Why Massage Therapy Needs Modern Psychology

Why Massage Therapy Needs Modern Psychology

Christopher Moyer is a counselling psychologist who specializes in the niche field that is where massage therapy and psychology intersect. I had already cited him in my thesis without realizing he had only started blazing trails in the field. When the RMTABC recommended I check out more of his work, I was thrilled to find there is so much going on there. This post is just a review of key takeaways from his very recent Colorado lecture, above in full.

Christopher starts off citing he’s a huge fan of massage therapy but that he was going to leave some very unsettled listeners in his wake — this because he was going to criticize some practices that have become almost sacrosanct in the field, but that have little scientific backing. He then outlined how psychology is a field unique to many others in that everyone knows something of it. However, most people’s views on it are very outdated; when asked to name prominent players people revert to thinkers from decades back whose work has since seen major overhauls (my own use of the classically Freudian featured image reflects this stereotype). And this is a problem, hence the emphasis on modern psychology in this talk. He tied this in neatly to modern massage therapy: whereas psychology has evolved from models spun from theories rooted in authority to currently become a very open, inquiring, living science, massage therapy still rests on unexamined evidence in very many places, with a therapist’s authority frequently building a protective barrier around what inevitably becomes tradition.

The example he uses is a patient’s explaining away of their perceived longer sleep requirement as a result of their advanced age, when this is patently false. Massage therapists, he argues, should seize opportunities like this to educate their patients and to learn more about the phenomena being discussed, rather than complacently nodding in agreement and building pseudoscientific theories around what seems to be “common sense”. To this end, he recommended picking up two books: Why People Believe Weird Things (Shermer, 2002) and Excuse Me, Exactly How Does That Work? (Allen, 2014). This second author is especially enlightening as she’s a massage therapist who had herself believed and propagated various myths in the field before having her own eureka moment. Since then, she’s become something of a torch-bearer in this refreshing campaign for understanding in the field. Here she tackles a very common example of a massage myth, that of massage “flushing toxins” from the body:

Returning to our list of psychologists, one name generally unknown to the public is that of Carl Rogers, whose person-centred approach to therapy shows immediate relevance to massage therapy. His three core conditions for therapeutic change are congruence, acceptance, and empathy: that the therapist is genuine and not acting, and sharing his or her own life experiences to facilitate therapy; that the therapist accepts the patient unconditionally and without judgement, giving the patient room to be the main author of change in his or her own life; and that the therapist understands and empathizes with the patient’s own frame of reference. All three ring true for massage therapists, who — even if not expressly taught so — will have developed a natural leaning towards this style after a few years of work. Christopher hinted at developing Rogers’ ideas further within massage therapy, creating what he called “Affective Massage Therapy”. This would be massage therapy with added psychological support to better take care of patients’ needs. I mean, since we’re already tapping into this parameter, it makes sense for us to have some training in it. Lorimer Mosely, a physiotherapist from Down Under, is already integrating such an approach in his practice. His is a second very clear voice that resonated throughout my master’s research. Here he shows clear Rogersian leanings in how he explains pain to patients:

From here, Christopher discussed a few concepts that really need hashing out in our profession. First was the idea that the body may be able to store memories outside the brain, most often in limbs or muscles. Though often called “muscle memory”, a more accurate term for this phenomenon is “body memory” since that first term now commonly refers to the neuromuscular learning process that increases task efficiency with repeated practice (a good example are uchikomi in judo training; automating technique such that entry into a throw is almost reflexive). Body memory is used to explain surprising emotional outbursts during treatment, as in the case of a patient breaking out in tears: “painful memories were trapped in this muscle that was just treated, and the massage has released them.” We know from current neuroscience that this just doesn’t hold much weight. However, this phenomenon certainly warrants further study for it certainly is real. My own guess is that it is something about the relaxing massage setting and the application of Rogers’ core conditions allow for patients to reach such a point in treatment… but the bottom line is that we just don’t know.

A quick note on psuedoscientific claims in general and the harm they may cause before I move on. An immediate thought that bounces back in discussion is that, even if you aren’t telling the complete truth as a therapist, isn’t the placebo effect you’re ultimately creating good if it gets the person on their feet again? Well, no, as Christopher explains. Yes, it may be good in the short run, but there also exists a significant chance that your patient will read up on her or his condition further, or deal with another therapist later who will throw serious doubt on the claims you initially presented them. If they are hit with these doubts before making a full recovery, your patient’s condition could actually spiral backwards and there would be very little you could do to bring them back again since your therapist-patient relationship will be well tarnished — just visualize a hyper-inflated balloon getting popped, or read about Clever Hans (and then think about everything you know about energy healing). I’m continually surprised how often people think they should drink water after a massage, for example. Sometimes I enlighten them that this doesn’t really do anything, but very often I just let it go unless I feel they are actually going to be receptive to the change in thinking, because this ultimately pins me, usually a stranger, against their old therapist, whom they usually really liked, and those cognitive dissonance wheels start cranking.There have been times I’ve tried to explain away the placebo only to be met with a blank stare edging into incredulity.That’s usually the moment I just let it go. Further to all the above, building upon a placebo so strongly really inhibits dialogue with other health professions, but will be outlined in a minute.

More benefits of marrying massage therapy with psychology just tumbled: massage therapists could benefit from understanding flow state, the brainchild of the Hungarian psychologist with the unpronounceable name. This could be used to explain what’s going on when a therapist gives an exceptionally good massage and both therapist and patient are ecstatic (in psychological terms, the challenge and skill levels of the treatment are both high and adequately matched). In a not entirely unrelated vein, understanding the expertise needed for excelling in massage would go a long way in recruiting better therapists faster, and in discovering alternative career paths and advancement strategies in for them down the line — both domains dealt with in vocational psychology. Christopher aptly pointed out that massage therapy tends to be a very horizontal career, with few advancement opportunities beyond specialization or, for the odd few, teaching or administrative roles in related institutions. This could contribute to therapist burnout, explaining the statistic I was told by my peer assessor in Ontario about five years back: that the average “shelf life” of a massage therapist was a mere two years. Perhaps adopting a mentorship model, as was used in Québec up until around 2010 (if not still being the case), might perhaps expand our career path to include some vertical movement. Or even roles not really explored as yet, like working alongside health teams in hospitals or in research? Because massage therapy has the potential to be much cheaper and much more available than many of the drug therapies currently on the market, not to mention much more effective in dealing with things like pain or depression. Such research could even mark a change public policy, from dealing with health issues in a reactionary, rehabilitative manner, to one more forward-thinking and “prehabilitative”. Understanding and developing all these ideas further would help therapists better plan their careers, just as understanding attentional fatigue would help them better prepare their workdays, knowing that not only does their body take a toll but so does their mind (especially when effectively applying Rogers’ principles for an entire day).

A last idea that floated around the room during the lecture was the observation that one of the biggest barriers in dragging massage therapy to be on par with other allied healthcare professions (apart from making it a university degree program, in my opinion), is the problem of communication. Christopher joked how few massage therapists leave their treatment rooms after a successful treatment with the following outburst: “It worked… but why?!?!” And this is natural, but also unfortunate. We create this “massage bubble” wherein we don’t need to question our efficacy because everyone involved is always happy with the treatment… and so we don’t. Then, when pressed for an explanation, the combination of usually inadequate education combined with those half-baked ideas floating around the profession leads many of us to murmur something about meridians or chakras or emotions stored in muscle, to the discredit of our entire profession in the eyes of the other healthcare fields. This serves to isolate us from others who could very well help us, and whom we could certainly help as well. We are, after all, some of the best experts in soft tissues, palpation, and empathy when it comes to health.

A final point in wrapping up this summary: Christopher underlined the fact that the majority of the top-cited articles on massage therapy are actually in peer-reviewed psychological journals, not physiological ones… this alone should make us as a profession rethink where the real strength of our field lays. Maybe there are more similarities between Freud’s couch and your massage table than first meets the eye.

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