An article I wrote just got published in the Massage Therapy Canada Magazine. 
Follow this link to find it, starting on page 19...

http://magazine.massagetherapycanada.com/publication/?m=6443&l=1#{"issue_id":440455,"page":0}

Hope you enjoy it, and please share your thoughts in the comment section.

Reading through my first 3 reflections is an interesting exercise, it brings back some thought processes I thought I had worked through and figured out somehow, but as I read back, more questions pop up in my mind. 

I just had the sudden realization that curriculum is much more fluid and flexible than I ever had thought of at the beginning of this class.  As I wrote in my first reflection, I had a very limited understanding and grasp of curriculum studies when I entered this program.  Through the readings in The Curriculum Studies Reader and getting acquainted with curriculum scholars and their theories, I came to see that there is no perfect curriculum theory that can encompass all the needs of my students and support their learning, but if I combine some of the theories and thoughts, I could  create a flexible curriculum, which might  give me a chance at successfully implementing a style of teaching more adapted to the needs of my 3 courses.. 

I am thinking the difficult part would be to stay true and respectful of the belief system already in place at Langara College and in the Registered Massage Therapy education community.   At the moment, there is a thought that to be a Registered Massage Therapist (RMT) you must be very orthopedically oriented, this involves a rigid set of assessment skills including testing strength, mobility and sensory functions of each patient, almost regardless of why they came into the clinic in the first place. 

We have patients coming into our school clinic with complaints of fatigue and headaches clearly related to their stress levels being out of control, and our students are instructed to do a postural examination, pick a joint and do a full set of testing and range of motion observations and then give a possible diagnosis for this patient.  This makes no sense, we are basically asking the students to force a patient into admitting to a pretend injury or dysfunction, and then diagnose it properly.  All the while, there is a very real patient with a very real complaint that needs attention, but we are creating a situation where our students are taught to ignore this reality.  The students then miss out on a learning opportunity and a chance to truly connect with another human being in a deep and therapeutic way.   

As I write this, I am acutely aware that if any of my coworkers at Langara would read this, they would probably quickly point out how ironic this is, being that I have been hired at Langara College specifically because of my expertise  in teaching the orthopedic content of the RMT program, yes, I admit it, I am the one creating these super orthopedically oriented future RMTs.  Yet I am a firm believer that what I teach is only a small portion of what a Registered Massage Therapist actually treats in a full day’s worth of work, but for some reason, our community of RMTs have glommed onto this section of our education as if it is the greatest and most important component.  There is a belief that the more orthopedically oriented you are as an RMT the higher your value and you become instantly more respected as a practitioner of “true” health care. 

Therefore, RMT education puts a great amount of emphasis on orthopedic teaching, and I teach 3 of the 4 classes dedicated to this subject.

In my experience, which is 20 years worth of clinical work, the majority of my clients are seeking RMT treatments for conditions that are non-orthopedic, mostly stress related like fatigue, headaches, depression, anxiety.  Unspecific pain and discomfort are more common than any of orthopedic conditions I teach.  I rarely use any of the testing I teach my students because they are not appropriate or will in no way help the course of treatment and healing of my patients.

What I truly do in clinic is be there for my patients, listen to them and let them off-load, make them laugh, show them some compassion and allow them to just be themselves for an hour.  They think I am treating their knee, their low back, their neck and shoulders, but in reality I am aiming at treating their battered souls.  Their emotions and stresses are oozing out of their body in the form of physical injury, I can treat their ankle sprain until the cows come home, but if I don’t address their stress levels, I can guarantee they will be back with the same injury within a very short period of time. 

So in short, what I would really like to impart on my students is that orthopedics are great, but not the end-all-be-all of massage therapy.  The lessons they learn in their professional development(PD) classes and in their Pain, Stress and Sleep(PSS) classes will be much more valuable than anything I will ever teach them in my Spinal Orthopedics class.  Yet these  PD and PSS classes are despised by the students, and thought of as a waste of time by both students and a good majority of the teachers.  Teachers are made fun of for being assigned these classes. 

I taught PSS for a few semesters and I loved it, but I did not have enough knowledge to truly go into the subject in depth with the students.  I truly wish I had read Rita Charon’s work at that time, it would have been so helpful, and would have given me the vocabulary and the tools to properly teach subjects like chronic pain, depression and anxiety.  I am not-so secretly wishing I get assigned to PSS classes again in the future… 

Reading and working through Narrative Medicine from Rita Charon has opened a great door for me in my career, both as an RMT and as a teacher.  I had that nagging feeling for years that what I was teaching was not as important as our community of RMTs seem to believe it is, and that there was a greater purpose to our work than joint mobilization and ligament testing.  I unfortunately did not have to words to express these feelings, nor did I have the information to back up these beliefs of mine.  Reading Rita Charon’s work and then digging deeper into her resources and reference books, articles and research, I have been introduced to a depth of knowledge to tap into. 

I have been feverishly reading and incorporating this new information into my world, probably to a point where my coworkers now think I am annoying and way  too obsessed with this woman’s work.  I see this as part of the normal excitement that comes with knowledge acquisition, it’s a good thing, and I am aware it will pass, but hope it will leave a great indelible mark on me, my work and hopefully my students. 

I am trying really hard to impart on my students the thirst of learning, questioning and seeking more from their education that just the basic hands on skills gathering.  Hopefully, my enthusiasm rubs off on them, even just a little bit!

Reading Rita Charon’s Narrative Medicine theories  has been an amazing journey, I have been learning so much and acquiring new vocabulary, which has been helping me communicate with my patients, students and coworkers better.

I have been feeling like I was grasping the information and able to introduce it to my world properly, I made sure I paid full attention to my patients and students, tried to treat them all as singular humans with individual stories and needs. 

Recently though,  I was faced with the harsh reality that I was only good at it because I had not been truly challenged yet, all my patients and students have so far fallen into my comfort zone of thinking and processing information.

This wonderful bubble burst a  few weeks ago, when I received a call from my coordinator at Langara College, she asked me if I would be willing to support a blind student during the introductory to massage course, a 3 day weekend course that introduces prospective students to massage therapy so they can assess their interest in the full program.  This student, let’s call her Ella, had already taken this course a few weeks prior and it had not gone well for her.  The teachers were not properly prepared for her arrival, they had 19 other students and no understanding of Ella’s needs as a blind student.

After Ella complained of her treatment in class, mainly a lack of proper attention and focus, the college decided that she should redo the entire 3 day course, but this time properly supported by a teacher assigned solely to her learning.  I was the one they asked to support her. 

As I came in on the Friday to get ready, I had no real idea of how I would be helping her.  I had thoughts, plans and an overall scheme of what would probably work best for her, but no real concept of how it would all work.  Luckily, I am not one to be too attached to my ideas, because as soon as she walked in, I realized how big this task would be and how uneducated I truly was to the world of the blind.

As I introduced myself to Ella, I decided to let her know that I would have to rely on her to educate me on how she needed to be supported, this is when my education on singularity truly started.  Everything I knew about teaching, all my habits and my go to explanations had to change.  I quickly realized that using visual analogies with Ella would be useless when I asked her:

“you see the scapula?” 

and she promptly replied:

“No”

For the full three days, I had to constantly reevaluate my words and actions.  How to describe a birth mark to someone who has never seen skin color and it’s multiple shades, remembering to let her know when I walk away from her,  realizing that she cannot see the clock on the wall and that I must support her time management with regular reminders.  Learning to teach with my hands guiding her hands, and not counting on my words.  Also accepting that her relationship to her body is very different, she does not see her body, she feels it, so when I tried to teach her proper biomechanics, I had to figure out a way to get her to feel the proper postures and the improper ones, but also let go of my “it must be done this way” habit.  She was fine and comfortable in a very different posture than what I would have chosen for myself.

We finished the weekend with her giving me a card in brail  saying thank you for the support and for making her feel valuable and important.  I was in tears by the time she finished reading me her card.  However uncomfortable in my teaching I was during the weekend, I still managed to make her feel good about her learning experience.  I feel I owe that to my learning through our readings of Rita Charon’s book.  I am not sure I would have been able to pull off such a weekend positively without this learning.

I am thankful for my first ever card in brail.

What does curriculum mean to me?

My theoretical knowledge and experience of curriculum creating and understanding is very limited at the moment.  For the last 12 years, I have been teaching in a field, Registered Massage Therapy schools, which is very regimented in terms of curriculum.  We are bound by the competency document that our professional College, the College of Massage Therapists of British Columbia (CMTBC)  has set out for entry to practice examinations.  All of our students must meet a specific set of criterias in order to be eligible to write the entry to practice exams which will allow them to work under the title of Registered Massage Therapists ( RMT) in British Columbia.  Schools also must prove that they teach each competencies in order to be accredited with the CMTBC, without this accreditation, students graduating from a school would not be eligible to write the entry to practice exams. 

This has lead to RMT schools “bunching” competencies in groups of similar goals or skill levels and then creating classes around this grouping.  When a teacher is assigned a class, they are given the specific set of competencies assigned to that class and number of classes/hours this must be accomplished in.  Most classes are very regimented by the time a new instructor comes along.  When I started 12 years ago as a TA, the head instructor had been teaching for close to 20 years the same 3 courses, he had his ways of teaching and proceeded to teach me the “right way” of covering the material.  Don’t get me wrong, he was an excellent instructor and I am very happy I learned from him, but it did limit creativity and new thoughts.  When I officially took over his classes, I had no experience of curriculum other than his. 

Langara college started an RMT program in 2014, and it was exciting to be part of the start of a program, have a say in how we could set the curriculum with a more productive and student learning focus.  When I received my set of competencies and a vague outline of how I was expected to organize this particular grouping, I was able, for the first time to really look at my material and decide how I could best deliver this information to the students.  I unfortunately had no references, experiences or event the imagination to create anything different from what I already knew. 

Since starting this Master’s program, I have slowly started to change some of my classes to incorporate better teaching methods and more supportive language and instruction for my students.   Already, I am investigating a very different approach to testing and exam writing for my students this semester, and planning to revamp my Septembre classes over the summer. 

I am truly enjoying the readings I have gone through so far and taking in as much as I can to instruct my future curriculum planning.  My hope is that I will find “gems” and a guiding thought to grow my teaching and bring about more critical thinking and integration of knowledge for my students.

The Rita Charron book, Narrative Medicine; Honoring the Stories of Illness, has been transforming my private practice and how I work and communicate with my patients.  I am finding my voice, allowing me to reach my patients at a deeper level than just “where is the pain?”  now I am looking more into “why is there pain?” and “what is behind this pain?”.  I have noticed a change in my patient's’ words and chatter as I treat them, and we discuss the deeper meaning of pain and discomfort.  I also am finding a renewed sense of enjoyment in my private practice since incorporating these changes, I am more satisfied with my relationship to my clients and the results I am getting through my work.

Maybe I am too hopeful or demanding of the class readings, but having no formal education in the field of education, I am really looking forward to some base knowledge to support my work as a teacher, and looking to the class readings as a door to this knowledge.

Up until a few days ago, reading the John P. Kotter, Leading Change,  book has been difficult for me, I am a health care practitioner (HCP), I view people’s health and well being as overriding any other concerns, especially financial and business concerns.  This book on leading change has definitely stirred up some strong emotions in me, frustration and anger mostly.  I can easily imagine the employees’ stress levels increasing as they are being manipulated to produce more for the company. 

As any HCP will tell you, stress is a strong determinant of health, I see it in my clinic everyday, people coming in to see me in pain, unable to function, unable to manage their stress levels anymore.  They tell me their stories, quite often work is the main stressor and cause for their discomfort and pain.   As I read this book, I see my patients, I hear their stories, and I get frustrated. 

Monday, a thought came to me, many of my patients are trying hard to change their lives, most often they want to loose weight, start to exercise more, eat better, enjoy more time with their families and decrease their stress levels.  The majority of the time, they fail at this change of lifestyle and revert back to their old and comfortable habits, however detrimental they may be.  That is when my relationship to this book changed, I finally was able to see past the business applications and understand how this information could be applied to my clinical practice and my teaching.

As an instructor at Langara College, I deal with students constantly being pushed towards change, some can navigate these waters quite gracefully, others go kicking and screaming for the full two years of our program.  

A few weeks ago, I was at a PD day through Langara College, our teachers for this workshop showed us a chart that we could use to understand why some of our students can have such a difficult time and go through an emotional roller coaster while in our classes.  I had forgotten about this chart until our class on Saturday January 28^th where our teacher had a slide showing the emotional reactions to mismanaged change, it was titled “What can possibly go wrong?”. 

The following chart is the one that was given to our group at the PD day, it speaks of 5 necessities to be able to manage complex change effectively.  It also shows what emotions can arise in a person lacking one of those necessities and therefore becoming a hinderance to successfully managing change.  

I now feel I can use the information from Kotter’s book, your slides and this chart to help guide my students and clients through their changing lives.   Helping them see which of the eight-stage process of creating major change they are having difficulty with, maybe their vision is unclear, or they are lacking the necessary skills, or maybe they need short-term wins to maintain their motivation.   A common thread I see with my patients is that they do not incorporate the newly formed habits in their lives fully, they are not part of who they now are, therefore it is not uncommon to see them revert back to old detrimental habits after a short period of success. 

I also really appreciated your explanation of the Johari Window.  A complexity of working as a HCP is dealing with the “unknown” aspect of our patients, that part of them that is also unknown to them yet has a great impact on their health and healing abilities.  I spend a great deal of time trying to explain this concept to my students and how it is crucial to have a good grasp of the fact that most of our patient’s issues will be unaccessible to us yet they will greatly affect our abilities to help the patient.  I have taken the time to draw the Johari Window on the class board this week and went through it with my students, I found it very helpful to bring this concept to life for my students. 

So all in all, I am now aware that I was going through this book kicking and screaming, refusing to accept the information and visualizing how I could incorporate it in my practice.  I was resistant to the change, I had no vision, no incentives and no plan.  Somehow, this past Monday it all changed for me, and I am glad for it. 

How does it feel to be cared for?
In Quebec, your 18th birthday is a big one, you are officially and adult, you are allowed in bars, you can drink and you are finished with High School and have moved on to CEGEP.  It is a big deal, friends and family make a big fuss of you, lavish you with love and attention, humour, gifts and drinks, lots of drinks in some cases!
But what happens if your family is disjointed, ill and absent?  That was my lot, on my 18th birthday, my mother was yet again in a hospital somewhere, my father was missing, he had not given signs of life for weeks, one sister was studying in a far away town and the other was doing her best to make up for all this mayhem, but was overwhelmed with her own life, my two brothers had been absent from our lives for a few years by then, and probably didn't even know it was my birthday.  I had learned by then not to need to much from others, so on that day, a Friday, I was going along my business not to fussed about the fact that it was my birthday, friends had called  and there was some vague plans to try and get together later that evening and celebrate in a bar somewhere.  No dinner, no cake, as far as I was concerned, that was a certainty.
Alone in our apartment around 5pm, I was contemplating going off to the store to start gathering the necessary items for my dinner.  The doorbell rings, I buzz whoever it is in and wait to see who the mystery visitor coming up the stairs is.
My uncle and aunt, there with a cake, some flowers and bags of groceries.  Now these two had opted very early on in their relationship not to have kids, focus on career and be jet setters travelling the world over with no restraints.  For them to show up unannounced bearing gifts was unusual, and therefore even more of a heart warming moment.
Within minutes, my aunt was in the kitchen, preparing an extravagant meal for way more people than I could imagine at the moment, there was laughter in our home, it was magnificent.  My uncle was on and off the phone, contacting all my friends inviting them to an impromptu dinner party.  By the time he was done, 8 people were on their way and we were madly preparing a feast and decorating as if this was a 3 year old's party, streamers, banners and balloons everywhere!
During diner, my friends, uncle, aunt and I had fits of laughter, great political debates and I am pretty sure that we tried really hard to make plans to end world hunger.
It was wonderful, my hodge podge family had come together in the most wonderful kind of ways.
Sitting at that table, I felt love, the kind of love that has no boundaries, no strings attached.  No one was there out of pity for me, they were there out of pure joy just to be part of this evening.
26 years later, whenever I recall that birthday, I feel warmth and light and a smile immediately comes to me. In that moment, I was important, worthy of attention, love, humour and compassion.  I quite often go back to that memory, as one of the best moments in my life. Of course,since then, I have had many wonderful moments, but this one is special, it was unexpected and it came from the most unlikeliest of sources, my aunt and uncle.
My uncle passed away very suddenly 2 years ago, and I still miss him, he will forever be in my heart as the man who brought the party to me!

Mister Van Manen and Phenomenology.
Reading Max Van Manen's article on Modalities of Body Experience in Illness and Health has been an eye opening experience.  I was quite vague on what phenomenology was and how it could help with my field of work, massage therapy.
As a read along, I started to see how this form of research is really needed in my profession.
" The phenomenological approach asks of us that we constantly measure our understandings and insights against the lived reality of our concrete experience, which, of course, are always more complex than any particular interpretation can portray" (Van Manen, 1998)
What I understand from this is that, as RMTs, we need to constantly use critical thinking to adapt our book/science knowledge to the lived/felt experiences from our patients.   A prime example of this would be how to consolidate the evidence from research to real life clinic, for example, research says that we cannot feel or correct sacral torsions, nor can we prove they actually exists, yet in practice, many of us have found that treating as if a patient has a sacral torsion results in reduction of patient pain and dysfunction.  The research purist will say I am fooling my patients and nothing but placebo effect is shown is such cases, but is that realistic?  What about the Human factor?  That invisible variable that no scientific method has been able to measure and has a tendency to discard.
This is where I see phenomenology helping bridging the gap between our knowledge and our lived experience which is so prevalent in Massage Therapy.
Recently I was conversing with 2 orthopedic surgeons and one anesthesiologist, the conversation migrated toward efficacy of physiotherapy post surgery.  All three physicians have been observing that lately, physiotherapy seems to have lost efficacy.  To them, it seems that, in their push towards evidence based practice in the recent years, the physiotherapy profession has lost it's instinct and ability to treat the human being behind the dysfunction.  Of course, all  three admitted that this is just a vague observation, and not backed with actual data or research, but it did bring up questions on how we still have a long way to go with our approach to research and how we use it to improve our professions' efficacy.