Show Notes:

Whitney talks to Doug Nelson about the challenges and learning experiences of a great massage career spanning over four decades. 

Episode topics include:

  • What keeps you going after all this time?
  • What are some of the most fascinating lessons your clients have provided for you?
  • How do we all learn to be humble in the face of our own fallibility in the clinic and the classroom?

Get the full transcript below!

Resources and references discussed in this episode:

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Your Hosts:

Til Luchau Advanced-Trainings        whitney lowe
Til Luchau                          Whitney Lowe

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Your Hosts:

Til Luchau Advanced-Trainings
Til Luchau

whitney lowe
Whitney Lowe

Thanks for listening and subscribing to the podcast! Make sure to connect with us on Twitter, Instagram and Facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!

(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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The Thinking Practitioner Podcast:
Episode 44: Table Lessons (with Doug Nelson)

Broadcast date: 07/28/2021
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

 

Whitney Lowe:

Welcome to the Thinking Practitioner. Hello, and welcome to the Thinking Practitioner. Today's episode is sponsored by the HealWell Community. The HealWell Community is an interdisciplinary online community found by massage therapists for serious health care providers who know how to be real, curious, professional, kind, silly, and collaborative. In the community, you will have a chance to engage in honest conversations with practitioners from a variety of disciplines to talk about the issues that keep us from offering the best care. The HealWell Community members connect with colleagues from a variety of healthcare disciplines for discussion and education about monthly themes, like the BIPOC provider experience, weight bias and health care, and LGBTQIA issues in healthcare and more.

Community members also get a 10% discount on all Heal Well's continuing education courses, so do check it out today at community.healwell.org. Hi, this is Whitney Lowe, and Til is office week. He'll be joining me in the next episode once again. I'm very pleased to be joined by my good friend and colleague, Doug Nelson today. Doug, how are you doing?

Doug Nelson:

I'm good. I'm really happy to have this conversation with you, Whitney. It's great. Nice to meet. 

Whitney Lowe:

Yes. Always love to have our conversations, and we'll get to have this one in public here to share a few things with everybody. Doug, if you will, lots of folks know of you in our profession, but for those people getting introduced to you, can you tell us a little bit about yourself and your work, what kind of things you're doing these days?

Doug Nelson:

Sure. Yeah. I live in Champaign, Illinois, which is kind of in the center of the state, so about three hours from Chicago, three hours from St. Louis. Had a clinic here in Champaign since 1982. I've been in practice since 1977. Whoa, hard to believe the clinic's going to be 40 next year. Wow. We have 20, I think 21 therapists in the clinic. The clinic is one thing, a big part of my life, and I'm still seeing a ton of people every week. That's one piece. Continuing education is another piece. I have a continuing education institute called NMT MidWest that teaches precision neuromuscular therapy around the country, and I've been doing that since the mid '90s. Yeah, '97, '98.

Then, the other hat, but I'm also on the Massage Therapy Foundation Board as a trustee. I was president of the foundation up until this last March. Those are kind of the three hats that I've been wearing.

Whitney Lowe:

Yeah. All right. I want to ask you about this because this is ... You have had an amazing career trajectory in this field. One of the things that I wanted to ask you about is, this is quite remarkable, the length of time that you've been doing this, and what is it that keeps you going after all these years? We hear so many stories of people having burnout and not being able to keep going and everything. This is a long stretch of time that you've been doing a lot of work, having your fingers in lots of different pods there, what is it that kind of drives you and keeps you going so long?

Doug Nelson:

Because I think I'm just getting a clue.

Whitney Lowe:

That's good.

Doug Nelson:

That's what it is. I was like, finally, I might actually be getting somewhere. It reminds me of Pablo Casals, somebody asked him, "Why do you still practice at 93?" He says, "Because I think I'm making progress. I think for me, when I hear you ask that question, Whitney, I think about some research that I saw in the psych field and it was a 20 year longitudinal study asking those people that same question, what keeps you going?

I think their answer is, it parallels mine, that I will give you as well, which is number one, the sense that you're making a difference in other people's lives, at the heart of it all, it's about service, really, and knowing that in some way you've made a difference, and that is front and center. But the other thing that scored really hard for them, and as well as myself, also what I was kind of joking about, but not really, is that I feel like I am learning and growing every day, and that's a good thing.

The thing I love about this work, this chosen field of massage therapy is that I get to use my hands. I grew up on a farm. I would not want to sit in front of a computer all day long. I couldn't do that. I love to work with my hands, but I like to think. I like to problem solve, so I get to use my head. When you're working with people who struggle, people who are in pain, you get to use your heart. So, I get to use all three of those things. For just me, personally, the work suits me well, because I get to use all three of those things, and I'm feel like I'm growing every day.

Whitney Lowe:

Yeah. I have remarked to people numerous times about how ... It seems like we should have to pay to get to do these things that we do with people sometimes because it is such a remarkable experience and the fact that we can do this as a career thing is tremendously rewarding. Tell me a little bit about the ... This is just amazing a clinic with that many therapists, what have been some of your biggest lessons or challenges in running a large scale clinic operation like that?

Doug Nelson:

Well, first, I think it's going from therapist to clinic leader. Those are different hats, those are different things, and the skills of one are not the skills of the other. I think it's about vulnerability. Certainly I learned a lot about that this year as leading a group of people who depend on this for their livelihood through this whole pandemic experience. As a leader, you think, well, this is like that, I've had this for a long time. Well, this was like nothing.

But it's about, in some ways, also vulnerability and embracing that and uncertainty and plugging ahead. If you don't mind, can I circle back to something that you mentioned just for a second.

Whitney Lowe:

Of course, yeah.

Doug Nelson:

I remember once driving up to the foundation, and just for reference, my day is I see one person after the other, all day long. I don't have time to talk on the phone. Nothing. It's one person after the other. I have a little quick break for lunch. It's been my life for decades. When I'm in the car, thank God for Bluetooth, I do actually, often will take phone calls, and I was on the way to the foundation, and this woman gave me her 40 minutes saga, and it was a terrible saga with her struggle with health care.

When they got to the foundation, one of my staff said, It's amazing that somebody who's never met you would be that vulnerable, show the soft underbelly of their existence." Whitney, my response to her was yes. However, she's not the only person who's vulnerable, so am I. And because the moment that she comes to the office, she is going to realize that I don't have the answer. In that moment, Whitney, it won't take her long to figure that out, in that few minutes of that problem-solving, suddenly we're both vulnerable.

There's that joining, that connecting, and then we're going to leap off the precipice together. Again, what a privilege that is because she's never met me, and yet she's willing to take that leap with someone that she doesn't know, and I have to earn that trust, but it's not like, oh, I have the answer. And now that you're here, we'll figure it out together. It was a long journey and we figured it out, but it was far from linear, let me tell you that.

Whitney Lowe:

Yeah, I do always think this is one of the things that is so powerful and significant about the way many of us approach working with individuals as individuals and not as, for example, the body parts. I used to work many years ago in a physical therapy clinic and would be quite sort of astonished at the number of times I would hear comments about the shoulder in room three or the knee in room four, and the individuals were being treated as if they were a body part, and that's not ... We certainly know now where the ideal therapeutic outcomes are going to live.

I think so many people are just starving for that kind of connection and attention with a healthcare provider, to just have somebody listen to them and engage with them and merge with their experience to some degree of just saying, yeah, let's go down this path together and see where it takes us kind of thing.

Doug Nelson:

Absolutely. Absolutely. I think it's about that connection. Yeah, I'm going to go back to the cellist thing again, but for whatever, Pablo Casals, I'm a human being first, I'm a musician second, and a cellist third. For me, yes, massage therapy is what I do, but I'm a human being first, and this human beings sitting in front of me who's struggling, it's about that, first and foremost. Everything after that comes second. It's about that connection. It's about the ability also to say, I do not know, but there are different kinds of, I do not know. There's a, I don't know. Closed door. There's an, I don't know, which is an open door. To the, I will figure this, I will investigate this, and together, we'll see what we can do.

So many times, in healthcare, and this was this person's thing, is you see this provider and they say, I don't know, but you don't have this, which is my domain. So, you're off to figure it out to somebody else, and so you find out 30 things that you don't have, but nobody walks with you down the process to, what's really going on? That's a very lonely process for people. I think just being there, and relationship with people, is the strongest thing. But I have to say, nobody taught me that. That was not part of my training. It came later in years of screwing up.

Whitney Lowe:

Where did it come from? What was the teaching process that got you to that place? Can you point to something that was sort of like a key thing or was it just a gradual development over time of understanding and recognizing those things?

Doug Nelson:

Yeah. In some ways, I think back to late '90s, and I won't go into the experience, but I had this epiphany moment of discovering, I don't really know what I'm doing. I am confident, but it's bravado. I am confident without confidence. Yeah, it's funny how I went from whatever to the summit of mount stupid, and took up residence. I don't know, I'm embarrassed when I think about it. I think, at some point, Whitney, when I realized I didn't know, and I was filled with doubt, that actually is a really good thing.

Because doubt creates curiosity, which creates possibilities. When you think you know, there are no options available. That's not a good thing. That moment for me, of the angst of the struggle, turned out to be one of the best blessings. It didn't feel like it at the time, but a really good blessing for me.

Whitney Lowe:

Yeah. I want to dive into this just a little bit deeper here, because you and I have had some of these discussions before. As educators, this is something that I think we're both aware and cognizant of because we see it a number of times for individuals, for example, who may be teaching continuing education courses, or maybe they're just starting out on a teaching career. We don't really have a real strong teaching track in our field, like many other fields don't.

There's a temptation, I think, a lot of times when people get into some of these places, especially in teaching, continuing education, where you don't know who the students are going to be. You've got people in the room who just got out of school and people who've been working for 25 years, and they come up with a question and you don't know the answer to it. And you think, well, they're paying a lot of money to be here. I better have an answer, so I'll make something up or just say something that's inaccurate.

There is such a temptation to feel like you have to know everything. This has been one of the things that I've watched happen a lot over the years is like, how do we encourage educators to be okay, to be in that place of saying, God, I don't know. I've never heard of that before or I've never seen that before, and still be feeling okay about themselves, because, especially nowadays with Google in the classroom in your hand, if you start spouting off incorrect information that are just off the cuff because you think that somebody is not going to catch you at saying that something inaccurate, it's likely to come back and bite you easily.

Doug Nelson:

Right. But I would say the parallel, Whitney, is back to the clinic. I think, in the educational system, but the same thing happens in the clinic, and that's what I'm saying. It was an epiphany for me to realize I didn't have to know. What I needed are the resources to find out, and those are different things. Being comfortable with that vulnerability and not knowing, for me, translated back to the educational environment, where somebody asks a question and many times they look to you for an answer. But the thing is, for instance, will this work help such and such?

Have you ever seen ... Well, I've seen three people with that. Three people is nothing, right? I tell people, my opinion doesn't matter about this. If I could base that opinion and experience, and I'd seen 30 people who have that particular condition, and of that 30, here are the results that I obtained. Now, that's something different. Even if there isn't research literature to back it up, there's a deep thing, but anything other than that is kind of conjecture on my part, and they deserve better than that.

If they're asking that question, probably they have some knowledge about that or some experience with that. That's an invitation to, you know what? Explore that. Why don't you investigate that? And if you need some resources, I can maybe point you in that, but I'd love to hear what you discover because I'm betting you know more about that than I do. I think part of what people need permission is doubt and to explore different things and be validated in that way. I think that's really important.

Whitney Lowe:

Yeah. Do you think there's a value, this is one of the things that I talk to people a lot about, why I think it's important to learn a lot and to expand your knowledge base and to really have a good understanding of a wide variety of facets of physiology, biomechanics, psychology, all the things that go into making us be humans. And when we come to that clinic encounter with somebody to say, "I don't know about this, but here's some physiological or here's some reasons why there's a good possibility this might do something here and we'll sort of explore this together."

I certainly believe, and I'm curious to hear your perspective on this, that giving that individual some more grounded understanding of why this might work when you work together might have therapeutic benefit because of the sort of increased confidence that they have in you, and they desire that you're going to explore these things with them, but you've got some rationale behind you for why you're making the decisions that you are.

Doug Nelson:

That's right. It's funny, Whitney. I mean, for me, everything is about the clinic. It's so rooted in my experience, and I would say that's the value of the clinic. The surest path of confidence is lack of knowledge. The clinic will absolutely humble you, because people come in, and theories are easy, results are actually really hard. You have to create outcomes and results for people. You have to deliver the goods, and I love being held to that. I think that's really important. When that person says, for instance, and this happens all the time, so what do you think is happening? Why is this happening to me?

People understandably want that. For me, the answer is often, I don't know, however, if it's this, then this will be true and that will be true, and this will be true, and this won't be true, and that won't be true. However, it also could be this, in which case, this will be ... And I lay out that path for them so that they realize there are multiple pathways that this could go. I'm not lost. I have the skill sets to figure out which one of these, and together we'll go down each of those roads to figure it out.

That builds, I think, confidence in people, that they know that you have the wherewithal to follow each of those pathways, both to confirm, but more importantly, to disconfirm. I think that's one of the things, Whitney, with the foundation, and people know that I've been involved in research stuff, I think what people don't understand, the goal of research is not to verify, it's to falsify. For me in the clinic, I spend a lot of time doing that, where let's say I'm treating something, and I think, oh yeah, that's it. And the client's like, oh yeah, that is it.

When you do that, I feel such and such. That's exactly what I feel. Then I'll do something totally different that shouldn't be connected to that, and almost in a misleading way like, hey, what about this? No. Well, what about this? No. How about this? No. You know, you were on it before, but you seem lost now. It's like, well, I'm not that lost, actually. I was trying to just see if it was a something, but no, everything points back to the original thing. Okay. I think we actually might be right. [crosstalk 00:18:36].

Whitney Lowe:

Is that what you mean when you talk about research being there to falsify things, you're doing this to also disprove the null hypothesis essentially because [crosstalk 00:18:46].

Doug Nelson:

Yeah, what I'm trying to do is, it's easy to prove yourself right, because you will figure out anything to prove yourself right. It's harder to prove yourself wrong. That's the goal of research. For me, not growing up in that world and not be an academician, it's like, you know, that's a pretty smart track. I can do that in the clinic. I can try to prove myself wrong instead of trying to prove nine ways from whatever that I'm right about something. One of the questions that I always ask myself is, there are two, actually, every time I see somebody, number one, what makes me think this is soft tissue?

Because my expertise is my blind spot. I've had a few, a couple of them in the Table Lessons, things of, whoa. They were, yeah, brutal. Or, and the second question is, and what else would explain this? If people present with certain symptoms and you think, oh yeah, well, that's the low hanging fruit, what else would explain this? And being able to think on those other levels, keeps my brain open to other possibilities that I might ignore if I thought I was actually right or something. In the clinic, that's been incredibly valuable.

Whitney Lowe:

You and I have had, again, some of these discussions before, and my real passion is as an educator, and ask these questions a lot. I'm curious, since we don't, and you just mentioned this too, as a profession, we don't kind of grow up in our learning process as an academic profession, because our schooling is not really based in that kind of model. We're much more of this kind of mentor and guru model of our education. The information is passed down from generation to generation amongst practitioners.

How do we, and this is something I'm curious from your perspective of having worked so much with the foundation with research, do you have any ideas or suggestions of, what do we do to try to get the practitioners to more of that analytical doubt about what they're doing and look at these things from that kind of perspective of disproving the things that shouldn't really be there and look at it from that perspective, instead of trying to like, oh, here's my technique and let's find the different ways that my technique works kind of thing?

Doug Nelson:

Well, Whitney, again, I would broad brush this in a way, of thinking about ... i can look back in my own history. In the early years, it was, I have a fabulous answer and I hope it matches your question. Because whatever the question is, here's what I'm going to do. And then I just realized, what am I doing? I think, if we just look at this in a way of, how can we be flexible, again, it goes back to the clinic for me. Guess what? That didn't work, your lovely go-to strategy failed. This isn't something that you can argue with somebody. They either have results or they don't. And they look at you like, okay, then, what else we got? Then you switch strategies and you keep switching strategies until you figure it out.

Well, guess what? That's what researchers do. Einstein said, we wouldn't call it research if we knew what we were doing. Right? The goal is, it's really formalized curiosity. Once for me, in the clinic, once I felt like I had the license to not know and just to be curious and just to explore. I felt like clients really embrace that. Like, oh my gosh, here's somebody who's actually curious, willing to fail, willing to go the distance with me, and I am relentless. It's the Norwegian way. We don't solve problems, we just bore them to death until they just leave. We are so good at this.

It's just that, what did ... Leonardo called it [foreign language 00:22:41]. That just relentless obstinate pursuit of whatever. Some of the people that I've been around, I've been around some amazing practitioners and athletes and artists in my career, what a privilege, but that's what I saw in them, that just unrelenting, I will figure this out. I think that's really important in our field as well. It's about developing those skillsets too. I think I told you once, years ago, I did this thing of, I was asking every group, I taught, what was it? 31 seminars one year. I'll never do that again.

But every seminar I asked the group, name the skillsets you need to play basketball really well, and I timed them. I can't remember now, I think it was like 7.8 or almost eight skillsets that people could name inside 60 seconds. You know where this is going. Next question, what are the skillsets you need to do this work really well? The average over the year was less than three. It's like, are you kidding me? Like, we know more about basketball than we do about this work. You can't come up with skills that you need. And how do you develop a skill if you can't identify it? What are the skills necessary? And then, what is one thing, how is something else.

How do you develop those things? We can talk about palpation. That's nice. How do you develop those things? And how do you know that you are correct not telling yourself something? We talk about professionalism, that's great, as represented by what? How do you do that? Everything you say, you have to have a way to develop those skillsets. That's what any artist, that's what any athlete, that's what any ... We develop those basic skillsets. I'm not sure we do that well in our profession. I was certainly humbled when I started to explore that.

Whitney Lowe:

Yeah. When I hear you talk about how important these various different things are in your clinical practice, and I really resonate with the things that you're talking about, that are the most powerful facets of making good therapeutic change with people. What I don't hear is the emphasis on things have to be this particular technique or that particular technique. And yet, so much of our education, especially in the continuing education world is oriented around learning this modality and these particular techniques and do these specific things, this number of times with somebody, very much closer to the sort of recipe or prescription kind of model.

But I hear you talking about in your discussions here, that so much more of these broad-based skills approaches and mental perceptions about the ways in which you work with people. I'm assuming, obviously for you, that's very much informed by many years of developing a lot of skills, techniques and things like that, but that doesn't seem to dominate what you think is most critical in the treatment room. How do you think we balance that? I'm speaking to you kind of as a fellow educator, because I grapple with this. How do we get people interested in looking at some of the broader brush skills of what's really necessary to be a great clinician and not get so overly focused on, I've got to learn X number of techniques or this particular modality or that particular modality?

Doug Nelson:

Yeah. I think just remembering in one way, Whitney, that techniques are answers. An answer is only correct if it's in response to the right question. When you sit down with somebody, what is actually the question, like what is there ... I just had this a few, like last week or so, I saw this woman. I only saw her, it didn't, in one way, seem appropriate with my schedule because I solve really difficult things, but she just kept saying how never found someone that worked for her, but she couldn't describe to me what that meant.

She couldn't find what she was looking for, but she couldn't describe what she was looking for. I ended up seeing her just because I was so curious about like, well, what does that actually mean? I stayed and saw her, and you know what it was, Whitney? It was really interesting. Her husband died two years ago and she was absolutely devastated with that. Honestly, she loved the session. I think it had nothing to do with, in one way, what I did, because it was pretty just straight ahead stuff that I can't imagine anybody else wouldn't do.

But it was just that sitting with her and saying, I can't imagine how devastating ... I know how deeply I love my wife. I cannot imagine the hole that would exist with that. I could see in her face the, like somebody gets this. That's what she was looking for. She wasn't the shoulder in room three. She was this person who needed another human being to say, gosh, that must be very difficult for you, but again, those are skillsets that we need to, somehow we need to communicate that in the educational system as well. I don't know that we do that well.

Whitney Lowe:

Yeah. I want to kind of circle back. I want to take that piece and then sort of circle back on something too and ask your take on this. One of my real, both pet peeves and passions as an educator is looking at some of the structures that we have used throughout our educational history for measuring education and looking at, what makes good education? One of the big things that I've really tried to find a way to carve into our field, and I know this is not going to happen in my lifetime probably, but I'd like to think that I can make some contributions to it, is looking at this process of how we're sorting, validating education.

You were asking some things when we talked once about what kind of metrics we use to judge improvement with individuals. In particular, I've been studying for years a lot about competency-based education and looking at this whole issue of, how do we get off the clock? Meaning, we tend to measure education and hours, butt in seat hours in entry-level training programs or in continuing education courses. It's a 15 hour course or a seven hour course or whatever, without a regard for what do people really learn out of there. That might not be good for one person who gets the lesson in two hours and somebody else really needs twice that time to kind of get it because they didn't have a really good background.

What are your kind of thoughts about, have any ideas or ways that we can look at, how do we evaluate the quality of these educational experiences for people, or what kind of metrics we use to judge improvement for individuals?

Doug Nelson:

Boy, a couple of thoughts about that. One of which is again, it's about the kind of competency and outcomes that you're getting like, is this resonating with you? Do you understand this? And instead of ... The clock hour is like the crazy thing. If your butt was in the seat for 15 hours, you must now know this. Okay, any parent can tell you, that is not true. Okay? [crosstalk 00:30:15].

Whitney Lowe:

Yeah, I had a great analogy for that one time talking about the T model of education, just like, okay, I steeped my person in this T for X amount of time, so therefore it should have all the qualities of what that amount of timeframe is in. We just know that, that doesn't work. It doesn't translate that way.

Doug Nelson:

And further review, right?

Whitney Lowe:

Yeah.

Doug Nelson:

It is about, but again ... I'm so sorry to do this, but back to the clinic again, because you spent an hour with that person, now things are better. Really? You must be kidding. Part of it is about constant feedback. It's about, is this accomplishing your goal? It's about, it's one thing, I saw this back to the psych world, just by increasing feedback mechanisms, outcomes went up by 400%. Here's a wild thing. Just getting feedback from people, when they were measuring psychotherapists who said, oh, I do that all the time, when they were videotaped, they still weren't doing it.

In education stuff, in the clinic, it's that dynamic between here's what you need to know, is what I'm conveying, is that helping you understand this? That takes reflection. So, I think in the educational system, we need more of that. Here's a scenario, like I've taught you this, okay, that's great. What I do in my classes is, sometimes I'll see people and I'll just say, "I'll treat you for free if you'll sign this release and allow me to play this in my educational classes," and then I'll play an educational ... I'll play this when the person describes all their ... Then I feel, and then I feel, but what's really weird, and I feel that now you have to apply those things to this scenario.

You don't have to have the right answer. God knows, when I see them, I don't have the right answer. But just tell me what your reasoning is, why you decided to go that direction. More importantly, how will you know if you're wrong and how will you know if you're right? If they have a reasoned way to do this, I'm good with that. I mean, who's to say, if I was going to drive to Chicago, there are lots of roads to get to Chicago? Who's to say what the right road is, as long as you end up in Chicago? But I might want to go the really scenic route, and Whitney's saying, "Could we just get there already?" Well, let's take the [inaudible 00:32:40].

Okay. Your goal is to get there and as quick as possible. My goal is to enjoy the process and see the scenery. It's not about the end product. In one way, it's about, what are the criteria? And are we, along the way, you tend to uplink to the satellite as often as possible. If I may, I am going to go back to, this is horrifying, I shouldn't even admit this, one of the Table Lessons stories, Whitney. This woman called in. She was, I think in volume two. But this woman called in, her neck was really hurting and nobody could see her.

I'll stay. I'll see you. There was a little bit in her like, oh, I get to see him. Yeah, right? Lucky her. I want to do this thing in my own defense. You know when somebody's facing you and they point to the side of their neck, but when they're on the table and you're looking, well, you know where this is going. It's like eight minutes into this. But I practice what I preach. I said, "Is this what you were thinking? Am I addressing your concern?" And she said, yeah. You know, it's on the other side. There's not much to say in that moment.

But how far down the road would I have gone without actually checking in. For me, it's about checking in. Not only that, but is this the best way to do this? What if I did it this way? Do you like this or do you like, which feels more productive to you? Same thing in teaching, it is, okay, let's try the ... Is that working for you, is helping you understand? Or what if we tried something ... I try to keep it as plastic as possible, as fluid as possible, so that ... The end goal is to understand the material. Presenting it is one thing, understanding it is something else, and that takes reflective thinking.

It's like, you've heard the 10,000 hour rule, but Anderson actually wrote this whole book refuting that. He's the one, it's his research that was based on, and he was saying, "That is not at all what I'm saying. It's about reflective practice." Because if the 10,000 hour worked, I know a lot of people who've been playing golf for a lot of years. Well, I'm not even going to finish, but you know where this is going. They are not better. Right?

Whitney Lowe:

Yeah. Well, it's that whole thing too about like, yeah, you can talk about the 10,000 hours of practice, but if you practice something wrong for 10,000 hours, you're certainly going to reinforce, not what you're after through that time period too.

Doug Nelson:

Absolutely. What it is, is did this accomplish the goal? If not, how do I change it? How do I alter this? For me, that's why the clinic is so foundational, because when I ... I can't tell you, I mean, it's a daily thing for me. People go, "Last time, that didn't really help." Okay, great. There's more where that came from. Why don't we switch this? Let's try doing it this way. Let's try doing that. That's why I so deeply love that because it'll just push you to the edge of ... We need the Latin root. One of the Latin roots of humility is from the earth. I feel like the clinic for me is the earth. It will humble you, but it will ...

All those humbling things are also the learning opportunities, because honestly, if somebody comes in and I do whatever I do and they're helped, good for them, but I have learned zero at that point.

Whitney Lowe:

Yeah. I want to call attention to this too. You've made a couple references to Table Lessons, and want to go back there for just a second for people who may not be aware of that. You've got these, it's two volumes now, is that correct?

Doug Nelson:

That's right.

Whitney Lowe:

Yeah. Wonderful book that you did, or books now, called Table Lessons, where you were describing and illustrating some of the things that you've learned over the years from being in the clinic with so many people. One of the things that I really gained a great deal from your approach in writing this book was this wasn't a group of lessons to say here, do this, follow this particular protocol. You often left these, the books were a collection of clinical scenarios, and you often left them with a question mark at the end.

Tell me a little bit about that in terms of your approach of how you framed those, and what kind of things did you learn from the process of putting all that stuff together?

Doug Nelson:

Yeah, I think in some ways, Whitney, it was being reflective about some of these experiences, both the successful ones, but also, there are many in there that are difficult experiences, things I could have done much better. I think it was a way for me to personally reflect on all those things and hopefully, deeply embrace those lessons in myself and share those with other people. Oftentimes, in teaching, you might say something that is a very important principle. People would come back to me, often years later and say, I remember the story you told about a client where that principle was in play.

I don't think without that narrative context, they would have remembered the principal, which is the whole goal. Our brains are kind of wired for stories in that way. But the goal there wasn't to like, here's the story, here's the answer and you know who did it at the end. It was about, it's really just the process by which we struggle with these things in the clinic and sharing that process with people. I found that-

Whitney Lowe:

Yeah, I think, that contextual learning of seeing the content that you want to kind of get across to people in the clinical environment and seeing the very nature, we often talk about the clinic being messy, because it doesn't follow, often the guidelines and the rules that we're taught when we're in school or our training programs or whatever. And we're like, what the hell is going on here? I think the story is one of the best ways to help illustrate how you get into that and how you get out of it in some of those kinds of instances. That's one of the things that I thought was done so well in those books.

Doug Nelson:

Well, thank you. There's just so many things, and a lot of it comes up just in the things that people will say. You know what? When I knew we were going to do this, and for some reason, I picked up the book, I haven't looked at it for a while now. I just picked up this thing. It was this, the story, it was called, Who Was Assessing Whom? I was teaching this seminar. It was what I call level two, where six therapists come in and we see people together and problem solve and just the struggle. But there are people who have gone through the initial training program, so we're all at a pretty same level.

But afterwards, I saw someone who was one of the people we saw, and she said, "Boy, you can really tell who the different various abilities between therapists and all that sort of stuff." And it's like, it hit me. We go through all this stuff. You and I have talked. We do all these assessments that we do. I think we should remember the client is assessing us just as much as we are assessing them. I was asking her, "So, how do you know this, and what kinds of things?" She noticed when people weren't paying attention?

She noticed when two of the therapists were talking amongst themselves. She noticed when people were ... Their touch, when people were kind of spacing out a little bit or whether they were tentative or whatever. She just went through that. It was like, wow, there's a marker. We think we're assessing them. They're assessing us. I wonder, again, that's a humbling thought.

Whitney Lowe:

Yeah. I think that speaks again so much to the power of that interaction. One of the things that I constantly emphasize with people is there's a tremendous amount of power that comes from, why you're learning all this stuff, why you're spending all this time learning a lot of these details, is this has a whole lot to do with confidence and just the ability to think through problem solving processes, and that has lot of therapeutic power, more so probably than just, do this particular technique with this amount of pressure, these number of times. I think so many of those other things can end up being so much more therapeutically powerful for people.

Doug Nelson:

I think it's about confidence, humility. For instance, I have never driven, I could name a city, whatever downtown LA, or whatever. I've never driven there, but if you said you have to do this, I'll do it. I'll probably get lost, but I'll also figure it out, because I know I have the skillsets to get myself unlost, but I'm not stupid enough to think that I won't get lost. Because if you think that, you're really in trouble. You're really lost when you don't think you're lost. I think, again, those things are really important in the sense that confidence is about that baseline knowledge, those skillsets that you develop, that you can call on in that moment to address the situation at hand, that's really important.

That's why we need to work on those basic skillsets to be able to do those things. I'm so sorry to do it again. I just glanced at my cello. When my teacher, so I'm like three years in or something like that. Anyway, I'm not very good, but some of the basic stuff that ... God, it was boring and I wasn't all that great, I got okay with it. Then I started playing the Bach prelude. Guess what? Some of those things that I really hated are right back in my face again, it's like, oh, I can't get away with anything. That's like, again, do we do that in this profession? Do we work on those basic skillsets so they are so fundamentals that we can call on them in the moment when things don't go as planned?

I have to tell you, it's another table lesson thing, but one of my clients is an engineer. He lives next door to this orthopedist who's just brilliant, and wonderful guy, but a little crusty, just ... He's an orthopedist, right? He's perfect. They're having some single malt scotch, and they're watching training videos that are ... Orthopedist, it's very much, it's engineering, right?

Whitney Lowe:

Yeah.

Doug Nelson:

At one point, my friend, the engineer said to him, I think like 98% of what you do, as [inaudible 00:43:03], I could probably do that. Doc took a sip of his scotch, looked at him and said, "You know what? You're right. Here's the thing. It's the other 2% that matters."

Whitney Lowe:

That's right. Yeah. 

Doug Nelson:

Oh my God. Yeah.

Whitney Lowe:

That's the part [crosstalk 00:43:17] for too.

Doug Nelson:

Exactly. It's all good until it's not good. That's what we work for. That's why we develop those skills. When the bus starts to move off the road a little bit, you have the skillsets to bring it back on the road. That's just true in every aspect of life and in different others. Why wouldn't it apply to this? 

Whitney Lowe:

Yeah. I saw a cartoon once that was about a similar kind of analogy. It was about a plumber going to a bank and giving the bank manager a bill for $400. The bill was itemized, $5 for tapping on the pipe, $395 for knowing where to tap. It's that sort of thing of the ground that we make around us that I think often gets there. One more thing I want to kind of ask you and tap into before we close up here today, you shared with me an anecdote of an episode one time when you were talking with a group of physicians about your work and about the potential for massage therapy, and I thought there was a lot of really powerful lessons and things in there.

I want to have you share that with our listeners about the questions that, that brought up for you and bring up for us as a profession too.

Doug Nelson:

Oh, I know what you're referring to. Yeah. Every year, I have been presenting as a guest lecture to the University of Illinois Medical School. These are MD PhD program people. I mean, they're total slackers. After I got into the work and to, kind of the background stuff, we did some hands-on stuff, then questions. One of the questions from one of the fourth years was this, are you a representative sample of your profession? Oh boy. He said, "I guess what I'm really asking is, who knows where I'm going to end up when I practice, but if I'm going to refer people to the power and promise of all the stuff that you just presented, what confidence will I have that those people will be able to deliver the goods for my patients?"

Yeah, that's a humbling thought. Because we need people to deliver the goods. We need people with that level of competency, because gosh, I just saw, again, the global burden of disease musculoskeletal, it's just getting ... The need is greater every year. The need for what we do is amazing, but we have to meet that need. We have to have the skillsets. We, as a profession, need to do that. We have to rise to the occasion. Guess what, Whitney? It's not about us. It's because it's needed out there. We have the potential to do that, but potential is not reality, and permanent potential is not a good thing.

How do we, as a profession, rise to that to meet the need that's out there? That's a question that, some very broad question, but one that as somebody who's been in the profession for a long time, I want to see this profession continue for generations to come. It's been my whole life, and it's something that is just deep in me as a passion, but I want to see it generations to come because I believe in what this has to offer society at large.

Whitney Lowe:

Yeah. That story had a big impact on me because it really, for me kind of reinforced, when you get to those days that are just difficult and you're in the grind and you feel like you're pulling a locomotive up a hill and it's just like, are we ever going to change the educational system and all this kind of stuff? These kinds of things helped me get back to that feeling of understanding, this is why I keep doing these things. For me, this really goes back to a lot of the very early times when I kind of, early in my career, had a existential crisis about what I was doing in this field and what it was supposed to be about.

And I realized, after kind of sitting with this for some time, was like, I do have a bigger mission overall. My mission really is about helping to heal pain in the world. It just happens to be that massage therapy and massage therapy education is the tool or the vehicle in that respect, that I'm going to ride to help get us there. But I really think this is a good lesson for everyone in terms of understanding the why behind, why do you go to the effort of spending money on additional educational practices? Why do you put forth greater effort to try to be better?

And that's because you're needed. You are so badly needed out there, and you can bring absolute life-changing reflections and changes to people that will make a dramatic difference in their quality of life, and that has so many different impacts on other things in the world too.

Doug Nelson:

Somebody asked me kind of what you started with Whitney, is about being in the profession for so long, and what would you say to someone starting. I would say, remember why you started the journey, because there will be days when it's going to be really, really difficult. Goals will fall by the wayside in those moments like, oh, forget it, this is ... But if you are deeply connected to the why, as you say, you got behind all this and what your mission was. That same thing is for me, I feel like there's so many people who fall through the cracks of health care, and we have the potential to serve that niche in a way that no other profession, quite in the same way, can do.

That is a mission that when I'm just tired and exhausted and feel like Sisyphus, as you said, it's like, get over it, buddy. This isn't about you. There's a bigger mission at hand, and that will keep you going.

Whitney Lowe:

Yeah. Wonderful. Well, Doug, I look forward to any day that I get the opportunity to chat with you, and this has been delightful to sit here and go through some of these things. I know we could go into this for hours and dive deeper with it here, but for our listeners, tell us a little bit, where can people learn more about you and your work? I know you told us a little bit at the outset, remind us again, where we can find you and find more about what you're doing.

Doug Nelson:

Sure. The website for Precision Neuromuscular stuff is pnmt.org. My email is doug@pnmt.org. Again, Whitney, thank you just, again, for everything that you've done, for the profession you've done, so much for the foundation, but just contributed in ways that the profession owes you a great debt for everything that you've done, and it's deeply appreciated.

Whitney Lowe:

Well, thank you, sir. Thank you. Thank you for sitting in the chair opposite me here today. Great to have this chat here with you.

Doug Nelson:

My pleasure.

Whitney Lowe:

We'd like to also say thanks to our closing sponsor for this podcast. ABMP is proud to sponsor the Thinking Practitioner Podcast. ABMP membership gives massage therapist and bodyworkers exceptional liability insurance, numerous discounts, and great resources to help you thrive. Like their ABMP Podcast available at abmp.com/podcasts, or wherever you happen to listen. Even if you're not a member, you can get free access to Massage and Bodywork Magazine, where a Til and I are frequent contributors, and Doug is as well, and special offers for Thinking Practitioner listeners at abmp.com/thinking.

Thanks again to all our sponsors, and especially to you, the listeners, for hanging out with us on the show today. If you will stop by our sites for show notes, transcripts, extras, links to like the things that Doug mentioned, I'll put some links in there too, to his books so you can find those there. You can find them on my site at academyofclinicalmassage.com, and also on Til's, at advanced-trainings.com.

Please do send us questions or things you'd like to hear us talk about. You can email us at info@thethinkingpractitioner.com, or look for us on social media. You can find till under his name, Til Luchau, and also me under my name, Whitney Lowe on social. If you will also, rate us on Apple Podcasts, as it helps other people find the show, and you can hear us on Spotify, Stitcher, Google Podcasts, or wherever you happen to be listening, and please do share the word and tell a friend. 

Of course, if you're unable to fund us on any of those locations, you can always grab an orange Frisbee and put it on your parents' old 45 RPM turntable and you can listen to us there. So, we'll see you again here shortly. Thanks again for listening, and do some good therapy.

 

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