Massage & Bodywork columnist (Table Lessons) and MTF President Douglas Nelson discusses honoring the uniqueness of every therapeutic encounter and remaining open and curious to each client. We discuss the partnership between client and practitioner, outline strong leadership during the pandemic, and define the difference between excellence and art in the work.
“Connecting the Dots: A Key to Massage Integration in the Health-Care System,” by Douglas Nelson, Massage & Bodywork, January/February 2021, page 30, www.massageandbodyworkdigital.com/i/1315831-january-february-2021/32.
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0:01:05.2 Darren Buford: Welcome to The ABMP Podcast. My name is Darren Buford. I'm the Editor-in-Chief of Massage & Bodywork magazine and Senior Director of Communications for ABMP.
0:01:11.7 KC: And I'm Kristin Coverly, licensed massage therapist and the Director of Professional Education at ABMP.
0:01:18.5 DB: Our goal is to connect with luminaries and experts in and around the massage, bodywork and wellness profession, in order to talk about the topics, trends and techniques that affect our listeners' practices. Our guest today is Douglas Nelson. Doug is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, President of the 20-therapists clinic, BodyWork Associates in Champaign, Illinois and President of the Massage Therapy Foundation. His clinic, seminars and research endeavors explore the science behind his work. For more information, visit nmtmidwest.com and massagetherapyfoundation.org. Hello, Doug and Kristin.
0:01:56.0 Speaker 3: Good morning, good morning.
0:01:58.7 KC: Hello and welcome, Doug. We're so excited to have you here. It's your first time with us on The ABMP Podcast, let's share a little bit of your story with listeners, so they know what brought you to where you are today. What drew you to the massage therapy profession?
0:02:11.2 S3: No, I started in the arts, and it didn't take long to figure out that probably it wasn't gonna be where the bus was going, in one way. For all my friends, they went on to do really great things in music, and it was something I was passionate about, but passionate to a level, but I knew they had something that I didn't have, was this deep passion for the work that at some core level I knew I did not possess, which was a little bit painful. So I ended up being involved in yoga and self-care things, and in a very circuitous way, I discovered massage therapy, and that was in 1977, and I've been doing it ever since and never really looked back.
0:02:56.5 DB: Doug, we've had the luxury of working together in Massage & Bodywork magazine, since January, February 2009, when your initial Table Lessons column launched. I love, and the editors love, the premise of the somatic sleuth, where the column is based on. Where did that come from? Can you tell us a little bit more about that?
0:03:16.9 S3: Well, first, it's a little like 2009. Oh, my goodness, right? It's been that long. Wow! That's a little hard to believe. The idea really came from, I think I had written a couple of articles for Massage & Bodywork and met Leslie Young at some conference, and we just started talking about just the connection with clients and in sessions, and it's something that I'm really passionate about. For me, the different hats that I wear, the grounding principle is always being in the clinic, that for me is the ground on which everything else is built from. And I think in that conversation with her, we started... I think I might have shared just some lessons learned and also how... It's really interesting Darren, for me as a teacher, you can tell a principle to a group of therapists, and they're like, "Yeah, whatever." But when you tell a story, maybe a story about why I didn't adhere to that principle and the outcomes were terrible, people remember that story, because it's very personal.
0:04:28.7 S3: Stories are just so central to our lives. There's a quote from Joan Didion, "We tell stories in order to live." And our stories are our lives really, and in the clinic, every therapeutic encounter, every moment with the client is another story, is another opportunity. And to share that and to share those lessons learned, it's a great way to communicate for me as an instructor, to communicate these very important principles in a way that's lived. And so it's not academic, it's not just cognitive, it's like, "No, this really matters, and here's what happens when these principles are employed in real life." The word praxis, putting principles into action. Theories are easy, results are actually hard. In the clinic, the delivery system, making it happen every day with every client is just something about which I am crazy passionate about.
0:05:31.9 KC: And too, I absolutely echo everything you said about storytelling being so powerful. It also really allows the therapist readers and listeners to the pod today, to really connect with the message that you're sharing. It's relatable, and they can also start thinking like, "Oh, I had a somewhat similar experience with the client," or they might be inspired to have a similar experience with a client, because in your columns, even though each of them is based on a specific client story, from a bigger point of view, they're really about how we as therapists can be open and curious and how we approach a session and how we approach each client. What would you say to therapists who are interested in being more curious with their clients and being more open, but are tentative or lack the confidence to do that? How can they develop that curiosity?
0:06:27.7 S3: You know, there's some interesting research about storytelling, where they've put people in an MRI scanner. And what happens is, in an FMRI, the brain waves of the storyteller and the story listener actually synchronize. Is that like, are you kidding? Right? And so when you say relatable, think of the reverberations, the ramifications of what you're saying. So we relate to stories, we really synchronize with the storyteller, and so your thing of, "Oh, yes, I've had an experience like that. I've made that same mistake." And I think for me, I try to make the Table Lessons, if you look through, they're not a bunch of glory stories, there's some horror stories as well. Things like, Wow, could you do that worse? Like that, no one else has done that. That's life in the clinic really, it's about the struggle, and the struggle is where the learning happens, that's really important. When someone comes in and you do what you do, and it works fabulously and the client leaves, and say, "That's so neat." Well, great, good for them. You as a therapist in a way, have learned nothing, it's the struggle that is the vessel for learning and growing as a therapist.
0:07:56.1 S3: Now, relatable also is not therapist to therapist, but therapist to client. You know the word communion? The definition of communion is the sharing or exchanging of intimate thoughts and feelings, especially when it's on a mental or spiritual level. Wow! So I think of every session as a communion in a way, it's to be respected. And I am putting myself out there as a human. It's a human-to-human connection. It's not, "Oh, you're coming to me, therapist; you, clients." It's not like that. It's one human to another, one person who struggles to another, and together, I think part of it is that thing of putting down the flag and saying, "We will figure this out together, you and I will figure this out." Now, it feels like I'm just supposed to understand the question and what is the question? The question used to be, What's the matter with you? Now, it's more like, What matters to you?
0:09:09.6 S3: I think back of some of the clients I saw yesterday, two in particular, who were athletes referred by University of Illinois. It's so interesting, this one young man said, "Why do you keep doing this after all these years? Why don't you just farm out what you do to your staff? And I said, "And miss the opportunity to meet someone like yourself?" This kid was unbelievably impressive. Who would wanna miss that? But it's that human-to-human connection, and it's everything.
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0:10:41.3 DB: Now, let's get back to the podcast. So when someone comes in and you've established that rapport with them, do they feel invited? Did they feel even more connected to you? I'm wondering 'cause some clients/patients are looking for the "expert."
0:11:00.8 S3: It's a partnership, and I think once they understand that, it also invites the person. Many of the people that I see have seen other people. The surest path to confidence is lack of knowledge. So, as you know, they've been in other places where people are very confident, it's just the results didn't come out. And oftentimes what happens is, you go to see someone and they're very confident and they do what they do, and then it doesn't help, and then it's like, "Well, this isn't it." Well, that's fine for everybody, except the client, patient. Well, now what am I supposed to do? So in that vulnerability moment, it is together, we will figure this out. And the keyword is what? Together. So it invites them to participate in the process. In some ways, they feel like, "Well, this guy can't do it by himself, I guess I need to help him." Like, I need to be involved in this process because it's not like I'm gonna show up and this guy is just gonna make something happen. We have to, as a partnership, work together to solve this problem.
0:12:06.3 KC: Absolutely, and I think in the same vein, something you wrote in a recent column that I absolutely love and resonated with is, "Your hands are asking questions and inviting connection." So not just the verbal invitation for connection, but your hands are doing that throughout the session as well.
0:12:23.0 S3: Yeah, I think about this a lot when I think about, would you agree with the statement that touch is a form of communication? Everybody says yes. Then you must also by default agree that all the rules of communication apply, and what are those rules? Do we know those rules? And do we follow them? The first rule of communication is really about listening, and you can talk with your hands, you know when somebody just comes in, start doing stuff, that's talking with your hands. Or you can listen with your hands, and I think we've all felt the difference when we're on the table, but if I talked about clarity and brevity for the next 45 minutes, would it make it clear? Probably not. When you get it, you get it. That was not true for me when I was doing treatment, I would throw everything I could at the person thinking something's gonna work. If we did that in this podcast, people wouldn't make it to the end.
0:13:22.7 S3: So in a way, I feel like the nervous system has the same thing, like, what is the point here? What are you trying to tell me? So what are the ways that we link all this together, so that what we do is thematic and clearly communicates to the nervous system? And you should have a point. It's really in a way about expression and communication, and it's like a piece of music, it's not just notes on the page, it's that the person who wrote that is trying to communicate something and the artist needs to interpret it in a way that is clearly communicating something. Otherwise, it becomes... And this is this thing of, it becomes transactional, not transformational.
0:14:08.0 DB: I'm kind of lost right now as a client with somebody who's suffering from some injuries to my elbow, specifically golfer's elbow, and I've had tennis elbow, and I am totally lost in that system right now. From the primary care physician to the physical therapist, to PRP injections, and when one of those sequences doesn't totally work, everybody's just like, "Eh, maybe go back and start over again." I'm looking for that direction that you're talking about, that you're approaching your sessions or your clinic is, and that is just so different than what I'm literally experiencing out in the world. And it's, again, it's just refreshing to think about that because I want to be an active participant in the session. And I know a lot of clients are looking for that as well.
0:14:56.5 S3: Yes, and to do that, Darren, then you must understand the context of that. If I might step back, so the person says, What do you think this is? For me, it is, I don't know. And you can see in that like, Oh, like you don't know. And it's like, No, no, no, no, no, here's what I mean by this. If in this first session you're asking what I think the problem is, I don't know yet, but here's what I do know. If it is this, then this will be true and that will be true and this will be true, but these three things will not be true. So in your case, if it's lateral epicondylar pain, if it's the extensor digitorum, these things will be true, these things will not be true. If you do this movement or exercise, this will be true, these won't be true. But if it is from the supinator, these things will be true and these things won't be true. And then as you go through this whole set of criteria, now you invite the client to really watch what happens in their life and what makes a difference, what does, what does not, and together we put all that information and we take a plethora of information and start narrowing it down and down.
0:16:14.4 S3: And then sometimes what happens is, it becomes really clear that, Okay, now we know what the problem is, and many of the Table Lessons columns are like this, but it's ultimately not in my domain, but what makes it all work is the depth of your understanding. Each of us as a therapist, you must deeply understand these things. You can't just have the lateral epicondylar protocol, it's all good, except when it doesn't work, and guess what, it doesn't work a lot of the time. So that's one of the things for me. What do you do when your go-to strategy doesn't work? And then what's plan B and C, and D and E? And how will you know to make that change? That's what's really important, and that's where the artistry happens.
0:16:58.6 DB: Doug, this has been a really challenging year. What has that been like as a clinic owner?
0:17:06.1 S3: Very difficult. It's been the hardest challenge of my career, not surprising, because everybody else is struggling with the same sort of thing. What does it mean to lead? Oftentimes in the past, you have a situation that comes up and you can say, Well, this is like that, because I've faced something similar in the past. This is like nothing any of us had ever faced before. When the shutdown first happened for us in March, to go into the clinic, which is normally just bustling and just, you know, there's energy, to walk through those halls and see nothing happening, just to see it closed was just, oof! My wife said, for me, I slept like a baby in those first few weeks, I woke up crying every two hours, so it was just so difficult to know what a difference we were making in the community, and then to see all that stop. That was really hard.
0:18:14.3 S3: And then to deal with the uncertainty of what was coming forward. Again, I hate to be a nerd, but in the world of stress and pain research, uncertainty is the thing that makes those experiences worse. It's true with pain, it's true with stress. And interesting with pain, especially if you had managed it and then you lose control of it, that's even worse. So again, to have this fully functioning, vibrant clinic, and then all of a sudden to have it not doing anything and then not to know what is coming, how do we know? Okay, for the next three weeks, we're just gonna do a hard shutdown and that's what it is, but that was not true. And then as things began to open up and we were able to start seeing clients on June the 1st, again, it was filled with uncertainty. And you know what, what you could do is, you just compile a bunch of information and then you think, "This is based on what we know now, this is what we believe, there's no right answer, but we're just gonna move forward and these are the choices that we're gonna make." And that's what we did. And we've been really blessed to be able to do that, and up through this point.
0:19:32.4 DB: And in that situation, how are you leader both to the practitioners who work for you and for the clients that are coming to you?
0:19:41.9 S3: Yeah, so this was really interesting, Darren. The one thing about having the clinic the size that it is now, is that many other people who come there, I've never met, and this is very different. People are coming and going, and we have a couple of different locations. Actually, three right now. So when we had that shut down, I told my staff, I wanna make all the phone calls, and believe me, that's a lot of phone calls to cancel appointments. At one office, we see over 300 people a week, so, oh my gosh. It was such a great experience for me, because I would say, "Marie, I'm so sorry to have to cancel your appointment, but it looks like we have to... " And then she would wanna tell me about the meaning that my staff has had in her life. And so that phone call to cancel the appointment turned out to be a 10-minute phone call, times like... You go, Oh my gosh, I'll never forget that one day. I call this other person I'm like, "Hello, this is Doug Nelson, and I need to... " And she said, "Doug, are you a little tired?" I said, "Why do you say that?" And she said, "'Cause you called me three hours ago to cancel this very appointment."
0:20:53.8 S3: I was like, "Okay, I think I'm done now." She said, "I think that's a really good idea." So it developed this relationship with the clients who come to see us, and that's really important, because it's always about relationships. And I also send videos about just understanding the stress of it all to our clientele. I think that he certainly saw my vulnerable side as did my staff. There's no pretending here, this is really difficult for everybody, and it was a shared vulnerability.
0:21:35.7 DB: I really love that you did that, because early in the podcast, when we started in April and May of 2020, this became a conversation that Kristin and I were having with a lot of leaders, which was like, How are you reaching out to your clients? And because in our personal lives, we had numerous instances where, whether it was a hair stylist or our own massage practitioners or whatever, whatever service that we're getting, where people weren't reaching out and that was not by email, certainly not by phone. So the leadership that you exhibited there is exactly what I was looking for as a client, because that makes me feel comfortable. And you know the first number I'm gonna call when things open up again, just because of the steps you took there.
0:22:18.4 S3: Yeah, and in the end it's always about relationships and demonstrating in what way do you demonstrate your care. A phone call like that, just in a regular thing. This is all my staff knows, if you see somebody with something very specific, call them three days later to check in and see how they're doing, 'cause it just demonstrates that you care. We just went through a thing where... I know this doesn't make a lot of sense, but the State of Illinois in end of November, when we went into Tier 3 mitigations, require that everyone who comes to see us needed to have a doctor's okay, like a hall pass from a physician. Like, Oh my goodness, are you kidding? So it was devastating in some ways to the schedule because everybody had to go through their provider to find something like this, but on the other hand, we had over 450, I think of these notes.
0:23:12.3 S3: Kristin goes to her provider and says, "I need you to write this little note just for me to see massage therapy," and the provider says, "Well, why?" And then Kristin explains why this is really important to her. So in the last couple of days, I just took... Actually, I just happened to grab the phone a couple of times, and these were actually people who were new to the clinic, they had gone to see their physician, and the physician said, "You know, before we do anything else, why don't you go see these people? Because this actually might... " Look at that, right? And then I've been working my way through, I may end up with him in our missions, 'cause I've been writing thank you notes to all of those providers who wrote us notes. And I just actually got... How weird is this? A thank you note for the thank you note from this physician and talked about creating this relationship, which is really cool. So, in the end, you just find a way to turn it into something that develops that sense of connection and community and relationship.
0:24:19.5 KC: I love that it comes back to relationship and connection.
0:24:23.7 S3: Yeah. It's the therapeutic encounter. And this is not... In the end, you still have to deliver the goods, you have to master your craft so well. You think about someone like Yo-Yo Ma, you hear him play, and it's like, Oh my goodness, it just moves you to your soul, but on the other... So he has that skill, but I've heard people who are masters of their, in a way, craft, but it's totally unmoving, and it's like you can be an excellent orator and have nothing to say.
0:25:00.0 KC: Doug, what message would you like to share with our listeners? What do you really want them to hear, as they're sharing this podcast experience with you today?
0:25:09.5 S3: Outside of my treatment room, I have this scroll that I brought back from Kyoto, and it's a famous Japanese saying called, "ichigo ichie," which means; one life, one moment. And it was in the days of the samurai priest, warrior, and you're in your house, and all of a sudden this person would show up in your backyard and you offer them a bowl of tea, and you know that never in your life will you ever see this person again, this is this one moment. Well, guess what? That moment with that client is exactly that. Every moment is one life, one moment, and when you see it that way, you begin to cherish it in ways and don't take anything for granted. And therefore, you become reflective, not reflexive in the work, and that will make you not only a better therapist, but it'll make you a better person, and savoring each connection, each relationship. There's also the expression in the yoga tradition, "No one bathes in the same river twice," because you are not that person, and the water is not the same water."
0:26:26.3 DB: Doug, let's bring it full circle here. Clearly, you are passionate about music. My son is a musician, he is a percussionist, so it is in our blood over here in our family as well. Tell me a little bit, are there any correlations between bodywork and music?
0:26:45.4 S3: Absolutely. Music is life. Art is life. And again, music in that way is about expression. Your son plays because he wants to communicate something, and I do the work because I wanna communicate something as well. You can go through the motions, which is completely unfulfilling for everyone, or you can use it as a way of deepening the human spirit and the connection between the audience and the artist. And the other thing is, another parallel is just the depth of the craft. I'm actually a new cello student, I'm three years into it, and I'm getting better 'cause my wife doesn't close the door as often as she used to, but it's a 10 to 1 ratio, 10 hours of practice is like one hour of performance. Do we do that on our craft? Do we apply those same things to the discipline of massage therapy as artists do with that principle? I think it's a challenge, and I think it's really invitation to deepen your craft and then also explore that and communicate that, use that as a way to create connection with our fellow human beings.
0:28:21.5 DB: I wanna thank our guest, Doug Nelson, for joining us today. Doug, where can listeners find out more information about you, your clinic, and the foundation?
0:28:31.5 S3: For the clinic, it's bodyworkassociates.com. For the teaching institute, it's pnmt.org. We've moved that now from nmtmidwest to pnmt.org. And then for the foundation, it's massagetherapyfoundation.org.
0:28:51.8 DB: Excellent. Thank you so much, Doug.
0:28:53.6 KC: Thank you, Doug, it has been a true pleasure to have you with us today. Thanks for taking the time and sharing your insights, knowledge and wisdom.
0:29:02.3 S3: It's my privilege, my honor to be with you.