Issue link: https://www.massageandbodyworkdigital.com/i/1358392
health-care providers have done in similar circumstances. For our client with back pain, we might begin with some tactics based on their situation and our experience, and then look at what the data says about the most effective manual therapies. This is a good time to ask the all-important question about our approach: "What's missing?" Author note: Steps 2– 4 address the "practitioner expertise" and "research evidence" elements of evidence-informed practice. Step 5: Plan and Execute a Course of Action We're getting closer. We have identified the problem, challenge, or goal for our client with back pain. We have examined the contributing variables and challenged our assumptions about the situation to see if we've missed something important. It's time to move from thought to action. What will you do, and why? What will you not do, and why? What accommodations will make this session or series of sessions completely personalized to your client? Each of these decisions needs to have a considered rationale. Critical thinking isn't about knowing more. It's about using information in a more sophisticated way. —Sandy Fritz And of course, as we go through the session, we constantly shift our strategies based on immediate verbal and nonverbal feedback from our client. In the classroom, I give you didactic knowledge and skills and practice. But ultimately what I want you to be able to do is think on the fly. Then you can take that knowledge and be able to autonomously go into that situation. —Robin Anderson Critical thinking means being able to think outside the box, and realizing that every client is not the same, so every treatment plan should be individualized, and the best interest should be put forward for the client, not the therapist. —Brent Jackson Truthfully, most massage therapists probably go through some version of these steps in an unconscious, unanalyzed way for every client (often while we wait for them to get on the table), but I maintain the more aware we are of the process, the better choices we make. And we're not done yet. Step 6: Reflect on Results What is the point of engaging in high-level critical thinking for our clients if we don't put as much high-level reflection on the results of our efforts? If your client gets some relief, that's wonderful—but what will you learn from this, and how can you build on it in the future? If your client doesn't get relief from your work, that's even more important to track so you don't go down the same dead end the next time you work together. If you changed tactics midsession to adapt for your client's responses, it's important to note for next time. This, among other reasons (e.g., demonstrating progress to the client, communicating with other health-care providers, billing insurance, gathering data for a possible case report), is why it is so important for massage therapists to carefully document their actions and client progress. I think about critical thinking through the question of "How do you chart it?" Sometimes it's a backward look at the session. As you look backward on the session and you go through the steps you took and try to chart them, you start to ask, "What did I miss? And how do I improve on that the next time?" —Diana Thompson We tend to not teach follow-through critical thinking: What happens after two sessions, or four? What if you come to the realization that massage therapy isn't the right tool—how will you deal with that? —Annie LaCroix CHALLENGES TO CRITICAL THINKING We could stop here. We've defined critical thinking, which is difficult in itself, and we've laid out some steps that can help MTs accomplish this complex and important task. We're done, right? Wrong. Because when we ask "What's missing?" (Step 4), it's obvious there's still a big unaddressed issue: A lot of challenges make critical thinking difficult. And to present a discussion on this slippery topic without naming some of these challenges would be a job half-done. CONFIRMATION BIAS It is a natural, totally human impulse to give positive attention to information that validates what we already think is true, and to minimize or negatively scrutinize information that challenges our worldview. This is true not only in massage but in the world at large, as we see daily. But to claim we are open-minded, evidence- informed critical thinkers, we must be willing to have our worldview challenged. If I see something that fits what I think is true, then that catches my attention. It looks like evidence to support my "fact" over anything else. And that's where the thinking might stop. —Til Luchau It's hard. It can be painful and scary. And it is necessary. Don't worry—your strong understanding of your work will only be made stronger when credible but unexpected information appears to broaden it. DECISION PARALYSIS Because critical thinking requires us to process so much information, and because humans are complex beings, it can feel overwhelming to try to get a complete handle on all the nuances of any one person's situation to make clinical decisions. Is there even such a thing as enough information? The workaround for this quandary is to start with safety, and to proceed with caution from that point. Then we can add challenge and intensity to our L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 59