Features Patient Care Practice
Staying ahead of the storm

Every year, hundreds of graduate students enter the massage therapy
profession across Canada, with high hopes of a satisfying career. Most
aspire to bring excellent care to their clients, and some may have
ideals of attaining further qualifications, or owning their own
business someday. Yet our statistics show that a great many therapists
drop out of the profession in their first five years.

Rumours persist that “everyone burns out in five years.” Obviously this is not true, as many therapists continue treating for decades. To give a personal example, I am almost 70 years of age, in my 26th year of practice, still regularly do an average of 15 hours of massage each week, and have never missed a day’s work due to massage-related injury.

There are many possible reasons for the high dropout rate of RMTs from their jobs, and it is not possible, in this article, to explore all of them. But I would like to explore this concept of “burnout”: to define what people mean by this term and discuss possible causes and prevention.

PHYSICAL BURNOUT

When some people use the term “burnout,” they mean the inability to continue practising due to physical injury or pain. To use more precise terminology, they are referring to repetitive strain injury (RSI), or overuse syndrome.

Many therapists are able to enjoy a very lengthy career (some, more than 20 or 30 years) without injury, so we must consider why others experience physical difficulty.

One factor is that some therapists have poor body mechanics: they stand, move and massage in positions that predispose them to repetitive strain injury. They may not have been taught proper body mechanics in school; they may have been taught but did not practise properly, or they may have forgotten the good body techniques they were taught. Some people go into the profession in a state of poor physical conditioning and are not fit enough to take on this physically challenging work.

Another aspect of the problem is that some new graduates go from doing a very small number of massages per week at school into a busy practice that puts demands on their bodies to which they are not accustomed. New therapists are often pleased if they secure a position where the clients are booked for them, and they may find themselves performing six or more hour-long treatments with only a short break for lunch. While this may be financially desirable, the sudden, increased demands on their bodies may cause development of repetitive strain injury. Massage therapists are typically prone to tendinitis of the muscles of the shoulders and wrists; pain in the muscles that attach to the scapula; and low back pain. New therapists might be better off to build a practice gradually so that strength and endurance can be built to meet the demands on the body. 

Case study
An investment counsellor has a client who is a massage therapist and has been in practice for a year. The therapist has been working extremely hard, treating a high number of clients per week.
She tells the investment counsellor that she had to treat as many clients as possible and save her money, since the professional life span of a massage therapist is only five years. Obviously this therapist’s behaviour is self-defeating and her prophesy of a time-limited practice is likely to come true.

Prevention
To prevent physical overuse syndrome, a therapist would be wise to keep in good physical condition, incorporating activities such as yoga, tai chi, dance or martial arts, as these disciplines focus on body stance and positioning. It would be advisable to have a consultation with an experienced RMT teacher who could evaluate body mechanics and give suggestions for remediation if necessary. It is a good idea to build a practice gradually and to schedule clients so that there are regular rest periods. An informal internet survey indicated that a majority of massage therapists found a 30-minute break between appointments helped them to avoid fatigue in their working day.
It is vital that therapists schedule time to rest, exercise, and receive a massage, and that they learn to say “no” to clients when they are overbooked.

MENTAL BURNOUT
Many therapists aspire to owning their own practice. This is an excellent goal for some, but others may find the business aspect very stressful. The owner of an independent clinic may have to deal with landlords, leases, buying equipment, paying for utilities and maintenance of the office, and perhaps supervising other therapists. Also, it takes a while to build a profitable practice and there may be financial strain. Therapists working as employees or contractors in an environment where they do not feel valued or respected may also experience mental burnout.
 
Prevention
Opening an independent practice may be feasible for someone who already has business experience. Otherwise, a new therapist might be wise to work as an employee or a private contractor, to gain experience before attempting to open an independent practice. Taking a small business course may be advisable for new therapists who wish to become independent business operators, as there are many financial issues to consider.

While this may be an attainable goal for some, there are other therapists who love the work, but will never be comfortable in the role of a business owner. Even therapists who do not have the goal of being an independent business owner would be wise to look to the future by taking some business courses. This education will help them negotiate contracts that are in their best interests and reflect their growing experience, and therefore “worth,” as an experienced RMT working for others.

Therapists can also experience boredom if they keep doing the same type of treatment year after year. We are required to obtain continuing education credits, and sometimes studying a new modality and adding it to the practice can provide the variety we need to keep the work fresh and interesting.

EMOTIONAL BURNOUT
When a therapist tells me that their work is stressful because they take on all their clients’ troubles, I consider that a warning sign for emotional burnout.  

Some clients like to rest quietly during a massage, while others like to talk, sometimes pouring out their problems. Massage therapy students are sometimes told that they should discourage the clients from talking, and tell them to “breathe” rather than talk.  However, the reality is that as tight muscles relax, the problems that caused the tension often come pouring out. For some clients, this is part of the therapeutic process. In our role as massage therapists, we are not qualified to counsel, but we certainly can allow clients the opportunity to talk and we can listen empathetically.

The important thing to remember is that listening does not require us to emotionally take on the clients’ problems. We can give advice about relaxation techniques and give referrals to appropriate counselling services. In such situations, it is good to recall a saying that was common in ‘pop’ psychology: “Remember who owns the problem.” The client owns the problem: it is the client’s life and he or she must deal with their stressful work, their difficult colleagues, their dysfunctional family, their ailing relatives, or whatever the problem may be. We cannot do it for them.
By taking on the client’s problems, we make ourselves less effective in helping the next client and in dealing with our own lives.

It is important to practise “letting go” of both the emotional worry and the energy that accompanies those negative feelings. While clients are in the treatment room, we focus all of our energy on them, but after the clients leave, they take their problems with them and the therapist must let go of both.

Prevention
It is normal to feel emotionally drained after working with a client who is very ill, or who confides upsetting personal problems. We may take on this negativity in a conscious or subconscious way.
In a conscious way, we must remind ourselves of our Scope of Practice and not take on the client’s problems in an inappropriate manner. For example, this would include counselling outside of our Scope of Practice, giving medical or financial advice, going to the client’s home, inviting the client to our home, lending the client money or treating the client free of charge.

A transfer of energy takes place during a massage. Although the therapist may be performing a clinical treatment rather than an “energy” treatment (such as Reiki), there is still a transfer of energy. 

Awareness of this process can ensure that only healing energy is imparted to the client, and that the therapist absorbs no undesired energy. If you feel very tired or drained after treating certain clients, this is a sign that you need help in protecting your energy.  There are basic exercises that can be practised to reach this goal and a consultation with an experienced therapist may be helpful.

It is also important to schedule regular time off and vacations in order to get away from the practice both physically and emotionally. Therapists who practise at home would be well advised to vacation away from home so that they get a total break from their practice and their clients.
 
CONCLUSION
Massage therapists are in a caring profession where we spend our energy to help others feel well. It is important that we also care for ourselves so that we can enjoy a long and satisfying career.

Lee Kalpin has been a registered massage therapist and clinic owner since 1984.  She has also written and taught courses for massage therapy programs for many years, and strives to remain current in the science and ethics of massage therapy.  Many past students continue to contact her for guidance and mentorship.