In the world of education, the term critical thinking has taken the limelight as a necessary skill for reaching deeper levels of understanding of any concept or situation. There is significant value in comprehending what critical thinking is and how the skill of thinking critically is developed, especially given the nature of the work we do in massage therapy. Not only is critical thinking essential to our approach, it is an exceptional life skill in general. The intent of this article is to define critical thinking, outline its components, and offer guidance on how to develop critical thinking skills and apply them in your massage practice.

What is Critical Thinking?

The Foundation for Critical Thinking (www.criticalthinking.org) offers the following definition on its website: “Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.”1  
Critical thinking differs from regular thinking in that it goes beyond simply acquiring knowledge and comprehending concepts. When a person chooses to think critically, they take knowledge received from regular thinking to the next level. They ask questions and make visual observations to gain as much information as possible. Then, they break that information down and analyze it in order to illuminate connections between concepts and scenarios, and use those connections to get to the root cause of problems. Without an understanding of the root cause of a problem, it is difficult to solve it.

Components of Critical Thinking

Critical thinking includes the following actions:

Evaluation/Observation

This action involves defining the problem by gathering facts through the senses and past experience. What do you see, feel, and hear? What are the symptoms of the problem? What do you already know about how the area or situation would function if it was working properly?

Analysis

This action involves asking specific questions to obtain more detailed and useful information. Simply asking who, what, when, where, why, and how can get you to the details you need. Avoid yes/no questions, as these don’t invite details.

Synthesis

This action involves identifying how these pieces of information relate to each other. Synthesis is finding links between concepts, objects, and processes. How does one thing influence another? What assumptions are revealed by the information you have gathered?  What else is affected by having this assumption? What are the benefits and drawbacks of believing a particular assumption? How can an assumption be verified or disproven? How does a belief influence other thoughts, behaviors, or actions?

Application

This action involves deciding on, and implementing, a possible solution to the problem. Can you encourage a new habit, change a behavior, develop a new program, or facilitate a process of change? It’s helpful to focus on what you want more of rather than what you don’t want so you can encourage a positive outcome.  
After implementing a possible solution, critical thinkers return to the first action of evaluating the outcome to see if it was effective. Did the initial solution solve the problem, or is it necessary to analyze again now that new information has been gathered based on what did and didn’t work with the first possible solution? The cycle can repeat until an effective solution is reached.

Critical Thinking in Massage Therapy Sessions

How can we use these components of critical thinking to enhance the work we do as massage therapists? In what situations do critical thinking skills matter in the world of massage? The most obvious answer is client assessment and treatment planning. A client comes in with a problem. Their low back hurts, they have a kink in their neck, they’re experiencing numbness or tingling in the arm or hand. The list of potential concerns a client may bring to your table is vast. How do you know what is causing the problem and which approach to take to support relief of discomfort and return to health? Let’s run it through our critical thinking process outlined above.

Client with Tingling and Numbness in the Fourth and Fifth Fingers

You have a new client named Sally who is experiencing tingling and numbness in the pinky and ring fingers of her right hand. She is a first-time client, so you go through a thorough health history evaluation to start building a picture of her life activities.  
A thorough health history form will include questions like “What are your current symptoms?” “Do these symptoms interfere with your activities of daily living?” “Have you had any past injuries and/or surgeries?” “Are you taking any medications?” etc. It should also have a comprehensive list of common conditions or possible sensations the client might be experiencing so you are giving them language to start with. Sometimes clients don’t know how to describe what they are feeling; therefore, giving them some initial cues can be helpful in obtaining the information you need.
Based on the health history form, ask additional, detailed questions about what was reported. What does Sally spend most of her time doing? What is her occupation? Does she work in front of a computer all day? How is her work station set up? Does she travel for work? Does she always carry her purse on the same shoulder? If she travels, does she always roll the suitcase with the same arm? Is she involved in any sports or exercise? Does the sport or exercise involve repetitive motion, such as swinging a racket or club? What exacerbates her pain? People develop the most ingrained patterns through constant repetition, so notice these patterns, especially involving one-sided movement.  
Next, conduct a postural assessment. The details of conducting a postural assessment are available in the Massage & Bodywork article “The Posture Window” (September/October 2017, page 52). What do you already know about the nerve branch that innervates the fourth and fifth fingers? Where is its pathway? What can you see in Sally’s posture that might cause a compression at any point along that pathway? What position would structures surrounding the pathway be in if they were healthy and, therefore, what needs to be manipulated back into a healthy position in order to release the compression? Be sure to look at the big picture, not just the immediate area that is affected. Typically, the symptom occurs further down the path from the problem.
Finally, apply this information to your hands-on approach. Educate Sally on what you see, and coach her on adapting her body movements and patterns to support the new pattern you have encouraged her body into.  
The next time you see Sally, or better yet, when you call Sally for a postsession follow-up, find out what has changed, if anything. Has there been improvement? What are her current sensations? If the change is positive, repeat your treatment approach. If there is no change, or if the change is negative, adapt the next session accordingly until you identify the root cause.

Expand Your Critical Thinking Horizons

Even though client assessment and treatment planning are the most obvious areas of massage therapy that critical thinking skills can be applied to, there are other critical areas. When building your business, critical thinking will help you determine which marketing approaches work and which don’t. If you have to manage a difficult or inappropriate client, critical thinking can give insight into why they are behaving as they are and how you can most effectively direct them. It’s beneficial, especially in ethical situations, to foresee potential challenges and practice your approach so you can cultivate confidence. As with any skill, practice is the key to refinement. If you simply begin to notice situations in your life where critical thinking skills could be applied, within or outside your massage practice, you’ll realize there are plenty of opportunities to practice.

Note

1. M. Scriven and R. Paul, “Defining Critical Thinking: A Draft Statement for the National Council for Excellence in Critical Thinking,” accessed July 2018, www.sciencedirect.com/science/article/pii/S1877042816312666.