This is a repost of an article by my colleague Jamie Johnston. Jamie is a British Columbia-based RMT, owner of the Massage Therapist Development Centre, a website packed with information. Jamies is among a small but growing group of professionals who are breaking free of the culture of the tribalism inherent in many manual therapy modalities. With this breaking free comes the opportunity to view the hands-on and hands-off work from broader perspectives. While many view this process as threatening to the teachings of single educators of brands, what it represents is a larger, more pragmatic view of the impacts we make as therapists.
Jamie posted this article to social media and, with the share that I made, I added the following comments:
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Keep the faith, Jamie M Johnston. Branding of modalities, overtly or covertly, often creates tribalism. Much of this comes from the consumer, with rightful pride in the line of work they chose and from protectionism of the outcomes that they achieve. The positive results are most commonly credited back to the modality and educator’s explanatory narrative, and much of the tribalism is reinforced through subsequent CE training. I, too, got quite defensive early on, when deeply immersed in the MFR tribe, when others questioned my narratives, outcomes, and reputation and I listened to little of what doubters had to say. This attitude was fostered in my MFR training, “don’t care about people who question you, care about how happy your patients are,” and other pithy slogans were passed around the rabbit hole until we all recited them by heart.
By the truth is we all get good outcomes. If we don’t, we are slapped into taking more training. When that works, we assume the improvement was due to the insertion of the magic that a particular modality had to offer.
We all learn recipes for helping. We lean back on the explanations taught in our modality training, but if those basic tenets were universal truth, then no one outside of that modality would achieve what we achieved.
Outcomes rest more on the relationship we build with the patient than on the tissues or pathologies we think we are accessing. Therapy truly is about relationships, though those concepts are difficult to package and sell. There is much more to say about this, but that’s for another time.
Chin up, as hopefully as newly minted therapists come out into the workforce, they will be better trained and educated in these concepts. The modality empires may always exist, but over time even they will catch on that they are not unique….maybe.”
How Challenging Our Identity Can Make Us Better Therapists
I struggled to write this post but decided I would go ahead with it anyways.
Over the past couple of weeks, I have received a couple of scathing emails from someone who unsubscribed from the blog saying that the information on here is misleading, arrogant, disrespectful, has nothing to do with basic massage therapy skills, and is a disservice to the profession.
It’s not the first time I’ve received a message like this, and I’m truly sorry the information we try to spread made someone feel this way.
But then I have to take a step back and ask why?
Why would a couple of articles get someone this upset?
Then I witnessed some discussion on a couple of Facebook threads and there was a word used… this word can incite some pretty big emotions in people.
The word was “cult” (and for the record, I’m not saying any group within our profession is a cult, I was just reading) and for some, this is a word that can incite anger. Especially when we’re referring to different groups within our profession!
According to one source, what makes this word so powerful is the “us vs. them” mentality which is sometimes seen in Facebook group discussions.
So, I want to use this post to dissect why I think this kind of stuff happens and how we can all grow together.
Challenging Our Identity
I have written an article before that touches on this topic but for those of you who haven’t read it, I’ll give you a little bit of my story.
I was raised in a very religious family by loving well-meaning people. However, as I grew older and got into my teenage years, I started to question things and couldn’t always get an answer that satisfied me. Most of the time when I questioned things, people would get upset because I was questioning the very foundation of their belief system.
As I got into my twenties I started to take more of a step back from my family’s faith, I kind of still had a foot in it, but the rest of me was pretty much out.
Then in my thirties, I got to the point that I had to make a decision. Being involved in the faith didn’t make me happy, but there was genuine concern over leaving it altogether. How would my friends and family react? This was all I had ever known, how do I just leave and start a new life?
It was scary!
My entire identity revolved around being a part of this religion, I was identified by my faith!
Now, I’ll be the first to admit that as scary as that was, I still have supportive parents and family, sometimes we just have to put our differences aside. I realize you may be looking at this and thinking, what does this have to do with massage therapy, so just be patient with me for a minute.
I saw an interesting video the other day where the person was talking about the way we teach things to children can have a profound effect on them later in life.
They talked about grabbing the brain of a person when they’re young and if we dictate things to them in a way that presents something as fact, their very lives can be shaped by what has been put in their head.
They will genuinely believe whatever has been told to them.
I can’t help but liken this to my experience in college.
I didn’t really question the information being presented to me (in all fairness, I had no other advanced education past high school, so hadn’t really been taught critical thinking skills) because all the information I needed was in the textbooks and why would the instructors tell me something that was incorrect? I had complete faith in what was being taught to me.
I think for most of us, once we’re done college we look for the next best thing in continuing education and go down a road of looking for the best manual techniques we can find. Sometimes this results in following a couple of instructors (or maybe just one), then investing in Levels 1-4 of manual technique “X” and shaping our careers around these specific technique styles.
All of this could be happening in the early or “youth” stage of our careers, everything being taught to us is being presented as fact and we genuinely believe it because…why wouldn’t we!?
Knowing all of this, I can’t help but liken it to some of the things I see happen in our profession and I think I realize why I get some of these scathing emails once in a while.
We can spend several years doing these courses having great success with the patients who come into our practice, all the while this is shaping our identity as a therapist. Your patients refer their friends because you’re the best manual therapy “X” provider they’ve ever been to!
You have the absolute best of intentions and you genuinely help most of the people who come and see you (none of us have a 100% success rate) because your hands and the technique you use works so well. Your practice is thriving, so why question it? Plus, you go to another course from the same provider and you’re surrounded by like-minded people who are also having great success with these techniques!
Then somebody questions it.
Your very identity, intentions, practice, and success are all questioned.
If you changed, how would your colleagues react? what about your patients? their referrals? your place in the community?
Your very identity could be changed…and that’s REALLY SCARY…trust me, I know!
Challenging our own belief system, whether its the one you were raised in, or the type of therapist you are might be one of the most difficult things you could ever do, but the thing is, it doesn’t have to be!
Evidence-Based Practice
Last year at our associations AGM there was a huge discussion around evidence-based practice.
Some of the discussion centered around reading research and applying it in practice. I wouldn’t say it was a heated discussion but there was certainly a bit of controversy. Much of this was around how to make research easier to access and making the information easier to digest.
Then when it was all over, an interesting thing happened.
An accountant came up and asked me “what does evidence-based practice mean?”
I said: “well, it means using your experience in practice while reading the most current research and staying up to date on new findings so we can better serve our patients for better treatment outcomes.”
She said: “isn’t that just a given!?”
You’d think so?
This is where I have to give a shout out to Erik Meira, he wrote a post on his blog a while ago about the “evidence-based funnel” instead of the evidence-based stool many of us had come to know, it looks like this:
Evidence-Based Practice funnel via Erik Meira
Quite often with discussions I see online, and from the odd scathing email I get, some of the things people say are:
“I deny research in my practice because my experience is more important than research”
“I question YOUR research and you do not accept our anecdotal experience”
Well, first off, I don’t actually conduct any research, I just read the available research. But the thing is, no one is saying your experience doesn’t count. In fact, as you can see in the illustration, clinical expertise is a HUGE part of being an evidence-based practitioner. If you’ve been in practice for any length of time and had clinical success, your expertise is vastly important to you and your patients.
As you can see, another critical part is patient values and circumstances. You are part of their values, they trust you, they like you, you have helped them!
In fact, one paper shows us how patient’s expectations play a huge role in recovery from pain and rehab from injuries. If one of these patients has come to you for treatment before and you helped them, their expectation is that by coming to see you again, you will help alleviate their pain.
This helps to show us how treatment outcomes do not depend wholly on the type of technique we use but are also influenced by patient attitudes and beliefs.
Another aspect of this is the confidence of the provider. When you suggest how a technique or treatment will help it can enhance the expectation of the patient that they will, in fact, get better, which can improve those clinical outcomes.
One thing that also comes up is that some of us are trying to discount what has come before us. Well, this isn’t true either, all of those who wrote textbooks, developed new techniques, and taught us in the early years deserve a huge amount of respect for what they did. The only issue is that some of these books were written in the ’80s and much of what is taught, research has shown to no longer be accurate.
However, at the time these people were visionaries and they should completely be given due credit for that.
While it is important to give these past authors their due respect it is equally as important (if not more so) to give respect to the new information coming out which is helping to shape current practice. Just like how those in the past pushed the profession forward, so is the new research, and we must include this in our practice.
Great Examples And Putting Differences Aside
The whole point of this blog and many others similar to it is the sharing of new knowledge and trying to help educate other practitioners.
When I get some of these scathing emails, while it can be disheartening, I look out and see the other side, which are some great examples of those who changed their narrative for the better.
MTDC coach Walt Fritz travels the world teaching his courses on “Foundations In Myofascial Release”, and is quite well known for it. Yet, just recently he changed the name to “Foundations Of Manual Therapy” because this is a more accurate description of what he does.
Walt has been doing this for a long time and that title change could have alienated him from his audience and some of his mentors from the past. I know it was probably hard, but he challenged things and had to change his identity because he is doing his best to keep up with current evidence.
I look to our friend Ann Sleeper. For years Ann taught courses in “Muscle Energy Technique” with a narrative that was used for many years. When faced with what new research says and coming to a better understanding, she has changed the narrative in her courses.
While she is essentially teaching the same “technique” her description behind what is happening has been updated. This is another example where I’m sure she found it quite difficult, she was known for years as the person who taught this technique, it was part of her identity.
I recently heard of another instructor who for years has taught “Muscle Energy Technique” and has also decided to update the narrative of their course due to the new things we understand around biopsychosocial aspects of pain and what new research has been telling us.
These are great examples, and part of what makes them great examples is how long they have been teaching, they have a huge following, and could have easily kept teaching the same thing. Instead, they decided to update, change, and adapt, which in turn will hopefully happen to their respective audiences.
We don’t have to have the “us vs. them” mentality (and I know this happens in the technique, pain science, and other groups) if we could be open to sharing ideas and actually looking at what good quality research says. Growing up, one of the things I used to hear at home was how we could get our point across better “if we season our words with salt”. So, perhaps I can do a better job of that when writing these posts, perhaps we can do that within Facebook groups, and perhaps we can all do this when attending live courses and events? We all want the same thing…to help our patients as much as possible and be successful therapists. To do this, we don’t have to learn a new technique, but we do need to give an accurate description of the one we’re using, communicate well with our patients (and probably season our words with salt here too), and do things they like.
And maybe sometimes we just have to put our differences aside.
You may access Jamie’s website and add your comments there (or here) at this link.
Cheers,
Walt Fritz, PT
Copyright© 2020 Walt Fritz, PT
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