Ep 25 – “The Client is Always Right … Really?” with Cal Cates and Kerry Jordan of Healwell

00:00 Kristin Coverly: Anatomy Trains and the Laboratories of Anatomical Enlightenment are excited to invite you to dissection live stream, a regional and layered journey through the human body with Tom Myers and Todd Garcia. September 11th through 14th. Student Jan Ball, who attended the last dissection says, "The whole live stream dissection course was truly a unique educational experience. It was profoundly moving, I gained so much from it. It was one of the most valuable educational opportunities that I've had, I'm truly grateful to Tom, Todd and the whole team of people involved who made this unique opportunity available." This experience will be delivered through Zoom webinar with high quality audio and video, multiple perspectives, and time for questions visit anatomytrains.com for dates and details.

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01:02 Kristin Coverly: Welcome to The ABMP Podcast. My name is Darren Bufford, I'm Editor-in-Chief at Massage and Bodywork magazine and Senior Director of Communications for ABMP. I'm joined by my co-host, Kristin Coverly, Vice Massage Therapist and Director of Professional Education for ABMP. 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 guests today are Cal Cates and Kerry Jordan from Healwell. Healwell offers live and online courses for massage therapists and other allied health professionals to support meaningful integration on massage therapy, as well as interprofessional collaboration and the role of self-awareness in effective and sustainable caregiving. Healwell partners with hospitals and other healthcare facilities, and their team of specially trained MTs, support patients at hospitals throughout the Washington, DC area. For more information, visit healwell.org. Hello friends.

02:00 Kerry Jordan: Hello.

02:00 Cal Cates: Hello, nice to see you, hear you.

02:03 KC: Nice to hear you, too. And hello Kristin, how are you today?

02:05 KC: Oh, hello. Welcome, I'm excited. This is gonna be great, pod listeners, you're in for a good one today.

02:12 KC: We both, Kristin and I, not that I'm an editor so not that I hadn't already read your article numerous times, but we reread your article and in preparation for this, the article we're referring to is, The Customer is Always Right, but are they really? From Massage and Bodywork magazine, the September-October issue that just went live. What lead you to write about this topic? Was it like a personal experience of years of working with clients or seeing MT struggle with the client-therapist relationship?

02:43 KJ: Yes.

[laughter]

02:47 CC: Yeah, yeah. I think we're always interested as humans and I think at Healwell, in what makes people think the way they think, and this whole, I think massage therapist get really wrapped around the axle, as they say, about this whole idea of sort of sales and relationship, and it seems like a ripe topic for exploration. And certainly, I think in these times when we're really trying to make people as happy as we can 'cause it feels like there are less customers available in the world of COVID than there might have been, previously.

03:20 KJ: Definitely, I think we saw a lot of this hesitation in our oncology massage classes because people have a story about how when you have to give an oncology massage, you're not giving a real massage and you're gonna have to apologize to the client and they're gonna hate it. So I think a lot of what we wrote started from there, but I think that that happens with all kinds of massage therapists and all kinds of clients.

03:46 KC: Let's start, not necessarily with the adage. I love the adage and you do this really amazing breakdown with it, do MT sell a product?

03:56 KJ: Everybody sells a product.

03:57 CC: Amen. She's putting words right out of my mouth, I don't care who you are, you're selling something.

04:02 KC: So we are selling something. If we're liking it to someone coming into a store looking for a product, someone's coming into our practice looking for a product. How does it get so much more complex so quickly when where massage therapists selling a product versus a product in the store? Let's talk about that for a minute.

04:20 CC: Well, I think massage therapists are particularly skilled at making things more difficult than they need to be. And when you ask the question about us like selling, are we selling something? And of course, we both unequivocally say, "Yeah, everybody's selling something." My mind went straight actually the Levi store for instance, and that like even if you are a salesperson in Levi store, people don't come in looking for jeans, they come in looking for something that's gonna make them look the way they wanna look. It's too simple to say that when you walk into the Levi store, you don't say, "Make me amazing." You say, "I don't know, this is my waist, this is my inseam and I particularly like this cut," and then everybody stops thinking and you go to the rack that has that on it and they go, "Here you go."

05:05 CC: And then you leave, not dissatisfied, but not changed it. But nobody's gonna come in and say what they actually want, because that's not how people communicate. And I think this is the art of massage therapy that we talk so much about that anybody can give a good rub and the world would be a better place if everyone was getting a good rub on a regular basis. But when you come to see a massage therapist, you want a person who's gonna hear what you're not saying, and that's the product you are buying, is astute attention from this person who knows what it's like to be in a body and to not be great at communicating what you want for that body.

05:46 KJ: And I think it all starts with intake. I think, this is the place where everybody turns their brain off, like at the Levi store, because I think that a lot of us do intake, just like you described. Tell me your inseam, tell me what cut you like, what color, great, I have that.

06:04 CC: Yeah. What hurts, what pressure have you joined in the past, great, let's go.

06:10 KC: When really, we need to start thinking a little bit more like a detective, would you say? Like looking beyond the facts that they're giving. I love what you said a quote from your article is, "humans are terrible at being explicit about our own expectations."

06:22 KJ: Yeah, yeah.

06:24 CC: Yeah, yeah, but that doesn't stop us from being angry when they don't get met, which is really... I think that's the bind we find ourselves in as massage therapist is that the lack of expression of those expectations doesn't make us any less attached to them as clients. So yeah, when they don't get met, we wonder, "God, it's like that person didn't hear me at all." It's like, "He didn't say anything." [laughter] But yeah, we just finished. We're gonna be loading up a class actually about intake skills. And this is the big thing that we really highlight in that class, is that, I think when you say, "Do you wanna be a detective or is this sort of the approach?" Yes and no. I think you wanna be like the detectives who get to be in the movies, who see that there's blood on the floor, but then they lift up the corner of the blanket and they go, "Wait a minute, there's ketchup over here. This is very interesting," and that it's not, "What is this? Ketchup? That's really interesting. I'm curious about how this isn't adding up," and that it leads to more curiosity.

07:32 KJ: We all need to be The columbo of massage therapists.

07:33 CC: That's right, that's right. But the new catch phrase of intake will be, "Eh, just one more thing!"

07:40 KC: How are you still curious on the sixth massage in a row intakes portion. You're still thinking about the last session, you're probably thinking about the next session, you're hungry, it's lunch time, how do you still stay curious?

07:55 KJ: Again, I think this isn't for all people all the time thing. I think this is about being present because when you're not present, you can't be curious, you can't be attentive, and I think that's, and Cal, you sort of referred to this, but that's what we're actually selling is, I am selling you one hour of my complete and undivided attention and caring, and really caring with my hands, with my ears, with my heart. And so I think that it really is all about being present and that's a hard thing for everybody in all walks of life. And it's certainly a hard thing when you're tired, and you're worried about your rent money, and do you have enough PPE for the next three sessions, and did you have enough time to air the room and do all the things, but it really, I think it's really critical that we stay really present. And I think that if you say present, the curiosity followers.

08:53 KC: I think therapists will be nodding their heads a lot at a lot of things in the article, but one of them is when you say, "Clients might be right, but factually wrong." So tell us a little bit more about what you mean by that and then how to address that in the moment as a therapist?

09:10 CC: I think this is a hallmark of what's wrong and what's challenging us as humans right now in the world, and certainly, in our country, is that your experience is always valid. What you think is happening to you is right and science. So I think that it is our job to recognize and legitimize what's being expressed to us as what a person thinks is happening in their body, or even what they think might be the problem. They can come in and tell you that they think it's because there are tiny little people inside their body that are twisting up their subscapularis or whatever, and you don't even have to refute that, and you can still do what you know is correct and they walk out, "satisfied." So I think we have to get really good at knowing when is it important for us to be right, and when can I hear what the client is saying and still do what I know is sort of factually and scientifically effective, and let them feel heard.

10:15 CC: Sometimes we need to educate and sort of be like, "So that's not true," and I'm a little concerned that your understanding of the situation is this. But I think just as often, we can hear what's being conveyed in the way they understand what's happening for them, and even if it's factually incorrect, I can do something that is scientifically, mechanically accurate, without having to have a whole conversation about setting them straight.

10:40 KC: This is the tough part though, this is where the article gets really good, and what I mean is like, "I hurt here, you touch here. Why aren't you touching here?" And so what's the real trick there? Do you start there? Are you explaining why you aren't starting there? What's the real connection with the client that the client understands at this point, can partner with a therapist and understand the process together?

11:08 KJ: I think it's about how you sell, what you're selling. And I think you have to touch there at some point during the session, that's kind of the only hard and fast rule I have for that, for that scenario. Absolutely, do not let the session end without you, touching that spot, no matter what, but I also, I think it is about therapeutic relationship, is relationship is the important part of that. And you do need to explain, "Here's what I'm hearing and I think there has to be room for, is that right?" The client tells you all these things, and then you say, "So what I'm hearing is your right shoulder really hurts particularly kind of right in this spot, and I'm hearing that this is how you've been using your body and this is how long it's been going on, is that right?" And then based from what I'm hearing you say, "This is what I think I'm gonna try." And I think we also are very anti-fixed. You can't fix anything, don't tell anybody you're gonna fix anything, don't tell yourself you're gonna fix anything. And so I'm gonna address what you're telling me in this way, I have some things I think will be helpful. And then there has to be invitation for the conversation to continue, and if while I'm doing these things, it's not working for you, say something.

12:34 CC: Well, I think that so much happens in what we call intake around managing expectations and getting a sense as a practitioner of what does this person think is gonna be true in an hour. At the end of this hour, how do you wanna feel? And somebody comes in and they've never had a massage before, they're, I don't know, early 50s, they described this thing that sounds as you're listening like something that's been ruined for a really long time. You know that you're not gonna change their whole bodily experience in an hour, certainly not in a way that's gonna last until they come back maybe a month later. So before you even get them on the table, we recommend that you say like, "So talk to me about how you'd like to feel in an hour, and getting down to function, "What is it that you can't do now that you wish you could do, and how do we get you closer to that?" And I think a lot of it is art and listening and curiosity, and it's also just asking useful questions and then shutting up. That is such an underrated skill. [chuckle]

13:41 KC: And I think that leads perfectly, the shutting up piece, right into listening. So when you're talking about listening, you mentioned active listening, listening with your eyes and maintaining curiosity. All wonderful. What are some tips that you have for other therapists on how they can really enhance their listening skills and create a good environment, good relationship with their client that way?

14:02 KJ: You know, it's funny. When we teach together, one of the places where Cal and I part ways is on note taking. I believe there is I have plenty of science to prove that I'm right, that when you're taking notes, it is actually harder for you to really absorb information. That being said, I think that when you jot some things down, it does help you remember and it shows the client what you are saying, it is worth writing down, it is important what you are saying. I always likened it to going to restaurants where the really fancy ones where they don't write down your order, I hate that. It doesn't make me feel good. It makes me worry, even if you got it right when it comes back to the table, I've spent the whole time waiting just worried.

14:49 CC: You ruined my whole experience.

14:52 KJ: And so I do think that making some small notes, and maybe it happens after where like as the client's getting undressed or getting on the table, maybe that's when you jot down your notes, if you don't wanna do it sort of while you're sitting there face-to-face with them, but I think that a little note taking is really useful for you, the practitioner, in really remembering, because I think we think we're gonna remember everything. I know, I think I'm gonna remember everything. And particularly when somebody is interesting and their problems are interesting, and I'm listening attentively, I think There's no way I'll forget this, but then six more clients come in who are also quite interesting. So I think that taking some notes is a good way to sort of show the person you're listening in a very physical sort of way, and then also to kind of enhance your own listening and memory.

15:41 KC: You talked about listening, actively listening and participating in being present, but what about watching and using your eyes? Because what people say and what people do are two totally different things a lot of times. And their body language can be saying something totally different, probably before getting on the table and even while, or maybe, even especially while they're on the table.

16:01 CC: Yeah, I think that's true. And I think it's an example of a place where we see things. And I think as massage therapists, this is why so much of what we do at Healwell is about self-awareness and understanding your own stories about suffering and wanting to heal other people suffering. Is that you watch a client, maybe they're a brand new client, maybe you've seen them a whole bunch of times, but you watch their body language tell you how much they don't like their body, while they're telling you sort of what they think that you might be able to do for them. And your heart just sort of breaks as you watch them be disappointed in this outfit that they have to travel around in. And I think many therapists feel like they have to comment on that, and you don't. You can attend to that with a closed mouth. And I feel like that's one of the skills of listening and of paying attention is, I saw this, I took it in, I integrated it in my understanding of what it's like to be in your body, but when I call your attention to it, I actually put a wall between us.

17:12 CC: It doesn't create connection, it makes you feel like my research subject, and I'm saying, I actually know you better than you, and I can touch you in a way, and I can ask you gentle questions while we work that opens the door for you to be kinder to yourself, without me saying, "You know, I hear a lot of self-judgment," because then, oh, then you're judging yourself about judging yourself and it's this whole spiral where I was trying to be helpful, but I just made it worse.

17:41 KC: But Cal and Kerry, I probably watched 45 minutes of YouTube videos and I went to WebMD, and they say that this is what you should do.

17:55 KJ: It's really hard now. I think people have the perception of being really, really well-informed now because of the Interwebs.

18:02 KC: Yeah.

18:03 CC: Yeah. Well, and I think this comes back to our ability to stand our ground in the most nonconfrontational way, kind of like we joke in the article. If your person is trying to make coleslaw with a chainsaw, that's legit dangerous and it's time to intervene, but mostly, people are trying to make coleslaw with a pocket knife, it's gonna take forever, nobody's gonna get hurt like, "Okay, if you wanna go home and drink cod liver oil or whatever this thing and it's like, "It's not gonna undo what I did," and if you feel like you're taking control of your health by doing that, okay. I think it really also, this is a big piece of listening and communication, is how invested is this client in this information? Did they bring it because they want to pay you to do this thing that they don't know how to do, but that they know is gonna work or do they just not wanna show up without anything? Do they show up because in the desperation of 3:00 AM when I couldn't sleep because of this pain, I looked this up and it made a lot of sense to me at 3:00 AM, and that you can go, "Yep, I know what that's like at 3:00 AM, your body language and face can say, "Been there," and then you can be like, "So that's possible and... "

19:12 CC: So I think we really just have to soften our desire to correct people and to really understand when they're sharing these sorts of information pieces, what's their goal in sharing it? Are they actually trying to direct the treatment or are they just trying to show you how desperately they've researched, making this stop. So I think it boils down again to like, what's the client's reason?

19:39 KJ: Yeah.

19:41 KC: And so what happens if someone does come in after consulting Dr. Google? They're prepped, they've got their "information" ready for you, maybe it's not 100% factual or something else happens where communication goes a little rye and you're a little challenged. Instead of that deer in the headlight look, what are some good phrases that we can all have in our back pocket to pull out in that moment when we're dealing with a client? What are some of your favorite phrases to help negotiate some of these situations a little more gracefully?"

20:11 KJ: I think, say more about that is a really, really useful phrase because it buys me to some time as my brain starts worrying, and sometimes you get to something else. Sometimes the thing that you said on the face of it wasn't the thing that you said, or doesn't what you mean, or you're, again, Cal's took us down, it's actually because I'm panicked about this other thing and so I said this thing. And so I think say more about that, gives you a little more information and a little more time to sort of construct your response.

20:46 KC: What about when things... I mean, especially right now, if things were to turn controversial and in the article, you even advised a little side bar about masks.

20:55 KJ: Yeah.

20:55 CC: Yeah.

20:56 KC: Yeah, that topic.

20:58 CC: Well, I feel like it's important to remember that things are never... They never turn out as badly as you imagine. And I think when we are afraid to say, "No, I actually need you to wear a mask," what we imagine is some crazy scene out of a Coen Brothers movie where the client snaps your neck and kills your cat and runs out of your, and it's like, no, they're just gonna, maybe, be rude and mean. And I mean, maybe, you have to say like, "No, seriously, we can't do the session unless you're gonna wear a mask." And I am sure there is some percentage of people who will cross the rooms and be like, "Nope, I'm getting a massage." I think those people tend to broadcast that that is their way of being so maybe you warn your officemates, your colleagues, whatever, like, "We got a person coming in today, I'm expecting them to be a little resistance to the mask, do you have my back?" But I think that being clear is the thing and that we run into problems when we equivocate. When I make it seem optional or when I make it seem like, well, it'd be great if you'd wear a mask, but probably I'm in a cave, if you just look a little bit disappointed. People who don't wanna do it are just gonna... And they're not being "manipulative."

22:19 CC: This is how humans interact. They read your body language, they hear the way that you deliver this request and they go, "Oh, there's wiggle worm here, I can handle haggle." And you have to make a no-haggle sale and say, "Nope, these are the terms of engagement, take it or leave it."

22:35 KC: What do you do in a session when somebody says something that you don't agree with, when they're on the table, they're just making some small talk.

22:42 CC: It's interesting. One of the things Healwell does is we do a podcast called massage therapy without borders, and I think it was maybe last week, we had Pam Fitch on talking about exactly that and sort of what do you do? And there isn't a, "This is what you do," because there're all kinds of factors that go into like what is your relationship with this client? How offensive was the comment, do you address it during the session, do you wait till after? How do you set your philosophy of your practice so that it's clear from the outset that this is unwelcome. Pam talked about, she knows a practitioner who will put a sign up on their door that sort of says, "This is a insert hot button issue, presently free zone." So this is a Trump free zone, or this is whatever, election free zone. It's on the guy's door so that when clients come in, they just see like, "Okay, this isn't a thing we're gonna talk about. It's funny, it puts it out in the open, it disarms everybody and then you just know that this is something that's sort of not on the table.

23:46 CC: We are all much more attuned, certainly, in the States at this point, to issues of racism and homophobia and class difference, and I think that people feel more emboldened to say things that might be "offensive," but I also feel like I personally know that I feel a stronger imperative to not just let it go out of some idea of professionalism, and how you manage that, I think is definitely a challenge. I think Pam Fitch gave everybody some really good tips in our podcast, and one of them is to use, I feel statements, and to just say, "So I feel uncomfortable talking about this, and it would really be helpful to me if we avoid this topic during the session." It doesn't call the person out in a way that puts them back on their heels, it puts it on you and it makes a suggestion about, "This is how I think we can deal with this at least in the next, however many minutes are left of this session." And then I think it still does leave the question down the road of, do you keep seeing this client depending on the level of offensiveness? Do you actually say to them, so that actually makes my treatment space feel unsafe, and I think if we're gonna continue to work together, we have to either avoid this topic.

25:08 CC: So I think it really depends on, do you own your own practice, what is the policy where you work? I think there are a lot of those sorts of factors that come into it, but I don't think you have to allow hate speech to continue in front of you, out of some commitment to professionalism. I think that you can very, simply and without accusing, address the behavior to stop it during the session.

25:31 KJ: I worked for a couple of years with a person who I feel deeply was given to me by the universe to push every button that could possibly be pushed inside of me during our sessions. And I talked at length with my colleagues and my peer supervision settings about, do I fire this person or not, but it was really great practice. It gave me a lot of chances to grow my courage to the sticking point and say, that hasn't been my experience or to just practice like, "You're making me uncomfortable or this is not appropriate for what we're doing right now." And we had lots and lots of uncomfortable moments, and we had several moments that I assumed would be the end of our therapeutic relationship, but she just kept coming back. So sometimes I think we're not good at practicing those things either, even at home, even with people that we love and feel safe with, we can practice that a little more, and then it's not so jarring when it happens with a stranger.

26:47 KC: So many therapists, I think when something uncomfortable comes up like that in a moment, they either freeze, ignore it or just have an uncomfortable like, laughter response, like just an instinctive, "Ha-ha-ha-ha, let's keep moving on," like, "Oh, let's change over here." And I think it's really important for people to really think about this in advance before it happens. Prepare yourself, get your strength, get your wording. So that in the moment you can react in a way that you're proud of later, and that you feel good about afterwards.

27:21 KJ: As a profession, we need to start making this part of the skill set of massage training earlier and that practicing all of these sorts of uncomfortable conversations, and practicing a strong back and a soft belly in lots of different ways is gonna make better practitioners and it's gonna elevate our entire profession.

27:41 CC: And I think when you continue to see a person who makes you feel that way and you don't address it, the other thing that you're risking is you stop seeing that person, you say, "Oh, this is... " You give them a nickname, "Oh, so and so is coming in today." And it's no longer this human that you are serving, it's this person that you are tolerating and that you're tolerating a sliver of them, because this piece that you don't wanna see of them becomes all you can see, and I think that happens so insidiously that we don't notice it and I feel like that's the other real benefit of sort of nipping it in the bud and just saying, "This is what I need to take care of myself so that I can take better care of you."

28:22 KC: I wanna thank Cal Cates and Kerry Jordan for joining our podcast today. Where can all the listeners find all of your valuable information at?

28:32 KJ: You can visit our regular website at healwell.org, and you can find all of our online course offerings at online.healwell.org.

28:42 KC: Thank you.

28:42 KC: Thank you so much, that was amazing.

28:44 CC: That was a treat.

28:46 Speaker 5: This has been a production of Associated Bodywork and Massage Professionals. ABMP is the leading association for massage therapists and bodywork professionals in the United States and beyond. From liability insurance to Professional Advocacy, award-winning publications to the world's largest continuing education library for massage to this podcast, no organization provides more for its members and the profession than ABMP. ABMP works for you.

29:19 KC: Thank you for listening. If you haven't already done so, please subscribe to The ABMP Podcast on iTunes, Google Play, or wherever you find your favorite podcasts.