The national conversation about culture, race and gender that has dominated our media and attention of late—from Black Lives Matter to a proposed wall between the U.S. and Mexico, to Bruce becoming Caitlyn and some politicians calling for Muslim refuges to be blocked from the U.S.—has highlighted the perceived differences between us, spotlighted the real challenges and discrimination many citizens face, and led some people to call for greater understanding of races and cultures outside each of our own.
As health care providers, called to offer care and nurturance to clients of all genders, cultures and nationalities, massage therapists might consider themselves immune to biases. Yet, we all have biases, according to psychologists including Samantha C. Sweeney, Ph.D., who specializes in multiculturalism in her Washington, D.C., practice, Family Psychological Services of Capitol Hill. Everyone does, she said—including health care practitioners.
“If you have biases or judgments, they happen so automatically in the brain that you don’t realize you have any type of reaction, because it feels natural and it’s what you have experienced your entire life,” Sweeney said. “Part of being a service provider is making sure you are treating your clients with the utmost care and equity—and that’s really difficult to do if you have these biases.”
Bias, or prejudice, according to experts, can develop based on how we have seen cultures portrayed in news and entertainment media, our family upbringing and where we grew up or live currently. (Visit implicit.harvard.edu/implicit/takeatest.html to take tests administered by Project Implicit, to discover your biases related to gender, race, disability, weight and age.)
According to Sweeney, when a person who thinks of him- or herself as free of prejudice finds out that isn’t completely true, the person’s reaction can be one of disbelief or shame—a reaction that can get in the way of working through his or her limitations related to cultural understanding.
“I think that’s why people might stay away from getting to the heart of their own biases—they don’t want to know what those biases are, because they think if they have them they’re a terrible person,” Sweeney said. “That isn’t the case, [and] the important thing is to bring these feelings into conscious awareness.”
Understanding the effects of the subtlest of prejudices, when the client before you is of a culture, gender, race, age, size or gender-identification not your own, will benefit communication and client outcomes, according to experts in the field of cultural competence, an area that helps people become conscious of their biases, and rewire their brain’s responses and resulting reactions.
“Cultural competence is important in that [it helps you] fully understand the client on your table or walking into your office,” said employment lawyer Natalie Holder, founder and CEO of QUEST Compliance & Talent Management Training, which has provided cultural competence education to organizations including Yale Medical School, FOX News, Time Warner, Proskauer Rose and the U.S. Department of Agriculture, among others.
“The better you understand your client, the better they will be able to communicate the issue they are having,” Holder said. “The more the practitioner understands her client, the greater the trust between herself and her client, and the more capable the client will feel discussing any maladies, ailments or other information the massage therapist needs to know about.”
Cultural competence training is in place at many U.S. medical schools and hospitals, said Steven Millerman, president and founder of EMCAY, an advertising agency specializing in multicultural marketing in the mainstream health industry, and such training helps a person understand his or her own culture and how it might differ from others’ cultures, in areas including language and behaviors.
“Just from a customer service perspective, [cultural competence] has a lot to do with running a business, so whether you are a massage therapist or a surgeon, making people feel comfortable, gaining their trust and finding out what concerns are on people’s minds before the visit is important,” Millerman said.
One specific example of cultural competence at play in a health care practice could center on religion or faith, he said, “Especially in the African American and Hispanic [cultures].” A client may say something about relying on faith in relation to a physical challenge, and, Millerman explained, might make a statement such as, “I’ll leave it in God’s hands.” If a client says something like that to you, he asked, how do you respond?
“The key thing is, it’s not a good idea to dismiss that type of response,” Millerman said. “You may want to tell the [client] what they need to do from a clinical perspective, but the last thing you want to say is, ‘That’s not going to work, you need to listen to me.’
“You definitely want to acknowledge where people are at,” he added.
Holder specializes in teaching people how to recognize micro-inequities, such as gestures, offhand comments and body language that can make people feel either included or excluded.
“In a massage session, a micro-inequity might be a comment the massage therapist makes to the client on the table about her ethnicity or cultural identity,” Holder said. “For example, many African American women have hair weaves or clips, so a micro-inequity might be the massage therapist making a comment about that, and eroding trust with the client.”
Practicing massage therapists may take continuing education in cultural competency, or hire a training firm to come into their practice to train employees. Massage therapist Roger Buttrick, who practices in Medina, Ohio, attended diversity training offered when he was still in massage school and employed at an aluminum company. He said it changed how he communicated with people, and helps him today in the massage setting.
Before beginning a session with a female Muslim client, for example, he knew he should ask her if there was anything she wanted him to do in order to increase her comfort.
“She said she only wanted her arms and legs and back massaged, but didn’t want to be uncovered,” Buttrick recalled. “My ability to ask that question came from the diversity training.”
Massage therapists are told, by educators and publications, to learn to speak the language of physicians in order to practice in hospitals; of athletes and coaches to progress in sports massage; and of corporate culture to succeed as on-site therapists—and developing such competence is no different when reaching out to clients of another culture, size, gender, sexual orientation or ethnicity.
Even if you don’t take a formal cultural competence class, you can learn to become more aware of your own biases, and change your reactions, Holder said.
“Practice makes perfect—or, at least, practice increases the opportunity to be perfect,” she said. “But if you are going to stay in an insular environment, you are never going to rewire that muscle that helps you change how you interact with others.”
She suggested attending cultural events that might push your comfort, visiting websites to do research about a group you might not be familiar with, and maintaining curiosity in a way that creates shared conversation. When she meets someone with a prosthetic leg or guide dog, for example, she said, “Before I ask anything about their abilities, I [share] something about myself, [and] I might talk about how I am navigating across the street, so the person feels there is a conversation going on rather than an interrogation.”
As you become more aware of your own biases, reactions and behaviors, dive deep, suggested Sweeney, and beware of political correctness and superficial behaviors.
“Don’t just stop at the surface level of, ‘I have a black friend and a Latino friend and an Asian friend, so I’m good,’” she said. “Continuing your journey in cultural competency is a lifelong thing; it really is.”
Dearborn, Michigan, has a large Muslim population, and massage therapist Melissa Perry sees many Muslim clients in her practice there.
“There is so much going on right now culturally with regard to Muslims, and I think the best thing we can do as therapists is be open and receptive and just know that in the end, everybody is a human being like everybody else,” she said. “They know they are a minority, and they want to educate people about their spiritual culture.”
Massage therapist Paiton Milbourne, who practices just outside Baltimore, in Towson, Maryland, said being in a major metropolitan area means she counts among her clients people from India, Russia and Holland; Christians and Muslims; gay people; and a male client who prefers to dress in women’s clothing. She said the language of professional, nurturing touch is the most important way she communicates with all of her clients.
“They just want to be like everybody else, and relax and get massage,” Milbourne said. “I am here to make their muscles relax and make them feel as comfortable as possible.”
If you practice in a city or town that is home to a variety of races and cultures, yet your practice reflects one particular type of clientele—whether it’s Caucasians, athletes, women, older people, gay men or straight men—why is that? Have you consciously chosen to practice on a certain clientele based on your education and specialty, or is something unconscious and more ingrained at play?
Discovering your own biases and reactions, learning about cultures and races, and improving your connections to and conversations with people could bring more clients to your practice, and help current clients feel even more secure and comfortable. That’s a good thing, because as massage therapists know, under our languages, religions, clothing and customs, we are all simply human—and we all need healthy touch.
Karen Menehan is MASSAGE Magazine’s editor in chief. Her articles include MASSAGE Magazine and “Massage Therapists Launch Fair Workplace Campaign” and “The Purpose of Play” for massagemag.com. She has also edited and written for Imagine Magazine, the Sacramento Bee newspaper and the LIVESTRONG Foundation.