Consent and the Social Container
on saying yes to small business
In the last couple of years I’ve become a consent nerd. Consent shows up in so many interesting places! Lately I’ve been noticing how it shows up in acupuncture education.
One of the first classes in the POCA Tech program is called “Touch and How to Do It”, which is our introduction to trauma informed care and also to the ways that verbal and nonverbal consent appear in a community acupuncture clinic. POCA Tech students start clinical observation in the first year — we want them in the clinic as soon as possible — and so having an awareness of consent is important for tasks like taking out needles, putting blankets on people, etc. For many acupuncturists, thinking about consent is limited to making sure their patients sign an informed consent to treatment, as part of their intake paperwork -- which, don’t get me wrong, that’s important! Nonetheless we want our students to think of consent not as a one time event, but an ongoing element of safe practice.
A hot topic in higher education these days is Borrower Defense to Repayment, or the process by which someone can have their student loans forgiven if they enrolled in a school based on misleading information, particularly in relationship to future employment or earnings. As you might imagine, this is potentially an issue for acupuncturists. POCA Tech’s whole existence is about trying to avoid student loan debt for our graduates, so Borrower Defense to Repayment doesn’t affect us directly — but it’s useful to think about in relationship to consent.
I’ve heard representatives of other acupuncture schools express frustration with the bind this represents, particularly in terms of teaching “practice management” classes to students. It’s common for people to complain that acupuncture schools should offer better business classes so that students are more likely to be successful after graduation. To which acupuncture school administrators and faculty reply, We’re trying! But students are resistant to these classes and they don’t pay attention!
I can’t argue with that because I was totally one of those students. Thirty years ago, I did not want to learn what my school tried to teach; I used to read novels during practice management classes. My attitude was basically hell no. In hindsight, and now that the shoe is on the other foot as they say, I think that what was missing was a process of informed consent.
Like most students, I enrolled in acupuncture school because I wanted a career as an acupuncturist. I didn’t realize that having such a career almost certainly required becoming self-employed. More importantly, even if I had recognized that, I didn’t understand what self-employment would mean for my life. (And nobody spelled it out for me). You can’t really consent to something if you have no idea what it means.
And I don’t think you can even learn about business — especially acupuncture business — without enthusiastic consent. (This concept is typically used in reference to sex and it means the presence of “yes” rather than the absence of “no”.) Small business is difficult — but it’s infinitely more difficult if you’re resistant to having a business in the first place! Enthusiasm is pretty much a requirement.
Because if you do open your own business, the universe will ask you regularly, in ever more creative ways: Do you want this? Are you sure? Are you really sure? How about now? Now that other acupuncturists are yelling at you, now that your clinic (literally) went up in flames, and oh also, here’s a pandemic and a lockdown — NOW do you really, really want this?
And you have to say yes, over and over, in the face of every challenge. I really, really want this business. You have to say it like you mean it.
Learning how to bill insurance or market your practice or (insert any other practice management topic) in a class in acupuncture school is not the same as saying yes like you mean it to running your own business. And you can’t fully say yes to something that significant if you can’t think and talk through the details of it — but it’s hard to think and talk through the details if the topic itself feels so stressful and/or shameful that it makes you cringe.
Or as a second year student, J., put it: Money is traumatic for a lot of people. It’s very common to shut down around the topic of money, which makes it difficult to pay attention to classes about business. Becoming a small business owner or manager means making decisions about money that affect other people as well as yourself, and that can be an overwhelming prospect. In other words, acupuncture is the easy (and fun) part of running a community acupuncture clinic; it’s creating and maintaining a social container for your practice that’s hard. A first year student said after orientation, “This program is like exposure therapy for small business.” I said, “Oh my God, thank you, that’s EXACTLY what we’re going for!”
This past weekend at POCA Tech was our second year students’ introduction to discussing the social container in detail. We have a whole ebook about that topic that we’ll be working our way through. If you’d like to read it, here’s the PDF or you can download an ePub copy here. (Big thanks to Gail Roudebush for the editing and formatting, and to Troy Sostillio for tending to the Publications part of our website.)
In the appendices there’s a business plan for a community acupuncture clinic; there’s research about what kind of marketing works for community acupuncture clinics; and there’s a list of steps to opening a community clinic, but most of the book is about mindset.1
Developing a mindset that helps rather than hinders you as a small business owner takes time and reflection. I think this type of consent happens gradually and also usually requires some structured support. Most people need time and space to think through all the daunting elements of starting a small business; they need exposure to the scary parts in small, tolerable increments. It can’t just happen at the end of an acupuncture program, in the context of a few specific classes, when students are already tired. It has to be built into the program from the beginning — or at least that’s our working hypothesis, ten years into having an acupuncture school.
I think acupuncturists applying for Borrower Defense to Repayment is partly about realizing belatedly that there’s this whole world of risk and demand that they didn’t grasp and never consented to when they signed up for a career in acupuncture. The alternative to graduates feeling surprised, misled, and overwhelmed is to try to make that world visible and understandable to students while they’re still in school. Which requires not insignificant intention and effort but I’m glad we’re doing it. I’m glad we’re creating a space for people to say yes to small business. Maybe even hell yes.
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