Critical thinking is one of those things that just about everyone says we should do more of—or do better. But few people have a fully formed idea of what it is, whether it can be taught, and how it can be evaluated. If you had to define critical thinking, what would you say? As I wrestle with this concept, I find that critical thinking is a lot like a tomato seed: The harder I try to grasp it, the further it squirts away from me.

You don’t teach critical thinking. You nurture it. —Sandy Fritz

Critical Thinking: What is It? (Take 1)

For every simple, declarative statement I can make about critical thinking, I can think of a dozen examples where it is not applicable. Critical thinking is situational, it is highly personalized, and it is absolutely vital—critical, you might say—to doing our work well. But what the heck is it, how do we do it, and how do we know if we’ve done it well?

It’s being able to step outside my own initial and emotional reaction to something and to look at it objectively from a variety of perspectives. —Allissa Haines

It is the ability to make professional judgments based on facts. —Susan Salvo

It’s the single biggest problem facing our profession, if not the world, today. —Til Luchau

It’s messy! —Sandy Fritz

Critical Thinking: Turning Knowledge Into Action

In that last paragraph, I made a value statement about critical thinking—that it’s vital to doing our work well—but not everyone may agree with that point of view. I think we can agree, though, that massage therapists should engage in ethical actions that are within their scope of practice to use their skills to help improve the quality of life for their clients. I propose that when we add foundational knowledge to the decision-making process, those skills become even more refined, and the work becomes safer and more successful: this is the product of high-level critical thinking.

This is my mission statement: I want to help massage therapists make safe, effective, and evidence-informed clinical decisions for their clients’ benefit. In pursuit of that outcome, I have been grappling with the problem of critical thinking for a long time. I used to duck the issue by simply providing relevant information, and then leaving it for my readers and students to use to make their own decisions. But my thinking has evolved, and I have come to realize that supplying a lot of factual information is not sufficient to address my goal. Now in my writing and teaching, I purposely emphasize helping people analyze how to use knowledge to take appropriate action—which turns out to be a key factor in the critical-thinking process.

Another driver for this article has been my work as an expert witness and a consultant in litigations where an MT has been accused of injuring a client. This is difficult and important work, and I am honored to do it, but it also fills me with frustration—mainly because I see the consequences of what happens when MTs don’t have critical-thinking skills, or don’t use them well. The harm done to clients and to the profession as a whole, in these cases, is heartbreaking.

Finally, I have been inspired by the contributors to my podcast, I Have a Client Who …—Pathology Conversations with Ruth Werner. I have had the opportunity to communicate with dozens of massage therapists who have questions that come up midsession, and who must make a decision on the fly—sometimes without enough information to feel comfortable or confident about it. I love these conversations, which do the opposite of my legal work; they fill me with appreciation for our colleagues who are working hard to do well and also to do right by their clients.

What I offer here is only one approach to critical thinking. I think it works for decision-making in a massage therapy context, but it is, of course, colored by my own filters and biases. That is inevitable. We cannot escape the limitations of our own points of view. However, we can become more aware of those limits and conscientious about trying to broaden them. I invite you to try the process I offer here. See what fits—and what doesn’t—and then analyze why that’s true, and whether it’s time to revisit some of your own conscious cognitive processes.

Most of the source material on critical thinking I relied on for this article is designed specifically for educators. This makes sense since the classroom is an ideal setting to promote and model how to use information in creative problem-solving. But critical thinking isn’t just for the classroom, and massage therapists (like it or not) are also educators: We help our clients learn about their bodies and what they can do to feel healthier, have more energy, feel less stressed, and have less pain. So being able to communicate information to inspire action needs to be part of every MT’s set of skills.

I also reached out to many of the people I respect most in the massage therapy field, including people in leadership, classroom educators, continuing education providers, textbook authors, and others, to gather their thoughts on this slippery topic. You will see quotes from them throughout this article, and I have compiled a short video with their key points and thoughts, as well (see page 63 for QR code scan).

I will start with another attempt to define critical thinking. Then, I will offer a set of steps that might work for massage therapists who want to become more disciplined about this process. Finally, I will address some of the many challenges to critical thinking our profession must struggle with.

Critical Thinking: What Is It? (Take 2)

At the beginning of this article, I tried to define critical thinking. But all I managed to do was describe it. Critical thinking is slippery. It is messy. It is important. But what is it really?

Definitions of critical thinking vary. According to Richard Paul, director of the Foundation for Critical Thinking, “Critical thinking is thinking about thinking, while you’re thinking, to make your thinking better.” This is a glib soundbite rather than an in-depth definition, but it starts us on an interesting path. From this definition, we can derive that critical thinking involves increasing self-awareness with the intention of getting better at what we do.

Here is another definition from the Foundation for Critical Thinking: “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 To paraphrase this somewhat ponderous statement, I’d say critical thinking is the conscientious processing of reliable information, which may come from many sources, to inform choices.

Another definition I like is: “Critical thinking is not a matter of accumulating information. A person with a good memory and who knows a lot of facts is not necessarily good at critical thinking. A critical thinker is able to deduce consequences from what they know, and they know how to make use of information to solve problems, and to seek relevant sources of information to inform themselves.”²

Other experts’ definitions of critical thinking follow similar themes, with varying points of emphasis on the quality of thinking, the importance of creative problem-solving, and the value of independence and autonomy.

Underpinning all critical thinking and critical reflection is curiosity. —Pam Fitch

From all these definitions, I propose that critical thinking for massage therapists requires three primary skills. We need to be able to:

• Evaluate information for relevance, trustworthiness, and completeness.

• Independently use that information to make plans and take action.

• Evaluate the effectiveness of that action to make adjustments for next time.

These skills are complex and challenging. When massage therapists perform them successfully, we are able to make compassionate clinical decisions that lead to safe, effective, and evidence-informed care (sound familiar?). These skills apply in any practice setting, from an outpatient chemotherapy unit to a cruise ship spa. In this model, evidence-informed practice is a key element of critical thinking.

Evidence-Informed Practice

Evidence-informed practice is a term with a specific meaning. It means making clinical decisions by balancing three different sources of influence: client values, practitioner expertise, and research.

• Client values must provide our framework of priorities as we consider options in the clinical application of our work. What does this person need? What do they want? What do they want to avoid? What are their values and hopes for this interaction?

• Practitioner expertise is what you bring into the session room with your education, your experiences, your observations of this client and others, and whatever other filters you carry with you. What have you learned in your previous work? How able are you to identify all the variables that must go into your decision-making process? Do you have the expertise this client needs, or is it necessary to obtain a new set of skills or refer them to another provider?

• Research can refer to what researchers have studied about any specific massage therapy question. It can also include what you’ve read in trustworthy textbooks or articles, what you learn from trusted peers and authorities, and what comes to you through other means of communication. Of course, it is your job to determine whether these sources of information are reliable and applicable.

When we blend these three elements together—client values, practitioner expertise, and research—we can be confident we are bringing our best to the table. This is the essence of best practices, and it is inextricably a part of critical thinking.

Critical-Thinking Steps

I have compiled a list of possible steps to take toward critical thinking in clinical decision-making. They are the product of much reading, trial and error (oh look—that’s critical thinking!), and consultation with other people in the field.

Critical thinking is the ability to think about the client presentation in a way that breaks it down into manageable parts, and to do that across different settings and with different client populations. —Tracy Walton

I offer these steps with the hope they might be helpful—not so much in terms of making the “right” clinical decisions (because there are multitudes of right decisions), but in terms of helping readers to more thoughtfully analyze their decision-making process to look for places it could continue to evolve. These are not a final product; they are a starting place that might inspire you to develop your own critical thinking steps.

Step 1: Identify the Question/Challenge/Goal

This step covers the “client” portion of the evidence-informed practice triad. The client’s goals and hopes—for a treatment series and for each single session—must be at the center of the decision-making process. The client’s goals may be something they want to achieve (“I’m here because my back hurts, and I want to have less pain”), something they want to avoid (“I’m here because I have back pain, and I don’t want to use opioids”), or both.

Step 2: Identify the Relevant Variables

The ability to weigh risks and benefits for massage therapy—that is, the variables that must inform our choices—is at the heart of our science education. This is where evaluating information for relevance, trustworthiness, and completeness becomes vital. And in a time when a massive amount of information (not all of it equally reliable) is instantly available, it can feel like an overwhelming process.

In my work I emphasize what do you ask a client, why are you asking it, and how their answer going to change what you do. —Tracy Walton

For our client with back pain, the variables will include their age, occupation, activity levels, onset of symptoms, exacerbating circumstances, underlying conditions, and many others. It is possible to put together algorithms and question lists to compile possible risks and benefits for bodywork, but while these can be a helpful place to start, they cannot anticipate every possible circumstance. We need to be able to think independently to accrue the necessary information.

Step 3: Challenge Your Assumptions

We cannot eradicate our own biases, but we can become more aware of them. When we recognize that our assumptions may limit how we process important information, we become more able to rise to the challenges set before us. For example, we may observe our client with back pain appears to be overweight and their shoes are worn down unevenly. Obviously (it seems to some people), they must have issues with their feet, knees, and hips that culminate in the back pain. This is an interesting line of inquiry—that this is the cause of their trouble—but not a safe assumption. We make all kinds of assumptions every day, and it is our responsibility to test those assumptions whenever we recognize them.

One of the questions I always ask myself is, “And I know this how?” Just asking that question was a defining moment in my own career. —Doug Nelson

Step 4: Consider Possible Strategies (and Alternatives)

It’s time to think about our strategies—and then take another look and reconsider what we might be leaving out. This is where we compare our first impulses to the current research to see what other practitioners or health-care providers have done in similar circumstances. For our client with back pain, we might begin with some tactics based on their situation and our experience, and then look at what the data says about the most effective manual therapies. This is a good time to ask the all-important question about our approach: “What’s missing?”

Author note: Steps 2–4 address the “practitioner expertise” and “research evidence” elements of evidence-informed practice.

Step 5: Plan and Execute a Course of Action

We’re getting closer. We have identified the problem, challenge, or goal for our client with back pain. We have examined the contributing variables and challenged our assumptions about the situation to see if we’ve missed something important. It’s time to move from thought to action. What will you do, and why? What will you not do, and why? What accommodations will make this session or series of sessions completely personalized to your client? Each of these decisions needs to have a considered rationale.

Critical thinking isn’t about knowing more. It’s about using information in a more sophisticated way. —Sandy Fritz

And of course, as we go through the session, we constantly shift our strategies based on immediate verbal and nonverbal feedback from our client.

In the classroom, I give you didactic knowledge and skills and practice. But ultimately what I want you to be able to do is think on the fly. Then you can take that knowledge and be able to autonomously go into that situation. —Robin Anderson

Critical thinking means being able to think outside the box, and realizing that every client is not the same, so every treatment plan should be individualized, and the best interest should be put forward for the client, not the therapist. —Brent Jackson

Truthfully, most massage therapists probably go through some version of these steps in an unconscious, unanalyzed way for every client (often while we wait for them to get on the table), but I maintain the more aware we are of the process, the better choices we make. And we’re not done yet.

Step 6: Reflect on Results

What is the point of engaging in high-level critical thinking for our clients if we don’t put as much high-level reflection on the results of our efforts? If your client gets some relief, that’s wonderful—but what will you learn from this, and how can you build on it in the future? If your client doesn’t get relief from your work, that’s even more important to track so you don’t go down the same dead end the next time you work together. If you changed tactics midsession to adapt for your client’s responses, it’s important to note for next time. This, among other reasons (e.g., demonstrating progress to the client, communicating with other health-care providers, billing insurance, gathering data for a possible case report), is why it is so important for massage therapists to carefully document their actions and client progress.

I think about critical thinking through the question of “How do you chart it?” Sometimes it’s a backward look at the session. As you look backward on the session and you go through the steps you took and try to chart them, you start to ask, “What did I miss? And how do I improve on that the next time?” —Diana Thompson

We tend to not teach follow-through critical thinking: What happens after two sessions, or four? What if you come to the realization that massage therapy isn’t the right tool—how will you deal with that? —Annie LaCroix

Challenges to Critical Thinking

We could stop here. We’ve defined critical thinking, which is difficult in itself, and we’ve laid out some steps that can help MTs accomplish this complex and important task. We’re done, right?

Wrong. Because when we ask “What’s missing?” (Step 4), it’s obvious there’s still a big unaddressed issue: A lot of challenges make critical thinking difficult. And to present a discussion on this slippery topic without naming some of these challenges would be a job half-done.

Confirmation Bias

It is a natural, totally human impulse to give positive attention to information that validates what we already think is true, and to minimize or negatively scrutinize information that challenges our worldview. This is true not only in massage but in the world at large, as we see daily. But to claim we are open-minded, evidence-informed critical thinkers, we must be willing to have our worldview challenged.

If I see something that fits what I think is true, then that catches my attention. It looks like evidence to support my “fact” over anything else. And that’s where the thinking might stop. —Til Luchau

It’s hard. It can be painful and scary. And it is necessary. Don’t worry—your strong understanding of your work will only be made stronger when credible but unexpected information appears to broaden it.

Decision Paralysis

Because critical thinking requires us to process so much information, and because humans are complex beings, it can feel overwhelming to try to get a complete handle on all the nuances of any one person’s situation to make clinical decisions. Is there even such a thing as enough information? The workaround for this quandary is to start with safety, and to proceed with caution from that point. Then we can add challenge and intensity to our massage incrementally, while collecting feedback and gathering more information as we go. It’s not a realistic expectation that a massage therapist will fully comprehend all the details that matter for every decision, but it is important that we add to our knowledge as our relationship with, and understanding of, our client deepens.

Nuance vs. Certainty

Humans like to know what the facts are. We are sometimes less tolerant of ambiguity that requires deeper understanding. As it happens, it is easiest to teach in this paradigm too—facts are easier to test than understanding. Open questions and answers that start with “It depends on . . .” can be uncomfortable and frustrating, especially for people who don’t have a lot of experience. Critical thinking requires practitioners to hold onto multiple, sometimes conflicting, possibilities until enough information has been gathered to take action. Then we must be willing to change our strategies, depending on what happens along the way.

I think that’s the biggest challenge we have in education—we teach in black and white. The problem with that is that the world is composed of various shades of gray, with virtually no black and white. I think that good quality education around critical thinking is diving into that ambiguity. —Michele Renee

Critical thinking is a commitment to let go of certainty. —Cal Cates

The more certain I notice myself feeling, the more suspicious I get about my understanding of a situation. —Til Luchau

Critical Thinking vs. Intuition

The concept of intuition as a contrast to critical thinking came up in several of my conversations with colleagues. But the meaning of intuition in this context is hazy.

Intuition is knowing without knowing how I know. —Til Luchau

Here’s my take on this: I think intuition is just processing information really fast. An intuitive person skips from point A to point G without being conscious of passing points B–F in the process. So in the context of clinical decisions, when someone feels “intuitively” drawn to a specific action, I suggest that if they examined that choice, they would be able to identify the subtle factors that drew them in that direction.

Intuition strengthens with experience because we have a bigger catalog of experiences that surprised us. When you have the most access to intuition is when you don’t know which way to go. —Cal Cates

Let’s bear in mind too that those intuitive choices don’t always work out well, possibly because the knowledge or observations on which they are based is incomplete. Not surprisingly, intuition gets more accurate with more experience. My personal confirmation bias interprets this to mean that “intuitive leaps” are actually the result of subconscious analysis. The more aware and conscious we are of these steps, the more able we are to perform safe and effective actions on purpose, rather than by accident.

Humility vs. Expertise

One of the greatest challenges I see in our profession comes down to balancing appropriate humility that helps us stay open and teachable, with appropriate confidence in our own expertise.

I think the element that goes into critical thinking most for me is humility. After 45 years of practicing, I could imagine that I knew something. But critical thinking is standing before my client as an utter innocent each time, and to not make presumptions. —Tom Myers

A place where this tension is borne out most acutely is when a massage therapist is given a direction from someone who appears to have more authority: a doctor or other health-care provider, a boss, a clinic manager, a teacher, an author, you get the idea. And they follow that direction, regardless of whether it’s in the best interest for the client. This can be a recipe for disaster. It is not a doctor’s job to know what your massage therapy looks like. Your teacher cannot predict all the variables your clients may present. Your boss may not understand massage therapy carries substantial risks for some clients. You have the capacity to assess risks related to massage therapy in a way no one else can do. Conversely, you also have the ability to foresee possible benefits for massage therapy others might not consider.

This tension points to our need to be able to communicate effectively with other health-care practitioners, which is a connected-but-different can of worms. So, when a prescribing physician recommends deep-tissue massage for a person with unilateral calf pain (this is based on a true story), a massage therapist with good critical-thinking skills needs to explain why that might not be a good idea. Likewise, when a surgeon flat-out prohibits a massage therapist from working with a recent shoulder surgery patient (also based on a true story), a critically thinking practitioner can initiate a conversation to see why the doctor thinks massage is not appropriate and explain how massage therapy can be provided safely in this circumstance.

The sort of storied closed-mindedness of the medical system is not what I’ve encountered. Every doctor I’ve talked to has said, “Oh! Well, when I think about it that way . . .”

I really urge people to engage with the medical profession, not to pretend that you know more than you know, but you do know what you do know, and dialogue with the rest of the profession is so valuable for us, for your own practice, and for the profession in general. —Tom Myers

It’s harder when the authority figure is a boss or manager or someone who doesn’t trust the massage therapist to make the right choices, or whose priority is not client safety. In these cases, the massage therapist may have to solve the puzzle of how to work in a setting that doesn’t support client safety by analyzing their options, trying a strategy of good communication, and possibly choosing to work elsewhere.

The challenges to critical thinking I have offered here are based on my own observations, seen through my own filters. They have been informed by my experiences, and by my conversations with others in the profession. For the sake of space and sanity I left many out, including the dangers of complacency, the challenges of assessing critical-thinking skills in learners, our lack of a widely accepted educational standard, and many others. You may identify completely different challenges than I have, but I hope you will be able to recognize them, analyze them, and consider how you might overcome them to expand your critical-thinking powers.

Sample Critical-Thinking/Practical-Application Exercise

This is an example of what it might look like to conscientiously run through the steps in critical thinking. I have provided a thumbnail sketch of a possible client, with some of the variables that might inform the massage therapist’s choices.

Leo is a 62-year-old man in generally good health. He is active: He used to be a runner, and now, when he can, he walks and hikes. In the last few years, he has developed osteoarthritis at his right knee, and now it is seriously interfering with his quality of life. His left knee is beginning to bother him too. His doctor says he is “bone on bone,” and he is a good candidate for a joint replacement surgery. However, Leo wants to avoid that if at all possible. He had a back surgery for a herniated disk 10 years ago, and he didn’t feel it was successful. His back pain has continued to bother him. Now he wants to explore every alternative—including massage therapy—to try to reduce his knee and back pain so he can return to normal activities.

What is this client asking for, and can I provide it?

From the description, we know Leo’s knee pain is interfering with his quality of life. He would like to be more active, and he really wants to be able to avoid a knee replacement surgery if he can, since his history with orthopedic surgeries has not been successful. He identifies his knee and back pain as the major obstacles to being able to “return to normal activities,” which used to include running, but now would involve hiking and walking. It is feasible to suggest massage might help address Leo’s knee and back pain, although it would be inappropriate to make any promises about his return to function.

What factors affect this client’s ability to safely receive massage therapy?

We know Leo is fundamentally healthy, but at age 62 it is likely he has accumulated some health challenges that might affect some decisions about massage therapy. He had unsuccessful back surgery, so that is a factor to consider, along with whatever medications he may use.

What more do I need to learn about this client’s situation? Do I have a clear grasp of what he wants and needs?

This step covers anything not explicitly laid out in an initial conversation: Leo’s health history and medications, and his goals for massage—with the caveat that those goals may change over time.

What skills do I need to bring to this client’s session? Do I need to refer this client to another provider? How might other strategies compare with my first choice? What have others done in similar situations? What have I missed?

This step covers the massage therapist’s homework and preparation. The question of referring out in this situation doesn’t seem necessary, but that might change if Leo is not happy with his progress, or if his pain gets worse instead of better. A look at what the research (both published scientific research and textbook sources) says about massage therapy for knee pain and spinal surgery patients may help the therapist make some choices about techniques and strategies. Finally, this is a place to try to think outside the box to see what might be missing from initial impulses.

Based on all this, what is my session plan?

It’s time to turn thinking into action. The session plan will be guided by Leo’s goals, plus the therapist’s set of skills, and what the therapist finds in the way of information about Leo’s situation. (Look: it’s client values, practitioner expertise, and research—evidence-informed practice!) Decisions will include what kinds of techniques or strategies to use but also specific accommodations in positioning (given his back pain issues) and for whatever medications he uses (which may or may not be in the context of his knee and back pain).

What worked well, and didn’t work well, in that session? What will I do differently next time?

At the beginning of this relationship, the client and the therapist mapped out some goals for Leo, and some strategies to achieve them. If their work together is fruitful, then Leo will be satisfied, and the therapist will have another success story. But if the work isn’t successful, then it will be necessary to make adjustments, try new things, or reassess whether Leo’s goals are realistic for a massage therapist. None of this will be possible without reflection on the session, and appropriate adjustments and changes as the work continues.

What Action Does This Inspire?

I hope we can agree critical thinking is critical to our profession, as we make decisions that impact our business success, our own wellness, and the outcomes our clients hope to enjoy. I expect we can also agree the obstacles that stand in our way are substantial—from the lack of consensus on what the term critical thinking means to the tensions that occur when we try to promote this set of skills for practitioners and students.

I believe most massage therapists probably go through some of the critical thinking steps I’ve outlined here with most clients, although we don’t always do it consciously or thoroughly. But don’t our clients deserve this level of care? The gathering of relevant, accurate, and complete information allows us to craft careful session plans based on our client priorities, our expertise, and the research. This should be a baseline skill for our profession. But a high-level critical-thinking process takes us a step further: It calls on us to reflect on our choices and evaluate our effectiveness, so our future interactions will be even more satisfying.

Contributors (with a small sampling of their many credentials) I am grateful to:

Robin Anderson, M.Ed, LMT, BCTMB, CEAS, Community Colleges of Baltimore County

Cal Cates, LMT, executive director of                   Healwell.org

Pam Fitch, M. Ad. Ed., RMT, Algonquin College, author of Talking Bodies, Listening Hands

Sandy Fritz, MS, BS, BCTMB, owner, director of the Health Enrichment Center, author of too many books to list here

Allissa Haines, LMT, co-director of Massage Business Blueprint

Brent Jackson, M.Ed., BS, LMT, Central Carolina Technical College

Annie LaCroix, MS, BA, LMT, owner of the Columbia River Institute of Massage Therapy

Til Luchau, director of AdvancedTrainings.com

Tom Myers, author of Anatomy Trains

Doug Nelson, LMT, BCTMB, president of the Massage Therapy Foundation

Diana Thompson, LMT, author of Hands Heal, founder of Hands Heal EHR

Michele Renee, DC, MAc, president of the Alliance for Massage Therapy Education

Susan Salvo, D.Ed, LMT, BCTMB, Louisiana Institute of Massage Therapy, author of Mosby’s Pathology for Massage Therapists and Massage Therapy: Principles and Practice

Tracy Walton, BA, MA, LMT, author of Medical Conditions and Massage Therapy: A Decision Tree Approach

Resources

Barshay, Jill. “Scientific Research on How to Teach Critical Thinking Contradicts Education Trends.” The Hechinger Report. September 2019. www.hechingerreport.org/scientific-research-on-how-to-teach-critical-thinking-contradicts-education-trends.

Bissell, Ahrash N. and Paula P. Lemons. “A New Method for Assessing Critical Thinking in the Classroom.” BioScience 56, no. 1 (January 2006): 66–72. https://doi.org/10.1641/0006-3568(2006)056[0066:ANMFAC]2.0.CO;2.

Campbell, Joycelyn. “Intuition: Knowing Without Knowing How We Know.” Farther to Go! November 12, 2014. www.farthertogo.com/intuition-knowing-without-knowing-know.

Contributing Blogger. “Yes, We Can Define, Teach, and Assess Critical Thinking Skills (Opinion).” Education Week. November 28, 2017. www.edweek.org/leadership/opinion-yes-we-can-define-teach-and-assess-critical-thinking-skills/2017/11.

Glaser, Edward M. “Defining Critical Thinking.” In An Experiment in the Development of Critical Thinking. 1941. Accessed March 2021, from The Foundation for Critical Thinking. www.criticalthinking.org/pages/defining-critical-thinking/766.

International Fact-Checking Network. “IFCN Code of Principles.” 2021. www.ifcncodeofprinciples.poynter.org.

Milam, Sam. “How to Develop Critical Thinking Skills.” SUCCESS. November 3, 2017. www.success.com/how-to-develop-critical-thinking-skills.

National Heart, Lung, and Blood Institute. “Study Quality Assessment Tools.” Accessed March 2021. www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.

Paul, Richard. “Critical Thinking: Basic Questions & Answers.” Think. April 1992. www.criticalthinking.org/pages/critical-thinking-basic-questions-amp-answers/409.

Sterling, Felicia G. “How Do We Know What We Know?” Scientific American Blog. November 24, 2019. https://blogs.scientificamerican.com/observations/how-do-we-know-what-we-know.

The Decision Lab. “Cognitive Biases.” 2021.                                                       www.thedecisionlab.com/biases.

Tomaszewski, Michael. “Critical Thinking Skills: Definition, Examples and How to Improve.” Zety Blog. February 10, 2021. www.zety.com/blog/critical-thinking-skills.

Willingham, Daniel. “How to Teach Critical Thinking.” Education: Future Frontiers Occasional Paper Series (June 2019): 17.

Notes

1. Michael Scriven and Richard Paul, speech excerpt from the 8th Annual International Conference on Critical Thinking and Education Reform (1987).

2. Critical Thinking Web, “What is Critical Thinking?,” accessed April 2021, https://philosophy.hku.hk/think/critical/ct.php.

 Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist’s Guide to Pathology (available at booksofdiscovery.com), now in its seventh edition, which is used in massage schools worldwide. Werner is available at ruthwerner.com or wernerworkshops@ruthwerner.com.