00:00 | I want to tell you about a patient I'll never forget. He was an elderly man whose wife had been coming to the clinic I worked at to see another therapist. So, with her encouragement, he figured he'd give massage a try.
00:14 | He came in twice, and he wasn't really sold on it. After his second appointment, we were sitting in the waiting area sorting out billing and rebooking, and I asked him if he wanted to book anything else for down on the line. And he wasn't sure. But his wife didn't hesitate.
00:32 | She looked at him and said, "No, you're rebooking right now. You're a completely different person when you come home from these appointments." He hadn't noticed it himself, but she had. Every time he walked back through that door after seeing me, something had shifted: his mood, his demeanor, the way he carried himself.
00:50 | Whatever was happening in that treatment room was following him home. So, we started booking him in about every three weeks. Now, here's the thing: he had been diagnosed with PTSD after serving in the Navy.
01:05 | He'd been on a vessel when a fire broke out, and he witnessed some crew members get seriously injured, and some of them didn't make it. And when he got on my table, he talked. Every single appointment. In fact, I'd have to kind of end the appointment a little bit early because of how much he loved to talk, just to give him enough time that we could have enough of a conversation.
01:27 | He'd open up about what he'd seen in the Navy. He'd talk about traffic, local politics, things that were frustrating him. And he swore, freely, without any filter, because he knew it didn't bother me. He could say whatever he needed to say without worrying about my reaction.
01:41 | And honestly, I don't think anything I did with my hands really mattered. It was always a low back treatment. But what mattered was what was happening in that room: the fact that he felt completely safe to be himself.
01:54 | You see, because I'm a firefighter, I understood what he'd been through in a way that most people in his life probably couldn't. He didn't have to explain it, he didn't have to soften it, he just got to say it, and I got it. That safety changed everything for him.
02:14 | And at a certain point, I had to apply for an extension on his health benefits on his behalf. The insurance company wanted measurable physical improvements before they'd approve continued treatment. I got on the phone with someone there and told them, "Honestly, I can't measure the improvement the way that you're asking, because the benefit he's getting isn't primarily physical. It's psychological."
02:37 | And then I told them what his wife had said. They approved it immediately, and then told me to include that note every year when he needed an extension. And I never had trouble getting his treatments covered again.
02:54 | That story is where I want to start today. Because what happened in that room wasn't really about technique. It wasn't about what I said. It was about the space that was created for him to use his language, his words, without judgment. And that is one of the most powerful things we can do for the people on our tables.
03:16 | (Podcast Intro) "Hey there, I'm Jamie Johnston, and you're stepping into a new era of thriving as a massage therapist. We're embracing who you are, pursuing what you love, and confidently shaping your practice. We'll challenge industry norms, spark change, and discuss what truly matters—things like mental health, evidence-based practice, and some topics we've long avoided. Let's create better outcomes for our patients and happier, more fulfilling practices together. Welcome to The New Generation Massage Therapist Podcast."
03:43 | Welcome back to The New Generation Massage Therapist Podcast. Today, we're going into element two of Hobfoll's five: the promotion of calm. And I want to start by being honest with you: most of us think of calm as something we create with our hands, but the research tells us a different story.
04:09 | Now, it's important to take into account that not everyone would be comfortable with a patient speaking the way that the fella in my story did. And that's completely okay. If that kind of language or that level of intensity crosses a personal boundary for you, you're allowed to say no. You're allowed to set that boundary in your treatment room.
04:28 | In fact, you should, because here's the thing: if something a patient says or does genuinely makes you uncomfortable, and you can't move past it, your patient will feel that. They'll feel the tension in the room, even if you never say a word. And tension in the room is the opposite of what we're trying to create.
04:51 | So if you find yourself in a situation where a patient's communication style crosses a line for you, it's okay to acknowledge that this might not be the right fit. Not every therapist and patient are meant to work together. Recognizing that early is better for both of you. And your safety is just as important as the patient's, if not more important.
05:14 | And on the flip side, your personal experience is one of the most powerful clinical assets you have. The reason that gentleman felt safe with me wasn't just because I was a massage therapist; it was because I was a firefighter. I had stood in burning buildings, I understood the culture, the language, what it means to see something you can't unsee. He didn't have to translate his experience for me.
05:39 | Now, that's not something every therapist can offer, and it's not something every therapist needs to offer. But think about what you bring. A massage therapist who's navigated persistent pain themselves brings something to that patient that I can't. A therapist who's been pregnant, who's gone through grief, who has experienced a workplace injury—there's someone on your table who needs exactly that.
06:06 | Your lived experience isn't separate from your clinical skill; in the right context, it is your clinical skill. The therapeutic relationship is the foundation of everything we're going to talk about today, and it works both ways.
06:24 | So let's talk about why language changes everything, and I mean that literally. Most of us were trained in a model of pain that goes something like this: something is damaged or out of place, it sends a signal, and that signal becomes pain. Tissue in, pain out—linear, mechanical.
06:46 | And that model isn't totally wrong, it's just incomplete, because it leaves out the majority of what's actually happening. The biopsychosocial model gives us a much fuller picture. And once you understand it, the way you use language in your treatment room will never be the same.
07:07 | So, let's break it down. The biological component—what most of us were trained to focus on—includes the bodily events that drive what are called nociceptors. These are sensory receptors that detect signals from damaged tissue or the threat of damage, and respond to chemicals released from that tissue. So we're talking about things like excessive load, tissue pathology, inflammation, genetics, or systemic dysfunction. That's the bio.
07:45 | The psychological component is everything else: the way we think, what we believe, what we predict, what we feel, and what we do. This is the part that gets left out of most clinical conversations, and it's often the part that matters the most.
08:08 | And the social component is the interactions we have with others and the roles that those play in our world: family, friends, colleagues, access to care, culture, community, and society.
08:21 | Craig Liebenson puts it really well in his most recent book. He describes the biological as a linear input approach focused on pathology, tissue, or biomechanics. The psychological is a top-down descending modulation of protective output responses. And the social, as upstream factors: things in the environment that have the potential to nudge an individual or a group's lifestyle and behavior in either a positive or a negative direction.
08:55 | I love that upstream framing, because it shifts how you think about your role. You're not just treating what's in front of you; you're influencing something much larger.
09:05 | And here's what's critical to understand: all three of these domains are one complex system. They don't operate in isolation. Pain is influenced by all three simultaneously, constantly, and differently for every person, every day. Which means what's driving your patient's pain today might be completely different from what's driving it next week. And the language you use, the words you choose, the story you help them build about what's happening in their body sits right at the intersection of all three.
09:40 | Now, the biopsychosocial model has become pretty popularized over the last several years, which is mostly a good thing. But popular doesn't always mean it's being done well. There are three ways clinicians tend to misapply it, and if I'm being totally honest with you, I've been guilty of all three of them.
10:04 | The first is what's called biomedicalization. This is when we say we're using the biopsychosocial model, but in practice, we keep falling back on biological factors, focusing primarily on things like tissue damage, physical function, or objective measurements. The psychosocial pieces get acknowledged, but never really integrated. We do the bio, and we nod at the rest.
10:30 | The second is fragmentation. This happens when we can't find a physical source for a patient's pain, so we start to imply or outright say that it must be psychological, that it's all in their head. I have made this mistake probably more times than I care to admit. I was trying to educate a patient about pain science, explaining the role of the nervous system, and they stopped me and said, "So you're saying it's all in my head?"
10:59 | I had to pedal back fast, because that's not what the model says at all. And when a patient hears that, you've just undone everything you were trying to build. The fragmentation mistake is the inability to make genuine connections between biological and psychological factors and apply the model in a humanistic way.
11:26 | The third misapplication is what's called neuromania. And I've been guilty of this one, too. This is where we overcorrect. We stop blaming the tissue and start blaming the brain instead. We reduce a patient's entire subjective experience down to neural networks and brain function.
11:50 | And while the neuroscience is fascinating, when we use it in that way, we've just traded one reductionist explanation for another. We've made the brain the new bad guy instead of the tissue. But the goal isn't to find a single thing to blame; it's to understand the person as a whole.
12:12 | And there's a term for this approach: it's called enactive care. It means you look at the person's complete experience, understanding that their pain cannot be reduced to any one single factor; that their experience and their interactions with their physical and social environment can make things better or worse; that people can reach a point where they stop believing in their own capacity, and that belief itself becomes part of the problem.
12:44 | And a quote from the research that I really like is: "Pain is an emergent property of the person as a whole, including brain and body in their environment." So let's look at that again: "Pain is an emergent property of the person as a whole, including brain and body in their environment."
13:04 | It means the story your patient tells about their pain, the words you use to help them make sense of it, the relationship you build with them in that room—all of it is part of the treatment, not a nice addition to the treatment. Part of it.
13:21 | So, what does this actually look like when someone's on your table? It starts with the therapeutic relationship. And honestly, it starts before you've done a single technique or before you've even put your hands on the person. Listen and validate the person's experience, not just their physical symptoms, their whole experience: what they've been through, what they've tried, how it's affected their life. Build a mutual understanding with them. Use empathy and compassion to create trust, not as a clinical strategy, but as a human being in the room with another human being.
14:04 | And be comfortable with uncertainty. And this one's really hard, especially for people who like to have all the answers. But the research is clear: no specific intervention works reliably across all people all the time. What helped your patient last week might not be what they need today. What's influencing their pain today might be completely different from what was driving it at your last appointment. And that's not a failure. That's the reality of working with whole human beings.
14:38 | And shared decision-making is how you navigate that uncertainty together. There may be aspects of a treatment that a patient really responds to because they've had success with it before. There are days that that approach will work, and days that it won't. There are days when you know a patient needs to do some movement work, but they're exhausted and it's just not the day for it. So be adaptable, be flexible, decide together.
15:08 | And of course, watch your language. When you shift from "Your tissue is damaged" to "Maybe your system is sensitized, and here's what we can do about that," you've just changed the story. When you move away from language that makes someone feel fragile or broken, and toward language that reinforces your capacity and their resilience, you're promoting calm at a neurological level.
15:32 | Think about the old Google Maps analogy. Don't just take the street view. Zoom out. Take the satellite view of this person's life and everything that's contributing to where they are. Because the intervention that makes the biggest difference might not be what you do with your hands. It might be the question you ask, the thing you reflect back to them, or simply the fact that they spent 60 minutes in a room where they felt completely safe to be themselves.
16:03 | Just like that gentleman from the Navy. He was always coming in for a low back treatment, but what he got was 45 minutes where he didn't have to explain himself, didn't have to edit himself, didn't have to worry about what anyone thought. And he walked out a different person. His wife noticed it before he did.
16:24 | So that's the promotion of calm. And it goes so much deeper than a great massage, because we know a great massage delivers calm. It's the language you choose, the story you help your patient build about what's happening in their body, the therapeutic relationship you show up to every single time, and the space you create for them to be fully themselves in your room.
16:53 | If today's episode has you thinking about how you talk about pain with your patients and whether the words you're using are helping or accidentally making things harder, I put together something for you. It's called the Trauma-Confident—the Trauma-Confident Therapist Starter Guide. It's a free resource I built specifically for massage therapists who want to show up differently in the room, with the frameworks, the language, and the confidence to do it. And you can grab it from the link in the show notes.
17:16 | Next episode, we're continuing through Hobfoll's five with element three: the promotion of self-efficacy. This one is going to challenge how you think about what a successful treatment actually looks like, and whether the way most of us were trained is accidentally making our patients more dependent, not less.
17:35 | If this episode resonated, find me on Instagram and let me know. These conversations are always worth having. And if you're getting value from The New Generation Massage Therapist Podcast, hit follow and leave a review if you've got a couple minutes. It helps more therapists find this content, and that's the whole point. Keep moving forward.
