This is the first installment of an occasional interview series with notable people in massage therapy practice, education, research, and related fields.
Alice Sanvito and I first became acquainted online, several years ago, when she wrote to ask me some questions about one of my research studies. We’ve been friends ever since, and our shared interests extend beyond massage therapy and research to also include playing guitar and making really good pizzas. She is quite active in a number of online communities concerned with massage therapy, where she is recognized as a bit of a firebrand. She is a skilled and experienced massage therapist and an asset to the profession. She is not afraid to ruffle a few feathers to help it move forward, and I firmly believe the profession needs more people like her. Let’s learn a little bit more.
Christopher Moyer: You have a really interesting background. Tell us a little bit about how you got to where you are today, including how you chose to become a massage therapist.
Alice Sanvito: I’ve had an uncommon life. I homesteaded in the Ozarks in my early 20s and worked as a cook in a couple of restaurants, mostly vegetarian places. I worked as a union construction electrician for thirteen years and was the first journeywoman in IBEW Local #1. I still have a union card and earned a 35-year pin. I got into construction for the money, which was good, but at some point I realized it wasn’t really what I wanted to do with my life. I wasn’t sure what I wanted to do next. I had a variety of interests, but when I thought of doing them as a job, I was afraid I’d no longer enjoy them. I had an interest in massage and would sometimes massage family and friends. One day I saw an article in the newspaper about a massage school and later thought maybe I could be good at that and earn a living at it. So I quit construction, but I kept my union card up in case it didn’t work out. We didn’t have state licensing in massage therapy at the time and there were no requirements, but this was the most comprehensive program available in St. Louis. It was the only program that taught anatomy; the other schools didn’t think it was necessary and some MTs were downright opposed to it because they thought it would ruin one’s intuition. That was in 1991. Things have changed a lot since then.
CM: Tell us a little bit about your practice. Where is your office, what approaches do you use, and do you specialize in working with any specific populations or conditions?
AS: I have my own office in a small, older professional building. The other tenants are mostly psychologists and psychiatrists and there is one other massage therapist down the hall. I have a mixed practice. I’ve always had an interest in pain rehabilitation and two weeks after I finished massage school I took my first continuing education class in sports massage. I thought it would be a good place to start learning about injury rehabilitation. I started working with several athletes and found I enjoyed it a lot. I’ve also worked with quite a few performing artists. They really appreciate good bodywork and I enjoy working with creative people. In recent years, I’ve been working with an increasing number of pregnant women. It wasn’t something I tried to cultivate but apparently there are not many MTs in St. Louis who do prenatal massage. They find me through the internet and I’m happy to work with them. I get quite a mix of clients and I enjoy the variety. One day I had an 86-year old female former gymnastics instructor followed by a professional football player. I’ve worked on high school athletes and people in their 90s. I’ve done quite a bit of work with bike racers and I see the usual chronic pain problems – neck pain, low back pain, and everyone’s chief complaint, that ache people get between their shoulder blades.
I’ve had over 1,300 hours of continuing education, assisted at neuromuscular therapy (NMT) seminars for ten years, and studied Russian massage for ten years; I also taught it for three years. Those were my primary modalities for almost twenty years until I discovered pain science about five years ago. That shifted my thinking quite a bit. I still use Russian massage a lot but I think about it differently. I’ve backed off on the NMT because I decided that causing discomfort was unnecessary and potentially counterproductive. I’ve begun incorporating a lot of skin stretching, inspired by Diane Jacobs’ dermo-neuromodulation (DNM) approach, and have resurrected some approaches I learned in a Feldenkrais class I took many years ago. If someone is coming primarily for relaxation, I think I’m very good at that and I focus on giving them a very nice experience. For clients with chronic pain, I think education is important so they can learn to help themselves.
CM: Who are some of the people who have inspired you in your massage therapy career?
AS: Wow, there are so many that it’s impossible to name them all. Early in my career, Judith Delaney Walker and the other instructors at the NMT Center in St. Petersburg, FL, especially Don Kelly, were very important to me. They were my first role models for massage therapists who really took the profession seriously, tried to be very science-minded, were very careful in their communication, and really strove for accuracy. They would challenge their students to think, and they did not mind being challenged themselves. They provided me with the intellectual stimulation I needed and it was through them that I first got exposed to research.
My Russian massage teacher Zhenya Kurashova Wine was also an important influence. Most other approaches were anatomically and structurally oriented. Her approach was physiological. She put great emphasis on the quality of one’s touch and she was completely opposed to creating any kind of discomfort, which was at odds with what I learned elsewhere. Without ever using the term “body mechanics” she taught me to work in a way that was less stressful on my body, which has probably allowed me to last as long as I have. She was the first of my instructors to focus on the roles of the nervous system and the skin, and she taught me to work with the body’s processes rather than try to impose myself upon them.
In more recent years, my online community has been an incredible resource. It brought me out of professional isolation and accelerated my learning curve significantly. Early on I “met” Paul Ingraham, Ravensara Travillian, Bodhi Haraldsson, and you. Until then I thought I was science-minded, but my understanding of what that actually meant changed dramatically when I encountered people who were a lot more educated and informed than I was. It was a bit of a shock at first, but my desire to learn overpowered my distress, and once I got over it I was thrilled to find folks who were serious about understanding the body and manual therapy.
It was through these online discussions that I discovered the field of pain science, something I didn’t even know existed, and the folks from the SomaSimple forums helped me to understand how to apply that in my practice. Diane Jacobs, Barrett Dorko, and Jason Silvernail inspired me, mentored me, and encouraged me. I felt very timid at first. I don’t have a degree, I have only one semester of college, and these folks were way up there having conversations I could barely understand at first; they were way over my head. I saw, though, that they knew something I wanted to know and so I hung in there. They never treated me like I was inferior, and over time I learned how to read and understand the research and apply it to my practice. I know that a lot of MTs are not yet familiar with current pain science and it can seem intimidating. I have tried to take what I’ve learned, pull out core concepts, and put them into language most MTs can understand so that they can make use of it. I think current pain science has many implications for massage therapy and that we would be wise to become familiar with it and embrace it.
CM: From your perspective, what is the most important challenge for massage therapy , as a profession, in the United States today?
AS: Taking ourselves seriously. I think that’s the beginning of overcoming the barriers that stand in our way. Our profession grew out of tradition, and a lot of the explanations we were taught come from a time when we didn’t have the information that we have now. To bring massage therapy into the 21st century, we have to update our thinking. I think that we can still keep the best that tradition has to offer, whether it’s a particular style or aesthetic. Even the stories, if we understand that they are stories, can be useful metaphors, as long as we understand they should not necessarily be taken literally. But if we are to take ourselves seriously, it means we need to be committed, from our very core, to really understanding how the body works and what we, as manual therapists, can do. To do that, we need to be willing to educate ourselves, to examine our ideas and whether they stand up to careful scrutiny, and to give those ideas up when they are not supportable. In the beginning, that can be very scary, and it can be very painful to realize that the foundation upon which you built your mental constructs is not very strong.
I really sympathize with MTs who experience a lot of distress when their assumptions are challenged. I almost quit at one point. When I came to the realization that – even as a massage therapist who had worked at being science-minded – a lot of what I thought to be true turned out to be unsupportable, I really thought I’d have to give up and quit. Fortunately, I didn’t, but I had to discard a lot of ideas, take a step back, and start from scratch, looking at every piece of information along the way and thinking about it very carefully – asking myself, what do I know for sure, really? I had to drop a lot of explanations and assumptions and I make very few claims any more, but I feel like I’ve got a much more solid foundation and I’m more comfortable tolerating ambiguity. A lot of MTs are going through similar changes as individual practitioners. I think the profession as a whole needs to go through that – to commit itself to being scrupulously honest, to avoid making assumptions and jumping to conclusions, and to be able to tolerate ambiguity. In a sense, I think we need to start over with the basics and build from there so we can have a more solid foundation from which to grow. I think we have nothing to lose and everything to gain. I’m not sure exactly how that will happen.
The challenge is, how are we going to keep massage therapy relevant? If we stay on the fringes, if we stay marginal, we are not going to grow and mature as a profession. I really believe, very strongly, that we have a lot to offer, that there is a lot of unrealized potential. There is a lot of suffering in the world and we make people feel better. We could do a lot more, for a lot more people, if we were willing to take on the responsibility of being true professionals.
Alice Sanvito has the courage to take her own path.
CM: You’ve been very active in online communities. How has this influenced you and your work?
AS: Developing an online community has been a tremendous opportunity for growth and has saved me from professional isolation. It is through my online community that I’ve learned about not just pain science, which is a particular interest for me, but so many other things that are important to our work. I have had the opportunity to be mentored by a wide variety of amazing practitioners and to participate in discussions with some of the best minds in our field and related fields. In turn, I’ve had an opportunity to pass some of this information on to others. My research literacy and critical thinking skills have grown – I’m able to read papers that went right over my head a few years ago, and this has helped me understand ways I can better serve my clients. It has also been valuable for problem solving. Even after twenty-four years of practice one encounters situations that are difficult to navigate. I have an online community where I can ask questions and get some help. I came home from work late one night feeling a bit worried about a client, feeling a little distressed that I hadn’t noticed something sooner and that I wasn’t sure exactly what steps to take. I was able to bring it up in one of my groups and pretty quickly I had some very helpful responses. We all need to be able to think things over and get an outside perspective, and my online community has provided a place for that.
We are fortunate now to have a wide variety of people, with a broad range of talents and skills, who are willing to share their knowledge and insight with us online. One can get quite an education.
CM: Online discussions about massage therapy, and whether massage therapy research and education really need to be integrated, can sometimes get pretty heated. What have you learned from this? How has your approach to such discussions evolved?
AS: Oh, wow. I’m not sure how to answer that. I think my learning curve is much better when it comes to pain science. My learning curve around this has been a lot slower. I’m not sure I’m getting any better at it. When I first got involved in online discussions, I was not prepared for how extremely angry and offended some people could get over what were really innocent questions. In my personal life, a lot of my friends were scientists and I was accustomed to being in an environment where it was okay to ask where someone got a piece of information or, if they said something that didn’t make sense to you, it was okay to ask, “Well, what about this?” I’m not sure if I *have* evolved, which is not a very flattering thing to say about oneself. Perhaps I’ve gotten just a little bit better at knowing when to cut loose. One of the things I particularly like about people who are more science-minded is that they are more focused on the information and don’t get particularly upset if you question something they say. In places like the SomaSimple forums, where they are very focused on the information and trying to understand pain science, the discussions can get vigorous but they don’t allow personal attacks. They have a strict policy against that, and I feel a tremendous freedom there to express myself, to ask questions, and to disagree. Things are not taken so personally there and one is free to wrestle with hard questions without worrying too much about offending someone. Most MTs are not accustomed to such discussions, though, and that may be one of the most difficult things for me. I think somehow I’m getting better, because I don’t seem to upset people as much as I used to.
Or, perhaps, more MTs are getting exposed to some of these ideas and so there’s less upset around them. I tend to be pretty direct and to the point, and that doesn’t always sit too well with some folks. That’s an area I’m still struggling with. Perhaps a lot of the challenge is that, online, you really don’t know who is on the other end. There’s a variety of people with a variety of points of view, backgrounds, education, experience, and variation in how they respond to ideas that are different from their own. In general, I try to notice those who seem more successful at getting their point across without causing too much upset, and I pay attention to how they communicate. I make it a point to stay focused on the information and avoid emotional language or comments about the person. I’m not easily offended and don’t take people’s upset personally. I know that for a lot of them, it’s an expression of the pain and confusion they are feeling. If there is someone in the discussion that is taking a stand for evidence and doing a good job of it, I’ll often back out of the conversation because maybe they can do it better than I can. If no one is taking a stand for evidence, then I feel an obligation to my profession to stick up for it, whether it’s welcome or not, because pseudoscience and misinformation is epidemic in our field and I think it’s important to counteract that. I try to pick my battles a little better than I used to, though, and it seems that either I’ve gotten better at not causing upset, or the online discussions are now more populated with MTs who are well-informed and more willing to wrestle with the tough questions.
Something I’ve never voiced but have wondered about is whether there isn’t an element of possible unconscious sexism involved. It seems to me that when there is a very well-informed male with what I would consider high status – advanced academic or research credentials – that they tend to be treated with more respect and draw less anger. I’m not convinced of this but it seems that well-informed women, even those with impeccable information and advanced credentials, will often get more emotional responses from participants. I’m not certain if this is true but it’s something I have wondered about.
(CM adds: I have little doubt Alice is right about this. The research into how mens’ and womens’ communication is treated differently, especially online, is growing. Here is one comprehensive overview of the issue.)
I am working on trying, as best I can, to avoid social nociception, but it’s a lot easier to learn about pain science.
CM: What is something you’d like more people to know about you?
AS: I’m pretty open and for those who know me well, I’m not sure there is anything that I can think of. For those who don’t: well, first of all, I’m actually a very nice person (I concur – CM) and, while I’m pretty blunt and to the point in professional discussions, because I want to be able to discuss the tough questions openly and freely, with clients I’m really very gentle and will rarely challenge their beliefs unless I think there’s potential for faulty beliefs to lead to harm. For those who are struggling with realizing that a lot of what they assumed to be true is not supportable, I want them to know I have a lot of compassion for them and that I’ve been through that, too. I almost quit. But I didn’t, and life on the other side of that is even better.
For those who have the idea that science is cold and uncaring and think that my being science-minded means I take a mechanical, unfeeling approach to my work and my life, I would like them to know that I have a rich inner life. I have a vivid imagination. When I dance and play music, there are moments that are transcendental and that is a normal part of my life. I experience it when doing massage sometimes, too. I know all about the experiences folks ascribe to “energy work” because I have them all the time, I just have a different explanation for them.
I’m also quite proud of having been the first journeywoman electrician in IBEW Local #1 and of helping to pave the way for the women who came after me. I’ve been a bit of an activist of one sort or another most of my life, going back as far as first grade. It seems to be part of my nature.
CM: You’re a performing musician, and are also very active in the dance community. Do you see a connection between those activities and your work as a massage therapist?
AS: Definitely. I had a great experience with a guitar instructor who also taught aikido and dance. I needed help with my body mechanics and he started my first guitar lesson by dancing with me, because in dance I already had a better concept of moving with ease. That guitar lesson not only improved my playing, it improved my massage because it heightened my awareness of movement. In all three, movement with ease is key and there is a beautiful interconnection between art and science. In all three, there is an interplay between myself and at least one other person and there is a constant seamless flow of paying attention, listening, responding, and adjusting. In all three, when things are coming together really well, the experience is transcendental.
CM: Among massage therapists, you are one of the strongest proponents of the need for and importance of massage therapy research. Why do you think it is important?
AS: Our field grew out of tradition. On one hand, one doesn’t need to know a lot to give an enjoyable massage and to create a nice experience. Humans have been doing this intuitively for as long as we have been around, and all mammals practice some sort of social grooming without ever having to learn physiology. However, if we want to grow beyond just making a nice experience for a friend or a loved one, we need to understand how the body works and how our touch affects the body. There is a lot of human suffering in the world and I think that we are in a position to alleviate some of that suffering, whether it is physical pain or psychological pain. Massage is very low-tech and potentially available to anyone. We don’t need expensive equipment or technology to do it or to teach it. However, if we are going to reach our full potential we need to know, realistically, what we can and cannot do. If we make a claim, we need to know if that claim can be supported with evidence and is not just something we made up. We need to know, realistically, how we can be helpful, what our limitations are, and when what we are doing might be detrimental. The only way we can really do this is through research. Right now, we have very little to draw from and we have to depend a lot on our own experience, the experience of others, and what we can learn from other professions.
Lack of research not only holds us back by limiting good information on which to base our approaches, but it keeps us from progressing as a profession in healthcare and in the public eye. Massage therapists often complain that we are not taken seriously by other health care providers and by the public, but to be taken seriously we have to take ourselves seriously as a profession. A medical doctor is not going to refer her patients to us if we sound like flakes or if there is no good reason for her to think our intervention might help her patient. A counselor is not going to refer his patients if he thinks we don’t have the professional maturity to work with them and there is no evidence to show that massage therapy might help them. The local hospital is not going to have MTs on staff if massage therapy has not been shown to be of benefit. The Veterans Administration and insurance companies are not going to pay for massage if it has not been shown to be beneficial and cost effective. If we have research that demonstrates that massage therapy can be effective in certain situations, other health care providers will be more likely to recommend massage therapy and the public is going to be more open to considering it as a valuable option.
Unfortunately, we don’t have much research available as of yet and a lot of it is of poor quality. There’s a bit of a Catch-22 situation in that, since there is no tradition of research in massage, it’s hard for someone to get a position doing massage research. Thus, we continue to have not much research focused on our profession. Most of the research that I read is not directly massage therapy research but research from other fields that has implications for us. If we can manage to break out of our own small world and start mixing more with related professionals, perhaps this will help to lead to more research opportunities for massage therapy.
CM: Thank you, Alice.