Episode 39: Are You Thinking Critically? (with Ruth Werner)

Til Luchau:

Hi, I’m Til Luchau. AB&P is proud to sponsor The Thinking Practitioner Podcast. AB&P membership gives massage therapists and bodyworkers exceptional liability insurance, numerous discounts, and great resources to help you thrive. Like their AB&P podcast, available at ab&p.com/podcasts, or wherever you listen more about that in a second. But even if you’re not a member, you can get free access to massage and bodywork magazine, where Whitney and I are frequent contributors and so is our guest today, and special offers for Thinking Practitioner listeners at ab&p.com/thinking. Well, my guest today is Ruth Werner. Hey, Ruth, how are you doing?

Ruth Werner:

I’m great. How are you, Til?

Til Luchau:

I’m excellent. Now, Ruth, you almost need no introduction. I hinted you also do an amazing podcast with AB&P. What’s the name of your podcast?

Ruth Werner:

My podcast is called “I Have a Client Who …” Pathology Conversations with Ruth Werner. It’s quite different from The Thinking Practitioner in that it’s just me and it’s quite short. It’s typically around 10 minutes long and people will send me their I have a client who stories and I just unpack them a little bit and it’s really, really fun. So be sure to listen and send me stories.

Til Luchau:

I concur with all of that. You keep it so focused and you make it so relevant and even take time and go back and clean it up with your editing, which sometimes we get to as well. I’m really impressed with what you’re doing there, both your choice of topics and the thoroughness and your concision and all that process. I’m loving that. And then you also have at least one…. more than two textbooks out, like with Books of Discovery. There’s one of those, isn’t there?

Ruth Werner:

Yes.

Til Luchau:

Which one is that?

Ruth Werner:

My book with Books of Discovery is A Massage Therapist’s Guide to Pathology and it’s now in its seventh edition. A lot of what we’re going to be talking about today has been developed from some seeds that I planted in that project.

Til Luchau:

All right. I wanted to talk to you today about your recent article and massage and bodywork magazine about critical thinking. But before we get into that, is there anything else you want listeners to know about you and what you’re interested and who you are?

Ruth Werner:

A lot of people are a little bit familiar with me and my story. My story is that I entered massage therapy in the early ’80s because I didn’t want a job that involved restaurants or computers. And that just seemed like a decent path to go down and I did not anticipate being so fully absorbed by it. And I especially didn’t anticipate being so fully absorbed by the science aspect of it because I spent my academic career avoiding the sciences as hard as I could. I’m a theater major. But when I found myself really connecting with understanding some of the anatomy and physiology, no one was more surprised than me and I take great joy in taking some of those really complex concepts apart and helping people rebuild them into their own versions of those complex concepts. I was [crosstalk 00:03:54]… Say again.

Til Luchau:

I said you’ve been doing this for quite some time.

Ruth Werner:

I have. The first edition came out in 1998.

Til Luchau:

Yeah. I had known about you forever before we finally get to meet… What are the six, eight years ago? But then world pandemics and circumstances thrust you into such a key position, key place in our field, at least in the USA here, where you’ve really been helping us through this time and helping us stay informed and co-leading and digesting what we need to know. So you’ve been really active, I know during this last year, year and a half, whatever it’s been.

Ruth Werner:

It has been a busy time and I’m just so grateful to have had a way to be helpful to people because that’s one of the ways we stay healthy is by finding ways to be helpful to other people.

Til Luchau:

Okay, so critical thinking. This is the question that I’m leading off with. Why would I, as a practitioner, be interested in listening to a podcast about critical thinking or reading an article in massage and bodywork about critical thinking?

Ruth Werner:

It’s a terrific question and I don’t have a great answer to it. I felt driven to explore the topic because of my position as an educator and I work with a lot of educators and I hear a lot of people moaning about how nobody knows how to do critical thinking anymore. That was one push. Another push is I have… One of the hardest things that I do is I am sometimes recruited to be a consultant or an expert witness, or in some other way, associated with litigation cases where a massage therapist has been accused of causing damage. When I have to look closely at those circumstances, of course, the big question in my mind is how could this possibly have happened. I see the consequences of people who are not necessarily thinking things all the way through.

Til Luchau:

That’s really interesting. When these real-life stories that you’re involved in that involve some harm or at least a really difficult scenario that ends up in court, you see a breakdown in critical thinking is one of the themes there.

Ruth Werner:

It certainly can be. It’s not always the case and it’s not always the case in these situations that the massage therapy was at fault, but sometimes it is. It becomes my job to analyze what should or should not have happened. And should is one of those words I use very, very sparingly. But in the context of people getting hurt, it’s fair to do that.

Til Luchau:

Yeah, yeah. That’s why we have no vocabulary maybe for those times. So more about this question, maybe the question is why did you get interested in writing about it and diving into it more?

Ruth Werner:

Well, another interesting thing that happened to me a couple of years ago was… I write a column for massage and bodywork and it’s on pathology. I had run a little bit dry on pathologies to look at. Instead, I wrote an article on specific client accommodations. We say accommodate for medications, or accommodate for bone fragility, or accommodate for whatever. I had since the beginning of my teaching career left that up to the student, the listener, the learner to decide what that looks like for them, partly because I’m not in practice, haven’t been in practice for quite a long time. And when I was in practice, I was only fair at it. I wouldn’t ever call myself a particularly gifted massage therapist.

Ruth Werner:

And so I don’t feel I’m in a position to tell people what they should be doing, but I wrote an article to say, “Okay, let’s analyze what these accommodations really are.” I started making lists. There’s a fairly finite list of specific accommodations. I thought this article would be so boring and nobody would look at it and I would just be filler. It was just something I couldn’t think of anything else to do that time. It ended up being one of my most popular columns. I got a lot of feedback on it and a lot of positive response. What I realized at that point was it’s not that people can’t think for themselves, it’s just that they want a little bit of guidance to get them started. And that’s a really-

Til Luchau:

That’s interesting. Here’s a tangent, by the way, sorry. Here’s a tangent. One of the most trafficked pages on my website, I think it’s like number 3 out of all 100-something pages is the page that lists contraindications. This is like from 20 years ago too. This was like an overly simplistic list that we were handing out in class at the Rolf Institute 20-something years ago. Robert Schleip and I put it together. That’s the one that gets the most search engine traffic over number three, takes a lot of interest. People are looking for that kind of guidance. They want to know, “Tell me what I need to know so that I don’t do something wrong or whatever.”

Ruth Werner:

Right. I resisted giving prescriptive advice for a really long time because I don’t want to limit what people consider as their options. But sometimes just to give some starter ideas about simple things like what’s a good temperature in your room for people who are really sensitive to hot and cold, things like that. I discovered people really, really appreciate. It’s not that they couldn’t have come up with it for themselves, but they really appreciate being prompted in certain directions. That’s another thing that really pushed me to say, “All right, what are the obstacles? Why are people having a hard time thinking for themselves, thinking independently? And… Go ahead.

Til Luchau:

So, for example, like how to make accommodations for a client condition, but even like how to set the temperature in the room. You’d like to help people think about those questions as opposed to giving them recipes, prescriptions. Yeah.

Ruth Werner:

Exactly.

Til Luchau:

Okay. Love it. So that got you interested?

Ruth Werner:

Yeah. And so-

Til Luchau:

And you just wrote a big article about it-

Ruth Werner:

I did.

Til Luchau:

… and interviewed a bunch of people and did a fun video of that, but also did a really thorough, I thought, job of breaking it down. I got to say, though, I’m a fan of both of you, but also of the topic. But I hear a lot from colleagues, students, this is like daunting or even makes me nervous. I’m giving voice to this hypothetical practitioner. It makes me nervous to have to think everything through. Can’t you just give me some steps to follow? It all seems so vague.

Ruth Werner:

Yeah, it is vague. One of the things I discovered when I first sat down to try to figure out how to convey ideas about critical thinking is that there is absolutely no agreement on what that means.

Til Luchau:

What critical thinking means.

Ruth Werner:

Yeah, what critical thinking is. The guy who ran the Critical Thinking Institute said, “Critical thinking is thinking about thinking so you can think better.” There are actually some tidbits within that little soundbite that are useful. But that’s just a little clever one-off. It’s not actually that useful.

Til Luchau:

Well, no, it’s not useful. It doesn’t tell me how to do it, but I’m just thinking about that for a second. But what you’re saying there is that it’s actually some process of reflecting on how I’m thinking, or how I’m making decisions, or how I’m deciding what I consider true, or what judgments I’m making, [crosstalk 00:12:55].

Ruth Werner:

Yeah, and what you just said… The word you just said, Til, that I honed in on the most in this was the reflecting part. It’s not that hard to come up with a pretty simple statement. Critical thinking is using facts to make decisions. Okay. Cool. Actually, that’s not complete because if we don’t then look back and reflect on whether that was successful, then we’re not achieving the goal of critical thinking, which is basically to deliver at least in the terms of a clinical setting. For me, the goal of critical thinking is to be able to deliver safe and effective massage therapy so that our clients have a good experience.

Til Luchau:

I think I got the reflection piece from your article and it just resonated with me. That’s one of the distinctions you made. You said it does involve stepping back and looking at having some self-witnessing capacity to understand how I am making the decisions, I mean, whether it’s like where to start my session, or what to focus on, or even how warm to have my room. It’s not just the decision that’s involved in critical thinking, it’s understanding how I make that decision and what might be involved in that.

Ruth Werner:

Yeah. We don’t have to analyze every tiny bit, but I have developed some basic kinds of steps. Do you want-

Til Luchau:

No, some just like doing that, but no, you’re right. That’s one way we make it less daunting is to realize, “No, we don’t have to analyze every single step.” So every little piece, but you have some steps you’re saying?

Ruth Werner:

I do. I have some basic steps that we can just walk through because as we continue this conversation, then we can talk about where people might get hung up or stuck.

Til Luchau:

Yeah. I want your steps. I love them, but let me just squeeze in one more question first that I could. Let me try it. How would I know if I wasn’t using critical thinking, I wasn’t thinking critically?

Ruth Werner:

I think there are some good answers to that. One would be your client’s not getting better. You’re not moving, you’re not helping your client move toward their goals.

Til Luchau:

Yeah, okay. Which-

Ruth Werner:

But another is-

Til Luchau:

Go ahead.

Ruth Werner:

You get more-

Til Luchau:

Sorry, I’m bookmarking that mentally because you said two things, client not getting better and client not achieving their goals, which is still related to your first step. But anyway.

Ruth Werner:

Right. Yeah, we have to remember whose goals we need to be addressing here.

Til Luchau:

I’m jumping all over you because I’m excited here about this. So what other signs would there be that you would let me know-

Ruth Werner:

Oh, the other that I think is true is that you get bored. If you’re not keeping yourself mentally engaged in your work, then everybody’s getting short-changed, you and your client, both.

Til Luchau:

Getting bored, losing interest.

Ruth Werner:

Yeah, doing the same thing, doing cookie-cutter things. Truthfully, I don’t think probably that most listeners to The Thinking Practitioner are people who do recipe-based massage, but there are 300-

Til Luchau:

It’s nice of you to say, but go ahead. There are what?

Ruth Werner:

There is something like 300,000 massage therapy practitioners of various titles in the United States.

Til Luchau:

Yeah. Okay. I’ve heard that number too. And then we have a lot of people that don’t identify as massage therapists, other sorts of manual therapists as well.

Ruth Werner:

Yeah. All right. So let’s broaden that. Some of them do recipe-based sessions. And if their client or patient is not making the progress that they are looking for, that doesn’t always change people’s approach. And to me, that’s a big lack of critical thinking that leads to poor outcomes.

Til Luchau:

Yeah. This is such a central question to people’s development in terms of mastery in their craft, how do we really get the results that mean something to our clients and sustain us through the years or decades of practice. But also as educators, how do we help practitioners use the information we give them in a way, like you said, it’s not cookie-cutter.

Ruth Werner:

Wow, that is the hardest question for me as in [crosstalk 00:17:27].

Til Luchau:

Yeah, right. Well, and then it goes back to my start, which was at the Rolf Institute. Rolfing had this deep paradox of being a recipe-based system, but imbued with some principles and this dialectic, this kind of tension between those two points of view, are we following protocol, or are we extracting and applying the principles was really a fundamental schism in the whole subculture within the rolfing world and led to… rose big part of it. One of the early political splits that was happening when I was teaching my first class there were basically some of the senior teachers wanted a one school, some state another school, and it was a big crisis for the community. But it was around this question, should we be sticking to the protocol, or should we be-

Ruth Werner:

No matter what.

Til Luchau:

No matter what. And if you’re not getting the results, it’s because you’re not that good at the protocol yet. [crosstalk 00:18:22].

Ruth Werner:

Or there’s something wrong with your client.

Til Luchau:

Perhaps. Yeah, maybe. That was one point of view. And the other point of view is, well, should we be educating people in critical thinking or applying the principles behind the protocol so they could understand it? They both had really compelling and passionate supporters. This is a personal one for me too. Anyway, I’m distracting from your steps. You got some steps.

Ruth Werner:

Yeah. So the first step, in many ways, it’s the hardest one, which is to identify what the question is. And partly, that’s hard because we may come in with an implicit bias that our client… because this is our target market, that our client is coming in for relaxation. And that is often the case, that the goal or the problem or the puzzle is I just need to relax. That’s a great goal, but it may not be enough information on which to base a strategy. The other thing is… Go ahead.

Til Luchau:

Oh, I’m sorry. Even if you’ve named that, I think you’ve gotten farther than a lot of people do, or at least so many times when people come to me for supervision or even on our social media forum where practitioners are bringing cases in, so many times the questions that come have skipped that first step of why is the client coming. They go right to like what do I analyze and what do I work on so that I can fix it? We don’t even know yet why the clients there and what they consider to be the issue.

Ruth Werner:

Well, and even the term fix it is problematic for me. But yeah, we have to… I mean, this is my paradigm. That’s another thing I should say about this, Til, is what I’m sharing here is Ruth Werner’s pointy-headed filter about what critical thinking should mean in a clinical practice?

Til Luchau:

Is that what you titled your article, by the way?

Ruth Werner:

No.

Til Luchau:

That was my guess.

Ruth Werner:

But I talk about my own bias throughout because we cannot step outside of our own bias. What we can do sometimes if we’re careful is recognize it and acknowledge it. My bias, which I am recognizing is the therapeutic relationship must start with the client’s goals. And the client’s goals and the therapist’s goals may not be the same. The sooner you realize and recognize that, then the sooner that conversation needs to happen. It might be that the client’s goal is to have fewer headaches. Of course, you need to work on my head and my neck and the therapist may say, “Yup, I want to help you have fewer headaches too and I see some other things in your body that might be contributing to these.” There needs to be a meeting in the middle so that-

Til Luchau:

That’s right. There’s at least an episode around that question of client goals, our goals, negotiating those, finding alignment, et cetera. Is that the essence of your first step, you identifying the question?

Ruth Werner:

The essence of the first step is figuring out what the challenge is. Another thing to bear in mind, especially with long-term clients who we work with over a number of sessions or a number of years is that those goals will change over time. Today it’s my jaw hurts and six months ago it was my hip feels weird. Those goals will change over time. The second step-

Til Luchau:

I just got to… Sorry.

Ruth Werner:

Go ahead.

Til Luchau:

I was going to say one more thing about that because I’m-

Ruth Werner:

This is awesome.

Til Luchau:

I am so passionate about this first step, especially there’s… If I don’t know what I’m focusing on, how am I going to know if I did it? If I don’t know what the client wants out of it, how am I going to know if they’re satisfied? It’s so tempting when I know a lot of analysis or assessment to jump right into that and look for, say, the movement thing or the structural thing maybe, or even the pain thing and think that’s my target when I haven’t even gotten a sense yet of what the client considers to be the disturbance. I’m fond of saying I work on disturbances, I don’t work on movement patterns, pain patterns, or structural patterns. I help people with their disturbance. I want to know like what’s bothering them.

Ruth Werner:

And that word bothering is really important. The idea of bothersomeness is now used in research about dealing with chronic pain because there are some circumstances where pain is just not going to go away, but what can change is how bothersome it is.

Til Luchau:

That’s right.

Ruth Werner:

Yeah, this is why I think the first step is sometimes the hardest one is delving into what the client really wants to have happen, both out of the session today and out of their relationship with you as a whole because those aren’t always the same thing.

Til Luchau:

Okay, then your second step.

Ruth Werner:

Okay, second step is identifying the relevant variables, right? It’s figuring out, “Okay, so now I know what we want to do is help Ruth with her headaches.” I’m not having headaches, but let’s just say. The variables that will feed into that will be things like how much sleep do they get? What kinds of meds do they take? What are their day activities of daily living? What are some structural postural things that might be a part of this? This is speaking from my pathology hat, what other underlying conditions might be contributors? Those are identifying the relevant variables. And within that, we need to be good at figuring out where to get useful information. And that’s like a whole different thing, information literacy.

Til Luchau:

When I read that in your article and to hear you talk about it, I think about that as I want to identify all the possible contributing factors or contextual things that might be part of this disturbance, what might be playing into this in giving the… You’re saying relevant variables. But yeah, what might be givens or circumstances or contributors to where we are today? What’s happening right now? Is that fair?

Ruth Werner:

Yeah, I think that’s totally fair.

Til Luchau:

Okay.

Ruth Werner:

Yep. The next step is really something that needs to be done all the way through, but I just stuck it in here because it seemed like a good spot, which is to challenge assumptions, to go back and make sure we really understand our client’s goals and we haven’t misinterpreted that according to our own bias, to make sure that we go back and we really have gathered the key information that’s going to help us make some decisions. Checking on assumptions is something that we need to do, follow through.

Til Luchau:

No, I like it. On a practical level, that sounds like just active listening, repeating it back to make sure that we see the nonverbal signals of agreement that, “Yeah, I got it now.” Are there other practical ways to apply that idea of challenging my assumptions?

Ruth Werner:

Yeah, absolutely. in the second step where we’re trying to gather information, we may only gather information from the resources that agree with us. So, for instance, if I’m living with chronic headache and you want to figure out some things that you might put in your strategy, it’s a use… This is where evidence-informed practice comes in and we look at what the evidence says, what does the research say? it might be that there are aspects of my headache or aspects of your work that are a great match or a less great match. We don’t have to make this stuff up all on our own. A lot of work has been done for us that we can use as a stepping off point. So when we challenge assumptions, to me, what that means is look at what other people have done to see if there’s something we might not have thought of that could be useful. Does that make sense?

Til Luchau:

It makes a lot of sense to me. Yeah, it makes a lot of sense. I’m just thinking as a practitioner, I’m obviously… Sometimes I actually do this now that I say it. But I’m not going to say, “Hey, hang on a second. Let me Google that, what you’re telling me and see what the evidence says about this.” Sometimes I’ll do it in that moment, but usually I’m doing that between sessions.

Ruth Werner:

Well, and a nice thing about this whole process is our experience of critical thinking can grow and deepen as we spend time with people. You don’t have to walk in your first session knowing all the things. It’s going to be long.

Til Luchau:

Or even come up with all of the responses and answers in that first session. Yeah. That’s right.

Ruth Werner:

No, I mean, the most important thing is not to hurt anybody, and that’s the safe part of safe and effective work. But the effective part is growing our understanding and our knowledge through our experience, but also what other people’s experience that will allow us then to bring our best to the table. And then the next step is to then… Now, we’re starting to think about what strategies you’re going to use. You have a whole, say, structural assessment, postural assessment, movement assessment thing that you use maybe to help you create some ideas about ways to help your client. And that’s wonderful. That’s when we start putting those plans together. But within this, we also need to consider alternatives. And for me, the most important question here is what have I missed or what am I leaving out of my ideas that might help this person? Again, that’s something we may discover as we work together over time and things progress.

Til Luchau:

We’ve identified the question, we have identified the variables. Those are steps one and two. Step three was challenging my assumptions. Now, stepping back a little bit, your fourth step, considering strategies, is that the same as my plan? Is that similar?

Ruth Werner:

It’s sort of the pre-planning

Til Luchau:

Why I want to try? Yeah, why I think I might want to try?

Ruth Werner:

Right. And then in the next step, it’s actually making the plan and executing it.

Til Luchau:

That’s step number five? Yeah, okay.

Ruth Werner:

That’s the session.

Til Luchau:

Step number five is making the plan and executing it. Okay.

Ruth Werner:

And that’s all great. That’s awesome, but it’s not finished because, for me, one of the most important parts of this whole business is then evaluating whether what you did was useful or not.

Til Luchau:

Step six.

Ruth Werner:

Yeah, step six and that’s the reflection part. Right?

Til Luchau:

Yeah.

Ruth Werner:

Hopefully, we are reflecting on our process all the way through, but where the rubber hits the road is if what we did helped our client in the way they were hoping to be helped.

Til Luchau:

So here’s where you loop it back to what they were looking for or what you agreed upon that you’re working on. You’re saying, “Did my plan move the dial at all in that way? Did that have some results we want?”

Ruth Werner:

Yeah, exactly.

Til Luchau:

Okay.

Ruth Werner:

And we don’t know that, we won’t know that unless we chart and take notes and conscientiously track progress and update about what our client’s goals are as they move through time.

Til Luchau:

And ask our clients what they’re experiencing.

Ruth Werner:

Yeah, exactly.

Til Luchau:

And ask our clients to pay attention between sessions to what happens and to come back to us and tell us about that. There’s lots of information that we can gather that helps us reflect on our results and loop back and basically test our hypothesis.

Ruth Werner:

That’s precisely it, isn’t it?

Til Luchau:

Yeah.

Ruth Werner:

I think massage therapists with all the goodwill in the world do some of these, but not most of them. I get really frustrated when I hear about massage therapists who don’t take notes or who take really, really cursory notes because they are losing out on the opportunity to really see what their work is doing and their clients are losing out on the opportunity to have better results.

Til Luchau:

Mm-hmm (affirmative), no, I’m with you, I’m with you. Yeah, I’m with you. I’m just thinking of the things I hear back from practitioners and students. It’s like, “It’s hard to know what to write down. Should I write down everything I did? Should I write down everything they said? Should I write down everything I think there’s?” There’s a whole art to that. Note-taking and recording, of course, has been systematized in various ways with some notes and things like that. Also just thinking my own notes tend to be pretty short. It’s usually just a couple of sentence. Here’s what they said or what they presented with. Here’s some things I think it might be and things I tried. And then I actually do make a note, here’s what I want to check in with them about next time.

Ruth Werner:

That’s the P part of the soap notes. Your plan for next time.

Til Luchau:

Plan for next time? Okay.

Ruth Werner:

Or it could be the plan for this time as well. One of the people I interviewed for that article was Diana Thompson, who is the queen of charting.

Til Luchau:

She was our, I think, episode three guest, way back when… Yeah.

Ruth Werner:

One of the things that she talked about with her own note-taking is how that time, that experience of sitting down and reflecting on the session reveals to her a lot of what her strategies really were. You can walk into a room saying, “Okay, based on everything I have figured out about Ruth and her headaches, I think she’s going to need some special focus to this part of her body,” and mid-session being guided in another direction because that seems to be yielding some better breathing or some better responses or however you want to track that.

Til Luchau:

So tracking, noting the places I want to investigate more because of responses I saw or investigate more. The other note that I make for myself, I don’t know if this fits in your steps, is really what do I want to go learn more about? What do I want to research now because [crosstalk 00:33:47] mentioned something that I don’t know about? I got to go check out Ruth Werner and see what she says about it, for example. Great. Okay, so those are your steps.

Ruth Werner:

Those are the steps. I put this out here not to say this is what every massage therapist needs to do and exactly in this order at all.

Til Luchau:

Oh, is that a recipe?

Ruth Werner:

That’s not my intention. My intention is to provide a starting place so that maybe people might be a little more systematic in the way they approach problem-solving. Our listeners, the readers of the article, whoever, may come up with entirely different ways of thinking about this process. But I think the steps are going to be more or less identifying the problem, figuring out what’s going to go into solving this problem and then seeing if you did it.

Til Luchau:

Yeah. What hesitancy, reluctance, or even objections do you hear about this? I can help if you don’t have your own list but-

Ruth Werner:

The main objection that I run into is people just not engaging, not feeling like this is something that is meaningful or important. When this article came out, I expected to hear a lot back on it and I have heard nothing.

Til Luchau:

Okay. Let me make it up then because I know what you’re referring to, I think. Certainly, I hear things that I can put in that category. For example, here’s a hypothetical hesitant reader of your article who says, “I just prefer to work intuitively. I don’t want to think about it so much. I don’t want to have to make it so linear. I’m actually more of a holistic person, anyway. I get a feeling for stuff and that works out really well.”

Ruth Werner:

Yeah, that’s a great one. I have opinions on intuition and I think you and I, Til, probably don’t completely agree about it.

Til Luchau:

Okay. Go for it. Let’s hear it.

Ruth Werner:

For me, what intuition is, is thinking really fast. When your hands are on someone and even I as a pretty mediocre bodyworker could put my hands on someone and then feel drawn to where they are wishing my hands would be. Do we call it intuition or do we call that a combination of my experience that most people really wish that they were being touched around the superior angle of the scapula? Am I sensitive enough to feel difference in the density of the tissues and that’s what’s going to draw me there? I am inclined to go with the latter, that I’m not just drawn intuitively to where people want my hands to be. It’s that this is a combination of several factors, including long experience.

Ruth Werner:

It’s not by accident that intuition gets better with experience. It’s because we’ve learned some things to anticipate, but we have to be open to intuition being incorrect. In situations where clients are dealing with complicated health issues, being driven by incorrect intuition is not just not that helpful. It could be potentially problematic. It could create problems. And so I’m-

Til Luchau:

Just so I know that I’m tracking you, the way I would know my intuition was incorrect is by, one, yeah, might be causing them problems they didn’t have before, or they might not be getting better or getting the results they want.

Ruth Werner:

Yeah, that’s an example.

Til Luchau:

All right. So you’re saying that intuition in your view is knowing something really fast, putting together really fast and based on experience probably and-

Ruth Werner:

Experience and sensitivity that we don’t always process in a conscientious way. So when you put your hands on somebody’s back, you can feel where the tissue is dense and where it’s less dense. If you put your hands on somebody’s knee, you can feel the difference in the quality of the tissue and where you feel invited to offer a little more pressure.

Til Luchau:

Okay. I’m curious, though, why did you think we didn’t agree?

Ruth Werner:

Well, when I asked you… In our interview, I said, “Til, let’s talk about intuition. What do you think intuition is?” You said, “Intuition is…” I actually have your quote. It was so fast. It was like instant. It was, “Intuition is knowing something without knowing how I know it,” or it was very similar to that first-

Til Luchau:

Knowing without knowing how I know.

Ruth Werner:

Yeah, knowing without knowing how I know.

Til Luchau:

Good. You’re right. Right.

Ruth Werner:

Maybe we are in agreement, but my interpretation of that is knowing something before I know how I know. But if you go back and look at it, you can figure out how you-

Til Luchau:

You can do it too. Sure.

Ruth Werner:

… got from point A to point C.

Til Luchau:

No, I don’t think we disagree at all. And that can happen really fast. My definition for myself and maybe… is a sense of knowing without necessarily a deductive process about it that I was aware of. It’s what you’re saying about the conscientious, you said, process of getting there. I may not be aware of that, but there is a sense of knowing that I often get. I’m not going through six steps to get there. I just got it. I feel it. Like you said, it was a direct sensory experience. Sometimes I feel something, but sometimes I just get a sense as well.

Ruth Werner:

Okay. Well, and my argument is that the more we become aware of how we come to that knowing, the more accurate we’re going to be, the better… You can call it intuition, or you can call it thinking fast, but the better we’re going to be at it if we analyze how we start.

Til Luchau:

Okay. So you’ve this hypothetical person that says, “Hey, I’m not that linear with my stuff. I just feel it and do it.” You’re saying you’re going to get better if you can analyze how you got there?

Ruth Werner:

Absolutely. I will stand behind that all day long. There’s decision paralysis, where you overanalyze and overanalyze and that interferes in your being able to be present and responsive in the moment with your client. And that’s a problem, that sort of going too far. Do you mean analytical part?

Til Luchau:

Overanalytical and… Yeah, that’s maybe something behind the daunted response. I am just daunted by having to analyze this complex situation my client’s giving me in any kind of systematic way. Why don’t you just lay down and let’s do something to see if it works.

Ruth Werner:

Yeah. But we want to make sure that that let’s do something is going to be safe. As we explore and test hypotheses-

Til Luchau:

There we go.

Ruth Werner:

… which is the essence of doing science, we’re going to get better at bringing our clients at solving the problems that they have asked us to help them solve.

Til Luchau:

Yeah. Well, yeah, the essence of doing science is forming hypothesis and then testing it. Even for those listeners who are not identified science fanatics, like you and me, I think it’s the essence of a self-teaching cycle that we do as practitioners. It’s the essence of staying on track with our clients. Don’t you think? It’s the way we know that what we’re doing is relevant as we go along. It’s that reflecting cycle all along the way.

Ruth Werner:

Yeah. And so I appreciate you’re saying that because I want to say to our hypothetical listener who is not crazy about the linear analytical approach that could be interpreted here is that this framework of identifying the problem and figuring out how to help our clients as they work on solving this problem that is holistic and the steps are just a starting place to make sure we’re covering some important bases. When you put it all together, it’s really three-dimensional because we need to challenge assumptions, we need to try to identify our biases, we need to reflect on whether we’re being effective all the way through the session, but also all the way through the therapeutic relationship. And to a certain extent, I mean, all the way through all the things, all the way through our life.

Ruth Werner:

When you and I had our interview, I looked back and saw it was on January 11th. I asked you, “What do you think critical thinking is?” And you said, “I think it’s one of the most important…” I think you said the word problem, facing our profession and our world today. I was reflecting on that because it was right after the 6th of January and we’re all still reeling about the effects of miss and disinformation.

Til Luchau:

Right. And shared realities and disparate realities, trusted sources and distrusted sources and all of those implications there. Yes.

Ruth Werner:

Yeah, yeah. And so these principles about making decisions based on reliable and trustworthy and complete information, that sounds simple. It’s not simple, but it’s so important. Now when it comes to helping your client with headaches or knee pain or whatever, that’s a little more closed and uncontroversial. But when it comes to making decisions about, “All right, well, CDC changed their guidelines about masks. Now, what do I do?” It gets a little more complicated. There’s a bunch of variables to weigh into that.

Til Luchau:

Yes, that’s right. And then that is so topical or timely to what’s happening in the world and it’s so complex in a sense too because there’s so many questions around sources of information, how do I know what to trust. There’s so many questions around implicit bias, but also, say, cultural perspectives and-

Ruth Werner:

Here are some important ethical and legal questions too about are we allowed to ask if our client has been vaccinated, or is that a violation of their privacy? Are we allowed to defer treatment of a client if they haven’t been vaccinated? Those are complex questions that don’t always have simple answers. And so we have to come back on critical thinking. What are the variables that feed into my decision about using masks or not using masks, about being vaccinated myself or not, about creating policy about vaccinations for clients or not? And some of those variables are things like what the law says.

Til Luchau:

Right. And maybe the fact that we have different opinions sometimes than our clients too or even different realities, different sorts of information, different worldviews than our clients.

Ruth Werner:

Right.

Til Luchau:

Okay, so then we challenge our assumptions, we consider our strategies, we plan and try something, we check it out, see if it worked.

Ruth Werner:

Exactly. Well, this is our repeating theme today, isn’t it? It’s that last reflective piece that I think makes the difference between critical thinking being effective and it just being an intellectual exercise.

Til Luchau:

Okay. I think we’re winding down, but just on the way out, what do we know about developing this? Is this a skill or is it a style? Is it a personality style? Am I just like a more left-brain person who likes to analyze stuff, or am I just a more right-brain person who would rather feel something and go for it, or is it something that people learn or is it… What is it?

Ruth Werner:

Yeah. In the people that I interviewed, I had different opinions about whether critical thinking can be taught. I think some people are more comfortable being linear and analytical and other people are more comfortable being three-dimensional and holistic. There’s not a value judgment on either side of those. My opinion, just my opinion is we really get the best benefit out of getting the best out of both of those approaches, that it is possible to be analytical and holistic. It is possible to be driven by compassion and critical not in the sense of saying bad things about people, but critical in the sense of analyzing carefully strengths and weaknesses in our approach.

Ruth Werner:

I don’t think that those things have to be exclusive of each other. An interesting problem and one that I have not begun to address for educators who ostensibly try to teach or at least demonstrate critical thinking practices is how to evaluate it, how do you evaluate someone’s ability to do critical thinking? Especially in a massage setting, that is… If we’re going to agree that teaching critical thinking is important… Let me take a step back.

Ruth Werner:

If we’re going to agree that doing critical thinking, the ability to think critically about clinical decisions is an important skill for massage therapists to have, then that seems like something that needs to be addressed in their education. If we’re going to address it in their education, that means we need to be able to evaluate it. The problem with educational models is that the easiest things to evaluate are yes, no, true, false, multiple choice, black and white questions. And that critical thinking does not lend itself well to multiple choice questions. Ask me how I know.

Til Luchau:

Ask me how I know and also my ability to reflect on how I decide things.

Ruth Werner:

Yeah. Yeah, how do we evaluate that.

Til Luchau:

That’s what we’re talking about, I think. The application that you’ve chosen in our conversation in your article is really how does this apply in a manual therapy session to client considerations? How do I decide as a manual therapist what I’m going to do and how do I track the results of that on the way?

Ruth Werner:

Right. The textbook, A Massage Therapist’s Guide to Pathology, the subtitle is Critical Thinking and Practical Application. In order to really fulfill that, that was where all of this began was I wrote a short piece that was a germ of what became this article in massage and bodywork laying out why it’s important and how it can be applied in a practical setting. And then I have examples or exercises where that might be applied in every chapter. But I think anyone could take a sample client, like the guy that I created, the fictional person I created for the article, who is someone who has knee pain and he really, really doesn’t want to have surgery and so he wants to see if massage therapy can help. It’s not that complicated. It’s as complicated as you make it basically. But there are some tangible steps to get people started on the process of thinking about what, A, how can I help this person, and B, how can I know of my health is successful? How can I know if what I’m doing is actually achieving that goal?

Til Luchau:

That’s great. Give us the full name of the book again

Ruth Werner:

A Massage Therapist’s Guide to Pathology, published by our friends at Books of Discovery.

Til Luchau:

Right. We’re going to get to their sponsor announcement in a minute, but we’ll go ahead and put a link in the show notes to that title, et cetera. Well, okay. Are there ways I can assess my critical thinking abilities? Is there any assessments or interesting methodologies around that?

Ruth Werner:

I have not been able to find great resources about the assessment of critical thinking skills. I think for me from the point of view of a bodyworker, a manual therapist, a bodywork practitioner, some of those assessments are going to be based on what am I learning every time I work with somebody? Am I open to learning new things? Am I open to being surprised? That was a big point that you made. And are they getting better? Are they getting the results that they hope for? And am I still interested in my work?

Til Luchau:

Nice, nice. I like it. Am I still interested in my work? Does my work still light my fire? That’s a sign that I got it going on at least in this domain we’re talking about. Critical thinking is one word for it, but we’ve covered a lot. We’ve applied it and we found ways that it’s really useful and clearly relevant to what we’re doing. Well, do you think of yourself as a linear thinker or a holistic thinker, or right brain, left brain, et cetera, upper, lower, middle, or back front brain, whatever you prefer? Well, what would you leave us with? Any further thoughts? I got that one more question about applying, but any of the further thoughts you want to make sure we cover?

Ruth Werner:

I think I’d just like to reiterate that it’s not an either or kind of situation. I think that critical thinking and intuition are not at odds with each other. I think that linear thinking and holistic thinking don’t have to be at odds with each other. We really reach our best when we focus on the things that each of those processes, each of those paradigms or points of emphasis have to offer that fit together.

Til Luchau:

Nice. What homework would you give somebody that was interested in refining this, or what awareness practice? What’s something that people can do if they want to go further with this?

Ruth Werner:

What I would love, Til, is if people would maybe take this practical application exercise that’s in the article and apply it to-

Til Luchau:

By the way, that’s page 60. I’m looking at it right here in massage and bodywork. What is this? The most recent issue, May, June 2021 at the time of recording. Yeah, we’ll put a link to that in the show notes as well. They’re going to take your sample of critical thinking, practical application exercise and-

Ruth Werner:

Yeah, and plug in any client, maybe someone with something simple to start and see what that process looks like, because I bet that most of those steps are in place. You’re just not recognizing them. The more you recognize them, the better you get at figuring out where you might be leaving things out, figuring out where your bias might be limiting your point of view.

Til Luchau:

Moshe Feldenkrais, “It’s hard to do what we want if we don’t know what we do.”

Ruth Werner:

Right.

Til Luchau:

Yeah.

Ruth Werner:

Yeah, exactly. Another thing I’d like to invite is for people who look at this process and say, “That’s nuts, that’s crazy, that’s crap. Here’s how I do it,” because I would love to see that. That’s an open invitation to contact me with your version of critical thinking because I think this is a discussion that could go a lot further.

Til Luchau:

Cool. How would people do that? How would people contact you?

Ruth Werner:

Best way would be through my website at www.ruthwerner.com

Til Luchau:

That in the show notes as well. Anything else, any other resources you want to name on our way out here?

Ruth Werner:

Would love to just point people toward my growing library of online, one hour, self-paced continuing education courses. They’re inexpensive. They’re really good. Right now, I have one up for helping people get caught up on latest information about COVID-19. The next one that’s going to go up on probably next month will be a massage therapist’s guide or a massage therapist’s introduction to pharmacology. I’m building a library of those. So would love for people to check them out.

Til Luchau:

Ruthwerner.com.

Ruth Werner:

Yep.

Til Luchau:

Fantastic. Well, thank you, Ruth.

Ruth Werner:

Thank you, Til.

Til Luchau:

Good conversation. Nice to catch up and nice to develop some more here for myself, more understanding about what you’re writing about and what you’re thinking in terms of critical thinking. Such an important and seemingly complex, but actually pretty fundamental topic to how we work and how we learn.

Ruth Werner:

I agree.

Til Luchau:

All right. Our closing sponsor, Books of Discovery, who published the book you mentioned before, has been a part of massage therapy education for over 20 years. Thousands of schools around the world teach with their textbooks, e-textbooks and digital resources. In these trying times, this beloved publisher is dedicated to helping educators with online-friendly digital resources that make instruction easier and more effective in the classroom or virtually.

Til Luchau:

Books of Discovery likes to say, “Learning adventures start here.” They see that same spirit here on The Thinking Practitioner Podcast And they say they’re proud to sponsor our work Knowing we share the mission to bring the massage and bodywork community in live and in content that advances the profession we share. Check out their collection of e-textbooks for pathology, kinesiology, anatomy, and physiology at booksofdiscovery.com, where thinking practitioner listeners can save 15% by entering thinking at checkout.

Til Luchau:

Thanks to all of our sponsors and stop by Whitney’s site. Whitney, by the way, we didn’t give you the shout at the beginning. Whitney’s going to be here next week. I know this is a topic that’s near and dear to your heart, Whitney. We missed you today. You’re going to be back next episode. Whitney’s site, where you can get the handout and show notes, academyofclinicalmassage.com. My site, advanced-trainings.com. Again, you can get the full episodes of those. Any questions you want to hear us talk about, email us at infoatthethinkingpractitioner.com, or look for us on social media just with our names, Whitney Lowe, or mine, Til Luchau. Follow us on Spotify. Rate us on Apple Podcasts and wherever else you listen. And please tell a friend. Well, thank you, Ruth Werner. Thanks for joining us again.

Ruth Werner:

Thank you, Til Luchau. Any time.

Til Luchau:

All right. See you later, everybody. Bye for now.

 

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