste), this would represent your wellness area focus.
OPTION 3) Biomechanical Wellness Area
The biomechanical wellness area refers to those activities which are performed by the mechanical components of the body. These include bones, muscles, and related soft tissues which help us perform the actions necessary to move about and perform work. If you would like to help your clients to move about and perform biomechanical activities, this would be your choice of wellness area.
Wellness Area Understanding Your Options:
Negative feelings and emotions resulting from poor psychosocial wellness can affect a person's biochemical wellness (i.e., worry may cause or exacerbate digestive abnormalities). Digestive abnormalities can in turn affect a person's mental coping abilities in stressful situations. Left long enough, this could lead to reductions in healthy activities, which in turn results in poorer biomechanical wellness. In short, anything that negatively affects one wellness area will eventually have some negative impact upon the other two. Consequently, it stands to reason, anything that improves one wellness area will eventually have a positive influence on the other two.
We wanted to make this point because many therapists are reluctant to commit to a single wellness area focus. They are afraid that to focus in only one wellness area will limit their practice. But, if you agree with our theory of how wellness areas interact, you understand that massage is always global in its effects. Furthermore, success in any trade or art form comes quicker if you can establish your expertise in a specific area. That is not to say, however, that you can't be knowledgeable about other areas of wellness. Having a broad-base of knowledge is always an asset because it helps you to recognize when a form of treatment is either called for or when it may be contraindicated. Then there is the money aspect (money? … massage isn't about money, is it?).
Whom do you think earns more money, the general practitioner medical doctor or the brain surgeon? the house painter or the award-winning portrait artist? the handyman plumber or the high-pressure boiler technician? Obviously, specialization has financial advantages. So why be a massage generalist when the world is full of people with specific problems for which there are specific massage treatment modalities?
Finally, one last caveat about wellness areas. It should be remembered that the only mandate of massage is to produce positive effects in a person's wellness through the manipulation of muscles and soft tissues within an appropriate environment. So choosing a wellness area focus is not an invitation to be counseling, assessing, or treating outside of this definition. You may know lots of useful things about wellness, but if you do not possess recognized expertise in psychology, nutrition, or non-soft tissue care, and you ever feel the urge to give such advice or treatmentsSTOP!
For example, after assessing an elderly client's diet and posture you suspect that she may benefit from an oral calcium supplement. It is not for you to make this recommendation. Better to refer the client to a physician or nutritionist that is qualified to make such assessments. Even such apparently harmless suggestions as "Go for long walks if you feel mentally stressed," could come back to haunt you if the person dropped dead of a heart attack as a result of following your advice.
If you have a proper wellness area focus you will have developed referral relationships with other certified health care professionals that specialize in these other modalities. Not only will your clients and colleagues respect your professionalism, you will be functioning within, and ensuring the proper use of, the existing health care system. Moreover, you will not be exposing yourself and the massage industry to serious legal and professional repercussions should your advice or actions result in harm coming to a client.
A Lesson From Real Life …
There once was an experienced therapist who was asked to work within a successful Physical Therapy (P.T.) clinic. Over the past few years he had shared many clients with the clinic and was certain of comfortable assimilation into the internal workings of the business. However, within three months, the relationship failed. Now they share very few, if any, clients.
The problem arose because the clinic owner felt the therapist was too "alternative" to work within the P.T. environment. What was discovered through later consultation, however, was that the therapist was actually very clearly focused in the psychosocial wellness area which is not really "alternative" at all. The clinic owner had just assumed the therapist was focussed in the biomechanical area. He further failed to see how effectively the two approaches to wellness integrated.
How wonderful it would have been for everyone involved, especially the patients, and before all of the good intentions and resources were wasted, if the therapist and clinic owner had possessed a common set of terms by which to define and differentiate their methods.
FOCUS 2 Therapeutic Outcome
Therapeutic Outcome Concept:
Therapeutic Outcomes define the benefits clients may expect from experiencing your massage services. Every massage treatment, regardless of style, produces generalized and specific beneficial outcomes. So why not call it beneficial outcomes? Honestly, therapeutic outcomes just sounded more credible. The intent here, however, is to help you recognize and communicate the primary benefit you want to provide (or that your existing massage service already provides). Simply wanting to "help people", or "make people feel better" are not specific enough terms for focussing your career. Nor will saying these things do much in the way of promoting your practice.
Once again, as we did with wellness areas, we made a list of all the therapeutic outcomes possible through massage and found we could divide them all into three categories: Experiential, Lifestyle, and Corrective.
Therapeutic Outcome Options:
OPTION 1) Experiential Outcomes
Remember the little quandry we got ourselves into when we realized that massage is valuable for both the sheer experience and for what it produces at a later date? This therapeutic outcome solves that problem.
Clients who simply value the sensations produced during a massage treatment want this therapeutic outcome. Clients who seek this therapeutic outcome either want an escape from the over-stimulation of a hectic life, or they desire tactile inputs because their lives are lacking in stimulus.
This type of massage is often bemoaned by "serious" therapists, yet it is an important and valuable form of treatment which was the driving force behind the growth of massage in Western culture. The subtle nature of the styles and techniques required to provide an experiential outcome of good quality take years to perfect. However, no matter how proficient a therapist is at providing good experiential outcomes, he or she cannot claim that those techniques will provide any long-term benefits.
Therefore, if you enjoy providing people with a rewarding, enjoyable experience within the context of a single massage treatment, this would be the therapeutic outcome you would choose.
OPTION 2) Lifestyle Outcomes
Lifestyle outcomes are for clients looking for any one or all of the following benefits:
If you believe massage is best suited for promoting overall health and wellness and is part of a healthful existence, the lifestyle option would be your choice of therapeutic outcome focus.
OPTION 3) Corrective Outcomes
To employ our door hinge example for one last time, this is where the hinges have broken, the door is lying on the ground, and the horse is running south on a northbound highway.
Corrective outcomes would be your focus choice if you want to provide rehabilitation of specific injuries, impairments, and diseases which are preventing your clients from performing their desired psychosocial, biochemical, or biomechanical activities. You will work in cooperation with physicians, psychologists, chiropractors, physical therapists, and other health professionals. You like to solve problems and see quantifiable improvements.
Send us a letter if you don't agree, but didn't that last paragraph read like an ad you would see in the career section of your local paper? We've only covered two focus principles and already we are communicating more effectively.
Therapeutic Outcome Understanding Your Options:
Therapeutic outcome focuses should not be confused with styles with names which modify the word massage with the intent of communicating a benefit. For example: Swedish Relaxation is a type of massage that most people believe only relaxes muscles. However, Swedish Relaxation massage could be used to provide experiential, lifestyle, or corrective outcomes. Unfortunately, (and knowing full well that this is a topic which is inflammatory to promoters of a particular style), there is a growing trend toward developing brand name massage styles which attempt to attract clients (and therapists) by modifying the word massage with a geographic, demographic, cultural, or founder's name.
Sports Massage, Medical Massage, Neo-Natal Massage, etc., are other such double-barrelled names for types of massage. At best, these names may help certain clients to identify with your service, but they do not communicate the benefits your service can provide. At worst, using these brand names only serves to limit the potential scope of one's practice, confuse the public, and polarize the industry. In the oft quoted words of Shakespeare, What's in a name? That which we call a rose, by any other name would smell as sweet. And so it goes for massage. All massage, regardless of what you call it is the manipulation of muscles and soft tissues. Therefore massage is massage. Period. The only distinction one can make (and which serves both the public's and the industry's mutual goal) is to tell people which therapeutic outcome you can deliver. That is, say you do massage, then describe the benefits. Don't try to combine the word massage with the benefit or target market.
When you focus your career with respect to therapeutic outcome rather than by brand name you are free to learn and use any number of massage styles, techniques, and modalities in order to achieve your clients' desired results. You also have the freedom to promote these benefits to any person or demographic group in need of such therapeutic results (e.g., athletes, business owners, assembly line workers, pregnant women, surgical patients, psychiatric patients, actors, farmers, Canadians, Americans, even Swedes). Don't laugh, we actually heard there was a client who thought he couldn't get Swedish Massage because he wasn't Swedish!
Furthermore, by describing the benefit of your massage service in terms of therapeutic outcome rather than by brand name you will be immune from any culturally- or socially-inferred baggage. It only takes one practitioner of a brand name style to do something wrong or unsavoury and you (if you promote your services under this brand name) immediately become tarred with the same brush.
At this point, you should understand the range of options for both Wellness Areas and Therapeutic Outcomes. Your choice of wellness area and therapeutic outcome options represents what we call your Core Focus. Which leads us to an interesting fact. If you combine all the wellness area options with all the therapeutic outcome options, you will find the entire range of possible core focuses you can have as a massage therapist. Since there are only three options in each, the range of possible core focuses is nine. That's all. Surprised?
Most therapists we have taught are surprised. The fact is, no matter which of the dozens of styles of massage you choose to learn or practice there will only ever be nine ways to describe what you do. Mix 'em, trade 'em, collect 'em … nine and only nine. Your job now is to choose one of these combinations. From this point forward, your career will have the clarity of purpose it needs to succeed.
But before we ask you to make your selection, we thought we should give you some further examples. The following examples are based on the potential clients' needs.
Now that you have seen these examples you may be asking "What if I have a client that one week wants Corrective Biomechanical and then the next week wants Experiential Psychosocial? How can I have just one core focus and not be in danger of losing my clients?" The simple answer is to remember that specialization has its advantages.
But let's not be too strident about this issue. You can have more than one core focus but only if each falls within the same wellness area. So, technically speaking, you could have up to three. For example, you could provide both Lifestyle and Corrective Biomechanical massage without too much difficulty or loss of focus. However, since each of the wellness areas require highly divergent skill sets and personality qualities, you will find yourself being torn in opposite directions if you try to specialize in more than one.
The fact is, trying to be all things to all people is one of the more direct routes to failure in massage. Attempting to cater to every aspect of each client's wellness means spending most of your time and money learning new techniques and styles rather than focusing upon and mastering one combination of wellness area and therapeutic outcome.
Therefore, if at all possible, attempt to stick to one combination of the options within these two focus principles. Granted, if you are a practicing therapist there may be some initial setbacks in your client base. But we have learned (through bitter experience) that the sooner one gets focused the better. Better for you, your clients, your colleagues and your practice.
Finally, if you have no prior training or experience, you may have no idea as to which of these nine options will suit you best. If that is your case, simply start by eliminating those options you definitely do not want to pursue. Hopefully, you will only have a few core focus options to explore rather than all nine.
Core Focus Resolution Statement:
Create a text document on your computer, tablet, or phone (or print this page), then record your wellness area and therapeutic outcome focus choices. Include as many reasons why they are the best choices for you and what your objectives will be for each.
FOCUS 3 Documentation
Well now, those first two focus principles were fairly darn exciting, and you covered a great deal of ground. Unfortunately, we have to throttle back the excitement level a bit in order to deal with the last remaining issue which makes up the Service Provided aspect of your career—documentation.
Determining your documentation focus has little to do with the types of documentation you might use; rather, it has everything to do with the amount of detail you keep and can subsequently provide to others.
However, for the sake of example, the following clipboards contain some typical documentation issues you may encounter throughout your career.
Returning to the concept of documentation detail, there are two options: basic and comprehensive. Both refer to the degree of thoroughness and technical depth. Obviously, these are fairly subjective terms. What may be basic to one may seem comprehensive to another. But let's not get too worked up about this right now. This will all make sense once you get to Understanding Your Options on the next page.
OPTION 1) Basic:
Basic documentation can range from nothing more than issuing receipts to your clients, to recording a few details about the treatments you deliver. Essentially, the basic detail option is for you if you prefer doing massage rather than recording the particulars of who and how you massaged. In other words, you hate paperwork.
OPTION 2) Comprehensive:
Comprehensive documentation involves maintaining and providing extensive documents which thoroughly record a client's time with you. From intake and treatment documentation, through to follow-up analysis and recommendations, your recording procedures will be exhaustive.
Documentation Understanding Your Options:
As a focus principle, documentation is a compatibility issue. You must determine if your chosen core focus and the documentation needs of potential end-users are compatible with your feelings about paperwork. This interplay between personal needs, core focus, and the needs of end-users should be resolved as early in your career as possible.
First, there is the issue of whether your preferred documentation focus is compatible with your preferred core focus choice. Usually, the required level of documentation detail tends to increase as one moves from an experiential psychosocial core focus up to the corrective biomechanical core focus.
However, this is not a law written in stone. You can provide biomechanical corrective outcomes and keep only basic, if any, documentation. But you can only do this when no one else needs to know what transpired during the treatments. Which leads us to the second issue—end-users.
End-users of documentation can be one or all of the following: you; your client; other therapists; other health professionals such as chiropractors, physical therapists and physicians; lawyers; and finally, third party payers such as health insurance providers.
If the end-user of the treatment documentation is only yourself, then the level of thoroughness and technical depth is up to you. If the end-users include your clients, then it must be at a detail level that makes sense to them. If the end-users include third-party payers and other health professionals, then you will definitely need to provide comprehensive treatment documentation. Therefore, if you have an aversion to keeping comprehensive treatment records, be aware of it now. Your decision will impact where you work and the types of clients you attract.
But remember, as we said earlier, you can provide biomechanical corrective outcomes and keep zero documentation; just don't expect many referrals from other health professionals or to work in a clinic which does insurance claims. You could also provide experiential psychosocial outcomes and keep mountains of treatment detail; just don't expect your clients to enjoy being put through range of motion exercises or listening to you review the details of their last treatment.
Documentation Resolution Statement:
Create a text document on your computer, tablet, or phone (or print this page), then record your Documentation focus choice. Include as many reasons why this is the best choice for you and what your objectives will be in this area.
Part One - Service Provided
In this section you learned about the three wellness areas in which people value activity: Psychosocial, Biochemical, and Biomechanical. You learned about the three possible therapeutic outcome options available through massage: Experiential, Lifestyle, and Corrective. You learned that your choice of wellness area and therapeutic outcome options combine to form your Core Focus. And you learned there are two levels of documentation detail which take into account your needs, your core focus, and the needs of end-users: basic and comprehensive.
Now you can start to put this information together into what we call a career focus statement. Just use the following example based upon the question What do you do? to circle your choices:
I'm a massage therapist. I provide my clients with corrective outcomes in the biomechanical area of wellness. I also provide comprehensive documentation detail suitable for other health professionals, specifically health insurance providers.
If you are just starting out, you can change the present tense of the question and response to the future tense i.e., "I want to be a . . ."
There is enough information in this statement for two purposes. First, and most obviously, you can use it to answer the question "What do you do?" Sure you might run into a few people who may need you to clarify a few details, but you certainly won't lose them. You'll also preempt any wink, wink, nudge, nudge looks if you give such a response.
Second, you can use it like a filter to screen potential educational and job opportunities. If the opportunity doesn't conflict with what you have constructed as your own focus statement, then go for it. But let's not get ahead of ourselves, you still have four more focus choices to add to this statement.
The preceding section helped you to define and communicate what you provide as a massage therapist. The following service method focuses will help you to determine how you provide your massage service. They include:
Approach to Wellness defines your underlying beliefs about wellness and its attainment. Care Mode defines your role in the therapist/client relationship, and Depth of Touch defines the physical depth at which you prefer to work on clients.
FOCUS 4 Approach to Wellness
Approach to Wellness Concept:
We hear a lot of talk these days about wellness models and wellness paradigms. These models or paradigms codify a particular approach for achieving wellness (the words model and paradigm are synonyms, the only difference being is that when something becomes a paradigm the price usually doubles!). Approach to wellness is neither a model nor the higher priced paradigm, it is simply how you believe the esoteric concept of wellness is, can, or should be achieved. For some, wellness is simply a matter of optimal physiological function. Others believe that wellness is a combination of physiology, mind, and spirit. Approach to Wellness addresses this issue of your closely-held beliefs as to the fundamental nature of wellness plus the best route for achieving, maintaining, or enhancing wellness. And yet, as important as one's philosophy of wellness is to their practice, it is often overlooked. But first, some background.
If you sat down and really analyzed this subject you would probably find that every person on earth has their own particular wellness approach. There are, however, three historically preeminent schools of thought on wellness which stand out above all others.
The first (in no particular order) is the Western medical approach to wellness. It is based upon the Greco-Roman traditions and philosophies of Asclepius, Hippocrates, Galen, and the discoveries made during the scientific revolution of the 16th and 17th centuries. The second is the great wellness tradition of India based upon the principles of Ayurveda. And third, from China, the approach to wellness based upon the concept of Yin and Yang. Add to these major players the ever-growing number of metaphysical, religious, and spirituality-based wellness philosophies and you have a lifetime of interesting reading.
As much as we would like to explore each of these further, we can't. This is a workbook and not a reference book. We must distill all this fascinating complexity down to a more manageable form. To do that, you guessed it, we made another list.
From that list, we identified a pair of wellness approach options that we believe best represent either side of the center point on the vast continuum of wellness approaches (for all our Buddhist and quantum physics friends, you'll be pleased to learn that we believe this continuum to be an endless circle). These are the Whole Client and Structural-Functional approaches to wellness.
Approach to Wellness Options:
Option 1) Whole Client
This option is based upon the premise that wellness is a function of the overall interplay of a person's physical, intellectual, and spiritual realities. If all these components are functioning harmoniously then the whole state of wellness is greater than the sum of all the healthy parts. Treatment of illness and dysfunction often overlooks the symptoms and looks for the potential sources of such conditions. If you like to take into account all the factors which may be impairing a person's ability to function normally, your approach to wellness is on the whole client side of the continuum.
Option 2) Structural-Functional
If you prefer to isolate and treat specific conditions, taking into account only the specific structures affected, then your approach to wellness would exist on the structural-functional side of the continuum.
Approach to Wellness Understanding Your Options:
As we mentioned at the end of the concept section, these options represent either side of the center point on a circular continuum of approaches to wellness. See figure 1 below.
For example, if we follow the whole client approach to a point further up and around the left side of the circular continuum, we find approaches to wellness which maintain that because every cell in the body "communicates" to every other cell in the body, what one does to one cell or group of cells must eventually affect all other cells. Therefore, a therapist with a whole client approach may focus on the structure and function of a client's foot because he believes that will affect the entire body. On the other hand, if we follow the structural-functional approach along its side, approaches to wellness exist which maintain that because the whole body is comprised of genetic material, we can treat individual structures like feet by understanding this common building block of life.
How far you take your focus of a whole client or structural-functional approach to wellness is your choice to make. We just wanted you to get your footing, so to speak.
Circles aside, the most important reason for establishing your approach to wellness focus is harmony. Harmony between you and your clients, and especially between you and your colleagues. Approaches to wellness are sort of like political beliefs: everybody has them, but as soon as people start talking about them, the problems begin. Better to discuss your views up front with your colleagues and employers in order to avoid any conflicts down the road.
Approach to Wellness Resolution Statement:
Create a text document on your computer, tablet, or phone (or print this page), then record your Approach to Wellness focus choice. Include as many reasons why this is the best choice for you and what your objectives will be in this area.
FOCUS 5 Care Mode
Care Mode Concept:
Care Mode defines your role within your client's wellness program. It is a function of the interplay between you and your client and does not exist independent of this relationship. In other words, it takes two to tango.
Technically speaking, the care mode principle addresses the need for an explicit understanding, between you and a client, as to whom will ultimately be responsible for the stimulation, maintenance, or restoration of one or more of the client's wellness area activities. Non-technically speaking, care mode establishes whether you will be equipping your clients to be independent or dependent upon your services.
We call these care mode option choices Active and Passive.
Care Mode Options:
OPTION 1) Active Care Mode
The active care mode is founded on an understanding between you and your client that massage is simply a temporary supplement. Put another way, you will work closely with your clients to find ways for them to find wellness independence. Therapists focused on active care for client independence are concerned with steering clients toward the necessary referrals, knowledge, and tools so they may control their own wellness levels. This active care approach is becoming a requirement for most insurance claims.
OPTION 2) Passive Care Mode
In the passive care mode, your clients become dependent upon your skills for maintaining their wellness. The passive care mode implies continual treatments in the face of no effort, no desire, or the inability to change for the better on behalf of the client. This is not as bad as it sounds. Very often people with disabilities have no choice but to rely on massage as a way to maintain even limited levels of wellness. Other folks just don't see the point in staying well independently when they can enjoy a massage every week and get the same results had they done all the work themselves.
Care Mode Understanding Your Options:
Both the active and passive care modes are valuable ways to practice massage. One is not better than the other. However, the choice you make will change the nature of your practice dramatically.
If you like the sound of the active care mode, that is, equipping your clients for wellness independence, you will need to develop a vast network of professional colleagues to whom you can refer clients. You need to do that because if you keep making clients independent without a referral network you will be out of business in short order. When a student brought up this very point in one of our seminars we responded by simply daring her to try making her clients independent of her services. She told us some weeks later that it was tougher than she thought it would be. Amazingly, however, she confided to us that once she shifted to the active care mode, many of her clients voluntarily increased the frequency of their visits. Obviously her client base was more proactive about wellness than she had dared imagine.
However, the network is still necessary. This is because once you do become good at helping your clients to achieve true wellness independence, word of your skill needs to get back to the other health professionals (and third party payers) in your network. They will then be more than happy to replenish the void in your client base by sending you a constant stream of their clients.
If you like the sound of the passive care mode you probably have a big heart. Clients who require the passive care mode will rely upon you to keep them functioning normally, or as normally as possible. If you do become a passive care mode therapist, you will not need as large a professional network but you may need to do some consumer advertising in order to keep your client base from becoming stagnant. Be aware however, if you choose the passive care mode it will be anything but passive for you. This is because clients in a passive care mode relationship are just harder to normalize than are clients in an active care relationship. Massage, like life, is just full of these confusing little ironies.
A Lesson From Real Life. . .
Debbie is a massage therapist who enjoys helping her clients move from lifestyles with few activities due to pain or immobility to activity-rich lifestyles. She also likes to provide her clients with the referrals and resources to keep themselves flexible and pain free. She likes seeing her clients from 3 to 10 times within a few weeks and getting the job done, which she perceives as building independence. To Debbie, permanent use of corrective measures is a contradiction in terms. Her clients make occasional return visits but often just to keep in touch, visit, and enjoy some mutual encouragement.
One day she received an offer to join a high-profile health clinic. She thought this would be great since she could refer many of her clients to the other health care professionals at the clinic. She became very frustrated, however, when she learned the emphasis was on regularity of client visits on a more or less permanent basis.
Within about 6 months of beginning at the new location, her client base began to suffer seriously. She had originally been brought into association with the clinic because of her great reputation and because the health professional running the office was desirous of a high profile, successful therapist. However, it was now apparent to Debbie that the clinic owner's desire to create client dependency was in direct opposition to her own beliefs about her proper role within the therapist /client relationship.
Eventually, Debbie realized her credibility with the physicians and insurance company which had referred many clients to her previous practice was in jeopardy. That was because fewer of the clients she referred to the clinic staff were achieving wellness independence.
Ultimately, Debbie and the clinic owner began to work at cross purposes, and she resented being chided for not re-booking every client she treated.
After consultation, Debbie learned she preferred the active care mode, so she made the transition into a confirmed active care clinic and has never looked back!
Care Mode Resolution Statement:
Create a text document on your computer, tablet, or phone (or print this page), then record your care mode focus. Include as many reasons why this is the best choice for you and what your objectives will be in this area.
FOCUS 6 Touch Depth
Touch Depth Concept:
The Touch Depth principle addresses an issue which is often only spoken about in hushed voices: some therapists just prefer to work at a specific body depth. The reason they whisper is because the prevailing attitude is: you do massage, you have to work at all depths. That's just hooey.
Depth of touch can range from barely touching a client's skin, to where you physically reach and manipulate the deepest layers of muscles, soft tissues, and organs. Some massage styles or techniques require working at all levels—others, just at one. But if you have a preference (and most therapists do), why not make the choice now? Better to do what you love than what you hate.
Now, the names of these touch depth choices just begged to be in Latin; however, in keeping with our mandate to help you communicate with the public, we made the difficult management decision and gave them decidedly unsophisticated sounding names. They are: Shallow, Medium and Deep. Impressive, huh?
Touch Depth Options:
OPTION 1) Shallow:
The shallow touch depth affects the epidermal and dermal layers and can range, as mentioned above, from barely touching the skin, to gentle stroking and stimulatory techniques.
Although therapists who focus on shallow touch may only be in contact with the most superficial body layers, shallow touch can produce beneficial results in deeper body layers and positively affect overall wellness.
OPTION 2) Medium:
The medium touch depth effects those mesoderm-derived structures beneath the dermal layer. These include groups of muscles, connective tissues, nerve fibres, blood vessels, lymphatic vessels, and organs.
Medium touch depth requires stretching, static and dynamic compression, and the application of friction techniques to the above mentioned structures.
OPTION 3) Deep:
Deep touch techniques directly and thoroughly affect the innermost layers of muscle fibers, connective tissue, nerve fibres and the endoderm-derived layers of blood vessels, lymphatic vessels and organs.
Epidermis: Literally: upon, upper, or outer skin. The outermost layer of the integumentary system. Commonly referred to as the skin.
Dermis: The layer below the epidermis invested with numerous blood vessels, nerves and glands.
Mesoderm: Literally: middle skin. It is the embryonic layer which produces all the skeletal muscle, cartilage, bone, blood and lymphatic vessels, dermis and the exterior layer of many internal organs.
Endoderm: Literally: inner skin. It is the embryonic layer that produces the internal coverings of many internal organs.
Touch Depth Understanding Your Options:
There is no doubt you will encounter styles of massage which will require the use of all the preceding touch depths—often within a single treatment. However, you must decide which touch depth interests you most because it will have a bearing on both the styles you learn and your overall technique.
Whether you prefer to work at a shallow, medium, or deep touch depth, you can make your choice independent of the core focus you decide upon. That is, it is entirely possible to flout convention and provide corrective biomechanical results with a shallow touch depth focus, or experiential psychosocial with a deep touch depth focus.
Also, keep in mind that the medium and deep touch depth options do not necessarily translate into the use of hard, crunching, or painful procedures. Given proper training, experience, and knowledge of anatomy, you can provide satisfactory results at the deep touch depth without causing your clients undue discomfort. If working at the medium or deep touch depth level does cause your clients to squirm, there is a good chance you are working too hard or inappropriately.
If the bulk of your clients constantly tell you to either work deeper or shallower you may be misleading yourself with regard to your preferred touch depth. If you haven't mislead yourself, there may be another reason. One possible explanation to consider has to do with brand name massage styles. Sometimes a client with a prior history with another therapist who practices the same brand-name style ends up associating the style with the previous therapist's preferred depth of touch focus. Chances are touch depth had nothing to do with the style, but the client won't be happy until you work deeper or shallower. That is why it's good to have a touch depth focus which you can tell clients about before a treatment begins. Remember, just because you do massage doesn't mean you have to go to depths at which you feel uncomfortable or unqualified to treat.
Having a touch depth focus will also prevent an even less desirable scenario than having clients nag you to work deeper or shallower. This is the scenario in which your clients simply suffer in silence. Without saying a word they will lie on your table in either extreme discomfort or utter boredom. When you ask these clients if they would like to re-book another appointment, they usually smile weakly then suddenly remember that their mothers will be in town for the next few months. You end up being the last to know that they took their dashed expectations to another therapist (or worse yet, have decided to never use massage again).
It is always a good strategy to tell clients your touch depth focus before you begin any treatments. As for career focus? Knowing your touch depth preference will make it easier for you to decide if you want to learn a certain technique. It may also prove to be a helpful piece of information for future employers. Suppose you end up choosing a shallow touch depth focus and you apply for a job at a big, multidisciplinary clinic where every therapist has a deep touch depth focus. Chances are they will need someone like you in order to appeal to a wider segment of the community.
Insightful Tip — Touch Depth
For the sake of clarification, muscles and their related soft tissue structures need not be beaten into submission. Too often, inexperienced therapists operate under the misapprehension that they must relax impaired muscles utterly, or restore function completely, within the scope of a single treatment—even if that means resorting to highly aggressive modalities and techniques.
The experienced therapist, on the other hand, knows that muscles and soft tissues need only be coaxed with gentle persuasion to be normal and they will, in the majority of cases, return to a state of proper function. He or she will also know how to virtually slide under, around, and through superficial tissues and structures in order to reach deeper layers without causing any undue pain.
There's a great maxim from the business world that really applies to touch depth:
Work Smarter not Harder!
Touch Depth Resolution Statement:
Create a text document on your computer, tablet, or phone (or print this page), then record your Touch Depth focus choice. Include as many reasons why this is the best choice for you and what your objectives will be in this area.
Part Two Service Method
In this second section you learned about the two approaches to wellness which split the circular continuum of approaches to wellness: Whole Client and Structural—Functional. You learned about the two types of care modes, Passive and Active, and how each defines a different role you can play within your clients' wellness program. And, you also learned about the three depths of touch, Shallow, Medium and Deep, and the need to communicate your preference in order to prevent any dashed expectations.
Now you can add your Service Method, or the How do you do it? portion to your Service Provided statement which you completed in Part One. Once again, circle your choices:
I'm a Massage Therapist. Specifically, I provide corrective outcomes in the biomechanical area of wellness along with comprehensive documentation detail suitable for other health professionals.
I provide this service using a deep touch depth, an active care mode, and a whole client approach to wellness.
You have now completed two-thirds of both your career focus and an effective communications statement regarding your massage service. A few words, however, about this communications statement: it is effective, it's also very dry, almost robotic sounding. We don't want you to worry about this yet. We'll explain more about this in the Conclusion which follows our next section which is Part Three — Service Context.
The previous two sections answered the what and how of your massage service. This section helps you determine and communicate the where of your massage service. Although it is only one focus, it is extremely important. If you end up in a treatment setting that conflicts with any of your other focus choices neither you nor your clients will ever be as happy as you both deserve. Ignore it at your peril!
The Saturated Market Myth
Because many therapists fail to make a decent living doing massage, it is assumed (especially by those not making a decent living) that there are more therapists than the market can support. In marketing terms: saturation has occurred. But market saturation implies that everyone who could use the service is using it — is this true of your community?
Despite the fact that every mammal (human or otherwise), and the growing number of pet iguanas on our fair planet can benefit from massage, we still hear the cry that the market is saturated. In a sense, these unnamed individuals are partially correct, they just need to add the following to their statement: "The market for massage therapists is saturated — with unfocused therapists sending the public vague, confusing promotional messages full of obscure terminology."
There is an unlimited market, however, for focused therapists possessing a vocabulary which the public does understand. You are now becoming part of this enlightened (dare we say elite) group of therapists, but that doesn't mean you can stop learning. You still need to hone your manual and business skills. Once again, having a clear focus is an asset because you will choose only those professional development courses and information which compliment your chosen career path. Neat, huh!
Focus 7 Treatment Setting
Treatment Setting Concept:
Treatment setting refers to the environment in which you apply your therapeutic massage technique. The following listing and descriptions of different types of treatment settings, although hardly comprehensive, should serve as a good reference. The intent here is to equip you with a better understanding of the range of possible treatment settings so that you may start thinking about any potential conflicts with your other focus choices.
Treatment Setting Options:
OPTION 1: Spa/Resort
In Europe, more of a lifestyle outcome facility. In North America, more of a retreat, pampering, weight loss and cosmetic facility.
OPTION 2: Salon
Gradually becoming more lifestyle focused, however, most salon-based massage practices are typically seen as having an experiential focus. Very difficult to be taken seriously as a corrective outcome therapist when you work in a salon. The best place, however, to be applying all those experiential outcome modalities such as herbal wraps, salt glows, aroma therapy, etc.
OPTION 3: Fitness Club
Traditionally focused on weight and exercise training. These facilities will range from strictly body building clubs (where a massage therapist may be available only on certain days or during certain hours) to the full-service alternative wellness center with full-time nutritionists, physical therapists and massage therapists.
OPTION 4: Chiropractic Clinic
There are over 35 different styles of chiropractic treatment. These styles range from disciplines using shallow touch depths in conjunction with reflex stimulation techniques and an underlying oriental medicine approach to disciplines that rely exclusively on mechanical joint manipulation and mobilization with a purely Western medical approach to wellness.
OPTION 5: Physical Therapy Clinic
Traditionally, a place for biomechanical corrective outcome therapists operating in an active care mode only. However, there is a movement within the physical therapy industry to provide their clients with a wider range of wellness modalities. Acupuncture, nutritional consulting, and psychological therapy are now commonly in use in this environment, as are kinesiologists (referred to in some locales as exercise physiologists). It's common now, especially when kinesiologists are present, for physical therapy clinics to have fully equipped gyms for weight training, exercise training, and aerobics.
OPTION 6: On-Site
First, we must clarify the difference between the terms on-site and out-call. An out-call is a thing you do and not a setting. Out-calls are about leaving your normal treatment setting to provide a treatment somewhere else. On-site refers to treatment settings that are established at a site where the clients are working, gathering, or recreating. For example, business conventions, sporting events, and recreational gatherings. The point about on-site to keep in mind is that the therapist just happens to be set up and available as all the activity goes on around him or her.
If you have experience with a certain demographic group like athletes, office workers, or even square dancers, working in an on-site treatment setting may appeal to you.
OPTION 7: Massage/Alternative Health Clinics
As recently as twenty-five years ago, clinics devoted entirely to massage and alternative modalities of achieving wellness within North America were few in number. These clinics, which have exploded in number, are full-service facilities offering their patrons numerous choices of massage and alternative health modalities. Each therapist in the clinic will have a particular skill and focus which he or she offers as part of the overall menu of choices provided by this type of clinical environment.
Treatment Setting Understanding Your Options:
We placed treatment setting focus at the end of the workbook because, although it is one of the first choices a new therapist makes upon graduation, the proper choice of a treatment setting relies on a clear understanding of the previous six focuses.
Your choice of treatment setting will form many of your clients', potential clients', and referral sources' initial impressions about the sort of therapist you are regardless of the reality of your particular practice. Treatment setting, therefore, is a critical issue.
If you attempt to establish a practice within a setting that conflicts with any of your other focus choices, you will find yourself having to adapt these other focus choices to meet the character and demands of the setting. This is simply not acceptable within a properly focused career. It is, however unfortunately, the rule nowadays more than the exception.
Therefore, you need to carefully inquire of founders/owners in order to establish if the operation is compatible with your other chosen focuses.
Treatment Setting Resolution Statement:
Create a text document on your computer, tablet, or phone (or print this page), then record your Treatment Setting focus choice. Include as many reasons why this is the best choice for you. Also, describe how your preferred treatment setting would appear if you were describing a set for a theatre production of "My Life as a Massage Therapist."
Part Three Service Context:
This was a very short section, but you did learn the about the seven most common types of Treatment Settings and the critical nature of this focus area.
You now have the final component for constructing your entire communications statement. Take your trusty writing implement and, as you read the following two paragraphs, circle the focus choices you have made:
I'm a Massage Therapist. Specifically, I provide corrective outcomes in the biomechanical area of wellness along with comprehensive documentation detail suitable for other health professionals.
I provide this service using a deep touch depth, an active care mode, and a whole client approach to wellness in a physcial therapy clinic.
And that, as they say, is that. Now you have a tool which not only allows you to focus your career but also helps you to communicate more effectively with the public. But don't just stop reading here, you need a few more bits of information. In the Conclusion and Appendix we show you how to get the most from this shiny new tool which you now have in your toolbox.
Okay, now you are set to go! Well, not exactly. Basically, what we have done to this point, is show you the basics of how to use a prism to separate your career focus into its constituent parts. Finding your career focus was the easy part, using it is another matter. Learning to use your career focus effectively is like learning to play the piano—it takes time and lots of practice. This conclusion will show you how to use your career focus properly.
As we mentioned at the end of Part Two, your career focus statement is somewhat dry or robotic sounding. That's because it has to serve two purposes: the first being for filtering potential learning and job opportunities and the second for communicating with other people. As it stands now it is perfect for filtering, but you need some more information if you want to use it for communicating.
For example, say you are at a social gathering and a woman asks you what you do. If you wanted, you could take a deep breath and just blurt out your entire career focus statement in one piece. The woman asking the question would then probably just give you a look as if to say "Suuure, whatev-vur?" and then start looking for the cheese puffs. We don't want that to happen now, do we?
A better way to use your career focus statement for communicating is to let it come out in pieces. Start by simply telling her that you do massage. She will then ask the natural follow up question, "What kind of massage?" This is the tricky part. Remember, there are no kinds of massage. Massage is massage. What she wants to know (whether she realizes it or not) is "Massage for what?" That's when you tell her your wellness area and therapeutic outcome specialty.
Now you've got a fairly good conversation going. You are telling this person what you provide using terms that shouldn't be totally alien to her. She may want you to expand a bit here and there, but you haven't lost her. At this point, she should be intrigued. She then might ask, "How do you do it?" Now you throw in your care mode, approach to wellness and touch depth. As you mention these you might have to explain each in cursory detail to keep her interest. Now, you are not only telling her what you do, but you are also educating her about the range of possibilities in massage. Finally, she might ask where you work and you can tell her your treatment setting. Throw in your documentation focus if there are no cheese puffs left. Turn the page to see a more specific example of this sort of conversation.
SCENE: A typical bank. Carol, a massage therapist, is standing in line. Robert, a senior production engineer at a local manufacturing firm, has just walked in and seen Carol.
(Genuinely pleased to see an old friend.)
Hey, Carol! I haven't seen you in ages. Gosh, you look great. How are you doin'?
(Startled from her waiting-in-line trance by ROBERT'S explosive enthusiasm.)
Wow! Robert! Well, I feel great. Thanks for asking. And you?
Couldn't be better! So, what are you doing these days?
I'm a massage therapist.
Oh, really? You mean like Shiatsu or something?
(Unfazed by ROBERT'S somewhat perplexed, but predictable response.)
Well, that's a technique I use sometimes. What I do, actually, is I help my clients avoid problems which might adversely affect their ability to perform certain biomechanical activities.
(Frowning, but in a genuinely curious way.)
(Getting enthusiastic herself now.)
Yeah, like walking or running. Actually though, I have a lot of clients who are computer programmers. They come to me because they know that if they can't sit and program all day they'd be out of a job.
(Bubbliness fully returned.)
Hey, I could use that! I'm writing technical manuals for our manufacturing business and all I do is sit and type all day. In fact, my wife has been telling me I'm going to cripple myself if I don't start taking more breaks. So, like, how do you do this stuff?
(Totally ignoring the fact that the line in front of her has moved on.)
Well, I like to find out all the factors which might be affecting your current condition. Things like how you sit, what kind of chair you use, even stuff like what you eat. It's called a whole-client approach. Then I'll work on those muscles and related soft tissues which are mostly likely to cause you problems further down the road.
(Full of awe.)
That sounds great! I didn't know massage could be so specific. How long does it take?
(Enjoying this conversation immensely.)
Well, each session lasts forty-five minutes. But I think it would take three or four visits to get a handle on your problem and for us to work out a treatment strategy. But I should let you know, Robert, I like to give my clients the necessary tools and referrals so that they don't always have to come running back to me to get them out of a jam. You've got to want to maintain your own wellness. It's called an active care mode of treatment.
(He pauses, somewhat taken aback by Carol's assertiveness. He strokes his chin and nods his head up and down as he thinks about what she just said. He has finally realized that Carol is serious about what she does, so he should think seriously too.)
Well, I've been wanting to get my act together, so why not start now? So where do you do this?
I work in the physical therapy clinic across the street. Hey, do you have private health insurance?
Yeah, I do.
Well, see if it covers massage treatments 'cause I can provide all the necessary documentation. Depending on your situation, you may not have to pay for it.
Whoa, now you're talking my language. But let me ask you this. Does it hurt? I'm kinda a wimp. A friend gave me a massage a few years ago and I felt like I was being tortured by the Spanish Inquisition.
I'm glad you brought that up. I actually prefer to work at a medium touch depth. I won't be trying to massage the insides of your ribs or going through your armpits to get to the underside of your shoulder blade. But even if I were, you should know that you really should really tell the therapist if you don't like something.
I just thought it would sound impolite since I wasn't paying for it. Besides, what do I know? he's like this big expert.
Hey, if you don't enjoy something, why put up with it? It's your body, why shouldn't you get what you want?
Well, it sounds like you can give me what I want and need. When can I come and see you?
Huh? Oh, that's me! Here, let me just do this first, Robert. When I'm done, I'll just wait for you over by the coffee machine.
Well, that was just one of over 6,000 different ways that conversation could have been played out. Over 6,000? That's the number you get if you multiply all the possible focus choices we have described in this workbook.
Had we not included the treatment setting or end user options in our calculation, you would still be left with 216 different ways to describe what you do and how you do it. Now you can see how important it is to get your thoughts straight before you start talking about what you do.
But let's go back for a bit and analyze what Carol actually said. You'll notice that she didn't necessarily have to use the specific descriptions of her career focus option choices to get her point across. For example, look how she described her therapeutic outcome focus. She didn't even have to mention the words Lifestyle or Prevention because it was obvious by what she was saying. In fact, many times she only mentions the name of a particular career focus option for its educational value as she did when describing her care mode focus.
That's how you need to talk about your career focus—naturally and easily, not robotically. But you won't be able to talk about your career focus naturally and easily if you don't practice. We suggest that you find a friend (preferably one with a sense of humor) and practice having a conversation together about what you do and how you do it. If you think you don't need to do this you're fooling yourself. That may sound a bit harsh, but even we, the developers of these principles, sometimes forget what to say, or how to say it.
If you still don't believe us, here's a good mental exercise to try right now if you think you can do this without practicing: You are sitting in the front row at the David Letterman show. Dave decides to bound down into the audience to ask people some questions to win a free canned ham. He picks you and asks "What do you do?" You say you are a massage therapist. Dave gets one of those crazy looks on his face and waits for the crowd to go ooooh and awwww for a bit. He turns to the crowd and says "Alright, that's enough out of you people." He turns back to you and says "What sort of massage do you do?" The stage is now yours. 30 million people are hanging on your every word . . . WHAT ARE YOU GOING TO SAY?
See what we mean? It's not exactly a cake walk. It takes practice. You could go blathering on about styles, or even try to mention your wellness area and therapeutic outcome (which is actually correct), but if you haven't practiced, you will probably freeze solid as you try to remember how you want to say it. In the end you'd probably say something safe like "I work at a chiropractic clinic." The hope being that, by mentioning something which is familiar to everybody, you'll get off the hook.
Remember what our imaginary therapist Carol said to Robert . . . I help my clients avoid problems which might adversely affect their ability to perform certain biomechanical activities. One doesn't come up with such a response after reading this workbook once and then not practicing.
Actually, as a little side note, during our classes and seminars, we often choose a hapless victim to illustrate how quickly one can get flustered and forget even the basics of speech when suddenly confronted with such a situation. On one such occasion, we picked a young fellow from a class of twenty or so and described the David Letterman scenario to him. Then came the question: "What do you do?" First he blanched, and after a couple of seconds of stammering (which probably felt like a lifetime to him) he managed to blurt "I help people so they can do stuff?" We told him that although we wanted him to think it was David Letterman and not Jeopardy (he answered in the form of a question) it was actually a fairly good answer. After a few more tries, his response began sounding far more relaxed and natural. The moral of our little story? Practice! Practice! Practice!
Promoting your Massage Career Focus
Now, what about other ways of communicating like advertising or promotional material? Once again, the approach is the same. Just build your message around the framework of your career focus statement using words that sound as natural as possible. For example:
TIME OUT MASSAGE CLINIC
Bored Silly or Just Need To Escape The Hussle and Bussle?
Our massage clinic specializes in relaxing or stimulating minds and bodies. For the bored, we use techniques that stimulate your psyche and invigorate your muscles. For the overworked, we use techniques which soothe the hectic mind and release those taut, tired or aching muscles.
Time Out Massage is your chance to do something nice for yourself. We do all the work, you just have to let the gentle touch, fragrant oils, soft lighting, and soothing sounds carry you away.
CALL: 555-5555 for an appointment.
Located in the Family Health Complex.
Sorry, no insurance claims.
Let's look at what we have here. Obviously, we are talking about two different services under one roof: Psychosocial—Experiential and Biomechanical—Experiential. Documentation is alluded to by the line Sorry, no insurance claims. That doesn't mean that they don't keep documentation, just that any documentation they do keep is probably basic in nature. Approach to wellness is not mentioned specifically either, however, the mention of fragrant oils, soft lighting, and soothing sounds implies a whole client approach. The care mode is obviously Passive since the ad says "We do all the work …" Touch depth is mentioned as gentle. That's okay because it fits the tone of the ad, so we can assume it is shallow. Finally, the treatment setting is given as the Family Health Complex.
From this example, you can see that your career focus statement really is just the tool for creating the framework for conversations and other forms of communication.
Up until now, we have just been telling you how to use your career focus statement for communicating with the public. What about communicating with colleagues and other health professionals? For these folks you can use your career focus statement almost as is. Just string it together in a way that fits the flow of the conversation. If the professional you are talking to doesn't know what you mean when you say things like active care, or a structural-functional approach to wellness, then you can explain these things as needed.
Which leads us back to something we said in the introduction about how these career focus principles would not only help you to see where you fit in massage, but where you fit in the entire health care system. If you turn to the Appendix, you will find the section entitled: Wellness Area Supplemental Information. This section breaks down other health care professions by wellness area. Depending on your own wellness area choice, these are the professionals you need to tell about your massage practice. Once you explain your career focus to these people they will be in no doubt about how you fit into their list of possible referral sources for their clients.
If you own a large massage clinic, you can now train your intake personnel to ask new clients which wellness area activities they would like the therapist to focus upon. Things such as documentation needs, preferred approach to wellness, care mode and touch depth preference can also be asked of each new client. From there, you can pair these clients up with the most appropriate therapists. Further to clinic operation, if you want to offer the broadest number of choices to the community, you can use these principles to select therapists from the entire spectrum of core focus combinations. This will give your clinic the diversity it needs to stay competitive as well as help you to avoid hiring staff with redundant skillsets.
If you own or run a school, you can now see how you can plan your curriculum in order to give your students the widest possible exposure to the many facets of massage. You simply have to ask yourself if the courses you currently offer cover each of the options in Service Provided, Service Methods and Service Context. But lest you think we have forgotten what we have said earlier, you can also use these principles to give your school a unique educational focus. An educational focus which is very narrow, but highly intensive in order to turn your students into experienced career focussed professionals from the moment they graduate.
In closing, there are some additional tools in the appendix which will further help you to implement your new career focus. Take particular note of the sections entitled: Specific Career Focus Statements, useful for a variety of different massage careers; and, Wellness Area Supplemental Information, a useful section to show you the career issues, resources, and networking opportunities specific to your chosen Wellness Area.
You have come a long way in just a handful of pages. You learned how a simple question like "What is massage and how is it valuable?" could lead to so much inquiry and eventual discovery. You also learned that it wouldn't cut the mustard to say massage is valuable because it enhances wellness until we could define what wellness means to people. You then learned that wellness is defined differently from one person to the next according to his or her slate of desired or necessary activities.
From there you learned how to define what you wanted to provide as a massage therapist, as well as how and where you wanted to provide it. You then learned how to use this understanding to communicate effectively with the public and your peers. Finally, almost imperceptibly, you have learned how to use a tool which will help you to filter every single training or employment opportunity that may come along from now until forever. Never again will you need to accept that which is convenient or expedient. From now on, you will always be able to recognize what you want, or that which you need, in order to succeed on your own terms.
Now, wasn't that better than spending five or ten years and thousands of dollars to accomplish the same thing? We thought so.
Focus Principle Options Overview
Specific Communication Statements
Although this workbook was written with the aspiring or practicing massage therapist in mind, the concepts can just as easily be used by instructors and administrators of schools or clinics. Therefore, we have included this page so that no matter what your chosen profession within the field of massage, you too can benefit from the principles presented in this workbook.
How to use this page: Each box below contains of list of six possible career situations, one of which should apply to you. Combine the phrase that applies to you with the italicized phrase below the list to complete the sentence. Finally, circle your personal focus choices (found inside the parentheses) to complete the meaning of the sentence so it is tailored to your needs.
Terminology Used in This Workbook
We use the terms therapist and practitioner interchangeably throughout this workbook. Although some states and provinces in North America, and countries around the world give these terms specific meanings in order to indicate a massage person's level of training, we do not attach any such significance to them other than to mean a person who does massage. If anything, this fact just underscores the need for more consistency throughout the profession.
We also refer to massage styles, techniques and modalities throughout the text. The terms style and technique are often used interchangeably by most practitioners, however, some people feel that the term style should refer to a particular named massage method such as Swedish Massage. The term technique, on the other hand, should refer to the entire manner and methods by which an individual fulfills the technical requirements of their profession. For example, if someone asks you what techniques you perform, you could respond by saying "I have learned many styles of massage such as Swedish, Reiki, and Craniosacral, and from those I have derived my own particular technique for achieving certain wellness objectives."
The term modality has come to mean the same as style or technique as well. Modality is simply the application or employment of a therapeutic agent. Therefore, modality can cover more than just hands-on techniques but also the use of heat or cold, and therapeutic devices such as percussion machines, steam chambers, salt glows, mud baths, etc.
For those of you who are sticklers for grammatical conventions, we use the term focuses as the plural form of focus. This is correct usage; however, the term preferred by the etymological cognoscenti is foci. We just think that most of you would feel silly running up to a friend and saying "I have discovered my foci!" as opposed to saying "I now know which focuses are most important to my success as a therapist!" Better yet, just tell your friends you have found your focus and no one will get hurt.
Finally, we have tried to provide clarification of obscure or difficult terms within the margins next to the paragraphs in which these words appear.
Wellness Area Supplemental Information
This section provides additional information and suggested resources for therapists specializing in a particular Wellness Area.
Psychosocial Wellness Area
Resources and Networking:
Traditional health disciplines and sciences operating in the psychosocial area where you may find resources and networking possibilities include:
Biochemical Wellness Area
Resources and Networking:
Traditional health disciplines and sciences operating in the biochemical area where you may find resources and networking possibilities include:
Biomechanical Wellness Area
Resources and Networking:
Traditional health disciplines and sciences operating in the biomechanical area where you may find resources and networking possibilities include:
— End of Workbook. Thank you for reading! —
Douglas is a technical writer and web applications developer currently working as a programmer/analyst at Mount Royal University in Calgary, Alberta, Canada.
Five years after a severe back injury in 1980, Dave went on to study as a massage therapist. His motivation? To be close to the only therapy that provided even temporary relief from constant pain. Then after ten years of practice in Canada, “successfully” treating thousands of pain sufferers by hand, Dave was provided with information from a kinesiological surface electromyography evaluation performed on one of his most challenging clients. Frustrated and at a loss for better ideas (and trusting the data), he added manipulation of a previously unaddressed muscle which produced a breakthrough in a single treatment: that single manipulation freed a borderline frozen shoulder and eliminated nearly all the pain – and the results lasted. Until that point it had been a frustrating game of “chasing the pain” i.e. not getting to the root cause. Excited by this breakthrough he went on to study as an sEMG technician in order to conduct his own tests and learn exactly what the muscles were doing when people were in pain. Information from his testing enabled development of a treatment sequence for the shoulder that ended up in studies at Idaho State University. Experience with the technology and privileges that came with the university's research provided access to every muscle function study of interest available at the time. This allowed Dave to dig into the work of all the world's muscle research and develop a unique model of functional assessment using sEMG.
Since the 1990's, Dave's treatment has been relied on by top performing athletes, dancers and martial artists, those recovering from orthopedic surgeries, and generally stressed individuals. As a passionate interest, Dave has enjoyed working with select special education teachers treating motor coordination problems in children diagnosed with learning disabilities.
Current Projects: Dave currently has two offices – one in Wimberley and one in Westlake Hills in Austin. His main location (Wimberley) is in the beautiful studio formerly known as Heart of Texas Yoga. His focus is helping junior and professional athletes achieve and maintain their highest function and performance. His Sport Neuromuscular Treatment is the sports application of Functional (Fun!) NMT which he provides for anyone who needs their body to function better. Dave's work includes fNMT treatment and Kinesiological Surface EMG training and consulting.
Dave is a Certified Dartfish Video Coach and uses slow motion video analysis of biomechanics in athletics and rehabilitation. He has used kinesiological sEMG (computer aided muscle analysis) in testing of exercise equipment, devices, and new treatment procedures as well as trained hundreds of specialized massage therapists for physical therapy and complementary healthcare clinics. He was the primary consultant to Champions Sports Medicine (Dr. P.Z. Pearce, Ironman Medical Director, Spokane, WA) in the creation of their Biomechanics lab.
Dave and his wife Andi have raised four sons and they are all very interesting people.
For more info about Dave and his work, visit his website.
Career Focus Workbook
Originally published by: Wellness Communications.
First Print Edition: Copyright 1996, Wellness Communications. All Rights Reserved.
First Online Edition: Copyright 2008, Wellness Communications. All Rights Reserved.
Second Online Edition: Copyright 2014, Wellness Communications. All Rights Reserved.
Third Online Edition: Copyright 2022, Douglas E.G. Helmer and David M. Lemke. All Rights Reserved.
Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the authors.
This is the You, Your Health, and Therapeutic Massage video the authors created in 1995.