July 15, 2011

Training and Boundaries

Over on my personal / poetry blog, writing about writing on this blog (I really don't know if this two blogs thing is going to work!) – I wrote this:
. . . I really think that a fifteen-year-old who gives her grandma back rubs probably does as much good for her as would the most highly trained specialist in Myofascial Some-Guy's-Name Technique or a level 6 master of some supposedly ancient Asian (conveniently untranslated; if pressed, untranslatable) lore. I don't think rubbing people and making them feel loved and soothed and comforted is really that abstruse or that difficult: the only reason it's a viable “profession” is that our culture is so isolating, so high-pressure, and so hypersexualized, that the only way most people can get the humane, attentive, non-demanding touch they crave is by paying for it. (Whole post here.)
Zhoen (surgical nurse and herself a qualified massage therapist) made a couple great points in the comments to that post:
Dunno. That's only about 50% of what I see a therapist for. The rest is the knowledge, knowing where to look, feel for the pain, the stress. I know when you are going to start and stop, know that you will listen when I ask for more or less pressure. A friend, a relative, may not have bothered to learn this, may not listen to me, may make it an emotional debt. When I pay a massage therapist, I have discharged my debt fairly and completely.

So, yes, in a way, you are right. But you are also half wrong. And it's not that everyone can't do it for everyone else (which is debatable) but that the in-kind cost is too high most of the time. You guys are a bargain.
In saying that knowledge was useless, I overstated the case for the sake of emphasis, something I may possibly have been observed doing before. Because I do depend on my knowledge, and it does serve me. But it's difficult to assess how much it serves me, because I can't really think my way back to how I would have done massage before I knew muscular anatomy. How many things would I have figured out anyway, or learned from the work of other therapists? I didn't know the subscapularis even existed before I studied anatomy. (It's the large muscle nestled, like the flesh of a limpet, in the underside of the shoulder blade). My first thought is, how would I know to work it, if I didn't know it was there? But actually I would have learned what you can do with it from getting massage. The practical lore is out there. I would have learned that, on some people, you can “wing” the shoulder and reach right under the medial edge of the scapula; and you can take the arm up over the head to get under the lateral edge. (If I was designing the curriculum for massage therapists, by the way, the “professional exchange” would figure largely in it: it would be monthly, if not weekly, event. If you want to learn to do massage, the biggest bang for your buck is not a class or a workshop – it's getting a massage from a good, experienced therapist.)

And of course, I use my book-learning about trigger points all the time, modified by my experience. But the book-learning is dangerous as well as useful. What if, as suggested in this excellent blog-post, trigger points (as muscular phenomena) are imaginary? What if all my laboriously acquired knowledge of muscular anatomy is mostly beside the point? The fact that some things work according to the theory may easily disguise from me the fact that other things don't. The more compelling the theoretical story, the more easily it overrides both common sense and my “intuitive” sense of what's wrong and what needs to be done. (“Intuitive” in quotation marks because it's shorthand for “probably tactile and visual sense processing of information gathered by mirror neurons.” But that's another post.) And the more I spend on acquiring a theory, in time, money, and brain-sweat, the more committed I become to believing it was worth it.

The other point Zhoen raises is the value of boundaries. The emotional, social, or sexual debts incurred by amateur massage may more than we can afford. We don't have social conventions defining and bounding amateur massage – or rather we have them, but they're mixed up with the conventions we have for sex. In Nepal (I'm told by someone who married into the society), a woman who marries, and moves into her father-in-law's house, is expected to do massage for her father-in-law, as a matter of course. But here such physical contact, without the boundary of a commercial transaction around it, implies that one is a lover. One of the tiresome tasks that's part and parcel of working as a massage therapist is reinforcing that boundary: making clear to clients that they have not, by getting a massage, become your lover. It takes some of the thick, amiable skin of the bartender or barmaid: “thanks, but no thanks, love. Drink up, and on your way now.” How distressing you find doing this is one good indicator of how long you'll last in massage: but again, its not a task you get trained in or tested on in school. Or not much. There's some high-minded and perfectly true talk of boundaries and how things oughta be, but not much that's helpful about what you actually do, unless you're fortunate enough to have an instructor who wanders off the syllabus. And even then, I'm not sure how much of this can be usefully taught in a classroom. It has more to do with confidence and having your feet on the ground -- with being neither particularly offended nor particularly pleased by people responding to you that way. You have to understand viscerally that it isn't, for better or worse, a response to you; it's a response to being touched. But -- this, too, is another post.


  1. It was exactly because I was too young, that I did not work as a massage therapist. I simply could't handle a request for sexual services, with my own lack of experience, my then thin skin. On the other hand, there was something wonderful working on someone who understood the exchange, and I could enjoy the work for the sheer joy of a job well done. In the end, I went into a more controlled environment, where the lines were clearer all around.

  2. Zhoen, I'm sure I couldn't have handled it, when I was younger. I feel that massage is my vocation, and sometimes I think that I wasted all that time I spent in other careers -- but then I realize, I really wasn't ready back then. It's difficult, sometimes, and I don't think the training programs -- which are trying so hard to be bright and professional and and determinedly upbeat -- really warn people properly. (And of course, God knows a middle aged man has it lot easier than a young woman.)