February 17th, 2008 Julie Onofrio
The therapeutic relationship is a very complex relationship that requires that we become more aware of the dynamics of relating to each other. One of the ways is by studying and learning about the Drama Triangle. I wrote about it initially on my website www.thebodyworker.com
It is really the underlying dynamic in most relationships but because of the power differential that occurs in the therapeutic relationship, the drama triangle can be more evident in a client/massage therapist relationship. There are three positions of the drama triangle -the rescuer, the victim and the persecutor. There is usually a combination of them at work in a therapeutic relationship or any relationship for that matter. One position leads to the next. The rescuer can become the persecutor or victim and any combination of roles.
As massage therapists we are often taught to ‘fix’ a clients pain and injuries. Many massage therapists come to the profession wanting to ‘help’ others. Clients come to us looking to be fixed and taken care of. One of the roles on the drams triangle is the rescuer. We think we need to get the client out of pain.
People who are in pain or sick or injured quickly take on the role of the victim -wanting someone to fix the condition for them. This is the basis for modern medicine. Needing to be fixed they will find a rescuer to help them. As massage therapists we often take on the role of rescuer but we can also move into any of the other roles with clients and also within ourselves. Becoming aware of how we rescue (help, fix) is not an easy process. It doesn’t just stop overnight. When the process occurs internally taking on various roles at different times, it is usually can lead to feeling stuck in building a practice or finding a massage job. We blame the economy or bad spa owners for our lack of success.
Rescuers need to rescue to feel good about themselves. They need victims to be successful. A rescuer thinks everyone needs their help even those who are not directly asking for it. Rescuers don’t know how to take care of themselves so they focus on others. Rescuers usually have deep unconscious beliefs about themselves that they are not good enough so they rescue to feel good about themselves. Rescuers see others pain so clearly because they are filled with pain of their own. It easier to help others with their pain instead of addressing their own pain. Rescuers are not usually aware of their own pain or even think that they have any issues to work through. They are so busy helping they can’t see their own pain. They say things like “I just want to fix this psoas” or “if only I knew more anatomy, I could fix this”. It is a very unconscious process meaning that most are not even aware of the dynamics and their own part in each interaction. Rescuing others tells the other person that they are not good enough or smart enough to help themselves. Rescuers often end up underming others and reinforcing the victim stance. It is hurting more than helping. Rachel Remen MD explains this beautifully in her article “In the Service of Life”.
The early child/parent relationship sets us up for the drama triangle with parents often taking on the role of rescuer. The child isn’t old enough, smart enough and needs to be protected from the world. When are early childhood needs aren’t met ( which they rarely are ever totally met even with the best of parenting) we often are left waiting to be rescued. We fear asking for help because we may be further abandoned and hurt. We begin helping others so that they will become dependent on us and not leave us.
The thing is that every person has within themselves the power to find the answers to their health problems, business building problems or whatever they are faced with. You and you alone are your best source of advice if you can only begin to access your true self and listen to yourself. As a massage therapist our role is to be present for others as they uncover their own answers and true self. The thing is that you have to know your own self first before you can do this with a client.
People don’t even become aware of their rescuing habits until it becomes too painful to bear anymore. This is usually when a career in massage comes to an end but it doesn’t have to end if one can find the courage to begin to get off of the triangle.
The way off of the triangle is to start learning to feel the pain of abandonment and/or the pain of not getting one’s early needs met. It means learning to take care of yourself in every aspect of your life from being financially sound, healthy, eating the right things, exercising and taking car of your internal needs for acceptance, love, appreciation and recognition. It is about becoming more aware of what you are feeling when a client arrives at your door wanting to be fixed. Staying present with the feeling means that you can have the feeling and not act on it but use it to become aware of what you are thinking or what belief you have about yourself that is creating this need to rescue.
Changing doesn’t happen overnight. It is a process and it can be supported by getting regular peer supervision sessions with an experience peer.
Posted in Building Your Practice, Changing Your Beliefs, Peer Supervision, The Code of the Caretaker, The Wealthy Massage Therapist | 4 Comments »
February 17th, 2008 Julie Onofrio
After my recent post on erections on the massage table and the diverse reactions to it and my webpage talking about them, I felt that is important to write a follow up on how deal with cases of men getting erections while on the massage table.
Since erections do happen we need to be able to deal with them in the manner that supports us both professionally and personally. Nina McIntosh in her book “Educated Heart” says this:
Some people wrongly believe that if a man is having an erection the practitioner must immediately end the session. There is the misconception that for a man to have an erection, he must be deliberately sexualizing the situation and either mentally or physically stimulating himself. The truth is that having an erection can be an innocent accident and just as embarrassing to the client as it may be anxiety producing for the practitioner.”
Women often react in fear to a male erection on their massage table because of the many cases of men looking for something more than just a massage. They think that if they don’t stop the massage, it may escalate to something more like an unsafe situation for themselves. Since erections on the massage table are not talked about much dealing from a place of fear can add to the embarrassment and shaming of both parties. You don’t want to add to the situation, yet you want to protect yourself.
If a male is obviously doing things to bring on an erection or relieve an erection it has no place in the massage room.
Each case has to be looked at individually. If the client has a past relationship with you and hasn’t had this issue come up before, it is most likely ok to continue working or talk about it.
If it is a new client and they are making sexual comments or acting inappropriately, a massage therapist has the right to end the massage at any time.
Terrie Yardly-Nohr in her book “Ethics for Massage Therapists” says it this way:
A therapist has the right to refuse to treat a client if the therapist determines that the therapeutic relationship cannot be maintained in an ethical manner.
If a massage therapist finds themselves constantly getting clients who are seeking more than just a massage it is often a good idea to have the massage therapist take a deeper look at their intentions and professional image. ( I actually worked with a massage therapist who was having this problem and she couldn’t figure out why. When I looked at her website I saw pictures of her in sexy tank tops showing more than was needed. Another always worked without proper draping and wondered why erections were more common.)
The more we can talk seriously about issues like this, the stronger we can become as a profession setting boundaries that can protect the massage therapist and educate clients. Healing on both sides of the issue can happen.
Posted in Ethics | No Comments »
February 9th, 2008 Julie Onofrio
One of the least talked about concepts in massage school is the therapeutic relationship that occurs between the massage therapist and the client. Cidalia Paivia in her book “Keeping the Professional Promise” says:
When a massage therapist and a patient come together, the therapist and patient enter into a therapeutic relationship. What distinguishes the therapeutic relationship from other relationships is its very special purpose and goal, which is to serve the needs and interests of our patients.
The Therapeutic relationship’s primary function is to facilitate the health and well-being of our patients, ensuring that we bring our full presence and commitment to this experience.”
When people come to us seeking help with their condition or distress, what happens is that a power differential is created. People come to us thinking we can ‘fix’ or help them. They think that we hold the answers to relief from their symptoms. They are vulnerable because they are in pain or under stress. The act of seeking help recreates an old pattern of relating to someone in power which is based on our early relationship with our parents or major caregiver. Since no caregiver is perfect and able to provide for all of our needs we are left with holes in our essence and we seek to fill these in most relationships especially one where a person is actually seeking help.
On the other hand the “helpers” have their own issues and reasons why they feel compelled to be the helper. While on the surface many help because it brings more meaning to the helpers lives, helping is also a great way to really learn more about oneself. Rachel Remen in her article “in the Service of Life” talks about helping in this way:
Serving is different from helping. Helping is based on inequality; it is not a relationship between equals. When you help you use your own strength to help those of lesser strength. If I’m attentive to what’s going on inside of me when I’m helping, I find that I’m always helping someone who’s not as strong as I am, who is needier than I am. People feel this inequality. When we help we may inadvertently take away from people more than we could ever give them; we may diminish their self-esteem, their sense of worth, integrity and wholeness.
Because the nature of touch can bring up so many deep and unconscious feelings and emotions in clients and the massage therapist, it is important that a massage therapist have an understanding of what happens in a therapeutic relationship and understand how what they do and say can influence the relationship.
The therapeutic relationship is based on the massage therapists ability to stay present with a client and not judge, fix or otherwise hinder the client’s process of healing. It requires that the massage therapist have a clear idea of what their own needs are and learn to get their own personal needs for appreciation, validation and to be needed met in other areas of their lives so that they can become and stay more present with the client for the clients healing process. Working within the therapeutic relationship requires that you be able to give empathy for the client. To be able to give empathy, one needs to have met their own needs for empathy first by doing the grief work that is related to not getting your needs met and working with a skilled peer supervisor or mental health counselor to rewire the brain and body for empathy.
Since so many of our needs are really unconscious, it is important to begin to become aware of our own needs and learn to take care of them outside of the therapeutic relationship so that we can become more present to witness the healing process in clients.
So often massage therapists find themselves crossing the boundaries between friendship and clients, wanting to fix a client, wanting to give more, getting paid less, giving advice and acting in other ways that will actually foster a client’s dependence on the massage therapist. The massage therapist will often start sacrificing their time and energy in order to help a client or so they think. There is such a fine line between helping and when helping is actually hurting that it is near impossible to distinguish until it is too late. The massage therapist will end up feeling resentful, burned out, facing physical injuries/illness which may lead to career ending events.
The presence of a massage therapist depends on their own awareness of themselves and the reasons why they feel compelled to help. Our early childhood is where it all starts. Our self esteem is developed at an early age. We begin projecting our unrecognized feelings on others shortly after birth. When our early needs for nurturing, appreciation and acceptance were not met, we see ourselves as less than worthy and it is reflected in all of our actions and reactions. When our own needs for empathy and mirroring are left unmet from early childhood, they often get in the way when we try to help others. We can learn to be of service more when we take the time to receive the empathy that we need for ourselves.
As a massage therapist, we owe it to our clients to do our own personal growth work and fill in the holes left by the wounds of our past. Learning about ourselves and setting clear boundaries in a massage practice can take you much farther in building your practice than any marketing plan. The clearer you get about who you are, what you are doing and why, the clearer your relationships with your clients and potential clients.
Posted in Building Your Practice, Ethics, Peer Supervision, The Code of the Caretaker | 6 Comments »
February 7th, 2008 Julie Onofrio
I wrote a page on my website a long time ago (2001 or so) on erections that occur in men when getting a massage. It always seems to cause quite a reaction particularly in men who routinely site all of the physiological reasons that erections occur.
Being a heterosexual woman of course, I only know about erections second hand, but do know that anything that is occurring physiologically has it’s root in our thoughts - most of what are unconscious thoughts. The way to become aware of your thoughts is to pay attention to what your body and feelings are telling you. What are men who get erections on the massage table unconsciously thinking? That is the real issue where healing can begin.
If the issue were a total physiological one- then why don’t all men get one at the time of a massage? Why don’t men who are stressed out or have something else on their mind that is bothering them automatically get one? Why do men who are with a loving partner that they trust have issues with erections when they are under stress? If the issue was just physiological it would be able to be controlled by changing the physiology. Erectile dysfunction could be remedied by massage then instead of the many drugs that are out there today. (Yes and maybe it can help in reducing the stress that is a part of ED.)
If erections were just a result of being touched then do heterosexual men get erections when they are massaged by males?
So what does it mean when a man gets an erection while getting a massage from a woman who is a total stranger in most cases? What must a man be unconsciously believing about himself or the act of getting a massage or even touched by anyone?
So often men seem to have a fear of getting a massage because of the fear of getting an erection during the massage. Doesn’t that actually set men up for getting an erection during massage - since what we think will become a reality. If men are concerned about getting an erection during a massage do they actually get one or are they less likely to get one because they are aware of their fears about it?
My writings in the article noted above are influence by a local psychologist -Anne Stirling Hastings who wrote a book called “Body and Soul: Sexuality on the Brink of Change”. In it she talks about just how much our society is influenced by the media and shame. Here are a few quotes to explain more about where I am coming from on this:
“The more ashamed and controlled a person or a culture, the more reactive he or she becomes to sexual stimuli to make sure this energy is not eliminated. The current cultural definition of sexual freedom is to be able to react to any kind and amount of stimuli we choose. Real freedom will come when we don’t have to react to stimuli, when we are able to allow our sexuality to emerge when it is right to do so. As sexuality is repressed, reactivity increases, and as reactivity becomes more intense, the cultural desire to control it increases.”
“Cross wiring, as I have defined it (the author of the book is saying this) reflects the incorrect associations between sexuality and anything else that is not inherently sexual”….she goes on to list categories of sexually cross-wired behaviors one of which is this category -Feelings that produce arousal and lists wondering if the person will arouse you or not during a massage.
Getting an erection during massage is not normal (as in it doesn’t happen every time) but it does happen. I have given massage for 20 years full time (probably around 20,000 massages) and I have only had one male get a full on erection. I know there are probably more who have had feeling stimulated or had the massage feel sensual. Touch is sensual as in appealing to the senses. Professional Massage isn’t sexual.
It is OK if it happens. A skilled massage therapist will be able to address the issue comfortably. If the line is crossed where the man is wanting something to relieve the erection that is a different story and it is called prostitution. It does not have any place on a massage table or massage practice. Males getting erections on the massage table is really a great indicator of where healing needs to occur for men and the massage therapist doing the massage too.
Why the massage therapist? Could there be some unconscious intention being played out? Most likely there is - but what is left to each individual massage therapist to discover.
So I hope this can be the beginning of a very important discussion for the massage profession.
Posted in Ethics | 26 Comments »
February 6th, 2008 Julie Onofrio
One of the main reasons that people are drawn to the massage profession is that they are seeking a career in which they can help others more and participate in work that is more meaningful. While that is all well and good, there is usually a whole other side to helping that people never dreamed they would have to deal with. When people come to the massage profession only to help, they seem to think that helping others will get them the money that they need to live or they may even go as far to say that they don’t need much money or that it isn’t about the money. Being in such a fog about money is usually what leads to such thinking or should I say they aren’t thinking.
I also get a fair amount of massage therapists emailing me or sharing their stories on various forums about how they are underpaid and not taken seriously by their employers. They initially agreed to specific terms without really knowing what they were getting into and are left feeling resentful when working on clients or dealing with the employers.
Mikelann Valterra in her book “Why women earn less” (which I think really could be called ‘why massage therapists earn less”), she outlines some things to think about to see if you are in a money fog:
Do you regularly balance a check book?
Do you know exactly how much you are making each month?
Do you know where all of your money goes?
Do you know if you are saving enough for emergencies and retirement?
Many high school students today are researching careers and jobs and the first thing they ask me on my site www.massagetherapycareers.com is how much can I make as a massage therapist? The massage schools will tell them that massage therapists are charging $60-$80 per hour and more but fail to leave out the fact that this is not really what you make as a massage therapist. If you are working for yourself you need to deduct expenses or if you are working for someone else you usually get about 20-30% of that which isn’t much after you pay taxes on it all.
It is good that high school students are asking today. I know when I went to college a very long time ago, I never went with the intention of how much money I could make.
Choosing a career based on your need to help others is really also saying something else. Why are you wanting to be a massage therapist? There is usually really an unconscious deeper need being played out which is usually really a need for love, attention or acceptance. Choosing a career without knowing or caring how much you can make could mean that you are in a money fog.
You can best do that by taking a look at what you charge clients for your services as well as what you charge for no shows or last minute cancellations. I read in one of the massage magazines awhile ago a survey that asked how many people charged for no shows and most said they didn’t and always made excuses for the client. I was quite shocked. (I’ll have to find that again.) That’s a great example of money fog.
The way to get out of a money fog is to track just how much you are spending and become more aware of your spending patterns and money blueprints. Also joining or starting a peer supervision group can assist you in becoming more aware of issues like this which is the first step and basically the answer to changing your beliefs about money. I am starting an online peer supervision/mastermind group very soon - hopefully next week and will start taking applications from interested participants so stay tuned for more information.
Posted in Changing Your Beliefs, Money issues | 1 Comment »
