Thresholds Part One
let's talk about money and transparency
I’ve been noticing thresholds lately (for a number of reasons) and thinking about how they apply to acupuncture. If you’re responsible for an acupuncture school, you have to pay a lot of attention to various mile markers in the program: for example, our clinical internship has three levels and students have to pass an evaluation to move from one level to the next; there are year-end exams to get from first to second year and from second to third year; and students have their own take on stages of progress. I think I’m primed to notice thresholds in general, though, because of my socioeconomic class. I’m a straddler:
A class straddler refers to people who were raised in poverty or working class backgrounds, and over time move into the middle or owning classes.
Being a straddler means crossing a threshold -- not just once but repeatedly, because you end up going back and forth as a result of having relationships with people in different contexts. There are the people I grew up with vs the people I went to college with vs the people who live in my working class neighborhood vs the people I meet in the acupuncture profession, and they are very different people. The boundaries between classes might be more or less obvious depending on the situation. Being a straddler can feel like trying to walk through a sliding glass door, where the glass is so clear that you think the door is open -- when it’s not. 1
My experience with attending a fancy liberal arts college, and then getting a master’s degree, was that there were unspoken rules and expectations about how to navigate those worlds. But nobody was going to spell them out for me; I was supposed to already know them. If I ever asked directly, I felt more out of place than before, because you’re not supposed to ask! These days there’s a lot more awareness of and support for the challenges of first generation college students. Something I learned from not having support in those situations, though, was how to absorb information by lurking on the edges. It was a constant, invisible DIY project: figuring out what to do and how to be.
Those particular skills served me well as a small business owner and they continue to be useful in navigating the acupuncture profession. (Though obviously I couldn’t resist naming my clinic Working Class Acupuncture which is less like lurking and more like waving a flag and yelling.)
Acupuncture is coded for class and race. See also, wealthy white ladies getting facelifts and the blurry line between health and beauty:
One of the arguments against community acupuncture, circa 2006, was that it would never work because people had to have a certain level of education to even be interested in receiving acupuncture in the first place. Acupuncturists told me flat out that I was focused on “the wrong demographic”. Obviously that isn’t true but the narrative persists, and it’s a self-fulfilling prophecy. If you lead with the attitude that a whole swath of the population couldn’t possibly be interested in your services, why would they be?
I wrote in a prior post that we regularly remind POCA Tech students about the difference between how a practitioner experiences giving a treatment versus the experience a patient has with receiving that same treatment. Because acupuncture is unfamiliar territory to many people, most new patients don’t know how to navigate the treatment experience. It’s full of unspoken expectations. Most acupuncturists, though, don’t recognize that there’s an invisible threshold for patients to cross, and thresholds are stressful and intimidating. The fewer resources you have, the more stressful and intimidating they are.
When you walk into a WCA clinic, you can see almost everything that’s happening. Everything important is out in the open. That’s intentional: We’re trying to make our operations as transparent as possible, especially for people like me who’ve learned to figure out what to do and how to be by watching. Those people won’t necessarily ask questions about what they don’t understand. They might not have words for what doesn’t make sense to them.
Transparency makes it easier to cross the threshold. It’s also a big part of what I’m trying to do with this newsletter (as you might have noticed). I want to show how things work at WCA and POCA Tech -- especially, how money works. (More WCA Numbers posts are on the way.)
I think WCA was the first acupuncture clinic in Portland to publicize our prices (this was pre-internet), and some acupuncturists were horrified. I was adamant that we didn’t want to make people have to ask what a treatment cost OR make them spend a lot of energy trying to quietly figure it out. We needed to offer that information right up front in a friendly, positive, nonjudgmental way. Money is a major concern when you’re crossing a threshold (can I afford this? will I be embarrassed? am I setting myself up for disappointment?), but there’s social pressure to pretend it’s not. Having to think about money while also pretending that you’re not thinking about money is draining and demoralizing -- and obviously it’s worse for people who come to the clinic because they’re desperate and/or in pain. Which is a lot of people. See also, Last Stop on the Try-Anything Train.
Now that there’s a coalition promoting a 5NP law for Oregon, I’m getting a steady stream of writing prompts in the form of acupuncturists’ opposition to 5NP laws. (Thanks?) The process of passing a 5NP law creates more visibility for acupuncture, but some acupuncturists argue this isn’t actually a good thing because the whole idea is that 5NP can be provided by trained laypeople, not just L.Acs. I think this argument is a demonstration of acupuncturists underestimating acupuncture’s threshold problem. Like, vastly underestimating it.
Licensed acupuncturists know they have a marketing problem (acupuncture schools know it too) but that’s not the same as recognizing that you have a threshold problem. Marketing can be a way of providing information in a low-pressure context, but it’s not enough. If you have a threshold problem, you need to think not just about how to educate people about the value of your services but also, on a human level, how to welcome them in and then walk them over the threshold, which includes trying to lower any barriers in their way. (See also, Accompaniment.)
5NP could be one good, collective way for the acupuncture profession to address the threshold problem, because 5NP is so inherently low-barrier, transparent, and non-threatening. It’s such a safe way to step into receiving acupuncture; all you have to do is sit down in a chair. You don’t have to talk, you don’t have to take off your clothes, you can see how the treatment process goes by watching other people receive it. The essence of 5NP is nonjudgmental acceptance. Not to mention that it’s often provided in community settings where it’s free, and L.Acs don’t even have to do the work themselves.
5NP provides an opening to build relationships with a wide range of community organizations; it’s an opportunity for licensed acupuncturists to cultivate a partnership mentality. Alas, that’s not something acupuncturists in general are good at. But as we like to say at POCA Tech, whatever you’re not naturally good at, you can work on!
5NP should be a win-win situation, and it’s unfortunate that some L.Acs don’t see it that way. I’m not sure where the acupuncture profession acquired the belief that making something more accessible is equivalent to devaluing it, but it sure seems entrenched. Resistance to 5NP is a manifestation of how the acupuncture profession has tied itself up in knots, and now it’s stuck, no pun intended. Isn’t moving stuck energy supposed to be acupuncturists’ whole thing?
Maybe my perspective on this is different because I grew up around people who bore visible (and invisible) scars from not having access to healthcare. It’s really, really hard for me to see any downside to something that opens up access, like 5NP. If I can do anything with this newsletter, I hope I can help change the narrative about who acupuncture is for (spoiler alert: everybody).
This actually happened (non-metaphorically) to one of my patients, an installation artist who tried to walk through an extra-clean sliding glass door in an art gallery. She injured her head and her neck and it took months to recover. Be careful out there!