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Since many have not been exposed much to peer supervision or peer supervision groups, I am going to be writing as much as I can about them. There are many forms of peer supervision. You can work one on one with an experienced therapist who is trained in peer supervision or you can work in a group setting with the peer supervisor as the facilitator. This type of sessions that meet with a individual peer supervisor includes a fee for service.
Once you understand the concepts of peer supervision and how to work in a peer supervision group, you can start your own group by inviting your fellow massage therapists in your neighborhood or just others that you know. You don’t have to pay for this kind of regular meeting unless there is a fee for the meeting room. You can hire a peer supervisor to come in for specific things like learning to bill for insurance or to look more deeply at your helping issues or whatever is needed by the group.

The basic things to understand are things like this isn’t therapy. It isn’t one person telling another what to do. It is learning to listen and provide empathy in order for others to grow on their own in a supportive group. It is basically what happens on your massage table with clients when you remain present with them and learn to become aware of when you are fixing others on a grander scale. I have written a few pages on my website www.massagepracticebuilder.com, about how to set up and participate in a peer supervision group that you can read yourself, but to really learn how to work in a peer group it is necessary to work with an experienced massage peer supervisor who has at least 5 years experience in doing massage and preferably the same amount of time participating in peer supervision themselves.

One of my basic rules which I have actually adopted from Parker Palmer’s groups which he calls ‘circles of trust’ is “No fixing, no saving, no setting each other straight.” When I inform a new group member of this they often are left wondering what they are going to say or do in a peer supervision group.

A peer supervision group topics is really determined by the participants and their needs. The first few minutes of the group are spent checking in with each person to see how much time they would like to have to speak in that session. While there may not be enough time for everyone to speak, the others often learn just as much if not more from the person sharing their issue or story. ( an in person peer group size is usually from 3-8 people.)

After starting and running my own unofficial and free of charge online peer supervision group (massage_practice_builder at Yahoo Groups ) in the form of an online discussion group (which I started in about 2000 and used for sending out my newsletter and now is open discussions ), I have realized that there are so many lurkers and the group is dominated by a few people who like to speak out that so many are missing out that I have decided to start a private online peer supervision group where participation will be mandatory (well to a certain extent.) The other thing I am seeing from getting regular requests for email consultations is that there are many massage therapists out there who are in rural areas and don’t have a network of support so again the online peer supervision group will fill that need. Having a smaller group will allow participants to get to know each other better and be able to talk about the deeper issues that surround their practice. I will be facilitating the group and also writing a regular newsletter to stimulate conversation. I will be charging a small fee for my time and 20 years experience as a massage therapist and 5 years in peer supervision. To find out more and apply to join please see my website www.massagepracticebuilder.com .

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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.

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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.

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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.

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Dating massage clients has in the past been seen as acceptable and almost a way of life when I went to massage school 20 years ago. Teachers dated students. Students dated each other. So it wasn’t anything to think that dating a client would not be acceptable.

As massage becomes more accepted as a profession it is important to start understanding the issues that come up around dating clients. Massage schools are starting to mention it in their classes and some states like here in WA are starting to make it illegal to date clients. In 2006 it was made into a law that massage therapists can not date a client within 2 years of seeing that client. The specifics are outlined in the WAC 246-16-100

The thing is that there are still so many massage therapists out there that don’t think it is a problem to date a client. What happens is that clients come to us for help. That act of seeking help often creates a reenactment of our early relationships with caregivers. They think that they will be taken care of like their parent (s) did or should have. Clients come to us in a vulnerable state and the act of getting a massage which requires that massage clients take their clothes off and let a stranger touch them also creates more vulnerability. To put it simply, clients can easily think and act like we are their parents and they want to recreate that early merging and bonding energy  that occurs that makes them feel safe. It happens in other personal relationships in fact all most all relationships. I can’t actually think of an instance where it doesn’t happen.
What happens is that the early feelings are also ‘remembered’ through the touch that is given in a massage which complicates the matter even more. Touch elicits the bodies feelings.

The therapeutic relationship is created where the client can come in and project their early feelings onto the massage therapist. Some of the ways that it is shown is when clients bring you gifts, offer to do things for you, or think that YOU are the cause of their healing. These are what is called signs of transference.

See also Handling Projection

The Massage Therapeutic Relationship

Transference for massage therapists on www.thebodyworker.com

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