Essential skills in working with veterans: In this episode, Whitney talks with Nicole Miller about her extensive work with the veterans population. We cover important topics such as

  • How is massage therapy being supported by the VA
  • What are important skills a massage therapist would need to work with veterans
  • Where can you get further training to work with this population
  • Essential precautions to be aware of in your work with veterans
  • ...much more

Get the full transcript!


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(The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

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        Til Luchau                          Whitney Lowe

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Til Luchau Advanced-Trainings Til Luchau

whitney lowe Whitney Lowe

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Full Transcript (click me!)

The Thinking Practitioner Podcast:
Episode 84: Working with Veterans (with Nicole Miller)

Whitney Lowe:

Welcome to The Thinking Practitioner.

Welcome to The Thinking Practitioner Podcast, and we are supported by ABMP, the Associated Body Work & Massage Professionals. ABMP membership gives professional practitioners like you a package including individual liability insurance, free continuing education, quick reference apps, online scheduling and payments with PocketSuite, and much more. ABMP's CE courses, podcast, and Massage & Body Work Magazine always feature expert voices and new perspectives in the profession, like from both of us, Til and myself, Whitney. Thinking Practitioner listeners can save on their membership by joining ABMP at abmp.com/thinking.

Til is off again this week. But I'm delighted to have my friend Nicole Miller with me here today. So I'd like to welcome you, Nicole, to The Thinking Practitioner Podcast. Great to have you here.

Nicole Miller:

Thank you very much for having me, I appreciate it.

Whitney Lowe:

Good. Nicole, for our listeners, can you tell them a little bit about your background? You've been doing extensive work with the veteran population for many years, and that's I believe how you and I first got connected through a number of different things. But tell our listeners a little bit about what you're doing currently, and also a little bit about the background and how you got into this.

Nicole Miller:

Thank you. Well, I've been a clinical massage therapist now really since I started right out of school in 2004. And immediately, I started to work at Crouse Health, which is a hospital here in Syracuse. And a few years later, we were aware that massage therapists needed more continuing education. So I started not only working with the patients there in community engagement but also started a continuing-education program there too. And over the years, both of those segments kind of have morphed. And to keep the long story short, in 2013 we launched the Veterans Massage Education program. And we did that because my boss at Crouse at the time asked me to visit Clear Path for Veterans, which is a local VSO. For those who don't know, a VSO stands for Veterans Service Organization, and they're usually distinct or separate from the VA, but here in Syracuse, Clear Path is just an amazing program that really helps support veterans outside of the VA in all aspects of life.

So I ventured to meet with the staff there, and what I had learned was they really wanted a massage program, one that was more sustainable. Often, they found that massage therapists would join their efforts and start to offer volunteer massage, but would quickly fall off the radar because they weren't prepared for the experience of working with veterans, and they felt intimidated and overwhelmed. To put this in perspective, Clear Path's flagship program is its Dogs to Veterans program. So they assign service dogs to veterans with typically severe PTSD. So that's the typical veteran who goes across or through the threshold at Clear Path. And then these massage therapists were coming on board to volunteer, and lo and behold, they just really weren't ready for that level of work.

So we worked all together. We crafted a program where we developed a CE program that would allow us to have a clinic actually on site there at Clear Path. So for five years, we ran a pro bono clinic at Clear Path. And this was all occurring simultaneously at the same time that the VA was developing their Whole Health program. So this is an amazing national program under the leadership of Dr. Tracy Gaudet, originally from Duke University. She became the leader for patient transformation at the VA, and championed this program called Whole Health, where we really look at the whole person. And initially... I'm hoping by sharing all this information I can help frame people's perspectives of what happened at the VA. But initially, they developed the program and they identified two types of Vas. And the first one was the flagship VA. I think there was 13 flagship sites in the nation. And their job was to launch the components of Whole Health. Of interest to us was massage therapy, chiropractic care, and acupuncture care.

So the flagship's job was to assign veterans to those programs to see how they do. And as we learned by the VA rapport in 2019, it worked great. The Whole Health model was in fact a veteran model for the veteran patient and established less pain, less stress, opioid reduction, and chemical reduction. So all of these things were established with that model, and that was exciting news for everybody across the board and especially for our field, massage therapy.

Then, they also developed another program where they used a select number of design sites, and I think there's 12 in the nation. And the design sites, their job was to measure the efficacy between the various modalities. So think back to flagship sites. One patient can go in and all of a sudden be assigned chiropractic care, acupuncture and massage all at once. And we established that the Whole Health program worked. Now the question was which of the modalities work well for certain circumstances? And that's the point of the flagship program was to determine which were best for PTSD or for pain management.

So Syracuse, where I'm from, their VA was selected as a flagship site, or excuse me, a design site. So when we look at the Syracuse VA, where I'm from, Syracuse VA was selected as one of the 12 design sites, which was really exciting for us, and their job was to launch phases of the Whole Health program. So they started off with chiropractor care and then acupuncture care, and the third leg in that process was massage therapy. So when we were developing our program, we included the Syracuse VA to participate. They actually came in and helped to co-instruct with some of our classes. They came to Clear Path and helped to participate in the pro bono clinic. And both programs grew simultaneously and were able to collaborate and help each other, which was really exciting.

I think it was 2017, they launched the massage therapy component. And their community care program, which dispatches patients to community care providers for services, were kind of at a loss. How do I dispatch 200 veterans to massage therapists in Syracuse? So when we were aware that they had that challenge, we gave them a list of all of our prior students and they did an initial launch of 200 and then an initial launch of 400. So they kept launching batches of veterans to massage therapists in our community, and that was an exciting time for all of us. And then Syracuse kind of got the attention of nationals to wonder, "How did you manage this Syracuse? You've launched more therapists than others." And it simply was because there was a group of massage therapists ready, willing and able to work with the veteran patients.

So since then, I think now Syracuse might be up to 9,000 veterans that have been established or launched to massage therapy in the community, which again, is really exciting. Our statistics are really high compared to other VISNs. A VISN is a geographical area within the VA system. So we're VISN 2 I think, but we had one of the highest launches. So we suspended our clinic program in 2018 only because, gladfully, the VA had now thousands of veterans that they were supporting and could support. So it just made more sense for us to work with them. We didn't necessarily need the pro bono clinic anymore. And then since then, we've continued to work with the VA. For instance, when I travel for veterans massage education, I'll often include local VA staff to come in and help teach some of the components of the program there.

In 2019, I was asked by the VA to help them start their med center program. So community care is the program which runs or manages care within the community, which services that the VA doesn't include. For instance, obviously the VA does not deliver babies. They're not an obstetric organization, so they'll always look towards providers in the community. Massage therapists, up until 2019, were all done through community care in our area. And then in 2019, they established the med center program. So they had asked me if I would help join their effort. And excitingly, I became their first massage therapist in the program and had spent the better part of two years just helping that program get up and going. And since then, I've taken a step back because to do that kind of work, it takes hyperfocus. You really don't have time to educate when you're doing that level of clinical care. So we're off to a good start and they've got, I think now 14 therapists working there within Syracuse and their satellite sites.

Whitney Lowe:

Wow, that is astonishing and incredible, and I just have to say congratulations. And I've said this to you before, I just think what you've accomplished there has been just so astounding and so inspirational for people. It's a wonderful model across the board for folks. I want to backtrack to a couple things that you had said earlier. When you were talking about how the program was initially getting started and there were massage therapists getting involved, and you said they weren't really ready for that level of work. Can you talk a little bit about what is it that they encountered that they weren't really ready for? I'm assuming this is not something about stuff covered in their entry-level education, but maybe something unique to veterans. What was the biggest challenges there?

Nicole Miller:

Yeah, I think the biggest thing is when you look at the biocycle social model of care, a lot of education programs prepare massage therapists fairly well for the biological aspect of care, especially with programs such as yourself, which really takes it to that next level. Helping massage therapists develop knowledge, skills and abilities in terms of orthopedic and other similar allied types of care. I think it was the emotional and the social aspect that they really were challenged with. You have to be prepared when you work with this population. I'm very upfront with the fact that we will, especially if you work in a clinical setting, you will encounter crisis management. So I think in my line of work, I'd have to go back and really think about it, but at this point, I intercepted four suicide ideations or people who had active plans for suicide. And it seems strange to say that when you're a massage therapist, but as we know with massage therapy, we really have an intimate relationship with our patients and our clients, and they will share more with us sometimes than they will with their own family or with their own primary care physician. So when you work with this population, you really need to be prepared.

If you're going to accept community care referrals from the VA, most likely they're going to be dealing with PTSD, musculoskeletal pain, and then some will be dealing with obesity and cardiovascular conditions. Those are the top primary reasons for referrals. And so almost all of those will have some element of PTSD involved. And so as a practitioner, you have to be prepared for those episodes. Some of our students in our program talked about how some of the veterans would trigger, have a triggering episode during session and actually hunker down underneath the massage table or evacuate the massage room. So that's the one area that I really want to caution people about, that you need to develop your knowledge, skills and abilities because literally you could save a life.

One of the classic examples that I give is in 2019, I was teaching a Warrior Hands program, which is a really amazing program. It takes place at Clear Path. And we all volunteer and we provide a full immersion training program. And most of the massage therapists in that program are also veterans, so it's highly intensive. But while we were teaching this program on day two at 9:00 AM in the morning, I look over and the student next to me is clearly startled. And I asked her, "Is everything okay?" And her hands are shaking as she's trying to hold her phone. And I look at the phone and I immediately realized it's a suicide text, so we went right into protocol.

One of my students, Sharon Wong, who's been trained by the program, did an immediate assist with the folks at Clear Path. We were able to get the authorities dispatched to the person, and luckily, we had heard within an hour that the person was safe. They were able to make a positive interception in time. And what we kind of surmised later was that this student had articulated she was going to this program and kind of identifying it, and this friend of hers saw it as one last chance to reach out. But this is just an example here. I'm teaching continuing education, and we go right into this protocol. I never would've expected any of this in 2004, but now I'm here. And I hope to be able to use my hindsight to help give foresight to therapists, to give them a heads up, so that they're not caught in these situations and not prepared.

Whitney Lowe:

Yeah, this sounds so critically important for appropriate care. And of course, the question that I think lots of people are going to me asking now is, where do you go to get this training? Because this is not just the kind of thing where you read a book or study some content or something like that. This is a lot of experiential psychological awareness stuff that's not... I mean, I know personally that's not easily taught. I had a background in counseling and I know a lot of this stuff doesn't come easy, so how do people learn this?

Nicole Miller:

Yeah, the first thing I would suggest is to contact or look up your state chapters for NAMI, N-A-M-I, which is basically mental health alliance. There's an international organization, and each state has its own chapter. And they will often offer trainings in various cities throughout the US on how to be that caregiver for someone who has mental health crises. So for instance, in our area, Syracuse, they will offer programs for suicide preparedness. And also, you can look at other places. For instance, in Syracuse, we have a organization called Contact, which is our local crisis management provider. They offer regular free programs for all types of health professionals, and what you can do to support someone during an episode when they come to you, what kind of questions you should be asking that person, and then what is your protocol?

And that's really what I think is difficult for massage therapists is they have a hard time with those questions. How do you say to somebody, "You made a statement earlier that I find concerning, and now I really want to have a deep conversation with you. Are you thinking about hurting yourself? Are you thinking about suicide?" it sounds strange to have to ask those questions, but sometimes you do. And in 2020 and 2021, I had a patient each of those years that came to me at the med center, at the VA, who was either in a state of ideation or a state of plan. And if I had done what I had been taught in massage school where I just go right into, got to get you on the table, get you through the session, get you done, get you out the door, I would've missed out. But they had made a concerning statement and I went right into protocol, started asking the questions. And ended up saying to them, "We're not going to have the massage today. You need a different level of care, a different type of care." And I physically walked them or wheel chaired them right into their primary care provider right there at the VA.

So it's also knowing what to do for a protocol. There are national numbers available. Everyone's pretty much heard of the crisis hotline, you should have that number ready and memorized so that you can call it if need be because you never know. And every moment can be a critical moment in episodes such as this. So I would say first start with those local crisis mental health organizations. See if there's some trainings just to start with.

The good news about our program is we are resurrecting our travel training again. And so I'm going to be in Illinois AMTA in March. I'll be in New York in April. And I'm in the process of connecting with some other folks to do some trainings across the US. We're also finalizing a hybrid format where some of our training will be available online because as we learned, there's such a demand for this program, and I just can't meet that demand.

Whitney Lowe:

Of course, yeah.

Nicole Miller:

So at this point, we're going to start to offer a hybrid program, where people can get some of the material online, and then visit for some online or some in-person training in areas near them. And I'm also hoping to get a couple people trained so that they can operate as well, so that we can make it more accessible.

Whitney Lowe:

And I was thinking too, I mean you've got such an incredible support network there in Syracuse with lots of people doing this, but also I'm thinking now too about the individual practitioner that is in maybe a smaller community somewhere, or something that just does not have that network of support, and maybe not even access to some of these capabilities for traveling to training programs. It certainly would be advantageous. This is of course, is one of the very big advantages of online training is being able to be accessible to anyone anywhere, because I think of all the people who could really benefit from doing this type of training and just some awareness about this.

And I'm thinking here too, not only of veterans, just all kinds of trauma instances where people could benefit from some of these concepts, ideas or training to some degree. One thing I'm going to ask here, because I know this is another place that we get into challenging understandings of scope of practice, do you have problems or challenges with people understanding the boundaries of what their skillset is when they talk about this whole biopsychosocial aspect, and how much to do something as an intervention versus sometimes just being there for people or knowing what those boundaries are? Does that come up as a challenge or an issue for you?

Nicole Miller:

It is a challenge or an issue for sure, because you have to make sure that veterans or the patient population that you're working with understands what your capacity is. Our capacity to care is endless. We're comparing and compassionate people, so that is without any boundaries, but our capacity to treat certainly has boundaries and definitions. So you have to be ready to refer. You have to be ready to say, "We're at a point right now in our therapeutic relationship where I'm recognizing you need a different type of care. You need to maybe suspend a massage or take a little time to go into consider some other type of care such as maybe talk therapy or what have you." So you really have to be ready for that.

And I think, again, when we reflect back on the prior experiences with our clinic and early on with Clear Path, a lot of massage therapists feel so responsible for their patients and their clients. They have a hard time letting go. And it's really critical when you work with patient populations that you have to know when to step aside and when to say, "Now is not the time for massage," or, "We need to bring this person on board to help us, both of us with what's happening in your care right now." And that's a hard thing for massage therapists because a lot of schools are really challenged with how much content they have to teach in a short period of time. And so there's just not enough time in base massage education to address some of these things. And like you were saying earlier, it affects other populations.

I also work still at Crouse Health, so I offer clinical massage at the high-risk obstetric patients up on 7th and 8th at Crouse. And so I deal a lot with women who are dealing with perinatal anxiety and depression. I've also, as part of that role, would attend support groups for patients as an outpatient support group, offering massage therapy. Well, lo and behold, one of the patients there came to session one day and she clearly exhibited some concerning behaviors and statements. And as we later learned, she was in a state psychosis, and I had to again do an interception at that point. So it certainly applies to other populations, and it is important that you realize that you have a capacity and not be afraid to reach out to others for care.

And the other thing I can really suggest to people, when I first started, I took Elaine Stillerman's class back in 2004 for pregnancy massage. And because I have a bachelor's and a master's in organization and management, I went into that hyper-business mode and I created a whole manual of massage for myself with protocols and so forth. And I thought at the time, "Oh, this might be a little corny, a little bit too much for this." And now I realize, "No, it's not." Massage therapists, if you're going to work with clinical populations, you should have a manual or some protocols in place with your support services for each one of those populations. So if you're going to work with veterans, you should get a list of VSOs in your area. You should know the crisis hotline, you should know the community care folks, you should have all those places. You should go visit your local vet center and do outreach with them, so that you can learn more and learn about who to connect with. So when these things happen, you have an immediate direct line to support.

Whitney Lowe:

Yeah, excellent. And I will ask, do you happen to have templates or suggestions for people of what should be in these kinds of packets you have? Any of those kinds of resources that are available to people?

Nicole Miller:

And actually, just finishing up, I was going to make a place, and I don't want to speak too prematurely here, I don't have it launched live yet, but on my educational page, I'm making a list of things for people to include, a resource place for massage therapists with whatever population you're working with. But first start with your locals. Really go right into your yellow pages. We're kind of aging ourselves here. But take a look around, and don't be afraid to go visit places. That's the other thing that I think we are kind of weak in. Make it a point to go visit the vet center and say, "Hey, I'd like to come and see what you offer. Can I get a tour?' Take a look at some of those places and really immerse yourself into that culture because that immersion is going to help support you in the long run.

Whitney Lowe:

Yeah. I want to go all the way back to your intro for just a second because there was another question that I wanted to ask in relation to what you were talking about in terms of the evolution of this program. You mentioned at a certain point that you had several different approaches that you were working with. Chiropractic, massage therapy, acupuncture, I think you mentioned also.

Nicole Miller:

Yes. Mm-hmm.

Whitney Lowe:

And then said that you had kind of divided these up and were sort of looking at outcomes from these different approaches. Did you all happen to document this in a way that could be valuable to look at for us to better understand, for example, what are the mechanisms of benefit from massage if it is extricated from these other things? Was that anything where they recorded that stuff formally?

Nicole Miller:

Yeah, good question. And just so the listeners understand, so what Whitney is talking about is at this time I was working at the VA and working in the med center program. And again, Syracuse is a design site, so one of their jobs is to measure the differences in outcomes between the various modalities. And they're doing this one because they want to make sure that care is efficient for the patient. And this is really important because a lot of massage therapists think every veteran should have massage and have it often. The reality of that is just not there. And for many reasons, not only for cost. But two, because some of these veterans, especially Vietnam veterans, will have multiple appointments at the VA throughout the week. They might have eight in a day, believe it or not. Because they might be coming for their PT, they might get their chiro, their massage, their mental health, their pharmacy check-in.

So they're having multiple appointments in a day or throughout the week and they're coming back and forth. And it's not easy, obviously in most major cities to go and park and then go to your appointment. So they really try to make their services as efficient as possible, not only again for financial purposes, but for purposes of the patients. So they're really trying to understand out of these integrative healthcare modalities, which is best for musculoskeletal pain, or which is best for PTSD, so they can then create the right recipe, if that makes sense.

And I know that with the Syracuse VA, they were measuring those outcomes. And they were measuring the outcomes between the community care as well as the med center too. What we established across the board is massage certainly helps with pain reduction, stress reduction, opioid reduction, and lesser pharmaceutical costs across the board compared to folks who didn't use the integrative health modalities or services. So all great things. I am eagerly waiting for the final report of what they find out specific to the specific services. So they have not yet established or put in writing this information specific to massage therapy, versus movement and so forth. So yeah, I think it was 2019, they came out with the first big report from the design sites, which established again, across overall the model itself is helpful. And now we're all waiting for the next one.

Whitney Lowe:

Yeah. Was there anything that sort of stuck out in your attention as you looked at that for the real places where massage shined brightly as beneficial for addressing things compared to some of these other approaches?

Nicole Miller:

Yeah. And I can speak a lot to case experiences. To give you an example, when I first started there at the VA, I had a pretty diverse patient load. And then all of a sudden after helping a couple of folks who live with MST, MST stands for military sexual trauma, all of a sudden I had a lot of referrals from that unit, the unit that over that oversees that healthcare. So all of a sudden I saw this increase in volume in those patients. And then the same for... I saw a huge increase in referrals from the spinal cord injury unit. So there's different units within the VA. So I started off with some, worked with their patients and then all of a sudden there was just this influx of people on my schedule from that unit.

So to me, that tells me those areas, massage is definitely effective. And when I speak about those areas, a couple things that I'll challenge people to think about is what type of work do you provide, and how creative are you as a provider? Because that's important. A lot of people think, "Oh, veterans, they're rough and tough, big people, they've been through a lot. They're physical, they're burly," whatever, however you want to describe. When you think of the Walton Pressure Scale, you don't always need to use a five out of five for veterans. In fact, I found it to be just the opposite for many of them because a lot of them had exposures. Exposures are exposures to things such as chemical exposures, radiation, wind, weather elements, what have you.

So people who have been challenged by exposures don't always do well with firm pressure because their skin, it tolerates pressure much differently than someone who hasn't. So you have to be really creative as a provider. And one of the things that I had learned, and I'm sorry to go off on a tangent, but-

Whitney Lowe:

No, this is wonderful. Yeah.

Nicole Miller:

... I hope my hindsight's your foresight. But one of the things that I learned is in, and I learned this actually from you, Whitney, not to sound strange, but I've taken your classes here when you visited AMTA in New York and have read your books. And I was always impressed with your philosophy that some really good planning up front and some good consultation makes for a great session and therapeutic plan going forward. And I cannot stress enough how valuable that thought is when you're working with patient populations such as the veterans. So when they come to me at the Syracuse VA, my first appointment with them, I might have had 10 minutes of hands-on with them, maybe 20 at the most. But the majority of my time with them is really talking and consulting with them. I would always spend time before they come in to review their histories and then spend time in engaging with them. And then the palpation time that I did was just really testing an assessment palpation.

So I never started right off with treatment. I would then spend a lot of time talking to them about what massage could possibly do for them, what does it look like, what are the risks, what are the potential benefits, and then let them decide if they wanted to proceed going forward. And then from there, I would start off slow. I never would start off with a five out of five on that pressure scale. It's really a two out of five or a three out of five to begin with, and then we modulate from there depending on their experiences. And lo and behold, many of these big burly folks actually did fairly well with a medium pressure versus a firm pressure or deep pressure I think as some therapists call it.

Whitney Lowe:

Well, of course, I've been singing that song for a couple of decades here, about how valuable and essential I think the assessment process is as part of treatment even, in that exactly what you're saying here is that when you begin touching somebody with this idea of finding what might be restrictions in movement or what might be areas of sensitivity or hypersensitivity, that very touch in the evaluation process is a huge amount of important information that you're going to get about how they may respond overall to some of the other things that you might be doing. So I do think that's a critical aspect of what's happening here. And one of the great benefits of us spending a lot more time with people, like you said, you might spend a whole lot of time in that initial session without doing a whole great deal of massage in that first session because some of this other stuff is so very important.

And the other thing I would stress and emphasize is in that timeframe, when you're going through the evaluation process with these people and you have a genuine caring attitude and you're expressing interest in their individual process, you are developing the therapeutic alliance and that rapport with them so critically, that's going to be an essential part of what's going to happen with them. I think the importance and value to that is not to be underestimated for sure.

Nicole Miller:

Absolutely. That's such a critical aspect. And like we were saying earlier, we have very deep relationships with our patients and our clients, so we need to be mindful of that. An example I can think of is I had a patient one time who was red flagged in the VA. Red flagged means there's a crisis involved with that person, so there's a protocol of care for them if ever they have an episode while with you. But this patient had lived with severe pain. And I can understand why he had the plan that he did. After trying for years different types of other services with the VA, we just found out massage was great for him. It reduced his pain. When he first started coming in for massage, he had maybe one day of function a week if he was lucky.

After about six weeks, he morphed to two days of function. And then after about two, maybe three months, he leveled out to about three to four days consistently every single week of being highly functional, being able to actually do things physically as well as emotionally. So we were all thrilled with this experience that he had, and we went on for about a year like this. Everyone realized he just had to have massage regularly for maintenance to continue to achieve this. Well, one day he came in and I had been listening to him for the weeks leading up to this appointment where stress at home was increasing. And then when I was asking him the amount of functional days he had, his pain levels, his stress levels, doing all those assessment and screening things that we do, I realized this trend where his pain was increasing and correlating directly with the stress at home, and the reduction in function was also increasing in correlation to that.

So at one point I said to him, "We need to bring on someone else in this alliance with us because massage isn't going to help you much longer, and you obviously have another priority." So it just speaks to what we were saying earlier, that you have to be ready to refer or tag team. I can say over and over again or stress the importance of team-based care. Team-based care, TBC as we call it, in a clinical setting. Years ago with more traditional formats of clinical massage or clinical care, people were fairly isolated. Most of the directive came top down from the primary care provider. But now places like the VA are fully engaged in a team-based care format, where everyone's communicating with each other. And if you work with veterans, you need to be ready to be a part of that team-based care and be aware of what the other providers do and what they offer, and then you're ready to shuffle when necessary.

And so with that patient, I could have just continued with my status quo, continued to offer the recipe of massage that we knew worked so well. But at that point, I realize we have to do a reassessment here. And in this reassessment, we need to redirect you to another type of care.

Whitney Lowe:

Yeah. When you see some of these people for longer periods of time, multiple sessions, do you see any kind of cumulative effects of the work that you're doing? For example, they get longer periods of relief after a greater number of sessions or something like that? Or is this just something where it's a constant intervention that needs to be there, that they just need to have this on a regular basis? I guess that's kind of a generalized thing for a lot of individuals that might be varying from person to person. But do you see any trends about that?

Nicole Miller:

Yes, I did in our clinic in Syracuse for sure. My goal is I love the idea of graduating folks from massage therapy. I don't think it's actually a very good idea that we maintain people too long. And remind you, I'm coming from the reference of clinical care, which is different than massage for wellness, right? It's completely separate. So when it comes to the clinical care, I love it if we can ultimately graduate people from massage and they don't have to come into us, and they can live more independently I don't want them to become addicted to massage.

And so what we found in our program, we had started a component where we would assign people to tai chi, or to yoga, or to movement modalities. And the idea was they'd start with massage. And then when we got them to a certain level of feeling good and then they were encouraged to actually move and exercise, because now they had the capacity and the motivation to do it, we would then transition them to where they'd have both massage and movement for a couple of weeks, and then launch them into the movement episode.

So that was really exciting and case wise, we were seeing some good examples. The unfortunate thing is COVID came along, and so that put a kind of big damper into that whole progression that we were seeing. But reflecting back on the cases, I did see where some people were doing well and doing well with... There's some research now that's starting to hint that exercise and movement can offer some of the same effects as massage therapy for some patient populations or some experiences. And when possible, I try to encourage people to also include that in their choices.

Whitney Lowe:

So there's a lot of wonderful things that you've been doing here. And also I want to commend you for your outreach efforts in trying to teach so many people across the country this stuff, because I just think it's so critically needed and so necessary. What have we missed here in our discussions? Are there any other key things that you think people really ought to know about working with this particular population? We've talked a little bit about some of the training necessities and things like that, but what have we missed?

Nicole Miller:

Yeah, I think what we missed is when I talk about these heavy-duty topics, I don't mean to scare people or frighten them. I do want them to use it as an opportunity to prepare themselves. So I don't want to intimidate massage therapists from working with veterans. Veterans by and large are healthy, strong people and they just need a particular type of care from therapists who have particular knowledge, skills, and abilities. And so I don't want to intimidate you from exploring this. It's an amazing, amazing opportunity to connect with a specific patient population.

The one thing I will encourage you to do is to start with immersion. Immerse yourself into the culture. Like I said, visit with some local VSOs or do some volunteerism, and then also connect with some of the main service providers in your area, like the vet centers or your local VA, and start to give yourself some support in that realm. And I think from there, you're going to start to develop some confidence and have some more preparedness as you continue forward.

Also, explore other education programs. Our program, there is so much information that is afforded over the course of our 80-hour curriculum, however, it's not the everything. So I encourage people, please look at some of the other providers out there such as yourself. I use a lot of the skills that I've learned from you in my clinical work with veterans and some of the other patient populations that I work with. So also, look towards other education programs that are available. Look at things like ABMP. ABMP has so many wonderful online classes and articles available that can support every practitioner no matter what patient population you work with, so long as you want to work in a clinical setting or as a clinical therapist. So make sure you grasp and grab those as much as you can, each and every one that comes your way.

Whitney Lowe:

Yeah, and again, I don't know that much about the whole VA system, but know that there's a lot more likelihood that you're going to find these centers and also the VOS centers that you talked about in larger metropolitan areas. And so my encouragement and hope is that you especially will continue working down the road on some of these resources for online training. For example, I live in a very small town and we don't have any significant centers that I know of, and I may just be ignorant of that, but within probably three hours of us. And that's across a mountain range to get there. So for those people who might be in places where there's not as much of a support network with some of those centers around them, I do hope that you all will continue working on the establishment and development of good training programs, where people can learn a lot of this kind of stuff, especially in the online environment where they might not have access to some of the other training and resources there.

Nicole Miller:

You know you just spurred a thought. And do you mind if I just share one more advice?

Whitney Lowe:

Of course, yes.

Nicole Miller:

Listening to you, I can better understand what you're describing. The VA has an amazing website with a lot of literature and information, but one of the things that they offer, which I found really helpful, is a online program called Make the Connection. So if you just Google Make the Connection in VA, it's a whole video pod series where they profile and interview various veterans of all eras, gender, gender identities, and experiences and conditions. So you can find a video if you wanted to for a Vietnam veteran who lives with PTSD, or you can find a video with a female veteran from the Gulf War who lives with MST. So you can find that. So I would really encourage therapists to go right online and start to watch some of these videos because we actually did that in our class. I would show at the beginning of our class a video and ask students to write down, what do you see here?

And then we'd go through our class and then I have them watch the same video and it was amazing how much they learned and can pick up more by watching that video the second time. And that is a great example of helping you to be immersed into veteran culture as well as the clinical culture. So you're going to learn a lot about conditions and the challenges that they live with as well as about the person because you're going to hear it from the voice of the veterans. So again, that's make the connection through the VA. I think that would be a helpful tool.

Whitney Lowe:

Great. Great. Thank you, Nicole, so much for this. Well, this has been a fascinating exploration of working with this unique specialized population. And I again, want to both commend you and thank you for your unflagging efforts in that effort to do that, to reach out to this group. And also to help teach and share with all you've learned and all you've developed with everyone else. So how can people connect with you or connect with other educational resources on this? What's the best place for people to connect there?

Nicole Miller:

For sure. So I'll give people an email directly because like I said, we're just about to launch that web platform. But in the meantime, if they want to, they can reach out to me. It's nicolemiller4750@gmail.com. And by doing so, I'll include you on the list and then once we get our platform, it's drafted right now, but once it's officially published, we'll make sure to send you an email to notify you of that. We're developing a program called Connected Roots, and the idea behind this is that we help all therapists connect with other educators, with themselves, with patients, and with medical providers. So we kind of see ourselves as the alliance in between all of those respective populations or groups that are involved with clinical care. So we have the specific page dedicated to resources and support for massage therapists. And we'll also include in that trainings as well, upcoming training locations.

Whitney Lowe:

That's great. And we'll try to include all those things in the show notes for this episode as well, so people can have that and go consult and look at that stuff there. Well, Nicole, thank you again so much for joining us today on our discussion.

Nicole Miller:

Thank you.

Whitney Lowe:

It's been wonderful talking about this. Do keep in mind, the Thinking Practitioner Podcast is supported by Handspring Publishing, and their catalog has emerged as one of the leading collections of professional-level books written, especially for body workers, movement teachers, and all professionals who use movement or touch to help patients achieve wellness. Handspring has recently joined with Jessica Kingsley Publishers' Integrative Health Singing Dragon in print. So head on over to their website at handspringpublishing.com to check out their list of titles, and be sure to use the code TTP at checkout for discount.

And we thank again, Handspring. And also, would like to say thank you to all of our sponsors, to all of the listeners, people who've joined us on the show here. And you can stop by our sites for show notes, transcripts and extras, you can find that over on my site at academyofclinicalmassage.com, and also over on Til's site at advanced-trainings.com. And he will be back with us next go round for another interesting discussion here. If you have questions or things you'd like to hear us talk about, please do feel free to email us at info@thethinkingpractitioner.com. You can give us ideas for episodes, or critique things, or send us your opinions. We'd love to hear from you all the time.

You can also look for us on social media under our names, Til Luchau, and also under mine, Whitney Lowe on social channels. So thank you again so much. We appreciate your being here. If you got a chance, please stop over, rate us on Apple Podcasts and listen to us on the various different social or podcast platforms, Google, Stitcher, whatever is your podcast preview of choice or podcast platform of choice. And we thank you very again. Thank again very much for hanging out with us.


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