resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
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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