When it comes to having the size of practice you want, what truly makes a difference? After more than 30 years training and coaching thousands of bodyworkers, from entry-level to expert, I had formed some opinions about how to build a full and satisfying practice; and I had a ready repertory of advice to give.
But though I had a long list of practitioners who had built fulfilling practices using this advice, I also knew good therapists who just couldn’t seem to get enough clients, even after years of trying. Was the difference something the practitioners did? Their attitudes and beliefs? Or something else, like their gender, location, or personality? Other than collecting a lot of success stories (which some would say did little more than strengthen my confirmation bias), I’d never really tested my opinions and advice about how to build a successful practice.
So, when ABMP asked me to teach an online course on the psychology of a full practice a few years ago, I didn’t want to just list my own opinions and ideas, no matter how good I thought they were. I wanted to know, in concrete, data-driven terms, what beliefs or attitudes successful practitioners have, and what tangible actions they take, that set them apart from those who don’t have the practices they want.  
Working together with fellow business coaches, other educators, and a good data analyst, we designed a large-scale survey to look for correlations between practice satisfaction (including both size and quality) and a variety of attitudes, characteristics, and actions. Though the resulting survey took some time for participants to complete (with 144 questions), it proved popular, with over 2,000 practitioners completing it (including massage therapists, bodyworkers, structural integration practitioners, and practitioners from a very long list of related hands-on specialties). We targeted both practitioners in private practice and those working for someone else. Professionals from 16 countries participated (with 95 percent from the United States, representing all 50 states). In very similar proportions to the profession as a whole,1 survey respondents were 83 percent female/17 percent male, an average age of 49, and in practice for an average of 11 years.

Confidence
Analyzing the data revealed a trove of surprises, both in terms of what did and didn’t relate with practice-size satisfaction. Though I’ll share more of these highlights in future articles, one of the most significant factors was self-assessed confidence in one’s own skills. No matter what their practice size, practitioners were much more confident in their “soft” skills, such as touch and listening, than in their “hard” skills, such as anatomy or assessment. This generally lower level of technical confidence suggests there are opportunities for schools, educators, continuing education providers, and regulatory agencies to help boost practitioners’ cognitive skills and confidence. But even more interesting was that in all six skill areas assessed (which included a range of cognitive and relational skills), lower self-confidence was strongly correlated with saying that one’s practice size was “much too small” (Chart 1).
Not surprisingly, too much self-criticism was also a significant detriment to practice satisfaction. Two-thirds of those with too-small practices strongly agreed with the statement “I am often critical of myself and my abilities,” while less than half of those with just-right practices agreed.
Of course, not all confidence is good, and not all self-criticism is bad. Over-confidence has its downsides too: egotism, arrogance, grandiosity, insensitivity, and a lack of caution or humility can be thought of as pitfalls of an excess of confidence or self-confidence out of proportion to others’ perceptions. And without self-criticism, there would be no drive to improve. But when confidence is too low, or self-criticism too high, the survey’s results suggest that our practices suffer.
While our survey measured the practitioners’ confidence in themselves, there is interesting evidence that practitioners’ confidence in the efficacy of their methods can influence their clients’ perceived results as well (Chart 2), suggesting that it’s important to believe in your modalities and techniques, as well as your own skills.2
I should point out that though it’s quite reasonable to expect that increasing confidence would likely result in more clients and more satisfaction overall, our survey showed only correlation, not cause. In other words, it’s also possible that some of the confidence/practice-size correlations were due to a lower number of clients causing practitioners to doubt their skills. However, even when this might be the case, increasing one’s skill and confidence clearly brings direct benefits when a practice is smaller than desired, including self-fulfillment, a sense of purpose, client satisfaction, and higher efficacy; all worthy aims, no matter how satisfied or unsatisfied we are with the size and nature of our practices.

*This project was supported by ABMP. Thanks to expert advisors Anne Williams, Cherie Sohnen-Moe, Drew Freedman, Eric Brown, and Irene Diamond, and to in-kind contributors, including Advanced-Trainings.com, Body Support Systems, and the World Massage Conference.

Enhancing Confidence
Here are 12 great ideas for increasing confidence in your skills from our panel of expert advisors,* survey-takers’ comments, and from the many stories shared in our discussion forum:
1. Rack up lots of experience. If need be, give sessions away for feedback. Keep working.
2. Stick with it. Our data showed that confidence and practice satisfaction both significantly went up with time.
3. Invest in quality training or additional credentials you value. Without enough of those to believe in your own possibilities, you’re wasting the time and money you’ve already put in.
4. Search for a mentor who believes
in you.
5. Find a coach, accountability buddy, or goals group to stay on track.
6. Get even better at providing the results your clients want. Supervision or a good training will help.
7. Collect, share, and celebrate your successes—both small and large—with friends, family, peers, social media, and your professional website. (Get a website.)
8. Trade with peers. Ask for feedback.
9. Ask for specific feedback from your clients.
10. Just do it, even if you’re afraid.
Action counts.
11. Get help with self-compassion.
We all need it.
12. Lighten up. Enjoy what you do.

Notes
1. “Massage Profession Metrics,” accessed December 2017, www.massagetherapy.com/media/metrics_massage_therapists.php.
2. R. H. Gracelay et al., “Clinicians’ Expectations Influence Placebo Analgesia,” The Lancet 43, no. 1 (1985).

Til Luchau is the author of Advanced Myofascial Techniques (Handspring Publishing, 2016), a Certified Advanced Rolfer, practice coach, and a member of the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the United States and abroad. He invites questions or comments via info@advanced-trainings.com and Advanced-Trainings.com’s Facebook page.