The Complete Clinician — Are We Mental Health Professionals? Part 3

This is the final episode of the Are We Mental Health Professionals? series — and this one gets personal.

Parts 1 and 2 were about your patients. This one starts by turning the lens on us. Because everything we've been talking about across this series — the psychological weight patients bring, the emotional complexity of these conversations, the pressure to get it right — all of that lands somewhere. And a lot of the time, it lands on us.

In this episode we cover:

• How integrating basic psychological techniques like abdominal breathing and guided body scans into your sessions outperforms physical therapy alone
• The NOI Group's danger signals vs safety signals framework — and how a simple conversation helped one patient reclaim yoga, movement confidence, and her relationship with her own body
• How to navigate mental health conversations without stigma — the language that opens doors and the golden rule you cannot skip
• The clinical evidence behind yoga, tai chi, and MBSR for treating MSK conditions and mental health simultaneously
• Universal screening — what it looks like in a clinic and what it looks like when you work solo
• The Mental Health Champion concept — and why solo practitioners are their own champion
• Practitioner burnout — what it actually looks like, why it sneaks up quietly, and why booking that counselling appointment isn't weakness

All three parts of the series are now out. Start at Part 1 if you haven't already — they're meant to be taken together.

🔗 Sign up for the Mental Health and Psychological First Aid waitlist:

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Transcript

Part 1: Turning the Lens on Ourselves

00:00 - I want to start this episode a little differently than the first two.

00:05 - Parts one and two were about your patients, about what they're carrying when they come through your door, and about how the things we say and do in the treatment room shape their experience in ways that go far beyond the physical.

00:20 - But in this episode, part three, I want to start by turning the lens on us, because here's something I've been sitting with as I've been putting this series together...

00:36 - ...everything we've been talking about—the psychological weight our patients bring, the emotional complexity of these conversations, the pressure to get it right—all of that lands somewhere. And a lot of the time, it lands on us.

00:54 - I realized something last week that I think is worth sharing. Things that used to bring me real joy—playing hockey, getting out and being social—I'd just quietly stopped doing them. I hadn't made a decision to stop; I just had.

01:13 - I noticed that I've been pulling back from people, getting frustrated by things that normally wouldn't register, feeling flat in a way that I couldn't quite explain.

01:25 - And when I actually sat with that for a moment, I recognized it for what it was. So, I booked a counseling appointment.

01:34 - I'm telling you that not to make this episode about me, but because I think a lot of you will recognize something in what I just described.

01:43 - And because everything we're going to talk about today—the tools, the techniques, the frameworks—they apply to us just as much as they apply to the people on our tables. So, let's get into part three.

Part 2: Introduction & Integrating Psychological Techniques

02:00 - [Intro Music] Hey there, I'm Jamie Johnston, and you're stepping into a new era of thriving as a massage therapist. We're embracing who you are, pursuing what you love, and confidently shaping your practice. We'll challenge industry norms, spark change, and discuss what truly matters—things like mental health, evidence-based practice, and some topics we've long avoided. Let's create better outcomes for our patients and happier, more fulfilling practices together. Welcome to the New Generation Massage Therapist Podcast. [Intro Music Ends] 

02:44 - Welcome back. I'm Jamie Johnston, and this is part three, the final episode of our 'Are We Mental Health Professionals?' series.

02:54 - If you're jumping in here for the first time, I'd really encourage you to go back and start at part one. We've covered a lot of ground: the research on massage therapy and mental health, the nocebo effect and how our language shapes patient outcomes, clinical reassurance, and the therapeutic alliance.

03:14 - This episode builds on all of that. Today, we're getting practical. We're talking about what it actually looks like to integrate some of these psychological principles into your day-to-day clinical work without overstepping your scope, without feeling like you need a psychology degree, and without burning yourself out in the process.

03:36 - So, let's start with something that I think is genuinely exciting. The research is showing us something really compelling: that when manual therapists actively integrate basic psychological techniques into their physical treatments, outcomes improve significantly. Not marginally—significantly.

04:02 - And in some studies, it outperforms physical therapy alone.

04:07 - Now, I know what some of you are thinking: 'Psychological techniques? That's not my scope.' And I hear that. But what we're talking about here isn't therapy; it isn't diagnosis. It's teaching a patient a skill that helps their nervous system do what it's already trying to do.

04:26 - Specifically, the research points to things like abdominal breathing and guided body scans—simple, teachable techniques that, when integrated into a session, produce notable decreases in pain and anxiety.

04:43 - So, think about what that actually means in practice. If a patient is on your table and they're guarded, bracing, holding, you can teach them how to breathe through that. You can walk them through a simple body scan. And in doing that, you're not just helping them relax in the moment; you're giving them a tool they can take home. Something they can use during a painful flare-up at 11 o'clock at night when you're not there. That's significant.

05:15 - Because one of the things that drives pain catastrophizing is the feeling of helplessness—the sense that pain is happening to them and there's nothing they can do about it. When you teach a patient how to downregulate their own nervous system response, you're directly countering that helplessness. You're building their confidence; you're building their resilience.

Part 3: Clinical Example – Safety Signals vs. Danger Signals

05:41 - And I want to give you a clinical example of how powerfully this can work, because the research is one thing, but seeing it play out in someone's life is another.

05:51 - I had a patient years ago open up to me about some significant trauma that they had experienced. As part of our conversations around her pain, we used a framework from the NOI Group that I had learned: it's the idea of the 'danger in me' signals versus the 'safety in me' signals.

06:12 - The concept is really straightforward: your nervous system is constantly scanning for signals that mean danger or signals that mean safety. And pain lives inside of that threat assessment.

06:26 - So, one of the most powerful things you can do is help a patient identify and deliberately engage with their own safety signals.

06:34 - So, we started talking about what made her feel safe, calm, and in control. And it came out that she used to love doing yoga at home, but she'd gotten away from it. Life had gotten busy, things had shifted, but it had been something that genuinely grounded her.

06:53 - So, we named it: 'Yoga at home is a safety-in-me activity for you.' And she took it and ran with it. She started doing it again consistently, and she added her own layer to it that I thought was beautiful: she started doing it by candlelight at night. Just made it her thing, her ritual, her space—something that was entirely hers.

07:18 - And the change was noticeable, and it came pretty quickly once she started doing it consistently. Not just in how much pain she was dealing with, but in her confidence—her sense that movement was safe and helpful rather than threatening. Her relationship with her own body shifted. That's the power of identifying and reinforcing safety signals. And it's something you can do in conversation. You don't need a clinical protocol for it; you just need to ask the right questions.

Part 4: Navigating Mental Health Conversations & Clinical Validation

07:54 - Now, I know that for a lot of us, the moment a patient starts heading toward emotional or mental health territory, there's a moment of internal panic: 'What do I say? Is this my place? Am I going to make it worse?' And I get it, I really do.

08:11 - But I also think we underestimate ourselves here, because we're often the people these patients open up to. Not their GP, not their therapist... us.

08:24 - And that means the way we handle those moments matters.

08:28 - The first thing to understand is that language matters here just as much as it did in part two—maybe more.

08:37 - If you suspect a patient is struggling emotionally, using psychiatric labels like 'depressed' or 'mental health issue' will often make them shut down immediately. Those words carry stigma. They make people feel categorized, judged, or like they're about to be referred somewhere unfamiliar.

08:58 - What works better is language that everyone relates to. Ask about sleep, ask about stress levels, ask how things have been outside the clinic. Everyone relates to stress, everyone relates to not sleeping well, and those questions open doors without making anyone feel like they're being handed a diagnosis.

09:22 - And the other golden rule—and this is non-negotiable—is to always validate their physical pain first.

09:31 - This is so important, because part of what makes these patients so vulnerable in this conversation is the fear that someone is going to tell them that it's all in their head, that their pain isn't real—that if they admit to struggling emotionally, their physical suffering will be dismissed.

09:49 - So, before you go anywhere near the mental health conversation, you make sure they know, unambiguously, that their pain is real, it matters, and that's why you're here.

10:02 - The mental health piece is an additive, not instead of. It's in addition to taking their physical experience seriously. And if you fail to do that—if you move forward with emotional or psychological factors without validating the physical first—you'll lose them. They'll feel dismissed, and they will likely never bring it up again.

10:24 - But once you build that trust, there's a really powerful thing you can do, and that's point people toward therapies that are doing double duty.

10:34 - There's moderate to good quality clinical evidence supporting yoga, tai chi, and mindfulness-based stress reduction (or MBSR) for musculoskeletal conditions. These aren't alternative medicine 'fringe' recommendations; they're clinically studied interventions that have been shown to simultaneously treat physical MSK conditions—things like low back pain and osteoarthritis—while also actively reducing symptoms of anxiety, depression, and sleep disorders.

11:09 - That's remarkable. One recommendation that addresses both the physical and the psychological simultaneously, and it puts agency back in the patient's hands. They're not waiting for their next appointment; they're not dependent on you. They have something they can do today, at home, at their own pace, that the research says works.

11:34 - The yoga story I shared earlier is a perfect example of this in action. That recommendation wasn't abstract; it was specific to her, grounded in her history, connected to something that she already knew brought her safety. That's what makes these recommendations land. Not just 'yoga's good for you,' but: 'this specific thing that you already love has clinical evidence behind it, and here's why I think it could make a real difference for you.'

Part 5: Building Systems & Universal Screening

12:05 - Now let's talk about how you actually build this into your practice, because good intentions are one thing, but without a system, they stay intentions.

12:15 - For those of you working in multidisciplinary clinics or larger practices, there is a really elegant solution worth knowing about, and it's automated, universal mental health screening integrated into your digital intake forms.

12:30 - The key word here is universal. If you only ask certain patients about their mental health, those patients feel singled out, they feel targeted, and that stigma response kicks in before the conversation has even started.

12:47 - But if everyone who books with your clinic receives the same intake questions, nobody feels singled out. It's just part of how your clinic operates; it normalizes the conversation before anyone even sits down with a practitioner.

13:03 - And the phrasing matters enormously here. The language that research has found to be highly acceptable and non-stigmatizing is something like: 'Mental wellness can affect pain and function. Would you like more information on resources for stress, sleep trouble, or depressed and anxious feelings?'

13:24 - Notice what that does: it educates briefly—'mental wellness affects pain'—without alarming them. It offers rather than diagnoses, and it gives the patient full control over whether they engage with it.

13:40 - The other important piece is that your clinic has to explain why you're asking. Patients who understand the clinical rationale—that you're asking because it affects their outcomes, not because something seems wrong with them—are far more likely to answer honestly.

13:58 - Now, I know that a lot of you listening aren't working in multidisciplinary clinics. Many of you have home-based practices, or you work solo, and you don't have a team to build systems with. So, I just want to speak directly to that, because the clinic model is one way of doing this, but it's not the only way.

14:18 - And I'd argue that for a solo practitioner, the opportunity is actually just as significant. Here's why: in a clinical setting, the screening happens through a form; in your practice, it can happen through you, through the relationship you've already built, through the trust that already exists in your room.

14:38 - You can do your own version of this screening. Make it part of your intake for every patient, not just the ones who seem like they might be struggling. Ask about sleep, ask about stress, ask about mood using the non-stigmatizing language we talked about.

14:53 - Have some referral options ready to go so that when someone opens up, you're not scrambling. You have something tangible to offer them.

15:02 - And the thing is, you're already positioned for this. People open up to their massage therapist—we know this. It happens in our rooms all the time. The question isn't whether these conversations will happen; it's whether you're ready for them when they do.

Part 6: The "Mental Health Champion" & Practitioner Self-Care

15:20 - In a clinical setting, there's a concept worth introducing called 'the mental health champion.' The idea is simple: one designated person—a manager, a senior clinician, a support staff member—takes on the specific responsibility of tracking affordable, accessible mental health resources in the community. Referral pathways, local counselors, crisis lines, community programs... all of it.

15:49 - But why does this matter? Because the mental health landscape changes constantly: waitlists change, programs open and close, pricing shifts, and keeping track of all of that is a job in itself—one that most clinicians don't have capacity for on top of their caseload.

16:07 - When you have a mental health champion, the rest of the clinical team is relieved of that burden. They can confidently bring up mental health in-session, knowing that when a patient says 'I think I could use some help with this,' they have somewhere to point them—a real resource, a name or a number that actually leads somewhere.

16:29 - For those of you working solo, you're your own mental health champion. And that just means building the habit of keeping a small referral list updated: a few local counselors, a crisis line, some community resources. You don't need a spreadsheet; you just need to know that when the moment comes, you've not fumbling. You have something to give them.

16:51 - Because that moment, when a patient opens up and you're ready, that's one of the most meaningful things you can do in this profession.

17:01 - I want to close this series by talking about something that I think we don't talk about enough. And that is that our work is hard. Not the technique, not the protocols... the emotional weight of it. Sitting with distressed patients, complex presentations, people who are struggling in ways that go way beyond just having a tight muscle or a stiff joint—that takes something from you.

17:28 - And if you're not careful, if you're not intentional about it, it accumulates.

17:34 - Burnout in our profession is real. It's common, and it often sneaks up on you quietly, in ways that don't look like what you expect burnout to look like.

17:45 - For me, it didn't look like exhaustion; it looked like losing interest in things I used to love. I stopped playing hockey—because that's been a part of my life for as long as I can remember—and I didn't even really notice that I stopped.

18:01 - I started pulling back from people—making a conscious decision to—getting frustrated by small things that normally wouldn't touch me.

18:10 - And it was only when I actually stopped and looked at that pattern that I recognized it. That's what burnout can look like: not a breakdown, just a quiet withdrawal from the things that used to make life feel full.

18:23 - So, I booked a counseling appointment. And I'm telling you that because I think it matters for you to hear that this happens to practitioners who care deeply about this work. It's not a sign of weakness; it's a sign that you've been giving a lot, and that you need to give some of that back to yourself.

18:41 - In a clinical setting, the mental health champion concept extends to this, too: that designated person or that supervisor, that senior colleague, can also serve as a safeguarding lead—a safe space for practitioners to bring difficult cases, navigate emotionally complex conversations, and reflect on what they're carrying.

19:04 - When you have that sounding board, you don't have to feel like you need to be a mental health expert. You just need to be a practitioner who cares, and who has support.

19:14 - For those of you like me that are working solo, this matters even more. Find your person: a colleague you trust, a supervisor, a counselor—someone you can bring the hard stuff to. Because the pressure of sitting with difficult caseloads without an outlet is exactly the kind of thing that quietly hollows you out over time.

Part 7: Final Thoughts & Conclusion

19:39 - And so, I want to close this series—all three episodes of it—with something that feels true to everything we've been exploring.

19:48 - Are we mental health professionals? No, we're not. But we are professionals who work with the whole person, every single session. Whether we acknowledge it or not, whether we're trained for it or not, the people who come to see us are bringing their nervous systems, their fears, their histories, their stress, their grief, right alongside whatever's happening in their body.

20:17 - And that means that we have a choice. We can show up to that reality as passive participants—just working the tissue, keeping our heads down, staying in what feels like our safe scope—or we can show up to it as practitioners who understand what's actually happening in that room, who know that our words shape outcomes, who know that how we listen matters as much as how we treat, who know that a simple conversation about sleep and stress, handled well, can change the trajectory of someone's recovery.

20:56 - That's not being a mental health professional; that's being a complete clinician. And I think our patients deserve that from us. I'll see you in the next episode.

21:12 - So, that's a wrap on the 'Are We Mental Health Professionals?' series. All three parts are out now, so if you haven't listened from the beginning, go back and start at part one. They're meant to be taken together, and each button builds on what came before.

21:29 - If something in this series landed for you—if it changed one conversation, one word choice, one way you think about what happens in your treatment room—then it's done exactly what it was supposed to do.

21:42 - If you want to go deeper on this, particularly around mental health and psychological first aid, I have a sign-up list with more resources coming; the links are in the show notes. And if you're part of my community, keep an eye out, because this content is now uploaded into the platform for you to watch.

22:01 - If you're finding value in the New Generation Massage Therapist Podcast, the best thing you can do is follow the show and leave a review if you have two minutes. It makes a real difference in helping other practitioners find these conversations, and this is exactly the kind of conversation our profession needs more of.

22:20 - Take care of yourselves out there, and keep moving forward.