Interviewed: Ravensara Travillian – massage therapist, research scientist, and educator

This is the third installment of an occasional interview series with notable people in massage therapy practice, education, research, and related fields.

Ravensara Travillian is a remarkable woman.  A licensed massage practitioner since 1992, she is also experienced in many other fields.  She has worked extensively with several refugee communities.  She has been a software programmer.  She earned a Ph.D. from University of Washington and has worked as a scientist for the European Bioinformatics Institute in Cambridgeshire, England.

She has studied the reproductive cycle of the sun bear, an endangered species.

She is a cancer survivor.

She has helped build the FaceBase knowledge repository of data on childhood craniofacial disorders such as cleft lip and palate.

Her Erdős number is 3, way lower than it needs to be to make me envious.

And, presently, she is working on some ambitious projects that integrate her work as a massage therapist with her knowledge and experience as a scientist and educator. Read on.

Christopher Moyer: Are you a scientist who also does massage therapy, or are you a massage therapist who also does science?

Ravensara Travillian: Based on time devoted to each pursuit, I used to be a scientist who also did massage therapy. Now that has changed, and I am a massage therapist who also does science.

CM: How did you choose to become a massage therapist?

RT:  I was working in the software industry, and seriously burning out on it. Two of my coworkers had started a night program in massage therapy. I had never heard of such a thing, but it clicked with me the moment I heard about it, and so I enrolled doing the same thing–working at my day job, and going to massage school at night, for a year.  Soon after that I took a position as the massage therapist at Harborview Medical Center’s Refugee Clinic, and got to work with survivors of war and genocide who dealt, daily, with the effects of post-traumatic stress disorder.  Those were seven of the most meaningful years of my life.  I also developed a private practice during that time.

My mother was a pioneer who challenged all the obstacles to attend medical school in Alabama in the 1950s, when medicine was considered an inappropriate career for women. She was truly passionate about her work. Being raised in a medical family by someone who lived and breathed that work ensured that I was never intimidated by hospitals or medical jargon, because it was so familiar. As a result, other healthcare professionals trusted me as someone who could be a bridge between their own work and massage therapy. I developed my practice treating clients with some very complex and serious conditions, such as high-risk pregnancies and cerebellar stroke.

travillian-massage

Dr. Travillian has considerable experience providing massage therapy to persons with serious health concerns.

CM: But that trust was not simply because you had a familiarity with jargon – you’re a trained scientist.  Tell us more about that, please.

RS: I was a total science nerd as a kid – even before I started grade school, I could find the stars by name in the constellations, and tell you about their natural history. I grew up playing with zoology, chemistry, and math, as well as with balls and bicycles.

I’ve loved science my entire life – I can’t even remember a time when I wasn’t curious about the natural world and how it worked. And I was very fortunate that the grown-ups in my life encouraged that curiosity and supported it with reading, field trips, museum and planetarium visits, and more. Because they were so supportive, it lit the flame in me to pay that back, and now I mentor youth in the refugee community in support of their love of learning. This can help them build better careers and lives. But, also, to see that love of learning take root, to see their curiosity and enthusiasm for learning unfold, and to see them challenge ideas and support each other – nothing could make a teacher happier.

All of that earlier life work was amateur science, though – I actually focused on humanities as an undergraduate, getting a bachelor’s degree in French and German, and then on social sciences in graduate school, earning a master’s degree in Southeast Asian studies. My interest in other cultures really blossomed then, and I did a lot of work with Vietnamese and Cambodian communities in the U.S. That’s the connection that led to my becoming a massage therapist at the Refugee Clinic.

I loved my massage work, and at the same time, I saw so much more need than I could fill. Many of my immigrant clients saw me as their advocate in a system that they didn’t understand, and wanted my help in navigating it to get the care they need. They didn’t understand how massage is not an integral part of the healthcare system in the U.S., as it was in their own culture. And I also saw so many of my massage therapist colleagues – good, warm, deeply caring people who wanted nothing more than to help, and to be a force for good in changing the world for other people – getting trapped in dead-end rabbit holes of false explanations of the body and the natural world that didn’t match reality.

They truly wanted to understand, but were trapped by the explanations that they were taught by educators whom they trusted to get it right. And, worse, because of the beliefs that they subscribed to – and paid good money to learn – they were alienating healthcare professionals who were fearful that massage therapy’s connections to pseudoscience could undermine their patients’ medical care. So the massage therapists wanted credibility, legitimacy, referrals, and reimbursement for the valuable work they were capable of, but their education also trained them to do things that made those goals harder to achieve. Meanwhile clients wanted more massage therapy, and healthcare professionals wanted to refer to massage therapists, but not at the price of being forced to choose between healthcare grounded in reality versus a treatment that espoused obviously incorrect ideas about how biology, physics, and other sciences actually work.

As someone with a foot solidly in both camps, I thought I could see how they’re pinned. So I decided to use my grounding in science to build bridges between massage therapy and mainstream professional healthcare. I closed my practice (except for one woman living with a very complex condition; I stayed with her until the very end a few years later) and returned to school, completing a PhD in Biomedical and Health Informatics at the University of Washington School of Medicine. That’s when I made the transition from amateur to professional scientist.

sun bear

Dr. Travillian’s scientific background includes detailed study of sun bears, an endangered species.

Informatics is the science of information–how we find and collect it, how we organize and evaluate it, and how we share it with each other. My PhD is in an area where semantics intersects with technology. Another way to say that is that I study how we can use computers to collect, organize, and share meaningful biomedical knowledge. Now I am working to apply that research to support massage therapy in adapting to the massive social changes it is currently facing.

CM: And now you are involved in projects that integrate your training in massage therapy with your training as a scientist.

RS: Yes, I am starting the Pacific Northwest College of Allied Health Sciences (PNCAHS), a school to extend these practices in a sustainable way.

Grounding the humane and client-centered work that we massage therapists already do in a foundation of science is so important that it is reflected in the name of the school. We consider professional massage therapy to be an allied-health discipline, meaning we commit to the shared body of mainstream medical knowledge that other client-centered, biomedical healthcare professions are founded upon. We also emphasize science as the best way of correctly understanding how the natural world works, including the human body in health and in illness, and for translating that understanding into safe, effective, and cost-effective treatments for clients.

One of the PNCAHS programs will be a master’s degree in Advanced-Practice Professional Massage Therapy (APMT), which will integrate massage therapy and science.  Within that name, Massage – non-sexual touch with the intention of providing care, relief, comfort, solace, attention, and other positive outcomes – is central.  But further, Massage Therapy recognizes that we’ve specifically trained in the shared, structured body of knowledge, developed across many centuries and cultures, about how humans relate to one another through our natural inclination to use touch to help someone feel better. We are proud of our membership in the worldwide community of massage therapists.

Professional means that we actively participate in the shared body of scientific, biomedical, and biopsychosocial knowledge that is the foundation of all modern, mainstream, client-centered healthcare professions, and that we subscribe to the same ethical values and practices that those professions share: autonomy, beneficence, non-maleficence, dignity, and justice.  Practice emphasizes the crucial importance of putting theories and knowledge into active service and outreach for our clients, and Advanced is meant to reflect how hard we work to gain a rigorous and nuanced understanding of how our natural world works, and of how humans operate in relation to each other within that world.

This resembles the path some other healthcare professions have taken before us. Nursing and clinical psychology, for example, encountered challenges similar to the ones that massage therapy now faces. As a result, we actually have many potential allies who understand our struggles, and who can offer their experience in the hope that we can use it as a model to advance our own professional success.

The master’s program is in development, and we are aiming for program applications to be available this coming December or January and for classes to commence in September 2016.

In the meantime, we are integrating massage therapy and science by offering continuing education classes and workshops on science-based Trauma-Aware Massage Therapy, professional ethics, and other massage topics; live-blogging interdisciplinary workshops on an open-access, free-of-charge basis, with other evidence-based healthcare professionals who are eager to see us take a place at the decision-making table; developing technology tailored to the information needs of massage stakeholders; and conducting client appreciation events to raise awareness of our clients themselves and to heighten our visibility in those client communities.

CM: As scientists and as educators, you and I encourage people to think critically and to be skeptical.  With that in mind, what might you say to someone who is skeptical that you can make this ambitious goal a reality?  Or to someone who is skeptical that there is enough potential interest and support from the massage therapy profession to make an advanced degree program viable and sustainable?

RS: First of all, I would tell that person that they are right to raise such questions. Any time that someone is advocating for a cause, trying to sell you something, or attempting to persuade you to believe claims, you should investigate that information thoroughly. And after you investigate, if you are not satisfied with what you find, you should walk away. People deserve to settle for no less than honesty, integrity, transparency, and accountability. And it also needs to be valid – to match up with reality. If it isn’t, then you can’t rescue it, no matter how much you may personally like whoever is pitching the project. So you need to raise lots of questions like that, and to get transparent answers, to figure out whether the idea has a reasonable chance of succeeding.

With those aspects in mind, here is what I have to say. I agree that the goal is very ambitious. However, we know that professionalization is doable, because other healthcare professions have successfully traveled that path before us. We are no less capable of doing it than they were if we are committed.

Nevertheless, it is clear that the larger massage therapy industry is all over the map when it comes to attitudes about professionalization. Put yourself in their shoes for a moment – if half the people you are walking with want to take one trail, and the other half want to take a trail that goes in the opposite direction, then how do you ever get any further? If you choose one trail or the other, half of the people in your group are not going to get what they want, right from the start.

That situation is what our national organizations faced when the Affordable Care Act came into being. They were unable to seize that moment because factions of their membership, to whom they owed consideration, had entirely opposite goals about where they want massage therapy to end up. Meanwhile, time is passing us by, and clients who could really benefit from massage aren’t getting it because we haven’t taken a place at the table.

Advanced-Practice Massage Therapy is optional and self-selected. That means that our membership can all have the same goals, which are to integrate with mainstream healthcare professionals for the benefit of clients, and to let go of behaviors that prevent us from achieving that. Within APMT, we won’t have to be always at odds with each other over our foundation, and we don’t have to have the same arguments that the broader profession is so often engaged in, because we are all on the same page about the path we are on.

That is a huge part of accomplishing a mission together – to agree on what that mission is so we don’t get stuck at the very beginning. Once we have that agreement, then the rest of the plan becomes strategy, tactics, logistics, and resources. I’m not making light of those challenges, but those are all well-trodden paths. That’s where people asking about APMT’s viability should have some pointed and specific questions for me, and where I intend to do a solid job of connecting the dots.

For your second question – is there enough interest and support? – that is a very good question that we need to consider carefully before proceeding. The history of massage therapy is littered with enough well-intentioned but failed initiatives that we can’t afford yet another. There are many individual massage therapists who want to practice massage in a way that is compatible with reality and science; they have supported us wholeheartedly from the outset, and we are grateful for it. There are also potential clients who feel they might benefit from massage, but who hesitate because massage therapy’s alignment with alternative medicine is inconsistent with the information and treatment they get from their trusted healthcare providers. We offer them the opportunity for a true integrative team approach, and they support us.

There are potential colleagues in professional healthcare who feel that massage therapy might benefit their clients, but they also see massage therapists declaring publicly that massage is an alternative to the ‘slash, burn, and poison’ of modern medicine, and these potential colleagues see no basis for integration with a profession that lets such a viewpoint be expressed without challenge. We offer them the opportunity to trust us to work on a team with them, without undermining their relationship with their patients. Similarly, third-party reimbursers see the potential of massage therapy, though the low quality of much of massage research leaves them unsure which claims about massage therapy are true and which are just hype. For them, we will offer rigorous evaluations upon which they can make solid decisions regarding the safety, efficacy, effectiveness, and cost-effectiveness of massage therapy as a full-fledged component of mainstream healthcare.

To ensure sustainability, we are working with business mentors, including Irene Diamond and the Center for Inclusive Entrepreneurship, to ensure we are implementing best practices in business operations. One of those best practices is a lean launch. For example, instead of investing massive amounts of money on our own facilities at the outset, we rent small facilities that permit us to not only save money that we can re-invest in providing services, but also to take the workshops, clinics, and special events to the participants who might have difficulty traveling to us. In the last few months, PNCAHS has conducted two Trauma-Aware Massage Therapy workshops for massage therapy continuing education at the Seattle Crisis Center and at the Kent Regional Library, conducted twelve free veterans massage clinics at several other locations, held a Veterans Appreciation Brunch for our clients at the Bellevue Hilton, and held a chocolate-making class as a fundraiser. We are also leveraging open-access resources from other professions to build enduring resources that will, in turn, be available on an open-access basis to the entire massage therapy profession, so that anyone who wants it has access to the same knowledge sources as APMT has.

Viability and sustainability are so crucial to APMT that they are ‘baked in’ from the very start, and I encourage people to ask as many questions about these topics as necessary, until they get satisfactory answers that connect the dots with clarity and validity.

Raven Alice Jason

Alice Sanvito, Jason Erickson, and Ravensara Travillian at the 2015 San Diego Pain Summit. Dr. Travillian will also be a featured speaker at the 2016 San Diego Pain Summit.

CM: You’re very passionate about advancing massage therapy.  What is it about massage therapy that motivates you in this way – what is it that makes it so valuable, and worth this kind of effort?

RS: The rich, joyful meaningfulness of it all. I used to wonder if there was something wrong with me, because I would leave the Refugee Clinic feeling encouraged and empowered. I mean, what kind of person could listen to so many stories of the horrible things that had happened to these people, and not feel like bursting into tears? But with time, I realized that it wasn’t the content of the stories that was making me feel so positive, it was the trust that my clients showed by letting me get close enough to them to share their experiences, and the resilience, strength, and grace that they exhibited by being able to keep going without giving up.

Touch is a basic human need, and our society makes it hard to get that need met in healthy, constructive ways. Providing other people with caring, focused, attentive touch, and earning their trust as someone who will keep them safe in doing so, is the best job in the world. I’m very grateful that I get to do it.

CM: Thank you, Raven.

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