I am proud to welcome Sara Firman, BSc. MPhil. LMT, to The Psychology of Wellbeing. She is an independent spa therapist, consultant and writer who shares a her wonderful perspective on spa culture on her Vision Spa Retreat blog. Her unique perspective comes from working in clinical, spa and private settings as both a therapist and a manager in the U.K., Israel and the U.S. When I was writing my blog post on “The Science and Spirituality of Spas” I stumbled onto her blog, which was filled with ideas that totally resonated with mine. How wonderful to find someone who shares my ideas but is able to express them even more eloquently than I can. This article was adapted from one that she previously wrote on her blog. I hope it resonates with you as much as it did me. –Jeremy
If spas unreservedly ally with evidence-based healthcare, they will lose a great deal of their heart and soul, and their potential as places of holistic healing. Alternatively, they could lead the way in the art and science of the healing arts by seeking new models for our understanding of the highly creative and innovative healing practices that have found a last bastion of support in spa.
Science depends on quantifiable measurement, yet so much that is important in healing or therapy cannot easily be measured or quantified. Perhaps it never will be. The current focus on evidence-based therapy is a concession by science to the subjective nature of the therapeutic experience. But it is incomplete without taking into account the context of an individual’s own process – which may or may not conform to the scientific norm.
Healing is a highly subjective process and one-size does not fit all. Just because a given technique or procedure works for a majority of clients does not mean it will work in any given individual case. Conversely, what does work in a given individual case will often not be scientifically valid for a majority of people.
Alternative healing practices, many of which have been adopted or adapted by spas, provide effective intervention through clarity of intent, close attention to subjective context, increased awareness of the impact of the therapist’s mindset on the client, and intuitive flexibility in applying a broad range of skills. None of these fits conventional scientific research models.
In fact, evidence-based therapy is based upon a model that seeks, as much as possible, to negate the effect of the individual practitioner, including his or her capacity for imaginative and intuitive responses to the individual client. Evidence-based therapy seeks to develop standardized protocols, applicable in situations where a given client fits a given profile. This model attempts to minimize risk to clients and liability for practitioners, but it may also stifle the particular healing capacity and therapeutic creativity of the individual healer-practitioner.
It is arguable that the most effective healer-practitioners are not those who adhere most dogmatically to protocols, but those who are able to bring the entirety of their training, and experience to bear spontaneously and instinctually in the moment, with regard to a unique therapeutic challenge.
A strictly evidence-based approach to the use of spa therapies may seriously limit the potential therapeutic value of this work. If spa therapists are going to make a difference in the lives of their clients, they must feel encouraged to bring the whole of their individuality to their interaction with each client.
Prevalent medical care tends to be prescriptive and global, while alternative approaches are often more exploratory and individual. Part of the human condition may be to discover how to live with the unknowable aspects of life: idiosyncratic, individual, changing, chaotic but with some pattern to them nonetheless. It’s these kinds of patterns that conventional science is not comfortable with.
Inclusion of the more individual, anecdotal, and idiosyncratic dimensions of research could well be relevant to more effective therapy. These are often the types of information that alternative practitioners are interested in, and routinely use in their practices, but relatively rarely document or report upon. (Spa practitioners document even less, which is a great pity.)
These are also often the types of information that clinical practitioners would like to incorporate into their practice, but can’t because of the strictures of an evidence-based approach that prohibits their consideration. Yet it is this type of subjective, anecdotal information that makes the experienced healer (whether clinical or not) effective, and exceptional, at what he or she does.
There are some who find credible ways to gather and make use of this type of information, in particular regarding explorations of human consciousness, subtle energy work, spirituality, and emotional intelligence, all of which may be applicable to some of the healing modalities offered at spas.
For example: The Institute of Noetic Sciences, The International Society for the Study of Subtle Energies and Energy Medicine (ISSSEEM), The Fetzer Institute, The Institute of HeartMath, and The National Center for Complementary and Alternative Medicine (NCCAM) all reference science though they are working at the cutting-edge of a science that convention has yet to recognize widely.
It is possible that there is a future for healing practices that don’t fit the conventional scientific model – including many that are offered in spas and other wellness centers– if we are able to identify appropriate areas of interest, appropriate recording formats and appropriate research methods.
I’d like to see spas and spa organizations promoting and contributing to these ideas before they adopt, wholesale (and without careful consideration of its implications,) the predominant methodology of science. It will be a great loss if research based on existing models in medical science is used to regulate and standardize away the healing arts that spas have helped to resurrect and revive interest in.
I agree! The restaurant industry has become overly protocol-oriented and standardized, and as a result we have a lot of big chains where we know exactly what to expect every time – a substandard, uninteresting, disappointing meal. In contrast, the restaurants where the executive chef calls the shots are by far more interesting. They provide a culinary experience – not a standardized product.
Let’s not see the spa industry make the same mistake. In anything human-related (massage therapy, psychotherapy, coaching, etc), science matters. Evidence-based is desirable. But only as a way to inform – not prescribe – practice. Everyone is different, and what works for most people most of the time doesn’t work for everyone all the time. A true professional knows how to use science as an important part of his or her practice. A poor/rookie practitioner applies blindly the same techniques to all of their clients, without discerning the subtleties of each case.
Industry will always push for more standardization. It covers them, limits risks and increases control. But it also limits personalization and thus the effectiveness of the most devoted practitioners.
So I’m with you, Jeremy and Sara! This is another very interesting and important article! Thank you!
Really well said Marie-Josee. Thanks!
Thank you for sharing this parallel MarieJ which helps to illustrate so many of the points I am hoping to make. The intersection where science, industry and people meet is a challenging one.
At a time when there are those who would deny science from a religious viewpoint or from a wish to manipulate information for political purposes, expressing reservations is a tricky thing to do.
The scientific method is a tool with limitations and advantages that it is important to recognize and understand.
Creativity, Caring, Community … these are as essential – or perhaps more essential to life – as the R words (Rationality, Repeatability, Regulation, etc.). Pure science is inspired by Curiousity – it can serve those C words.
Yes! That’s it! The scientific method is a tool – a means to an end. A very good one indeed, but it’s still not the end in itself.
You articulate your point very well, Sara. There’s no reason to understate it. Be proud to make it loud and clear, and people will hear!
Thanks for sharing, this Jeremy. (And you are just as eloquent, by the way—and I speak from experience!) I’ve been following Sara’s writing with interest since you introduced me to her posts. Yes, she is very like-minded and her words resonate w/me, as well. However, before we even begin to address allying w/evidence-based healthcare, it would be wonderful if we could improve upon the education of our spa therapists to ensure that they are indeed providing the best of all possible care to their clientele—with their hearts and souls. We need to see better (as in truly healing) treatments/services offered on spa menus across the U.S.
Mary, you are right that key to all this is having people who really do convey the art, science and practice of care and healing. In my experience, it has not been not so much a problem with a lack of skillful people but an inability to provide settings in which such people can do their best work. Attracting and keeping them depends upon this. There is also the value of putting novice practitioners alongside experienced mentors.
I’ve wondered if education, at least as it is conventionally interpreted, can ever replace apprenticeship which is now a rare thing. It’s interesting to know that ‘[t]he literal translation of educate is to draw out of, lead out of, etc. The Romans considered educating to be synonymous with drawing knowledge out of somebody or leading them out of regular thinking.’ (Gregory Rineberg, Word Power http://tinyurl.com/3n9sftf)
So, perhaps we’ll need to think out of the box regards education too.
I couldn’t agree with you more, Sara—regarding the ‘inability to provide settings in which such people can do their best work.’ Wouldn’t that be a wonderful thing! I love the apprenticeship idea! Is there a US spa out there who would take up this challenge?!
On another note…the Romans were good, maybe too good, at leading…and led many astray in the end! (I’m specifically referring to their art of bathing and where that led…)
Thanks for your commentary. Enjoy your work very much.
Really interesting – re: the Roman’s definition of education. Today, it seems that conformity is pretty much the goal… It’d be good to find a balance between the 2.
I also found that definition of education very interesting. It defintely is a paradigm shift from the way we think about education today. Todd Kashdan wrote an interesting article this week about keeping the individual in education: http://www.psychologytoday.com/blog/curious/201105/3-ideas-prevent-schools-killing-creativity-curiosity-and-critical-thinking.
Another set of C’s (see my earlier suggestion Creativity-Caring-Community) are to be found in Todd Kashdan’s article. It could be helpful to ask what kind of education would encourage them in people of any age, not just children:
Curiosity – experiencing a sense of wonder and discovering new information
Creativity – generating novel, adaptive ideas
Critical-thinking – deriving one’s own perspectives and conclusions after a discussion
This is a very good article. I am a former athlete who played for the Denver Broncos football team. Back then, when I played, after a hard game you could find me relaxing in a spa. Most people do not know the essence of a spa but trust me, it healed me after every game.
I like Sara’s ideas: integrative medicine seeks to marry the best of allopathic and non-allopathic traditions, and seems ideal for many healing spas. Some traditionally trained physicians have begun to learn about these differently-evidenced based fields, and integrate those ideas into their practices and consulting.
Three quick ideas:
*first, there are different types of evidence: a case-report in traditional allopathic medicine is story-telling in other cultures, and more valuable than a double-blind RCT;
*second, the institutions you cite are quite disparate in their viewpoints: e.g., The Fetzer Institute, The Institute of HeartMath, and The National Center for Complementary and Alternative Medicine (NCCAM) are considerably more traditionally “evidence-based” than the Noetic Sciences group;
*and third, I’ve long thought that nutrition–especially condition-specific nutrition for both prevention and treatment–ought to have a central, celebratory part in healing, but do not know of a spa or group of spas that have taken it as a therapy and skill set of core importance (even in our age of obesity).
Thank you John. I’ve written quite a bit on my blogs about this theme. I’m noticing that what counts as ‘evidence’ differs in different people’s minds, as in your mention of ‘differently-evidenced based fields’.
In pure science, evidence is a changing thing as more information comes to light to support or refute findings. In other words it is not ‘proof’ – an extrapolation that media and marketers are quite keen on.
It’s interesting to know what the originators of the concept of evidence-based medicine, David Sackett et. al. had to say in the British Medical Journal back in 1996. There were three aspects, the last of which below relates to the theme I’m addressing in this post:
Clinical expertise (experience and practice of individual clinicians)
Clinical evidence from systematic research
Patient’s choice (taking into account individual values and preferences)
Read more: http://www.aquapoetics.com/2010/06/body-of-evidence.html
Recently in an article on research literacy for massage therapists (Massage Therapy Journal,Summer 2011), Martha Brown Menard pointed out another interesting factor regards the evidence provided by research.
‘One of the most common reasons for conducting research in health care is to shed new light on existing clinical debates. To be useful to the practitioner, research needs to be clinically meaningful – in addition to showing statistically significant results.’
She described in detail a research paper concerned with lactic acid accummulation in muscles and what it meant for sports massage practitioners. Her conclusion was ‘In this case, the evidence is strong but fails the test of clinical relevance.’
My point is that what we do with ‘evidence’ – the interpretation and application of it in real life situations – is what matters. We live in a world where information can be misused by those with ulterior motives and vested interests.
Arguably, in reality we live in a world where the only certainty is uncertainty. Science tries to give us a handle on that but it is a just a tool, a very good one, but with limitations in practice.
I expect some of the spa folk who ARE giving the topic of nutrition a central place might chime in on your last point, which is important indeed – especially when you describe it as a ‘celebratory part of healing’ bringing in the very human element of enjoyment.
How thrilling, Sara: I love the way you think about this.
David Sackett is a pioneer, as you are well-aware, in evidence-based medicine. I edited and wrote for “Alternative Medicine Alert: An Evidence-Based Guide for Clinicians” for 5 years, and we included his thinking in the formulation of the work. I am proud that it was so successful, well-researched and useful, and continues to be.
Of course, I’d love to know more about the spa folks who are giving nutrition (and cooking) a prominent role in their work.
Like you and Jeremy, I think that spas could lead a movement in healing and wellness, and make it fun, hospitality-rich and part of lifestyle…something that medicine has found it difficult to do (though some of us are working on it!)
Thanks for your leadership here.
John, I’m so pleased to meet you and blushing somewhat for having not taken the time to visit your website. Now I see your passion for good healthy food, and the evidence of all the background you bring to these issues 🙂
A similar evidence-based guide for spa professionals would be valuable if it truly tried to integrate those differently-evidenced viewpoints and to help people to think about what they do and why.
Non-scientists are sometimes rather in awe of science and tend to see it as a source of definitive answers or superficial credibility rather than a method for creative questioning and discovery. You model something different!
Hi John, Thanks for your commrents. I’m so glad to see that I am not the only one totally inspired by the way Sara thinks! I’m glad you guys could connect here on TPOW.
I love your comment about different kinds of evidence. There was a great comment made at the Global Spa Summit by Mark Cohen that “if we want to have an evidence based practice, we have to have practice based evidence.”
So in addition to Sara’s comment about applying the evidence we have properly we also have to evaluate our application and use the data to further understand the effectiveness of our methods. It seems to me there is no aspect of health care where this is done well.
Thanks for the great comments and dialogue!
There is no doubt that the spa business is really on its way up high! Good job on this post!
Curious about Adrianne Lukas’ comment – linking a website for cosmetic medicine which I guess is big business – I went a bit further through that site and discovered Freelance MD Blog. And a great post by Craig Koniver MD that I think is worth sharing here.
In it, he talks about the growing sense of demoralization within medicine and attributes it to an ‘industrial mindset’ where ‘doctors set the rules for patients’ and the ‘pharmaceutical industry blossomed beyond belief’.
He then went on to say that medicine has been focusing on the ‘wrong product’ and that the ‘right’ one is ‘relationship’. In my writing on spa I’ve talked about ‘community’ for the same reasons.
Now if medicine joins spa in order to deepen human relationships – and not primary to create more opportunities to make more money from more people – then I think there is hope for us all.
And if we use ‘scientific evidence’ to expand our worldview – rather than limit it to reproducible and controllable (and thereby more easily marketable) options – then I think there is hope.
Let’s stop talking about spa business being on its way up but about our humanity being given more opportunities to flourish (as Jeremy describes so beautifully in his latest post about hurricane Irene).
Since Jeremy’s blog site here is focused on positive thinking, I thought I’d offer this quote from Craig’s post which gives the situation a clever and positive twist – ‘Get your Dopaine Firing’ being the post title:
‘Did you know that when you form a deep connection with someone the Dopamine in your brain fires as if you were on drugs? Literally. Problem is, we have been trying to get our dopamine fired up from all of these material pursuits in life. No wonder we get bored and disinterested in modern medicine. All that system cares about is managing patients with more meds.’
You can read the full post here:
Thanks Sara, I get filled with hope when I hear other people talking like this. Our whole capitalist system revolves around driving dollars to the bottom line but we forgot that money is only as good as its ability to get us better health, better quality of life, more time, better relationships. You can tell we have a screwed up culture when we evaluate the success of our government by how many people are working. To me a successful government would mean people are working less . . . or at least spending more time working on the things that are most meaningful to them and not working for a buck. Doctors are not incentivized to keep people healthy, they are incentivized to do procedures. All the money is in surgery and drugs and so those become the solutions for every problem. We need a system where the highest paid doctor is the one whose patients never need an operation and never have to take a pill.
AMEN to that, Jeremy!
This from Shawn Achor (most popular post on Huffington right now): ‘So how can we pursue happiness right now? When I was counseling overwrought Harvard students, one of the first things I would tell them is to stop equating a future success with happiness.’ He notes that ‘It’s hard to find happiness after success if the goalposts of success keep changing’. And it’s also a very individual thing, which is one of my points about what is healing being a subjective thing that science can’t measure. Or spa business being something that can be standardized and replicated. Shawn loses me when he suggests that happiness is ‘work ethic’…. the old models keep creeping in.
Now whenever I hear the adages about success leading to happiness I always think of Tim Sharp’s guest article on “The Happiness Diet”. He teaches that you don’t get happy from being successful but rather finding happiness is what will help you to find success. Interesting perspective shift from the way most of us usually think!
I find it interesting that you see the push for spa evidence as a concession to the therapeutic experience. I see it the other way around, as a concession by Spas, to science, in recognition of how the growth of the industry is has lost it’s appreciation for cultural aesthetics and is loosing it’s boundaries.
Hello Heidi – My use of the word ‘concession’ may have been confusing and needs further explanation. [‘The current focus on evidence-based therapy is a concession by science to the subjective nature of the therapeutic experience.’]
Actually, ‘evidence-based’ as originally conceived (see my earlier comment giving that source in the British Medical Journal) did include (i.e. concede) the experience of both clinician and patient.
Clinical expertise (experience and practice of individual clinicians)
Clinical evidence from systematic research
Patient’s choice (taking into account individual values and preferences)
However, I doubt that many who use the phrase ‘evidence-based’ in the spa arena really understand what this means or how it is arrived at. Actually, we can’t point a finger at the spa arena alone – this ignorance is rife in media-driven science reports.
If you read the wikipedia definition I’ve linked to under evidence-based therapy in my article here, you’ll see the idea that it is an attempt to ‘ensure the best prediction of outcomes’, even when it is not certain what outcomes are desirable(!?)
Returning to your viewpoint: ‘cultural aesthetics’ are clearly subjective and would make a very interesting exploration in the context of spa. I see great creative potential in spa for providing these varied experiences. Another article.
Likewise, the concept of ‘boundaries’. I know from our previous connection that you are interested in interdisciplinary studies, which are an attempt to blur or leap boundaries in the interests of sharing knowledge. There is much to explore here.
Thanks for your thought-provoking comment here Heidi.
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