Episode 132 – Bodywork and Grief (with Ronna Moore)

Summary

In this episode, we delve into the intersection of massage therapy, grief, caretaking, and end-of-life. We touch on global palliative care practices, the role of touch in support for those experiencing grief, navigating sensitive conversations, and creating safe spaces for clients. Our guest, Ronna Moore, a massage therapist with over 40 years of experience, specializes in oncology and palliative care, and is pursuing a doctorate in public health focusing on the role of massage therapy in palliative care. Join us to gain insights into shifting therapeutic mindsets and exploring practical resources to support those experiencing loss.

Key Topics

01:19 Guest Introduction and Personal Connection

02:08 Exploring Grief and Loss in Massage Therapy

03:43 Understanding Palliative Care

05:22 Palliative Care Practices in Different Countries

23:16 The Role of Touch in Therapy

35:18 Role-Playing Therapeutic Conversations

36:46 Navigating Grief in Therapy

37:48 The Importance of Sensitivity

38:10 Avoiding Unhelpful Phrases

39:12 The Paradox of Comfort

40:15 Shifting the Therapist Mindset

47:05 Creating a Safe Space

50:01 Understanding Grief Models

54:46 Resources and Final Thoughts

Episode Transcript

Til Luchau

Nice to be here with you, Whitney. Nice to be here with you, Ronna Moore. Thanks for joining us.

Whitney Lowe: Yes, indeed.

Ronna Moore: Well, thank you too, to Til and Whitney. It’s enormously what feels like a bit of a privilege speaking to you because I’ve listened to you both for a long time and pod, TTP is up there in my top five podcasts I listen to.

So, it’s lovely to be able to contribute. Yep. That’s a compliment.

Til Luchau: You heard one of our episodes, Whitney talking to me about the passing of my wife and the process I was going through around that a few months ago. And you shared your, some of your perspective and some of your work. Can you tell [00:02:00] the listeners about yourself and about your work? What we’re talking about today.

Ronna Moore: Yes. that’s right Til and Whitney. I heard that Podcast and as I said in my response to you, I found it very touching and but also it was a kind of an invitation I suppose because I do work in the field of grief, loss and grief And so I, I suppose I took a risk a little bit in sharing with you some work that I have done with a colleague of mine, Dr. Sarah Fogarty, around massage therapy in the context of loss and And Sarah comes to Loss and Grief from a different perspective than me. She works primarily with pregnancy and childbirth. But my work as a massage therapist over 40 years has, led me towards, particularly in the [00:03:00] last decade, decade or so working in the field of oncology and palliative care.

And working in palliative care, you inevitably encounter loss, grief, death, bereavement. And about five years ago, I decided to reconnect with academia, if you like, and went back to university and undertook some postgraduate coursework in palliative care. And I’m midway through a doctorate in public health, investigating massage therapy in the context of palliative care.

Til Luchau: Tell our listeners what palliative care is and where you’re doing this.

Ronna Moore: Okay, so palliative care is an approach to care, and it has a fairly recent history, I suppose. It really came [00:04:00] to, to life, so to speak, in the 1960s, from the UK Cicely Saunders was perhaps one of the progenitors or founders of the concept of palliative care, and there are lots of other people as well.

There’s Balfour Mount in Canada. even, George Engel’s work with the biopsychosocial concept around just that as a model of care. So palliative care comes from the word palliare, and palliare means to wrap or embrace. And I think that’s a rather nice notion to keep in mind because it really is around wrapping around a person who has received a potentially life limiting diagnosis.

And, The, concept is to provide symptom management but also to take into account all the other aspects of a person’s life, [00:05:00] psychological, emotional, spiritual, social, and Within a multidisciplinary team, work to, or bring together as many resources as possible to support a person, who is living with an illness.

Yes. With the potential of that illness will cause their death. Palliative care in Australia is somewhat different. I think there’s a few iterations to palliative care in the Western world. The most recent model of palliative care is to introduce palliative care as soon as possible after a person has received such a diagnosis.

And whilst it may be that palliative care might be in the background, it’s nevertheless there. ready, if you like, to step forward when curative treatment starts to be withdrawn, if you like. But palliative care can be provided whilst curative treatment is still in place in Australia. [00:06:00] I think it’s a little bit different in the United States my understanding with doing some work with Cindy Spence, over a couple of years ago, I understand that once a person in, in United States has entered a hospice, one of the conditions of that is that they no longer receive curative treatment.

I’m not sure. Is that correct? You might have an

Til Luchau: In terms of the insurance coverage, that’s correct, yes.

Ronna Moore: Yeah, that’s it. I think that’s what I meant more around the financial aspect and unfortunately health care is tightly bound to the financial resources to support it. But in general terms, palliative care embraces the concept of total pain and it neither seeks to hasten nor prolong death.

It is interesting, the interesting features of it are that it is multidisciplinary by almost by definition because if one would not expect that any one clinician could be [00:07:00] able to support a person across that whole broad spectrum of issues and needs. and the other element of it, which is, Folds into the relevance for us on the topic today that we’re talking about today is that the unit of care in palliative care is the person with the illness, but also Their informal caregivers, and this is usually not always but usually a family member Could be a spouse, a child, a parent, best friend.

And so the attention is provided to that person. How is that person coping, managing, what support can be given to that person in order for them to help the person who is living with the illness. 

Til Luchau: That was, if I could just jump in with my experience there. Yeah, that was, there was a stark watershed moment in my process with my wife.

And unfortunately it is either you’re getting [00:08:00] curative treatment, in her case, chemotherapy, radiation, et cetera, or you’re in palliative care, which is about, symptom management and quality of life perhaps, and. Comfort. Those kinds of things. And in a lot of people’s minds, it’s about the end of life and dying.

Ronna Moore: Yes.

Til Luchau: And so it’s a big, the either or moment was a big one for us.

Ronna Moore: I’m sure that must have been a really hard transition to traverse. And Til, can I just say I really appreciate your curiosity and your courage, if you like, to enter this topic from a sort of in somewhat an abstract way. Um. in order to serve other body workers and therapists really.

And, I really deeply appreciate that. But I also would like to really say to you that [00:09:00] from, from my point of view, being the age I am and being on this planet, I have experienced significant losses, but they are mostly distal, they are not proximate. And I’m not making an assumption that for Whitney it might be similar, but for you it isn’t.

So if there are things that we, that, that we talk about, that you find perhaps a little bit too uncomfortable please. Take care of yourself and do whatever you need to do for that. I’m sure Whitney and I can power on in some form or another if you need to stay for a moment. But I just wanted to really say that.

 

Til Luchau: Yeah, thank you for that. Thank you for that permission, but also for the acknowledgement and reflection. I appreciate that. Honestly, I have a lot of energy for this topic now. How do we all as humans deal with loss and grief and then, you know, Bridging it into the work I do with Whitney, how do we bring those questions, gifts back to the profession and [00:10:00] all of us as practitioners, we’ll deal with that with ourselves, but also we walk in our door all the time.

Ronna Moore: Absolutely. Yeah, you two are educators. I’m not an educator. I just a- I have intellectual curiosity, but I’m also a human being and, and, and a therapist. So, we are all invested in what we’re talking about. Yeah. So just to say

Til Luchau:  I want to go back for a minute too and underline what you said about the unit of care in the palliative approach being the patient and the support system.

Because it was, and again, the stark difference we ran into was it was really hard to get information or even help thinking through quality of life questions around the treatments. There are many treatments that were offered and the oncologists and radiologists and everybody were really good at what they did and had them.

Lined up, you know, for us as one stopped working, the next one was ready. But the [00:11:00] question of at what point are the side effects or the, the suffering that came along with those treatments greater than the benefit was not one they were willing to go into. And they were quite clear about that. I was really, I was, I respected Our oncologist just said, no, I, I cure tumors and those questions about when is it worth it or what’s, you know, those aren’t my specialty.

I don’t, you know, I’m going to refer you to support services for that. But that was a clear demarcation. And so take care. Engage when it finally was the moment where Loretta says, okay, palliative care. that’s the next thing she decided to stop treatment. That’s when it was for her. Uh,

Ronna Moore: It’s really unfortunate that we do have these tendencies, don’t we?

In so many ways to, to create silos and and, and clear demarcations and there’s, I can understand that because one can’t really [00:12:00] expect an, well, I think the bottom line is that we, we would want our clinicians all and want of us all to be human enough to recognize that nothing is as simple as just this one thing.

You know, it all flows over into other elements of our life. And certainly with treatments I didn’t, I didn’t respond really well enough to say where I work. So I actually work in a cancer setting. So, so it speaks to me what you’re saying, Til. I work in a hospital in a cancer setting and I also had in the past I’ve worked in hospice and in community based specialist palliative care.

So I think there is a shift it’s small, but it’s there that there is more consideration around the whole person. You know, just about every. Every health service I know has a mission statement saying person centered care, but that hasn’t really, I think, well translated [00:13:00] yet. 

Til Luchau: Well, what’s interesting is I see it almost as a paradigm divide.

As a medical practitioner, you’re about curing things. You’re about fixing as if you’ll have it or getting rid of the symptoms. And then at some point when that’s no longer possible or the costs of doing it are too great, there’s another perspective that comes in. I think that’s what we’re here to talk about.

And what’s interesting as body workers or massage therapists, we often work with people through that whole process. And so the questions for my wife and me were up certainly, you know, how do I live well for her? How do I live well as well as I can, given the treatments I’m going through for myself?

How do I get the support or care I need? Those are certainly there before we formally entered palliative care.

Whitney Lowe: I’m curious too about, you speak a lot about you know, the, the sort of systems process of getting other people that are in, association with the person that you’re in primary care with, you know, sort of having communications with them, bringing them on to be a part of this process [00:14:00] and in sort of the massage therapy world where we are So much of what we’re doing is really just that one on one, in the one treatment room with that person without talking with other family members, let’s say, or something like that.

But we know those things are really important in terms of, you know, what we’re doing. You know, how is a person getting support at home? I’m just curious, do you have any like suggestions or input about how do we, how do we make a better connection with that individual and their, their, their bigger ecosystem of the things that they’re grappling with outside of, of our interactions with them?

Ronna Moore: Yes, it’s, it’s difficult. I’ve been blessed because I have actually been embedded in, in multidisciplinary teams all the time that I’ve worked in pall care. So I am, if you like, a worker surrounded by people who are all invested in working together in collaboration. And there’s no doubt that that is the case.

The that would be the exemplar of, of support, not only for people with life living illnesses, but for any illness or any injury, you know, that wraparound approach. So [00:15:00] I think massage therapists, because we are slightly on the edge of you know, we, we kind of traverse that health professional personal care service.

A domain. And as long as I’ve been a therapist, this has been the case lately. I think there has been a shift to, integrate massage therapy more into a health professional way of thinking. I know the work at heal well, for example, who, and I know you’ve spoken to Cal and in the past, and they are working extremely well with advocacy around, Ushering massage therapy into the settings that we can contribute in a team, in a team way.

So therapists, I don’t know what it’s like in the United States, but most therapists in Australia have solo practices. You know, they’re out there working in the, in the community possibly doing mobile services, but certainly, [00:16:00] in home clinics, that’s the predominant model. It’s not the only model.

but, for those therapists, if they have, uh someone they work with for a long time, and this is the kind of thing that might happen, is that the person is diagnosed with a serious illness, they may support that person, Whatever that looks like in the early stages of the illness and then maybe with that person all the way until the disease starts to progress and Then they become seriously unwell and the therapist may still be there, but they might be isolated And I think the only way to overcome that is to get a little bit bold and start making connections ourselves, because it’s unlikely, from my experience, health professionals I think we all tend to be a little bit defensive around our field.

I’d like it to stop, but it’s there. But [00:17:00] I think we need to advocate for ourselves and we can, we can As long as we have clarity around what we are doing, what we are doing with our patient or client, what we what we can offer, we have to have clarity around that and be able to articulate that in a way which can be received and understood by the health professionals we’re aiming to connect with and reach out to them.

And I think we ought to also. Or to get into the habit, if you like, of cultivating options for referral in our practice, even if we’re working in a solely MSK field, multiple scoliotal framework with injury rather than illness, even then I think we, we ought to, as therapists, try to establish relationships with other health professionals as a matter of course.

You know, be a little bit pushy, you know, sending letters, explaining what we do, [00:18:00] And just to set up those lines of communication because it can be an isolating experience working on your own. Um and I don’t think it’s particularly the best way to work for our clients. I think, you know, there’s much to be gained by, deepening communication with other health professionals involved.

And just about everyone we see will have a suite of health professionals in their lives. You know, whether it’s a dentist or a podiatrist or a physiotherapist, whatever it is, that is, is I know in my own life, I think to have a whole. panel of people taking care of me in some form or another. And whilst none of that is intense or critical at the moment, it may be in the future.

And if we’ve already established the connections, it’ll make it so much easier.

Whitney Lowe: Mm hmm. Yeah. Great. Thank you.

Til Luchau: Well, let’s take a step back for a moment. And maybe this question belonged up front. [00:19:00] And that’s, how is grief and loss even relevant to the practice of massage therapy? I mean, certainly when someone comes in and says, I’m going into palliative care, or my partner, son, relatives going to palliative care, that’s a clear sign.

Yes. But is, is it, Is there a bigger application that we should keep in mind as we think about this, about how grief is relevant to massage work?

Ronna Moore: Well I think, yes, the answer is, yes there is Til, because I think it’s the human experience, loss is with us in every aspect of our lives really so we are accumulating or experiencing losses all the time whether it’s lost kids.

That may seem insignificant, but the physiological response is really at base the same as for really significant losses. So I think when we think about [00:20:00] people coming into our space for some support, therapeutic support as a massage therapist, to keep in mind that it is possible this person has sustained a lot of losses through their life.

They may have sustained really significant losses. They, they may not share those with you. They may They may have come to you for that reason, but it’s more likely that, they will remain hidden. One of the paradoxes, if you like, of, being a massage therapist or body worker is that if we focus on establishing, cultivating a really good therapy, a relationship, then we invite sharing.

So it’s quite possible that even though the person has come to us without any intention whatsoever to share the fact that they have recently lost their mother or, you know, lost their job or whatever it might [00:21:00] be, a significant loss it may emerge. So, I think we need to be, as health professionals, I consider myself a health professional, I do work in health settings, so I feel comfortable to do so, that our main, main goal is, as we know, is, is not to, cause harm but I think, keeping in mind that all humans have the potential to be carrying losses and being attentive to that and alert to that without necessarily focusing on it, without even really probing.

And I don’t think that it’s what we’re going to be doing, but allowing the potential, allowing the possibility that loss, significant loss might arise. And I think that is an absolutely key element of being a therapist. It’s, it’s similar to trauma. I think we need to assume that people are. I never like assuming anything really, but I think we need to have in our mind that people can come into our [00:22:00] space carrying a lot and, just be Be attentive and be prepared.

I’m not sure what that is.

Til Luchau: I think I would go for your use of the word assume because I’m gonna, I mean, dealing with my own process, it makes me notice how universal many of these principles are to all kinds of loss. Yeah. And that I, As you know, practitioner in the field for 40 years had been dealing with loss and grief the whole time as a practitioner with my clients without it all being spoken could be the inherent loss of aging, loss of ability, loss of possibility, loss of options and future dreams.

But I think people are bringing those to us all the time. And like you said, not necessarily naming them or speaking them or labeling them. There’s something about what we do. That helps.

Ronna Moore: Yes.

Til Luchau: The potential to help.

Ronna Moore: What is that? That’s interesting, isn’t it? But I think you’re quite right, Til. There was something that I’ve just, it’s just slipped [00:23:00] out of my mind then, but I can always find something else that’s floating around in my mind.

I think there is something fundamentally distinct about what we do as body therapists. 

Til Luchau: How does it, what is distinct and how does it help what we do? 

Ronna Moore: well I think it’s to do with sort of the most obvious thing I suppose is that we touch people. And to touch people automatically has a, a sort of a double meaning in a way if you like.

Yeah. Yeah. Because When we said, like I said before, Til, your, your podcast touched me. So, you know touch is such a powerful phenomenon for human beings. It’s one, as you, obviously it’s one of our major senses and it’s I don’t know that, you know yeah, I think it was very interesting during the pandemic, the response to, we had quite a lot of lockdowns here and there was a, a very big focus [00:24:00] on separation and loss of touch or not being able to touch, not being able to hug people, not being able to be in contact with people.

It was quite interesting really because it brought a focus to touch, which I think touch is in a way has been sort of the core. the poor, cousin of the other censors. Not always Yeah, not always appreciated. So we are in a position that, there are a few other people do. Hairdressers certainly touch people from the shoulders up.

Til Luchau: And hear about problems all the time from the, that’s right

Ronna Moore: away because they’re creating this little bubble of you know communication, which is private and, or relatively private depends on how busy a salon is, can be a very interesting place to be sometimes to hear other people’s conversations.

But generally speaking, that’s right. Psychologists. Psychologists only, only a [00:25:00] small band of psychologists are able to touch their clients. Somatic psychotherapists, people who do HAKOMI for example, these invite touch. even people, I speak, I see people My cancer, my cancer clients, patients that I work with will often say, but they didn’t even look at me.

They didn’t even touch me. So they’ve gone to see their physician and the physician’s got the panel up there with all the bloods and scan results, et cetera. So they are, they’re interpreting those. scans to give information about the person that’s right in front of them and not making contact with that person.

There’s a lovely you, TED talk by, I think his name’s Abraham Verghese. It was, I think I’ve got it right. That’s in the echoes somewhere back in my head. He did a lovely TED talk about this very thing, about the, the, the [00:26:00] withdrawal of touch in ordinary in ordinary life. And What we do is we, and there’s two things about what we do we touch people, but we, it is also welcome touch.

It is touch to which people have automatically consented. You know patients that I see have had lots of things, done to their bodies that required touch, instrumental touch, if you like, and it can, as Til may well have been, may be well aware, a lot of that is brutal. And it means people have to brace themselves against that touch.

I don’t do deep tissue work very much anymore. Occasionally I do. If it’s, if it’s might be beneficial, but the touch that I tried to offer to people I work with is [00:27:00] without without resistance. It’s, it is designed to be a connection of comfort and pleasantness. You know, the, the definition of pain, these, the new definition says unpleasant or pleasant really just boils down to that.

So what I’m invested in is in pleasant touch because the pleasant touch is where we can talk to the nervous system. And that’s, in my mind, that’s what I’m doing. I’m doing my absolute best to talk to that person’s nervous system. And and

Til Luchau: To say comforting things with your hands.

Ronna Moore: Absolutely. Yeah. And, it’s all about all about, it’s, It’s about in, in the context of grief and loss, I think what we’re hoping to do is help a person if there’s grief and then there’s grieving, if you like, where the goal is really Not to fix [00:28:00] anything, we’re not going to make people better, if you like, but we may cushion them while or be, yes, help to cushion people while the grieving is happening.

And I think that’s the best we can ask for and it’s not much, but on the other hand, it’s a lot.

Til Luchau: So, yeah. That’s, that is a lot. I mean, you talked about this kind of inherent defensiveness we might have as a profession. And I think it’s often around this question. Are we making things better or are we just, in quotes, making people feel better?

As if making people feel better isn’t as valuable as some change in some of their dimension, which it’s easy to fall into that in this situation. We’re not going to rub the grief muscle and then the grief will be over. It reminds me. What is missing, I mean, what is missing in my case are, is, touch, literally witnessed and tracked, paid attention to. All those things happen in this context we did.

Ronna Moore: Yeah.

Whitney Lowe: Yeah. I’m curious to hear also about your, your take on this, because this is one of the things that, that frequently I grapple with this question, trying to find an answer to it, because so much of, I think, what makes an individual so valuable in a healthcare team working with somebody is, is oftentimes that degree of compassion, that degree of, of empathy that they can exude toward the other person’s experience.

And so much of that skill. Really comes with life experiences for so many people and we have an increasingly large number of people entering our profession now at 19 years old and 20 years old with very little life experience and a Person often comes in for massage and maybe doesn’t know that they’re going to have a really impactful Experience [00:30:00] like this because they haven’t been touched this way before and I think a lot of times these people are a lot less prepared for how to grapple with some of those things.

So I’m just wondering if you have any insights or suggestions about the kinds of things that we might be able to do to help better prepare some of the people who are coming into this work for some of the things that they might encounter.

Ronna Moore: Yes, Whitney, this is difficult, isn’t it? Because I think we are all, as massage therapists, we’re mad on techniques.

You know, we want to know how to do stuff to people. But I think certainly the longer I’ve been a Doing this work, the more I realized that yes, the technique techniques, of course, you know, that’s, we need those techniques, but it’s less about that than who we are as a person. And somebody coming straight out of school to, to become a massage therapist.

They don’t have life experience. That’s right. They haven’t been through a rollercoaster, [00:31:00] of loss and recovery and life coming and life treating us badly, if you like, and moving forward, they haven’t had those experiences, but I do think that there is a role for Teaching. There are some teaching things that can be, can be done.

I’ve, I’ve I’ve done a lot of work, if you like, when I say done, I’ve, you know, a lot of professional development around this very topic. compassion cultivation training is one. Stanford has a really great program, the CCT mindful self compassion teaching. I am actually a mindful self compassion teacher.

I think having an understanding of empathy and what, What all the iterations, how empathy can show up communication styles these can be taught. And I think there can be some investment in those, [00:32:00] elements of being a person who can be who can bring their whole self, to the work. And feel safe and comfortable to be there because I think we, of course, carry our griefs and losses with us.

And even a person coming out of school will be, will. so how do we, how do we fold those in to being a person who can be just be with? Suffering, you know, it’s yes. I think people have been around a while may have some some advantages, but not maybe.

Til Luchau: I mean, I’m making faces here because just in my recent experience, there was such a range of responses and it was really clear to see.

Not, you know, not to see necessarily, but to sense who had dealt with loss on [00:33:00] their own. And just to stick up for 19 year olds for a minute, it doesn’t really, it wasn’t related to the years of life at all. And you know, it’s who we are as people. And in that context, let’s say someone just out of school dealing with someone who’s bereaved and overt about it, open about that, they’re getting life experience right there.

And I would want them to be able to have a conversation with someone like you. Rana, someone like you, Whitney, about, gosh, what, what, what I say, what should I say? What would go on? What would help right there? Yeah. To grapple with those questions is often how we get there. experience at any age.

Ronna Moore: I think that’s right.

And Whitney, I’m really, because your last podcast I listened to you on ABMP was around education and new models of assessment and competency. I’m not describing this well enough, but it occurred to me at the time, I thought now how in this, in this way of [00:34:00] changing how we educate therapists, how can we fold in the These elements we’ve been talking about.

Because there’s problems around that, because I don’t know that we have skilled teachers in the area. I know Heelwell are doing fabulous work in that space. They spend a lot of energy well informed energy on directing our attention to the importance of presence. Communication you know, the whole suite of things that enable us to be.

The therapist that we want to be. So, it’s a challenge to you, Whitney, really, because, How you know Yes, we have to, it’s really important, but, it is not paid attention to enough. I did the weirdest thing with which was really in, in, A learning [00:35:00] experience was meant to be when it turned out to be, when I was doing a post grad in Palcare we had a whole series of, of lectures on communication, therapeutic communication.

And there is quite a lot of literature out there around therapeutic communication. but what we did as an activity is to We had actors come in and they played roles, if you like, and we went over and over again, different kinds of conversations. And the first one that I had with, professional actors are amazing and the first one said, well, when I was approaching her to say I was coming to give her a massage, she was a patient and she said, well, why would I want a massage?

You know, you’re not going to fix me. You’re not going to help me. Like this whole barrage that’s completely invalidating, you know, what I was trying to bring. But these are, these are real [00:36:00] conversations that people can have. They might not come out of their words, out of their mouths, but they might be thinking them.

And you know, how do we respond? So I think there is benefit. education around these issues because you can get better at it. There’s no doubt that we bring our personality, our temperament, our life experiences. We bring all those with us, but there are ways that we can actually develop mastery in therapeutic communication, in therapeutic alliance. We can learn this.

Til Luchau: Can we get specific? Like, do you want to name any things you’d love to see therapists either doing or not doing in those contexts when there might be grief in the room?

Ronna Moore: Oh, well, it’s really hard, Til, because I think what we learn in the literature around loss and grief is that whilst it’s a universal experience, it is completely [00:37:00] individual.

It’s like your own fingerprint. The way you grieve, and there was a really interesting I can’t remember which website, it is an American website. It’s quite a useful resource, but they conducted, they did this kind of mini little survey where they asked people to send in the things that people said to them when they were, had lost someone in their life, someone significant.

What did people say to you that was helpful and what did people say to you that was unhelpful?

And the interesting thing was when they got, and was quite helpful. Quite a lot, like it was in the thousands, I think, responses that sometimes they appeared on both sides.

So for some people that was a helpful thing to say and for some people that wasn’t a helpful thing to say.

So I think this is where delicate, delicacy or a sensitivity is really important. We, we need to follow the lead of the person in front of us. We need to [00:38:00] be open to whatever arises. We need to be totally there and totally present, but as for things, look, I think there is one thing, and I have done this myself.

Actually I’m ashamed to say, not that long ago, I came out with a phrase, which I think is very rarely going to be helpful, and that is to say to somebody, at least, someone has lost somebody, and you say, at least, and it could be, at least you have five other children or whatever, if they’ve lost their sixth child.

I mean, I can’t imagine, I don’t think there is any circumstance in which that is an okay thing to say. It’s just completely unhelpful. I did do that. and I know why I did. Because I was rushing, I was running late on the ward, and I wasn’t in myself, you know, I hadn’t really prepared myself, I had really, [00:39:00] Yeah, I was discombobulated, I was dysregulated. Mm hmm. So, I understand it, it was unforgivable, although I have forgiven myself.

Til Luchau: Well, here’s the paradox. We, we’ve said that what we offer is comfort, is making things feel better. And yet in our interactions, when we want to make something feel better by saying something, it’s almost guaranteed to be the opposite effect.

It’s the most helpful, the most helpful thing. And I’ve done my own personal study around this. I mentioned I think with you Whitney, taking this stack of sympathy cards. And going through them and analyzing them to myself and saying, what did this person, how helpful was this and why and you’re absolutely right.

It could, there’s not a magic formula, there’s not a protocol, there’s not a technique, but it was something about being willing to be in the pain with me. Yeah. And not offering, not even offering something to try to make it [00:40:00] better because. And inadvertently what happens then is the message can come through like it’s basically not quite okay how you’re feeling now and I hope it gets better for you.

Sorry for you that you’re suffering. 

Whitney Lowe: And you had alluded to this for, before or earlier, I’m just curious in terms of, in terms of what Til was saying too, there is just such a, a mindset that so many of us walk into the treatment room with that we’re supposed to fix something. And when something, you know, comes up or happens like that, there is a tendency to think that we need to do something to fix it.

I mean, like any ideas, like how do we get people to kind of get out of that mold and get somewhere different? 

Ronna Moore: It’s very hard because I think people move into this kind of work as a therapist, if you like, even putting the word therapist next to us, we’re automatically setting it up. To think we’re going to be solving problems.

And it’s really it’s [00:41:00] really hard to wind that back. And I think we need to shut up, you know, when we’re talking, when we’re with people. Because mind you, there, there’s been a couple of interesting research projects which show that in that interaction, when people come into a therapeutic relationship, could be physiotherapist, could be massage therapist, there is an expectation of competence.

So you have to find a way to be competent, but In such a way as we’re not yeah, I think we really do have to spend a lot of effort saying that all we’re doing is facilitating change, even if we’re not, even if we’re doing that. I’m, I’m really talking more now, not so much about grief and loss, but with even with injuries.

You know, I think we’re facilitating change in that situation but we’re not fixing things, you know, and I, I just think [00:42:00] we’ve got to stop saying, thinking we’re fixing things. Um. Even

Til Luchau: change, even change implies that something’s not okay.

Ronna Moore: Correct. Maybe, what would it be

Til Luchau: like, what would it be like to say we are highly trained, sensitive companions.

Ronna Moore: Yes.

Til Luchau: In a multisensorial, multidimensional way. Yes.

Ronna Moore: Yeah, that’s beautiful, Til. Yeah, I did this beautiful course called Companioning the Dying, and the amicus is a word for companioning. And to be an amicus, which is really to be beside someone. You know, we have skills, we’ve got resources, I’m, I’m offering them to you.

And that’s all.

Simple.

Ronna Moore: It’s really as simple as that. It’s just that the mindset for our work more broadly, it’s, it’s not really like that. It’s not set up like that. You know, we, we have to, we’re meant to have a result. Even the way billing [00:43:00] happens, you know. At least

Til Luchau: in our own mind, and we assume our clients might want that too, but so often what happens when we really let go of that and connect, we both walk away with Richer, fuller, or even more satisfied.

Ronna Moore: Absolutely right. Yeah.

Til Luchau:  I want a listener to send us their business card that says something like, nonverbal grief companion. Yeah. Certified.

Ronna Moore: Yes. That’s a good idea. I might do that. Yeah. Yeah.

Whitney Lowe: I remember, years ago hearing, I think this was a you know, a taped talk that Ram Dass had done, talking about people who were coming to him asking about, you know, how do I get trained to, to do what you do?

And he said, like, you don’t get trained to be like a professional. He was working with people who were dying, I think in, in palliative care. So you don’t get certified as a dier, you know, as a, as a dier person or something like that. 

Til Luchau: That’s just not, that’s not how it works.

Ronna Moore: Yeah.

Til Luchau: Life. Life is our certification.

Our heart is our certification. 

Ronna Moore: It is. I think that’s right. Being human, you know, and recognizing that all, all humans suffer, you know, it’s it is our nature to, to get old. It is of our nature, there’s the five remembrances, the Buddhist ones, I can never get the wording right. But it’s, you know, it is of our nature to, to, to become sick, to be old, to, to And to die and to lose people, you know, this is life.

And I think we, there’s a lot of expressions these days that, you know, we’re a death defying culture. I’m not quite sure. United States. And Australia is similar in, in some ways but not all. I think there are cultural differences to the way groups respond to dying. [00:45:00] And I think that’s a really interesting thing.

I mean, obviously people have been living and dying on this planet for quite a long time. It’s, it’s not something new, but I do think that there is a tendency in maybe I’m not sure whether it’s just the Western world, but I think we are inclined to be so focused on wellness and so focused on positivity and they are, they’re valuable, but they’re not.

All of life, you know, that’s life is, is not like that.

Til Luchau: That’s right.

Ronna Moore: Yeah, I don’t, I don’t know what else to say on that, but it’s just

Til Luchau: Well, and then we, we take in the enterprise of practitioners easy to, for us to fall into the role of the optimist or the hope holder.

Yeah. The one who is offering some sort of tether back to a hopeful position.

But who, who wants to hang out with a cheerleader when you’re feeling really bad? Yeah. Yeah. [00:46:00] Mm-Hmm. . It’s easy for us to fall into that role of the

Ronna Moore: yeah.

Til Luchau: Of that side of the paradox and not remember that sometimes it’s just the whole picture. That’s all we can offer. Are there any other questions that we offer that you wanna make sure we have time to talk about Ronna?

Ronna Moore: Well, I guess my, I, I didn’t really talk about models of Greek very much. And also there’s. I think it’s interesting that massage therapy is, is around the body. We did talk about that a little bit. and I think what can we do with a person? What can we do with our hands? What can we do with our hands?

Our session with someone. I think it is more about being than doing, but there are some doing things as well. And I think I spent a lot of effort. And remember, I’m, I’m not an educator, so I’m talking entirely from my [00:47:00] own experience of what I do. I spend quite a lot of effort making sure the environment.

in which a person comes is calm and steady. And that myself, apart from the example I gave you before that I am calm and steady. And there’s lots of elements to that. You know, it’s about temperature. It’s about the way I use my voice. It’s the way I might talk or not talk. The movements I make around, the room.

Everything. What happens when people have suffered a significant loss is that their brain is disorganized because as we’ve come to know in neuroscience, our brains work on, prediction, you know, predicting what’s going to happen the next moment and being able to move through the world on the basis of prediction, which arises from what we’ve experienced in the past.

So when a person, particularly if you’ve lost someone in your life. [00:48:00] Like Til has, someone who’s living in, in the house with you, there is so much sensory input that you receive from that person. You know, just the sound of the moving around the house you know, the smell they make as they come out of the showers, wafting over you the touch or all those, that whole sensory information is gone and the brain is struggling to, to figure out, you know, what’s going on.

So it’s deeply, um. Unsettling, deeply unsettling. And I think what we can do is create some predictability in what we do. It might be a simple thing, but I think just to anchor, to help to, to anchor ourselves and to enable a person to feel safe and anchored. There’s a, a concept called querencia which is where, if you’ve heard of that.

It’s a Spanish term, it’s a Spanish term for when the, a bull in a bullfight [00:49:00] finds a spot in the, the ring, which I’m not really I don’t like bullfighting, but The bull finds a spot to go to where it feels most protected and safe. It’ll find a spot in that, that arena. It’s cool. It’s the querencia.

And I often think of that, that, you know, I, I would like to cultivate that space for people that come into my space, a space where they can feel protected. Because the world, their, their world is not. It’s not particularly safe or it’s uncertain, you know, the ground is shifting. So for here, right now, with me, all the movements I make are to actually stabilize you in Querencia.

And I think we can all do that as Massage Service, we can all do that. mm, the other thing I really had [00:50:00] wanted to talk about. Which is, are all the grief models out there, but I think they can be really helpful. So if people are interested in, at the abstract models, these are all the, you know, academics that come up with explanations as to what’s happening with people whilst they’re grieving.

I think, Til, you might have sent me, The one about myths, myths, and there is one that I want to address because it’s such a sticky concept and that is the five stages of grief. And I know you spoke about that in your podcast. Should I keep talking or do you want me to stop? 

Til Luchau: Please, yeah, tell us something about that.

Ronna Moore: So, I think that this is really people have that, that five stages of grief. I keep hearing it all the time. It is such a sticky concept, but what’s happened since Elizabeth Kubler Ross came up with that framework that framework was originally, conceptualized for people who are dying [00:51:00] and morphed into people who who have lost someone who is dying and there, there are all sorts of subcategories under each one of those five stages. And there was an additional one, which was hope. But the thing is. It gave the impression that it was a linear progression. I know you spoke about this in your podcast, that it is not a linear process.

It is actually all over the place process and it will find a way forward. but there’s so many other elements to it than, than just the five stages of grief, a couple of the really lovely models that have emerged in the last two Three or four decades, I suppose, are the dual process model and the growing around grief model.

There’s several others, but they’re the ones that I, if you like, turn to, because that’s one of the other things that a massage therapist can do if [00:52:00] they have some, some awareness and maybe some professional development around grief is they can. do some gentle education around this. Just an explanation, you know, a simple drawing, which I do sometimes for growing around grief.

And that one is developed by Tonkin. And it really just says that grief, you draw a circle, it’s a black circle. And it actually, in the early days of one’s experience of grief, you’ve lost someone and grief is just takes over your whole life. It’s right here. It’s big. So even drawing that circle, but what happens as time goes on, the circle does not disappear.

That grief is still there. You actually grieving is the it’s learning how to carry that, I suppose, relearning the world, but learning how to carry that grief. Why would anyone, Stop grieving the loss of their loved one. That’s not going to happen. But what [00:53:00] does happen instead is that life starts to grow around.

So this, you have the black circle and then you have a bigger circle growing and a bigger circle growing as you start to engage in life in a new life, a different life. So I think that’s a really. It’s a great way of just simply explaining to someone if the, because people come with queries sometimes because I work with people who know they’re going to talk about their loss because that’s why they’re here.

So I think some grief education is quite useful. The other one is the dual process model, which means people oscillate between experiencing their grief in all its manifestations, you know, crying, sadness, yearning, all of that. All the things that arise when we, we have lost someone. That’s the grief side, if you like.

And then there’s the restoration side, which it means you have to go to social security and sort things out. You have to learn how to cook. If you’ve never cooked for yourself, you have to learn [00:54:00] how to go to an event. by yourself. These are restoration things and you oscillate between those two and you take a rest from the grieving.

You are not if you like, required to be grieving all the time. Give yourself a break and attend to these. So for listening. That’s how one moves forward, just that, that oscillation between the two. So I think sometimes it can be helpful to have frameworks. I’m very big on frameworks and models.

Til Luchau: I’m going to ask you, we’re going to find some, something to put in the show notes about those for people who want to know more.

Ronna Moore: Yeah.

Til Luchau: We’ll reference something there. That’s, that’s very helpful, Ronna. Thank you. Anything else you want to make sure we touch on?

Ronna Moore: You want to ask me anything else?

Whitney Lowe: No, I would say this has been very enlightening. Again, another, Interesting, perspective on, on this and, and thank you so much for sharing all these things here.

and also do you have, like some other resources or, or things where people [00:55:00] can learn more about what you’re, what you’re doing and offering there?

Til Luchau: There’s so much more I want to ask you. Yeah, but let’s get, make sure that people know how to get in touch with you as we wrap up the conversation.

Ronna Moore: Well, to get in touch with me, it’s probably I can give you an email address. I don’t have a website because I don’t, like, I don’t have a

Til Luchau: Yeah. How to get in touch with you. Like Whitney said, key resources, anything you want to leave people with in terms of how they can find out more.

Ronna Moore: There’s an American website. I think it’s called What’s Your Grief. Which is, I think it’s got some quite nice resources I’ve been in that I have, I haven’t checked recently, but I think it, it, it’s quite a nice resource. There’s lots of literature. If you go into, you know, any bookstore or look online, the grief section is huge.

And this just tells you that, you know. We, we live in. It’s inescapable, you know? 

Ronna Moore: but the other thing I would like to say just quickly is that even though grief is [00:56:00] universal very, most people, most people find a way forward in, in life over time, complicated grief, which is in the DSM as a mental health condition, affects a small portion of people. I think we need to remember that because even though our own griefs, griefs and losses can knock us completely flat, I think we need to be reassured that actually life is worth living. Does offer us, more than loss. Loss is there, but it’s not only, not the only thing.

I think that’s and I think that’s a way of reassuring people. if you do encounter people coming into your, your your space, your therapeutic space, who are grieving and suffering, that gentle reassurance and validation of the way [00:57:00] they are and reassurance. And just saying that. That most people, most people find their way through.

Just to support people. Yeah. There’s so much, so much to talk about in this topic, but I don’t think I have anything else to say today. Oh, there’s a couple. 

Til Luchau: That’s a good piece.

Ronna Moore: There’s a good book by a guy called George Bonanno. It’s more about trauma, but I think it’s he talks about resilience and I think that’s quite a good book.

There’s lots of good books. Lots of really good books out there. I don’t have anything specific, unfortunately.

Til Luchau: We’re going to list what you’ve said so far. And as I mentioned to you, there’s, this is part of a series that I’m interested in doing where we’re going to unfold resources. So don’t feel like you have to be comprehensive.

I mean, you’ve given us a lot about how grief can show [00:58:00] up in our practice room and ways that we can be with it as practitioners. 

Ronna Moore: Very nice to talk to you both. Thank you.

Whitney Lowe: And do remember the Thinking Practitioner podcast is supported by ABMP, Associated Body Work and Massage Professionals. ABMP members, membership gives professional practitioners like you a package including individual liability insurance, free continuing education and quick reference apps, online scheduling and payments with PocketSuite and much more.

Til Luchau: ABMP CE Courses, Podcasts, and Massage and Bodywork Magazine always feature expert voices and new perspectives in the profession, like Whitney Lowe, and I write for them as well. Thinking Practitioner listeners can save on joining ABMP at www.abmp.com/thinking.

Whitney Lowe: And thanks to all of our listeners and to our sponsors.

You can stop by our sites for the video, show notes, transcripts, and any extras. You can find that over on my site at academyofclinicalmassage.com and Til, where can they find that for you?

Til Luchau: Well, I like what you’ve [00:59:00] done with your website. I hope people do stop by and see how clear it is these days. Oh, thank you.

My website, Advanced-Trainings.com. If you have comments, questions, things you’d like us to hear from you about or hear us talk about, just send us an email or record a short voice memo on your phone. Send it to us at info at thethinkingpractitioner.com or look for us on social media. I’m at my name Til Luchau and Whitney, where can people find you?

Whitney Lowe: They can also find me on socials under my name, Whitney Lowe. And if you will rate us on Apple podcast as it does help other people find the show and you can hear us wherever you happen to listen to your podcast, your podcast player of choice. Please do share the word, tell a friend and again, Ronna, thank you so much for joining us with our conversation today.

Ronna Moore: Thank you. Oh, The pleasure is just mine.

Whitney Lowe: All right. Thank you.