Massage Peer Supervision

Peer Supervision defined by Webster is to oversee, direct or manage. The term supervision makes me think of a supervisor in a business setting who just sits back and tells me what to do.
The type of supervision I am talking about comes from other medical professions such as psychology, social work and nursing. The goal of supervision is to increase awareness and on-going self awareness of the therapist. Supervision is all about the therapist and whatever they need to become what they want to be!   The more support we can get as therapists, the more support we can give to clients.

Supervision could make your work life more satisfying by helping you understand stumbling blocks that get in your way and by giving you support where you need it, for instance, with setting limits, trusting your intuition or appreciating your assets. Good Supervision can give you confidence and free you up to do your best work ~ Nina McIntosh, Educated Heart

Supervisors are usually senior massage therapists who specialize in working with issues related to the therapeutic relationship that occurs in our practices. This is done through listening to how the therapist feels about whatever is going on in their practice.  It does not mean that the supervisor is going to tell you what to do!  The goal of supervision is to have the supervisor mirror what is going on in the therapist with the intent of having the therapist learn for themselves what it is they need to do in their practice. This is done through the process of active listening. During the process, the therapist may ask for the supervisors opinion knowing that is just that – their opinion.
Individual supervision is a one-on-one relationship where the therapist hires a supervisor. A commitment to meeting regularly is needed to build the relationship and work to find the core issues that the therapist is struggling with. Some common issues to work on are boundaries, transference and counter-transference, projections and specific details of practice. Working on an individual basis, the therapist gets the exclusive attention of the supervisor.

 

Some definitions of supervision:

‘A formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations. It is central to the process of learning and to the scope of the expansion of practice and should be seen as a means of encouraging self-assessment and analytical and reflective skills’ (Vision for the future 1993). ]
Butterworth & Faugier (1992) said supervision refers to a range of strategies, including: ‘preceptorship, mentorship, supervision of qualified practice, peer review and the maintenance of identified professional standards’ and was: ‘both a personal and professional experience’.
Swain (1995) differentiates supervision in contrast to more well-known procedures: ‘(supervision is)…not psychotherapy or counseling…nor is it directive management, individual performance review or staff appraisal. It is not a form of disciplinary procedure…it is not any of those things which some nurses seem to fear it might be or could be used for’.

When to use Supervision

  • Dealing with challenging clients such as those that are controlling, demanding or difficult to deal with.
  • Feeling like you are drained after working with clients.
  • Feeling sexually attracted to clients
  • Feeling bored or uninterested in your work.  Falling asleep yourself while giving massage.
  • Feeling resentful of clients or your job or your massage practice.

 

Understanding Projections for Massage Therapists

My concept of the $100,000 massage practice and the ‘wealthy massage therapist’ continues to bring mixed reactions. A few have emailed me privately saying I am full of crap but they don’t bother to say why or what their feelings are on the topic.

I have learned that when you are reacting to something so strongly and especially being moved to downright rude comments that it seems to have triggered something deeply with in you and it is not usually directly related to the current situation but something from deep in your past.

Projections are basically unowned parts of ourselves that show up in our live in all relationships and aspects of our lives. They are such an important part of our work and the therapeutic relationship which is the basis of building a massage practice and being successful as a massage therapist. Projection in the massage therapy profession is called transference and counter-transference. It is important to learn to start understanding projections where ever they may occur in your life if you are serious about building a massage practice. Projections are a really deep and intense part of our consciousness and it requires a real intention to help discover and work through projections. Projections are unconscious which make them so difficult to see and understand.

Elliot Greene in his book “The Psychology of the Body” defines projection as:

an attribute, impulse, feeling or perception that actually belongs to an individual’s personality, but is not experiences as such by the individual. Instead, it is attributed to objects or persons in the environment, that is, not oneself, and is then experienced as directed toward the individual by those objects or persons.”

Huh?
A.H. Alaamas, in his book “Diamond Heart: Book One. The Elements of the Real in Mans says this about projection:

Projection is one of the main defenses we use to avoid seeing the truth that lies inside us…. It is one of the first defensive mechanisms developed in infantile life…. When you are projecting you are actually acting at the pre-verbal, pre-conscious level.

Defenses are what are needed when you don’t have boundaries. Boundaries are anything that helps to differentiate you from someone else. They tell you where you begin and end. When you start to get mad at or blame others or react rather than respond somewhere your sense of self has been challenged. Your reactions are usually coming from that false self that was created in early childhood to protect yourself. The process of differentiation- of learning to be your true self – is achieved when you can learn to process these feelings from what you think and learning to hold on to those feelings and not react.

While I don’t expect everyone to agree with me, when you can say hmm… that sounds interesting but I think she is wrong and this is why and not get angry – you are feeling informed about something and not reacting – it usually isn’t a projection. If you are reacting and reacting intensely it is most likely a projection – meaning it is really a reaction about something else. This is especially the case when you feel like retreating and not even talking about it but when you prefer to just ‘leave’ or write rude comments or emails.

Studying and learning about yourself and your projections is a really big part of being a massage professional.  It helps keep you focused on the client and the therapeutic relationship.  Peer Supervision and Supervision can be helpful in this learning process.

The Drama Triangle – The rescuer massage therapist

The therapeutic relationship is a very complex relationship that requires that we become more aware of the dynamics of relating to each other. One of the ways is by studying and learning about the Drama Triangle.

It is really the underlying dynamic in most relationships but because of the power differential that occurs in the therapeutic relationship, the drama triangle can be more evident in a client/massage therapist relationship. There are three positions of the drama triangle -the rescuer, the victim and the persecutor. There is usually a combination of them at work in a therapeutic relationship or any relationship for that matter. One position leads to the next. The rescuer can become the persecutor or victim and any combination of roles.

As massage therapists we are often taught to ‘fix’ a clients pain and injuries. Many massage therapists come to the profession wanting to ‘help’ others. Clients come to us looking to be fixed and taken care of. One of the roles on the drams triangle is the rescuer. We think we need to get the client out of pain.

People who are in pain or sick or injured quickly take on the role of the victim -wanting someone to fix the condition for them. This is the basis for modern medicine. Needing to be fixed they will find a rescuer to help them. As massage therapists we often take on the role of rescuer but we can also move into any of the other roles with clients and also within ourselves. Becoming aware of how we rescue (help, fix) is not an easy process. It doesn’t just stop overnight. When the process occurs internally taking on various roles at different times, it is usually can lead to feeling stuck in building a practice or finding a massage job. We blame the economy or bad spa owners for our lack of success.

Rescuers need to rescue to feel good about themselves. They need victims to be successful. A rescuer thinks everyone needs their help even those who are not directly asking for it. Rescuers don’t know how to take care of themselves so they focus on others. Rescuers usually have deep unconscious beliefs about themselves that they are not good enough so they rescue to feel good about themselves. Rescuers see others pain so clearly because they are filled with pain of their own. It easier to help others with their pain instead of addressing their own pain. Rescuers are not usually aware of their own pain or even think that they have any issues to work through. They are so busy helping they can’t see their own pain. They say things like “I just want to fix this psoas” or “if only I knew more anatomy, I could fix this”. It is a very unconscious process meaning that most are not even aware of the dynamics and their own part in each interaction. Rescuing others tells the other person that they are not good enough or smart enough to help themselves. Rescuers often end up undermining others and reinforcing the victim stance. It is hurting more than helping. Rachel Remen MD explains this beautifully in her article “In the Service of Life”.

The early child/parent relationship sets us up for the drama triangle with parents often taking on the role of rescuer. The child isn’t old enough, smart enough and needs to be protected from the world. When are early childhood needs aren’t met ( which they rarely are ever totally met even with the best of parenting) we often are left waiting to be rescued. We fear asking for help because we may be further abandoned and hurt. We begin helping others so that they will become dependent on us and not leave us.

The thing is that every person has within themselves the power to find the answers to their health problems, business building problems or whatever they are faced with. You and you alone are your best source of advice if you can only begin to access your true self and listen to yourself. As a massage therapist our role is to be present for others as they uncover their own answers and true self. The thing is that you have to know your own self first before you can do this with a client.

People don’t even become aware of their rescuing habits until it becomes too painful to bear anymore. This is usually when a career in massage comes to an end but it doesn’t have to end if one can find the courage to begin to get off of the triangle.

The way off of the triangle is to start learning to feel the pain of abandonment and/or the pain of not getting one’s early needs met. It means learning to take care of yourself in every aspect of your life from being financially sound, healthy, eating the right things, exercising and taking car of your internal needs for acceptance, love, appreciation and recognition. It is about becoming more aware of what you are feeling when a client arrives at your door wanting to be fixed. Staying present with the feeling means that you can have the feeling and not act on it but use it to become aware of what you are thinking or what belief you have about yourself that is creating this need to rescue.

 

Peer Supervision/ Peer Support Groups

Peer Supervision defined by Webster is to oversee, direct or manage.  The term supervision makes me think of a supervisor in a business setting who just sits back and tells me what to do.

The type of supervision I am talking about comes from other medical professions such as  psychology, social work and nursing.  The goal of supervision is to increase awareness and on-going self awareness of the therapist.  Supervision is all about the therapist and whatever they need to become what they want to be!   The more support we can get as therapists, the more support we can give to clients.

Supervisors are usually senior massage therapists  who specialize in working with issues related to the therapeutic relationship that occurs in our practices.  This is done through listening to how the therapist feels about whatever is going on in their practice.  It does not mean that the supervisor is going to tell you what to do!!  The goal of supervision is to have the supervisor mirror what is going on in the therapist with the intent of having the therapist learn for themselves what it is they need to do in their practice.  This is done through the process of active listening.   During the process, the therapist may ask for the supervisors opinion knowing that is just that -their opinion.  

Individual supervision is a one-on-one relationship where the therapist hires a supervisor.  A commitment to meeting regularly is needed to build the relationship and work to find the core issues that the therapist is struggling with.  Some common issues to work on are boundaries, transference and counter-transference, projections and specific details of practice. Working on an individual basis, the therapist gets the exclusive attention of the supervisor.

Peer supervision (peer group) is a group of peers meeting to share their experiences.  This again is not to “fix” the problem, but to share the underlying feelings that arise in practice.  Active listening is practiced.  The group may also be used for networking and talking about business building ideas, but time on this should be limited.  Often groups will invite a supervisor in at times to provide direction, clarity and support.  Groups can be all massage therapists or include other disciplines.
Working in a group will give you the feedback of others.  Sometimes you may not have time to talk about your process if someone has a difficult issue.  We learn about ourselves from the processes of others.  Group dynamics may be difficult to manage and balance. 

Group supervision is a group of peers meeting with a supervisor to discuss their feelings about the therapeutic relationship.  

Supervision is the next step in building the massage profession.  I wish we had a better word to describe what it is and what it does.  Massage therapists are such individualists that the term may scare some off, thinking that the supervisor is going to tell them what to do! Massage therapists are also often isolated in their practices that it becomes difficult for them to view what is happening in their practice.

Some definitions of supervision:

‘A formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations. It is central to the process of learning and to the scope of the expansion of practice and should be seen as a means of encouraging self-assessment and analytical and reflective skills’ (Vision for the future 1993). ]

Butterworth & Faugier (1992) said supervision refers to a range of strategies, including: ‘preceptorship, mentorship, supervision of qualified practice, peer review and the maintenance of identified professional standards’ and was: ‘both a personal and professional experience’.

Swain (1995) differentiates supervision in contrast to more well-known procedures: ‘(supervision is)…not psychotherapy or counseling…nor is it directive management, individual performance review or staff appraisal. It is not a form of disciplinary procedure…it is not any of those things which some nurses seem to fear it might be or could be used for’.

The Need for Peer Supervision

When I first read an advertisement for a class on Supervision, I immediately thought that I didn’t need anyone telling me how to do a massage. 

I had been doing it for 15 years. My practice was flourishing, but I felt like I was working too hard.  I was finally making the money that I needed, but I thought that I just wouldn’t be able to keep it up for 20 more years.  After reading an article by Jack Blackburn,(see articles section specifically the series called Caretaking) a local Seattle Trager practitioner, I started understanding that there was a need for supervision in the massage community.

You may want to consider finding a supervisor if you experience some or any of these things:

  • Are you making the money that you need to pay the bills, save, pay your taxes and go on a nice vacation?  If you are making that amount, are you working too hard to get it?

  • Are you friends with some of your clients? Do you feel like you would miss them when they move on or you do? Do you see them socially or do they call you at home?  I often feel that our profession is different since we touch people and see them regularly.  What is wrong with being friends or caring about what happens to them?  How does being friends affect your treatments or how does the client feel?  It does effect client relationships in some way.

  • Do you feel obligated to come in on your day off for clients who are injured or call at the last minute?

  • Do you often work more than the scheduled time to try and get the client feeling better?  Do you expect a tip or other compensation? How does it make them feel?  It may make them feel uncomfortable because they now never know how long a session really is and they may feel confused as to how much to pay you.

  • Do you feel frustrated when you can’t “fix” a client?  Is your main treatment goal to “fix” a client?

  • If you don’t think you need a supervisor, you may be fooling yourself.

  • You can only take a client as far as you are willing to go yourself.  this means in every way- physically, mentally, emotionally, spiritually not just physically as many massage therapists may assume.  Do you do all the things you tell your clients to do? Stretch? Drink enough water? Exercise? Eat healthy food?

If you answered yes to any of these but don’t really think that it is a problem, you may be surprised when you start looking into these issues.  Most of these issues are a result of projection and the transference/countertransference process that occurs in any kind of relationship.  There is really no right or wrong answer for the above situations or any relationship issue.  What really matters is are your values consistent with your actions and how do you feel about what is happening.

This can be addressed when working with a competent, caring supervisor. 

 

Peer Group Structure

The Structure of you group is determined by you but there are some basic guidelines that you can use:

  1. Invite therapists in your neighborhood to join your peer group. It is recommended that the size of the group be 8 or less.

  2. Determine the structure of leadership. Will one person always lead or will the leader rotate?  The leader will have the role of allowing the person to speak without being judged or criticized.  The main purpose of discussion is to allow for how someone feels about whatever happened or whatever issue is being talked about.  (more on this later)

  3. Determine the level of commitment.  How often will you meet? 1x a month, 2x a month? How long will you meet for each time?  How long will you meet for – 6 months, 1 year or something in between.  You can also pick a time frame to re-evaluate the time frame

  4. Is there a place where you can meet regularly or does the meeting place have to rotate?

  5. What will you do if you are unable to solve a problem or issue? Is there someone else you can consult with? Hiring a peer supervisor to facilitate the sessions can be beneficial in helping the group to understand their “helping instincts” and help bring new insights.

  6. Have participants fill out a practice profile questionnaire to share with the group to help get to know each other.