When you learn about self care in massage school or read current articles on self care for massage professionals they teach proper body mechanics, proper posture, eat right, exercise, meditate or do some type of movement and of course getting regular massage to help stay grounded. While these things can help, they are really just the tip of the iceberg - the external components of self care. But knowing what things to do for self care and doing them are usually two different things. What leads you to take action or not take action is the underlying unconscious beliefs about whether you are worthy or need self care.
The best thing you can do to take care of yourself is to become more conscious of your unmet needs and repressed/suppressed feelings so that you can be more present in your massage sessions for your clients. That is what they pay you for really. Your unmet needs and old emotions are what get projected onto others and onto clients in the form of counter-transference. I have written about countertransference before here.
Your unmet needs and old emotions are projected into your practice, your money issues and your personal relationships. Self care that addresses these issues and helps you to become more aware of these issues can often reduce the physical stress of doing massage. The more you take care of yourself in that way, the more confident you become in asking for what you need and creating boundaries to take care of yourself in the client/massage therapist relationship.
Being financially responsible is one such method of self care which usually is not mentioned in self care classes/articles. Having the money that you need to live and run your business is the highest form of self care possible. The other way to take care of yourself is taking care of your personal needs for appreciation, love and nurturing. When you combine the two things you won’t have to worry about body mechanics or how hard you work on clients or working more than the agreed upon time.
Helping has a way of bringing up our unmet needs. It shows up in counter-transference. The reasons why massage therapists want to help others is usually filled with unconscious unmet needs and old feelings. Countertransference influences the client interactions and the healing process sometimes hindering it. When you are in a state of countertransference , projecting your old issues and feelings onto a client it can cause you to lose the objectivity you need to see the client clearly and hear the client clearly.
In simple terms, projection happens when you are not aware of your feelings or needs so you ‘project’ them onto someone else. Projections can cause reactions such as always giving advice to a client. To become more present means to be able to feel the feeling that is causing the projection (are you following this? It is hard to understand since it is unconscious.)
Remember - this is an unconscious process. Everyone is unconscious most of the time. Since it is unconscious you are not aware of what you are really doing. Becoming more conscious is a very complex process. We live our lives with many blind spots. Some people won’t even believe they are doing something unconsciously because it seems so real. It is real.
The way to track your thoughts and beliefs is through your feelings and becoming more aware of them.
Supervision is one such way of interaction that helps you to become more self aware. Supervision is not someone telling you what to do in the regular definition of supervision in the workplace. Supervision is the process of working with a more experienced massage therapist in order to understand your practice issues more and help you become more aware of yourself. You can learn more about the process of supervision on the website.
Working with a skilled psychologist can also take you deeper into your old patterns of behaving onto can do wonders for your massage practice and personal life. Since all relationships start in transference and the therapeutic relationship has a way of intensifying that transference it is important to find out more about your unmet needs. For the most part all we can do is grieve the loss of never having had them met as it is too late to get them met. Then it is a matter of taking personal responsibility for yourself and actions. The more you take care of yourself, your unmet needs and deal with the emotions, the more present you are able to be in your sessions and be there for clients. The more you take care of your internal self the easier it is to do those external self care things like setting boundaries around your time and financial needs.
Transference is one of the most important concepts to understand for a massage therapist but the least understood and talked about. It is usually covered in a few hour workshop in massage school. Transference is a very complex phenomenon that comes from the psychology profession. The reason that it is so important to understand is the fact that the process of transference is actually what can lead a person to becoming more aware of their thoughts and issues. Transference is what heals.
Ben Benjamin author of the book “The Ethics of Touch” defines transference as this:
Clients defer to the practitioner’s judgment because they desire to be helped by an authority figure that possesses greater knowledge, healing ability and, therefore, power.
Since a power differential exists in any health care relationship, the client may be inclined to respond to the practitioner as he or she would other authority figures, and in doing so, may recreate elements of similar past relationships. This situation is known as transference, a normal, unconscious phenomenon that appears during a therapeutic process. Professional helping relationships usually have a strong transference element in which the parent-child relationship is unconsciously re-established. In transference, unresolved needs, feelings and issues from childhood are transferred onto the helper.
Elliott Greene author of the book “The Psychology of the Body” writes this:
Transference is the displacement or transfer of feeling, thoughts, and behaviors originally related to a significant person, such as a parent, onto someone else, such as the massage therapist. It is a common reaction of clients to their therapists. A bit of transference happens in most relationships in which there is feeling present. Usually, transference-related feelings were formed in the past, so it could be said that these feelings transfer from the past to the present. In transference then, the client relates to the therapist and present moment as if the therapist were the significant person. In this sense, transference is a projection of the internal drama of the client, and the therapist is assigned a particularly important role and script.”
Nina McIntosh in her book “The Educated Heart” says this about Transference.
“Transference may sound complex and unusual, but it’s actually part of our everyday life even outside of our offices. It’s normal for any of us to bring the past into our present relationship. In fact it happens all the time. They are magnified ina manual therapy session because of the intimacy of the setting, the clients altered state and the way that the practitioner/client roles mimic those of the parent/child.”"Transference isn’t a rational process.
Terrie Yardly-Nohr in her book “Ethics for Massage Therapists” says this:
“The very nature of the therapeutic relationship allows transference to happen easily. Bodywork can trigger a variety of emotions from clients such as anger, frustration, sadness, fear, or joy. These feelings are generally the result of some emotion the client felt in the past towards another person.”
Cidalia Paiva in her book “Keeping the Professional Promise” says this:
“Transference refers to those situations where the patient projects onto the therapist old feelings or attitudes they had about significant people in their past, often parental figures. Transference is often referred to as ‘the unreal relationship in therapy’. The roots of transference are most often found in early childhood, and it constitutes a repetition of past conflicts with significant people in our lives.
So what is transference then?
Simply put, transference happens when there is difference in authority that resembles the parent-child relationship. The client who comes to a massage therapist receives the nurturing that they never received as a child and puts the massage therapist on a pedestal. The nurturing touch brings out the old feelings and emotions that were repressed or suppressed in early childhood. The client unconsciously begins to see the massage therapist as the nurturing parent and it can bring up feelings of attachment that were not resolved growing up. It is when the client unconsciously thinks that the massage therapist is their mother or father or other significant caretaker. Note the word - UNCONSCIOUS.
Attachment is what happens between a mother and child that allows the child to grow and build self esteem. The infant knows learns about themselves through touch. There are various stages of attachment that occur in child development where the infant feels like they are one with the mother. (And of course they once were in eutero.) As a child grows they learn that they are separate from the mother. This is where things often go astray. If a secure attachment is not formed in their early part of life, they will have life long challenges that result from that.
Massage and nurturing touch re-enacts the process of development. I actually think this is also why spa treatments are so popular with the use of healing waters and body wraps. Getting regular massage and developing a relationship with a massage therapist in which the client feels nurtured and cared for as if they were receiving it from their mothers can help heal the grief of not ever getting those early childhood needs met.
Transference is really important yet difficult to understand. The best way to understand it is to experience it. You may or may not have had some of these feelings arise when you were getting a massage from someone:
Feeling like you don’t want the massage to ever end
Not wanting to leave the office
Seeing the massage therapist outside of the office and wanting to follow them where ever they go.
Or from the other aspect seeing it in your clients:
bringing you flowers or special gifts
hearing about people’s personal problems
being asked to make exceptions in scheduling and payment options.
inviting you out socially as a friend
asking you out on a date or making other advances on you.
Or if you ever worked with a psychologist or mental health professional in therapy, you can come to learn more about transference from seeing your own. Becoming aware of your projections in a therapy setting can be a painful experience. It is a matter of getting a look at your unconscious thoughts through relationship. It can be a very eye-opening process and really lasts a lifetime.
While some of these things may just seem like normal things, it is difficult to know the difference. You probably won’t know the difference.
What you can do is create a code of ethics and a set of policies and procedures for your practice that will help you make proper decisions in any situation. It is having boundaries that teach people when they are in transference that you are separate from them is what will allow the person to heal and build self esteem.
The other thing about transference is that it not only occurs in these helping types of relationships but almost all relationships. Friendships, significant others, family members and the person who checks you out at the grocery store who seems to ‘look just like your mother”.
Reading and learning everything you can about transference can also help. These are some of my favorite books:
“A New Earth” is Eckhart Tolle’s book that is now being promoted by Oprah. They are teamed up and offering a free online class that starts on Monday, March 3rd.
When I read “A New Earth” a few years ago when it first came out, I couldn’t put the book down and it became an inspiration for me to continue writing about such things despite many massage therapists not quite getting it that they can build a massage practice using similar principles of becoming more authentic by being present.
So many massage therapists are caught up in knowing more, learning more and doing more and the client usually gets caught in the middle. Part of the problem is how we are trained to ‘fix’ in massage school and our new role with the medical profession requires us to do it even more by reporting on improvements and having treatment stopped when function returns rather than when pain is resolved.
I was at a spa a few weeks ago and overheard a massage therapist in the hallway talking to someone who had just come out of the massage room and telling her how stressed the client was and how much more work the person needed. I could feel the tension in the air. The person who had just gotten a massage was being berated for how much stress they had rather than being honored for who they are. Now I am sure I am reading into things because I don’t know the whole story but it is examples like these or other stories of massage therapists saying things like “I just need to fix their pain” or ‘it is my duty to tell people about mercury poisoning and other possibilities that could be causing their health issues or I don’t feel like I am doing my job.
What “A New Earth” talks about is our roles that we take on to protect ourselves and our egos from suffering and how that creates more. But it is suffering that can free us from our pain and unhappy lives.
The ego is not something that is bad or that we need to get rid of. He says “It isn’t wrong, it is just unconscious” We are alive today because our egos are invested in ourselves. Tolle says that ‘Our egos are just are false self. It is the unconscious part of ourself.” The way to become more conscious is to become more present and aware of our egos.
But awakening from being unconscious is a little like thawing out from having frost bite - it is painful as we start to regain feeling.
A common thing that I often hear from massage therapist that I work with is about how they don’t feel like they know enough to help people. Tolle says this is actually the best place to be. When you can admit you don’t know enough you can realize that you are enough just as you are.
Another way to become aware of your ego is to become aware of what you are feeling in your body. As massage therapists we have the unique opportunity to help people feel their bodies more. ( I actually think this is more important than any specific massage technique or method.) Tolle says “Body awareness not only anchors you in the present moment, it is a doorway out of the prison that is the ego. It also strengthens the immune system and the body’s ability to heal.”
I also so often see massage therapists who become their role thinking that they are the only ones that can help someone and that massage is the end all answer to the worlds problems. I used to think like that when I first started out saying things like ‘if everyone got a massage once a week there would be world peace” (well there might be!) I also hear them complaining about things like working for chiropractors who take advantage of them or not having enough clients because of the economy or whatever the complaint is at the moment. Tolle says that “Complaining is one of the ego’s favorite ways of strengthening itself”. It makes us feel better to complain. And clients come into us complaining about this or that, this work situation or family situation and they come in with their pain and their attachment to their pain.
He talks about roles and how we take on roles to get the needs of the ego met.
How can we as massage therapists learn to become aware of our roles and learn to just be as a massage therapist?
How can we learn to serve and become more present with ourselves and with our clients to help make “A New Earth?”
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 .
Peer Supervision is really a confusing term to understand. For the longest time I fought using the words and tried to call it everything but peer supervision - mastermind groups, mentoring, support groups.
The thing is that the best way to really understand what peer supervision is about is to experience it first hand. Once I participated and understood then I said - yes it is peer supervision.
Of course in my opinion every massage therapist needs to participate in peer supervision groups and I have been thinking about what needs to be done to get it included in legal requirements of becoming a massage therapist - it is that important.
A massage therapist needs peer supervision if they want to become the best massage therapist that they can be. I wrote up some information on my website about who needs peer supervision.
While I think that people who have survived the 5 years in business mark as a massage therapist are drawn to peer supervision more, it can be really helpful for a massage therapist who is still in school or just starting out to get the assistance that they need in setting up and learning to run a massage business. Most people starting out are too focused on things like money and getting clients and think that they don’t need peer supervision. They also don’t really understand articles like “In the Service of Life” or books like “how can I help by Ram Dass. I know I didn’t when I was first starting out and there was no way that anyone could tell me that that was me in the article and book. It isn’t until one has struggled long enough or starts to feel burned out that the seek out peer supervision when it is the exact thing that can help prevent it and help a massage practice flourish.
So I am starting an online peer supervision group that you can read more about at my website - www.massagepracticebuilder.com. It won’t be quite the same as meeting in person because you get so much from hearing people’s voices and seeing people’s physical reaction, but it will be a way that we can start learning and sharing from each other in a much deeper way to help protect the future of the massage profession.
