Recent massage therapy graduate, Orali Alcock reflects on her experience in professional practice one year on from passing the Allied Health Professions Council of South Africa's (AHPCSA) registration exams.
So you’ve finished your studies, dealt with the necessary legalities such as registering with the AHPCSA and you’re ready to offer the world your services as a Therapeutic Massage Therapist. You may have found rooms to practice from, or made the choice to do travel massage or opted for working for someone in a spa environment.
Yet your practice is not blossoming. The different avenues you have tried haven’t panned out – so what next?
Well, to develop a long term plan and a sustainable strategy it is useful to first understand the process that you have been involved in (perhaps unknowingly) during the past year - the transition from student to professional practitioner.
To contextualise what is meant by transition in this article I use the following definition quoted by Brown and Olshansky in their article “From limbo to legitimacy: A Theoretical Model of The Transition to the Primary Care Nurse Practitioner Role”:
...a point of reference from which a person’s life course takes a new direction requiring adaptation or change in restructuring behaviours and roles appropriate to the new directions. In addition to a change in behavioural response and new roles, this new direction in the life course also requires change in responsibilities, goals, identity and feelings about oneself in general.
A theoretical model designed by Brown and Olshansky describes four stages in the transition process:
1) laying the foundation,
2) launching,
3) meeting the challenges and
4) broadening the perspective.
Although the model was developed for nursing practice, in my opinion, it is relevant to all health care professionals if not all professions. In this article I have adapted it to my experience as a massage therapist.
In Stage 1 the newly registered therapist is laying the foundations for their new career.
This include the following:
• recuperating from studying and writing exams, spending time with friends and family, catching up on personal interests;
• negotiating the bureaucracy-waiting for exam results, registration;
• looking for a job, compiling a cv, writing letters of introduction and building a network of references, negotiating rates and benefits with employers;
• setting up practice, doing marketing and promotion, identifying suitable working partners among groups of health professionals;
• and of course worrying.
It is an anxiety provoking time in which the new therapist has to deal with both loss (their student life is over and with it the safety net it provided) and apprehension about the future and going it alone.
In Stage 2 the new therapist launches his or her career.
This is considered the most turbulent and difficult part of the transition process. It is an emotionally charged time when the novice practitioners have to confront their feelings of anxiety while trying to get through the day. Having too much time on their hands no longer feels like a vacation.
Making matters worse is that niggling feeling of being an impostor, of being inadequate.
Stage 3 involves meeting the challenge, building competence, gaining confidence and acknowledging system problems.
In Stage 4 new therapists start to broaden their perspective. They develop system savvy. By recognising their own strengths and affirming themselves, they up the ante.
Imposter phenemonon
The main focus of this article is on Stage 2 , a time fraught with anxiety and feelings of inadequacy and self-doubt. You feel like a “fake” or an “impostor”, not “being real”. You are insecure about your role, skills and knowledge base.
The impostor phenomenon is often experienced by recent graduates and is described by Brown and Olshansky as a:
...collection of feelings of inadequacy that persist even in face of information that indicates that the opposite is true. It is experienced internally as chronic self-doubt, and feelings of intellectual fraudulence.
Every therapist will recognise this situation. All of a sudden you are consulting a new patient, not as a student, but as a fully-fledged and registered health professional. Now you are the authority, not your lecturer or supervisor. There is no one to ask, to consult with, to provide a safety net. You now carry the ultimate responsibility.
And that, while you feel you are still struggling to do basic things like developing treatment plans; when you are still not sure how to prioritise and allocate sufficient time to address specific problems? When you are feeling the pressure to produce results and that your skills and knowledge are not enough or good enough.
Combine these feelings with a lack of profession-specific work fitness as well as getting the business side of the practice up and running and the outcome is high levels of anxiety, tiredness and fatigue. It becomes almost impossible to stay positive and motivated and to get things done.
These experiences are typical of someone starting out in a health care profession. You are not alone. However, the phases differ in duration from person to person.
Another factor that makes it particularly challenging for new massage therapists is that this profession has not yet been properly assimilated into the broader health care network. As a result there are no positions available in the public health care sector where new therapists could gain experience and develop skills before establishing a private practice. There are also no specific mentorship or internship programmes.
So unless the individual makes a point of building and maintaining networks, it can be a time of intense loneliness.
Talk, Read and Do
• Remind yourself that you have a qualification, and that you have passed a professional exam to be able to practice legally in South Africa. Passing the AHPCSA exam says that you already have the required knowledge to be a Therapeutic Massage Therapist, to be a professional health practitioner.
• Keep in touch with your former class mates. Talk to them about your feelings and the challenges you face. They are all going through the same process.
• Find more experienced colleagues and ask them about their experiences. Perhaps they will be willing to offer guidance and assistance. Join or start a support group that meets regularly where you can discuss your questions and successes.
• Talk to other professionals. They underwent the same processes when they first entered the job market.
• Talk to friends and family. Their insight and experience may surprise you. Ask for encouragement.
• Reflect on the situation. Self-awareness is hugely important. Knowing what it is that you are experiencing is the first step to putting it in context and managing it.
• Read your textbooks at leisure. (something a student has most probably not had the time to do thus far). It will help you deepen your knowledge and understanding without the pressure of exams and projects.
• Read online resources about starting a practice, the challenges of starting out, how to run a business etc.
• Read online professional journals and websites.
• Borrow books, journals etc. from colleagues and use the time to broaden your knowledge.
• If you are not flooded with paying patients immediately, find an organisation where you can volunteer your massage services a few hours a week. Not only will you gain experience and confidence while giving back to the community, it is the ideal way to integrate your practice into the community. The more you massage, the more experience you gain, the easier it gets to fill the professional role - so keep working even if it is initially for free. (It does however make business savvy to give a way your time to potential paying patients!)
• Enjoy this time. Soon you will wish for these idle hours in which to plan, read, write and study (yes, it never ends!) at your leisure.
• Have patience and compassion for your own experience.
Persevere and have faith in yourself.
Your time is now!
Orali Alcock practises in Paarl, Western Cape. She runs a private practice and is employed as a massage therapist at the local Hospice as part of their palliative care team. This article first appeared in the August 2009 issue of InTouch, the Massage Therapy Association of South Africa magazine
Yet your practice is not blossoming. The different avenues you have tried haven’t panned out – so what next?
Well, to develop a long term plan and a sustainable strategy it is useful to first understand the process that you have been involved in (perhaps unknowingly) during the past year - the transition from student to professional practitioner.
To contextualise what is meant by transition in this article I use the following definition quoted by Brown and Olshansky in their article “From limbo to legitimacy: A Theoretical Model of The Transition to the Primary Care Nurse Practitioner Role”:
...a point of reference from which a person’s life course takes a new direction requiring adaptation or change in restructuring behaviours and roles appropriate to the new directions. In addition to a change in behavioural response and new roles, this new direction in the life course also requires change in responsibilities, goals, identity and feelings about oneself in general.
A theoretical model designed by Brown and Olshansky describes four stages in the transition process:
1) laying the foundation,
2) launching,
3) meeting the challenges and
4) broadening the perspective.
Although the model was developed for nursing practice, in my opinion, it is relevant to all health care professionals if not all professions. In this article I have adapted it to my experience as a massage therapist.
In Stage 1 the newly registered therapist is laying the foundations for their new career.
This include the following:
• recuperating from studying and writing exams, spending time with friends and family, catching up on personal interests;
• negotiating the bureaucracy-waiting for exam results, registration;
• looking for a job, compiling a cv, writing letters of introduction and building a network of references, negotiating rates and benefits with employers;
• setting up practice, doing marketing and promotion, identifying suitable working partners among groups of health professionals;
• and of course worrying.
It is an anxiety provoking time in which the new therapist has to deal with both loss (their student life is over and with it the safety net it provided) and apprehension about the future and going it alone.
In Stage 2 the new therapist launches his or her career.
This is considered the most turbulent and difficult part of the transition process. It is an emotionally charged time when the novice practitioners have to confront their feelings of anxiety while trying to get through the day. Having too much time on their hands no longer feels like a vacation.
Making matters worse is that niggling feeling of being an impostor, of being inadequate.
Stage 3 involves meeting the challenge, building competence, gaining confidence and acknowledging system problems.
In Stage 4 new therapists start to broaden their perspective. They develop system savvy. By recognising their own strengths and affirming themselves, they up the ante.
Imposter phenemonon
The main focus of this article is on Stage 2 , a time fraught with anxiety and feelings of inadequacy and self-doubt. You feel like a “fake” or an “impostor”, not “being real”. You are insecure about your role, skills and knowledge base.
The impostor phenomenon is often experienced by recent graduates and is described by Brown and Olshansky as a:
...collection of feelings of inadequacy that persist even in face of information that indicates that the opposite is true. It is experienced internally as chronic self-doubt, and feelings of intellectual fraudulence.
Every therapist will recognise this situation. All of a sudden you are consulting a new patient, not as a student, but as a fully-fledged and registered health professional. Now you are the authority, not your lecturer or supervisor. There is no one to ask, to consult with, to provide a safety net. You now carry the ultimate responsibility.
And that, while you feel you are still struggling to do basic things like developing treatment plans; when you are still not sure how to prioritise and allocate sufficient time to address specific problems? When you are feeling the pressure to produce results and that your skills and knowledge are not enough or good enough.
Combine these feelings with a lack of profession-specific work fitness as well as getting the business side of the practice up and running and the outcome is high levels of anxiety, tiredness and fatigue. It becomes almost impossible to stay positive and motivated and to get things done.
These experiences are typical of someone starting out in a health care profession. You are not alone. However, the phases differ in duration from person to person.
Another factor that makes it particularly challenging for new massage therapists is that this profession has not yet been properly assimilated into the broader health care network. As a result there are no positions available in the public health care sector where new therapists could gain experience and develop skills before establishing a private practice. There are also no specific mentorship or internship programmes.
So unless the individual makes a point of building and maintaining networks, it can be a time of intense loneliness.
Talk, Read and Do
• Remind yourself that you have a qualification, and that you have passed a professional exam to be able to practice legally in South Africa. Passing the AHPCSA exam says that you already have the required knowledge to be a Therapeutic Massage Therapist, to be a professional health practitioner.
• Keep in touch with your former class mates. Talk to them about your feelings and the challenges you face. They are all going through the same process.
• Find more experienced colleagues and ask them about their experiences. Perhaps they will be willing to offer guidance and assistance. Join or start a support group that meets regularly where you can discuss your questions and successes.
• Talk to other professionals. They underwent the same processes when they first entered the job market.
• Talk to friends and family. Their insight and experience may surprise you. Ask for encouragement.
• Reflect on the situation. Self-awareness is hugely important. Knowing what it is that you are experiencing is the first step to putting it in context and managing it.
• Read your textbooks at leisure. (something a student has most probably not had the time to do thus far). It will help you deepen your knowledge and understanding without the pressure of exams and projects.
• Read online resources about starting a practice, the challenges of starting out, how to run a business etc.
• Read online professional journals and websites.
• Borrow books, journals etc. from colleagues and use the time to broaden your knowledge.
• If you are not flooded with paying patients immediately, find an organisation where you can volunteer your massage services a few hours a week. Not only will you gain experience and confidence while giving back to the community, it is the ideal way to integrate your practice into the community. The more you massage, the more experience you gain, the easier it gets to fill the professional role - so keep working even if it is initially for free. (It does however make business savvy to give a way your time to potential paying patients!)
• Enjoy this time. Soon you will wish for these idle hours in which to plan, read, write and study (yes, it never ends!) at your leisure.
• Have patience and compassion for your own experience.
Persevere and have faith in yourself.
Your time is now!
Orali Alcock practises in Paarl, Western Cape. She runs a private practice and is employed as a massage therapist at the local Hospice as part of their palliative care team. This article first appeared in the August 2009 issue of InTouch, the Massage Therapy Association of South Africa magazine
References
1) Brown and Olshansky “From limbo to legitimacy: A Theoretical Model of The Transition to the Primary Care Nurse Practitioner Role”,
2) Peter Wong Horng Hien, P, 2008. Presentation by Assistant Director, Nursing (Clinical) on Role Transition in Psychiatric-Mental Health: Advanced Practice Nursing 66.219.50.180/NR/rdonlyres/.../PeterWongCanada.pdf
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