resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
July, 2011, Vol. 11, Issue 07
The Inside-Out Paradigm: The Intake Interview
By Dale G. Alexander, LMT, MA, PhD
"The appointment begins when the client makes the call."1 This phrase, spoken by Dr. Richard MacDonald, DO, 25 years ago, was a turning point in my comprehension of just how important the initial interview with a client is both over the phone and in the office.It is the beginning of a healing contract that might last for a few appointments or for many years. This article will detail the basics of what has served me to assist my clients.
Over the 31 years of my clinical massage therapy practice specializing in chronic ailments, the problems that clients present are increasingly complex, layered and continue to inspire me to explore the "many dimensions of healing." To date, I still do all of my telephone interviews with prospective clients.
Initially, I seek to gather information about how committed they are to their healing, whether we are beginning with a third person trust based on a personal or professional referral or not. In addition, whether they have ever felt injured or misunderstood by other health related practitioners.
The emotionality conveyed by the tone of their voice generally is my best guide. When their voice tone is loud, demanding or commanding, I often ask whether they are scared, hearing impaired, or have been mistreated by other health related practitioners. I give them a chance to start over. I endeavor to keep this initial call to 10 -20 minutes. I give myself permission to encourage that they see a physician before seeing me, if they haven't already. I often refer prospective clients to other alternative health practitioners.
People committed to their healing consistently inquire first about your confidence to assist them and will add additional special circumstances and needs second, once they have established whether or not they sense you have the competence and experience to help them.
When prospective clients place their initial emphasis on money or time convenience for them, this is a flag to me that they are wanting professional care, but only if it meets their conditions. When someone calls to make an appointment for someone else, another flag goes up. Yes, there truly are people that busy, including me at times, but it stills says something about how they run their life including how they drive themselves. I typically book the appointment with the caveat that the named client will call me before the appointment so I may personally interview them.
When a client is looking for a named style of massage or bodywork, I ask them to describe their ongoing difficulties. The nature of what I do along the continuum of bodywork skills has become rather broad such that it no longer fits a specific label. When they ask me whether I have ever worked with their polysyllabic medical difficulty, I am specifically honest as to whether I have or not. And, if not, I request that they educate me. This might seem paradoxical yet it demonstrates from the beginning that I am willing to learn from them. I want to create healing partnerships where they are the star character of their own movie. I'm the hired help.
The Key To The Interview
The key intention of the initial "office interview" is for me to engage the person fully as a human being as well as a practitioner. I endeavor to gather a gestalt of how they see their problem and to assist their perception to include the internal functioning of their bodies and the potential influence of their mental habits and emotional fluctuations. This means I rarely listen to long stories anymore and correspondingly infer that I do not endeavor to convince them of anything. They have the choice to move forward, as do I.
When presented with a vague description of what is bothering them such as, "I have so little energy" or a more psychological inference such as anxiety or depression, I ask them an existential question, "what do you sense is your life purpose?" The turbulence related to identity consolidation in the midst of exquisite life transitions has an enormous influence on our human physiology. Examples of such transitions include the death of a loved one, a job loss, a relational break-up or a financial crisis, among many others.
When presented with a series of physical complaints, I often ask a layered question first. What have you been told about your problems, what do you believe is the root cause, and do you feel as though your mortality is threatened by it? This latter phrase is crucial to include because it flushes out people who really are scared that something has been missed in their medical care and that they might indeed be in serious trouble.
I ask questions to fit the person as I experience them. That is why I don't use standard written questionnaires. However, there is a philosophy and a method to how I ask questions. At the physical level, I seek to discover the earliest sign or symptom that has the longest history as this has assisted me most often to unravel what is happening within their physiology, accreted trauma or might be an indicator of a genetic link or deficit/defect. At the cognitive level, my job is to assist them to connect the dots between the events of their lives and to unhook from the ones that are acting as a drag on their healing. Assisting clients to find their way toward acceptance and/or forgiveness is still a higher octave of our work. We are all challenged to reconcile the difficult transitions of our lives. And, by assisting clients to connect the dots within their lives empowers their capacity to prevent future difficulties.
The following 10 questions and their time line will often trigger a light bulb for them, as well as myself:
Just yesterday, a prospective client with an identified aortic valve regurgitation responded to the flu question by saying that when he does have the flu it was most often of a respiratory variety and that it would last a week to ten days. He had not made the connection between his valvular regurgitation and how this might have extended his illnesses in the past. Such subtle yet revealing information allowed me to orient my skills to relieve the pressure within his chest to allow his heart more ease to do its crucial job.
Interspersed with, or following these questions, I go through the history of their organ systems quickly to ascertain any dysfunction or repetition of illnesses in their lives. I also will ask the same question in a different way if I instinctively am drawn to it. With a recent client who came to me with a rare form of cancer, we had identified that notwithstanding the official diagnosis, she had the beginnings of diabetes that once confirmed by her internist, has begun to radically change her life for the better. Improving a client's quality of life is perhaps our profession's highest service.
Another key to an effective interview is to personalize it. Be more vulnerable than your client.3 Invite a healing contract and define what this means to you while altering your language to include their sense of such a contract. Accept that they will not be able to give you a complete physical history because much of it has been compartmentalized or repressed. During your first appointment, the real opportunity is for both you and your client to decide whether you wish to move forward working together.
People have a tendency to get sick or to injure themselves as a way for their physiology to discharge its excess tension and thereby to rebalance itself. When a client reports a pristine medical history without either, I become quite curious. Typically, there is something they have forgotten or repressed which eventually comes to light over a series of sessions. And occasionally, what emerges is that they have had severe allergic reactions to one thing or another. Again, this is when I refer clients back to their physicians.
Part of our role as massage therapists is to be part of our clients' early detection team. The mathematical normal curve does allow for exceptional individuals to experience amazing health yet, as we age, the probabilities increasingly point to cardiopulmonary, cancer or orthopedic difficulties. In having followed my local newspaper for 15 years, the age of death so often occurs between 50 and 65, which is within the 40 - 70 demographic of those people who most often seek our care. We have a responsibility to assist them to discern those personal events which often signal something is amiss from the "inside-out."
Chronic ailments often have an accreted history involving multiple minor and major traumas underlying a recent physical event or might be the "canary in the coal mine" of the organ systems endeavoring to signal that something deep inside is in need of attention and care. Those chronic problems that seem to have no related physical event associated to their onset are the ones we need to be especially encouraging to our clients to seek consultation with their physicians.
The purpose of this column currently continues to be oriented toward assisting you to understand the "Waves of Aging," their most common origins, and their progressions that fly under the radar of typical medical detection, especially when clients present with chronic somatic ailments.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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