Archive for Licensing and Legislation

Is Massage a Profession?

August 18, 2009 Julie Onofrio Licensing and Legislation, News

Is massage a profession?  It is in my opinion and view.  I have been working in it for over 20 years.

What makes for a profession is part of the question.  I started looking for answers on how professions are defined but I haven’t come up with anything concrete.

Wikipedia says this about the history of professions.

Classically, there were only three professions: Divinity, Medicine, and Law[2]. The main milestones which mark an occupation being identified as a profession are:

  1. It became a full-time occupation;
  2. The first training school was established;
  3. The first university school was established;
  4. The first local association was established;
  5. The first national association was established;
  6. The codes of professional ethics were introduced;
  7. State licensing laws were established.[2]

It further goes on to say:  “A profession arises when any trade or occupation transforms itself through “the development of formal qualifications based upon education and examinations, the emergence of regulatory bodies with powers to admit and discipline members, and some degree of monopoly rights.”

A few years ago a white paper on just this topic was written by Rick Rosen called “On Becoming a Profession (pdf)”.  In it he sites his thoughts on what is required for massage therapists to become a profession. He has outlined and talked about in depth these things that need to be done to become a profession.

  • Establish a Body of Knowledge
  • Improve the quality of massage therapy education
  • Reorganize the credentialing process by putting licensure before certification
  • Create parity among our state massage laws to increase portability
  • Develop and promote a unified professional identity
  • Use lessons learned from other professions

The Body of Knowledge is in the works.  Rosen says this:

A Body of Knowledge is defined as “a
compendium of what an individual must know to accomplish work in a specific field.” In our case, this would be described according to the competencies that are required to practice handson therapies in a safe and effective manner. Identifying the knowledge, skills and attributes is a
critical first step in building a profession. It establishes the groundwork for determining standards in education, credentialing, regulation and clinical practice.

Keith Grant has also started a collection of massage competencies to further explain what it is we really do.

The quality of schools is under question with the recent large massage school chains buying up smaller massage schools around the country.  Our massage schools are also looking to younger people to fill their schools when the average age of massage therapists used to be 45.  Currently massage schools report much younger students which requires different teaching methods.  At 45 a person has much life experience to draw from and apply to starting and building a practice.  But with the creation of the many massage franchises massage schools are seeking out younger people to fill those positions because they are most likely to not need much to live on and are quite happy with a job that pays $1-$15 an hour.

Reorganizing the credentialing process is in the works too with the Federation of Massage State Boards working to create a more formal system for licensing.  The NCBTMB will hopefully transition out of the entry-level testing business and redirect its energies toward the development of new and innovative specialty certification programs.

With all of the work of the Federation and Body of Knowledge can we come to more of a consensus and accurately define our profession?  Hopefully that will come with all of the work that is being done.

And what can we learn from other professions?  Some say that nursing is the profession that most closely resembles the massage profession.  I don’t know much about the history of nursing but it might be something to look into.

Because of the work we do with clients is so different than most other professions – touching half naked bodies who are in pain and under stress, there is also the other side of this all and how we are trained to deal with client/therapist relationships – We aren’t for the most part trained in basic massage school.   While I have never been a big proponent of more training and licensing for the first time in 20 years I think it might be time to start doing some research and looking into creating 3-4 year programs like Canada and Japan.  When I first started out massage was more of a lifestyle choice- being able to help people and work your own hours and choose who you worked on.  It still is that but the demands of becoming a profession may require more initial training and more continuing education.

The other part of this – the question on is massage a profession? also depends on each individual and how they represent the massage profession and acting in a professional way.  I have always seen it as a profession and take my work and studies seriously.  I work with professional people in downtown Seattle and had to learn about being professional to survive.  Others who don’t take the profession as seriously may not see how it is growing and becoming a profession more every day.  (Did I just contradict myself?)

What can you do today to be more professional?  What does being a profession mean to you?  Is massage a profession or just a hobby for you?

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Massage National Certification Board

July 14, 2009 Julie Onofrio Licensing and Legislation

What is going on with the Massage National Certification Board?  A few weeks ago they announced that they are creating a new affiliation – USA Massage Resource Alliance (usaMRA) which is supposed to provide low cost resources for massage therapist to help respond to the failing economy.

The latest news it that they will be offering pizza discounts!  Laura Allen reported this info on her massagemag.com blog.   The  NCB has a new initiative in the works to expand their scope from a certifying body into a membership organization and will be offering pizza discounts.

AMTA Views NCBTMB Decision Not in Best Interest of the Profession in their press release on that decision.

Massage Today reports on more of the story and the reply’s by both AMTA and ABMP.

Earlier this year AMTA stopped supporting the NCB because they no longer agreed with their goings on and moved to start supporting the new MBLeX created by the Federation of Massage Boards.

I still am trying to figure out what this all really means.  There has been some talk of the need to be creating advanced credentialing for the massage profession and that is what the NCB should be focused on.  Their past history has led to loss of credibility with the massage profession in general and they are no longer working within their mission statement -  to define and advance the highest standards in the profession through a recognized credentialing program.   They haven’t been able to keep up with running their organization in it’s current state – how are they going to administer liability insurance and pizza discounts?

Who is currently running the NCB and what is their real reasons for doing this?  To me it just all seems like the are trying to defend themselves and keep their head above water rather then focusing on what the profession needs.

Is the NCB on it’s way out?  Do we need a new organization?  What do we need?

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Massage Therapists Getting Younger

July 6, 2009 Julie Onofrio Licensing and Legislation

Massage therapists are getting younger or so The AMTA Massage Industry Research Report says:

Nearly sixty percent (57.8 percent) of school administrators responded that the average age of students has declined at their school in the past five years, according to the 2008 AMTA Massage School Survey. School administrators estimate that the average student is 30 years old, with 36.6 percent being 25 years old or less.

Previous statistics from both the AMTA and ABMP showed the average age of massage therapists to be around 44.

Why is massage attracting younger people and what will the effects on the profession be from this change?

Massage schools enrollment is declining which means that massage schools are needing massage students.  Massage schools are recruiting high school students to fill their massage schools.  Federal Grants are also available to massage students which allows younger people without much money to go to massage school.

My website www.massage-career-guides.com which used to be www.massagetherapycareers.com was overwhelmed with questions from high school students asking about careers in massage and what was required to get into school.  Their biggest concern was over whether or not you had to take math and how much you could make.

My career in massage has been a lifestyle and journey.  It was and still is a calling – something that I was just meant to do.  Through it I learn a tremendous amount about myself and about what it really means to be a massage therapist.  I became a massage therapist because I love learning about health and I like helping people (which of course was also loaded with learning opportunities!).  If high school students are drawn to the massage profession because they don’t have to take math – what will that do to the quality of massages being done and the massage profession overall?

I also was quite intrigued by this discussion on linked in or facebook  (I can’t remember which or find the post) talking about younger massage students who were always texting during massage school and even during a massage!  They were doing it to prove that they could and they said something like ‘the client won’t know anyways’!!

These younger massage students are also the one’s who are getting jobs at places like Massage Envy that don’t pay much so it is keeping Massage Envy in business (Is that a good or bad thing?  we really don’t know that either- more posts coming!)

My concern over younger people joining the massage profession is also about whether or not a younger massage therapist can really understand what massage really does and be able to understand the therapeutic relationship and create and hold boundaries.  But I guess I didn’t get it either when I first started 20 years ago and many older adults don’t really get it either.

I am also concerned about the level of service that younger people provide (or not provide) just in the way of basic communication skills and customer service.  When I go into spas and find younger people working the appointment desk I just cringe at the things they say – “All deep tissue is the same” is my favorite!

I used to be totally against licensing of any sort and of even requiring massage training beyond 100 hour of education because that is all it really does take to be able to just do an efficient massage (That will be a whole other post soon.)  I now am thinking that it would be best if younger massage students did get 3-4 years of massage school that could add in the extra training in ethics, business and communication skills as well as learning to be present and work with the therapeutic relationship.    If this is going to be a continuing massage trend- students and massage therapists getting younger – we need to keep up with the changes and not let these students be left behind.

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Massage Therapy Classes

July 13, 2008 Julie Onofrio Licensing and Legislation

One of my gripes about the massage profession and the process of professional massage licensing is the fact that the National Certification Board of Massage and Bodywork (NCBTMB) requires that massage students take classes in Traditional Chinese Medicine (TCM) and understand how the meridians work in the body.  Just a few years ago there was only one test and that required knowing the meridians.

While I am all for TCM and go to acupuncturists myself for many various ailments – can you really learn enough about the meridians in a weekend workshop to be able to know what to do to work with them? Is it really necessary for massage therapists to know about meridians to have a successful massage practice?

To me TCM is a lifestyle and lifelong learning process. It takes a few years to be proficient in something like this. I personally do not anyone working on my meridians after taking a weekend workshop.

While the NCBTMB also has another exam where they don’t require having to know meridians they call the other exam – the National Certification in Therapeutic Massage. You don’t have to know about meridians but you do have to know about posture and alignment.  That to me is what a bodyworker knows since most of my extensive training (about 6 years of my 20 years in the massage profession) were spent learning structural integration.  I became a bodyworker after that. The test that requires knowing the meridians is called the National Certification in Therapeutic Massage and Bodywork. So apparently just because you know the meridians you can call your self a bodyworker.

The whole thing is very confusing because the profession has no clear definition of what the terms massage or bodywork even mean.

Now here is the thing – If you want to study meridians and TCM please so so and study it with all of your heart.  But don’t make me learn it or have anything to do with it.  I have no interest in it or have the time (1 year or more) to put into learning something like that.  It is not needed to practice massage successfully.

Yes it can help you if you are interested in it but making it a requirement is beyond ridiculous.   If you are a TCM practitioner I am not saying your work is not valid or important so please don’t take this personally.

The whole problem lies in the not knowing what is really needed to be a successful massage therapist.  From what I understand the NCBTMB does do surveys on what classes people have taken and they ask if people have studied meridians.  Of course they have studied it because they made it be a requirement!  Is it necessary?  NO.

Basic massage skills do not require knowing the meridians or anything about them or any branch of traditional Chinese medicine.

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Massage Politics

June 24, 2008 Julie Onofrio Ethics, Licensing and Legislation

One of the biggest controversies in the massage profession has to do with the licensing and regulation of massage therapy.  There are 38 states in the US that require massage therapists to have some type of licensing.  Each state differs in the amount of education, classes and definitions of massage therapy which makes it very confusing to understand.   The non-licensed states also have varying requirement to practice massage with the biggest problem in CA where each city has different requirements.

The groups that advocate licensing state that the reasons for wanting licensing are to protect the public from harm, create more professional standards of education, reduce the number of prostitutes doing massage to name a few.   The thing is that there is no proof that massage has caused significant harm to people.  Keith Grant has done an initial survey of medline on the cases of harm that are done to massage clients.  How much harm can be done in doing massage?  What is the definition of harm?  Is it harmful to have a massage therapist who says they are doing deep tissue massage when it is really swedish massage?  Is it harmful when a client leaves feeling more sore than when they came in?   Will any amount of education really influence the massage therapists skills and reduce the ability to do harm?

If there were a high degree of harm being done, wouldn’t our liability insurance rates reflect that?  And how much harm do over the counter drugs do?  I just recently had a friend who had excruciating back and abdominal pain for over a year and it turns out it was an over the counter drug causing it.  Is that harmful?

What list of side effects could be created to inform the public and teach the public to take responsibility for what happens in their massage?

The number of hours of education varies greatly as well as the topics of courses.  I for one started in 1987 doing massage after having 250 hours of massage school.  I was the last year of students to become a massage therapist at that number of hours.  The number of hours of training was going up to 500 hours in a few months and for no reason at all as far as I could see – no testing to see if it was needed… no research…no case studies, no statistics that showed that having more education would help create a more successful massage therapist.  The one thing I did notice was that once they did raise the number of hours, the massage schools increased their hours of training to exceed that 500 hours so that they could get more grant and loan funding for students.  I would love to see if the number of students/graduates jumped at that exact time!   The thing is that we have no information on what it does really take to be a successful massage therapist.  It is more than just doing a good massage.  You also have to be a business person.  But massage can be learned in a basic 100 hour massage class.  Keith Grant also has some information on that topic in his white paper “Issues in Massage Governance” (pdf).  He also noticed the same coincidental increase in the number of hours and the number of grants/loans.  He also talks about how people learn and sites that people learn better in smaller training programs and the preferred method is apprenticeship programs.  There are a few states that do allow apprenticeship programs to be counted as massage training – WA State being one of them.  It was actually the whole reason I started this website -www.thebodyworker.com but the thing is that you can only teach one student at a time unless you want to make it into a formal school, which doesn’t make it profitable.

This is the only information that I have seen that gives any insight into the issues that we are dealing with.  If there are some other studies, information, proof that more hours of education are needed to be a successful massage therapist then I would love to see it.

CA also has the highest number of massage therapists despite them having this licensing problem.  I think that most can become a massage therapist with 100 or 250 hours of training – correct me if I am wrong.  So is it the number of hours of training that make a successful massage therapist?

The thing is that when people hear that after taking 1000 hour training classes I think that they somehow think it to mean that they didn’t need to take that many hours or that it is implied that they aren’t knowledgable or that more training is not beneficial.  It could be beneficial to people who take it but it is not needed to be a successful massage therapist – that is all that it is saying.

The idea that massage therapists need all this medical training etc is really not true.  It doesn’t mean that it could help to have extra classes and training.  It does not mean that more training can give you more confidence and skills but they are just not needed to do a basic relaxation massage which is also very therapeutic.  After 20 years of doing massage and learning structural integration, triggerpoint therapy and many other things I actually am going back to studying the affects of touch on healing.  I once thought as an overzealous massage student that if everyone got a massage once a week (now I would say 3 times a week!) there would be world peace and now I would add – a great reduction in the number of diseases and health conditions that are on the rise.

So I actually don’t care much about licensing these days anymore despite this long post.  I just write to hopefully inform someone and to inspire others to seek the truth.  I am more than open to hearing any more on this topic, but quite frankly – I just want to do massage! (and write about it!)  I sometimes get tweaked and think I should join AMTA or get ABMP more involved especially when I think about the state of insurance billing for massage therapists here in WA State – which talk about a mess!  That’s a whole other category here.

So do you think you could do a really great massage just having 100 hours of training just on doing massage?   I have lots of friends who have that number of hours because it used to be that number a long time ago.  They are all still in business but it seems the more recent grads with 1000 hours can’t seem to make it.  What does it take to be a successful massage therapist?  Is it the number of hours of training?  Is it some secret method?  Is it just about the person and who they are and what they want in their lives?

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