June 25th, 2007 Julie Onofrio
Here is my summary of the things that I have found to be of importance from Keith Eric Grants “A Review of Issues in Massage Governance”
- Most states have licensed massage therapists under practice acts which limit many different types of massage and bodywork especially the ones involving energy work and movement based therapies. This makes people who practice different types of massage be required to study and learn Swedish Massage (and take basic massage school classes) and take a test that may not be related to what they do. A title act can will make it possible for all to practice the type of massage/bodywork that they want.
- There are no clear measurable standards of practice. (I think This also has to do with the fact that the massage and bodywork profession are so diverse it is near impossible to create categories for all.)
- Stress is the number one health issue and massage therapists with 100-150 hours of training are well equiped to treat stress.
- It isn’t necessary to have more hours of training and it has been shown that “practical experience is a prerequisite to effective use of later instruction and to moving knowledge from an academic setting to use in clinical practice”. ( I have always thought that people learn better after they see and work with various conditions and clients.)
- There is no proof of harm being done by massage therapists. Harm is usually used as one of the reasons for needing to license massage.
- There will always be massage therapists who cross the lines and exploit the professional therapeutic relationship. “Consumer protection is not a matter of training but of following the complaints and enforcing disciplinary actions” which most state boards are not equipped to handle.
- There is a direct corelation in the increasing number of hours of training that massage schools offer and the ability for students to get federal funding for massage school. Massage schools are wanting to get more students who can get funding for school and the State boards are responding to the schools lobbying efforts and increasing the requirements of number of hours of education.
- States are just increasing the number of hours needed and not increasing the standards of practice.
- Classroom learning only leads to the students ability to answer test questions adequately and does not show if they can actually apply it to clients/patients.
- “Research indicates that the environment that seems to best able to foster understanding leading to usability has much in common with traditional apprenticeships.”
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June 23rd, 2007 Julie Onofrio
One of the confusing things in the massage profession is the definintion of medical massage. Since there isn’t any clear defininiton of what it is or who can do it, the insurance companies are starting to define it for us. Here in WA State Group Health who’s credentialing process is managed by Axia or American Whole Health is one such company who is starting that process.
The isssue is - is medical massage a technique or just the ability to bill insurance companies? Since stress is one of the biggest causes of health issues and a beginning practitioner with 100 hours of massage training can safely do massage for stress reduction, setting educational requirement that are more than this will eliminate those therapists from being able to do medical massage.
Others who work with specific diseases such as cancer and other pathologies most likely need more training to work with these people effectively but there are no set requirements for doing so because we really don’t know how much is needed.
Some groups and associations are calling medical massage a specific technique and a specific method when all one really needs is the ability to do chart notes and fill out a bill correctly and write a report for a doctor or lawyer. I have been billing insurance companies here in Seattle since 1989 when I became a massage therapist after 250 hours of training. I have always been paid and never been questioned as to my credentials. Now we are even able to become providers with HMO’s and PPO’s but for the most part they don’t even pay my cash hourly wage.
So what exactly is medial massage? Who can do it? How do we define medical massage?
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June 20th, 2007 Julie Onofrio
I have been doing massage therapy for 18 years and have been reading the state boards website and everything I can on licensing and legilation issues and I am still not understanding the whole picture.
The thing is that there are two sides to the issue - those who think licensing is necessary to protect the public from harm, end prostitiution and create professional standards.
On the other hand are people who disagree with licensing and what it is doing to the profession. I am in that camp. My resoning for doing so has to do with the way the National Certification Board was created which you can read my version of it from what I saw happening and from what I read in the national magazines at the time about what was happening (I still have the magazines!) Keith Grant sums up most of what I had already suspected in his article on “A review of issues in massage governance”. In summary - there is no proof of harm, there is no proof that massage will reduce prostitution, there is no need for more than 500 hours of education or even 100 for that matter.
The reason why this debate is important is that it is what is and will be affecting every massage therapist at some time in their career. Politics is just about relationships. No one wants to get involved until their toes are being stepped on and then it it usually to late. Politicians, other health care professionals, INSURANCE companies and a small group of AMTA members are defining the profession.
I recently emailed the government regulations committees of all AMTA chapters to ask them about licensing issues in their state and I only got a few replies. I also asked members of my discussion group to let me know what is going on in their state and still only got a few replies. Most do not know what the laws are in their state and don’t really care. They just want to go about their business doing massage. I can’t blame them for wanting to stay out of it because it is soooo confusing and difficult to get two parties with opposing views to agree on anything.
I sometimes think that the two different sides -for and against licensing people - should get together and have a group meeting faciliatated by someone like Marshall Rosenberg (who wrote a book called ‘Non -violent Communication’. The thing we are not doing that he advocates is to talk about what we are needing. Politics tend to bring up the feelings. We get to caught up in the feelings and being heard and needing to be right that we forget or don’t even recognize what the underlying need is. I would surmise that we both have the same underlying needs- the need to be able to build and run a successful massage business.
I don’t know the answers to all of this but I do agree with Keith Grant in that apprenticeship programs are a big part of the answer, That is why I started my first site actually -www.thebodyworker.com was me starting to collect all of the information to create an apprenticeship program. And now that I have seen the results of peer supervision and clinical supervision, I would add that. There are already studies in other professions that show how successful that is in creating practitioners with integrity. I will be doing more writing and research on this very thing.
I am now working on collecting all of the different variations of state licensing scope of practice definintions and it is really scary to see the differences in what a massage therpist can do in one state and not in another.
I also will be looking into what is happening in the unlicensed states - are people having problems practicing and building practices or finding jobs? and what about Minnesota with their Health Freedom Act - is there more prostituition and less quailified massage therapists there?
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June 19th, 2007 Julie Onofrio
One of the challenges we are faced with as massage therapists is overcoming the idea that the public needs to be protected from massage therapists due to the harm that they can inflict on clients.
I am sure there have been a few cases of peoples conditions being made worse by certain massage therapists, but after reading Keith Grants well researched piece on just this issue it isn’t something that should be influencing licensing. Harm is all in the eyes of the receiver. I personally know 3 highly skilled massage therapists who are licensed and have had claims made against them for doing so-called harm to clients. Licensing does not solve the problem of people doing harm or do anything to protect the public.
I think what some people are afraid of is that massage therapists can just start a business after having 100 hours of training and they are afraid that they have just spent too much time and money on 1000 hour programs and are afraid of the other therapist getting clients.
Hearing about massage therapists who just learned massage out of a book or set up a business without any training brings up some deep emotions of fear and anger and resentment that usually have nothing to do with the fact that anyone can do massage. When we react so strongly to situations or statements it is usually a case of our shadow side acting up. It is usually something about the person making the judgement more than the actual fact that someone with no or little education can be successful in this field.
As Keith points out -Stress is the number one thing that causes disease and that can easily be treated by a massage therapist with 100 hours of training.
I do agree that anyone attempting to treat the conditions or diseases that are caused by stress may need extra training and education but how much really? But that should not be the responsiblity of licensing to determine - it should be the profession that sets up definitions and scope of practice rules so that we can control our own destiny rather than be have it slapped on us by politicians who know nothing about massage other than the 15 minute chair massage they just got from someone outside the capital!
If there were a great need to worry about how much harm massage therapist do, I do not think we would have such cheap liability insurance.
If you haven’t read Keith Grants “A review of Issues in Massage Governance” I highly recommend it! He actually does propose some solutions such as apprenticeship programs as an alternative to licensing issues. (If you don’t know who Keith Grant is he is a noted author at massagetoday.com and a teacher at McKinnon Institute and a leader in licensing and legislation issues in massage)
One of the reasons why I am so passionate about this issue is that I sometimes think wer are creating this issue ourselves. I for one went to massage school in 1987 and had only 250 hours of training. I immediately was able to bill insurance companies and do treatment massage without any problem. I did learn more as I went. As Keith points out there seems to be a direct corelation between the number of hours that schools are offering and the ability to get Federal Grants. I sometimes think the profession is creating all of this just to add hours of training to their schools (more money to their pockets). There are also other disiplines of touch that are being required to go to massage school and learn swedish massage when their work has nothing to do with Swedish massage. Why are they being lumped in with massage regulations when they probably will never effleurage someone.
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June 18th, 2007 Julie Onofrio
One of the issues that we are faced with as massage professionals is lack of a clear definintion of just what constitues massage, massage therapy and bodywork.
As I am researching the definitions that are created by the various states, there is a wide range of descriptions and scope of practice regulations included in the definintions.
One of the things that also concerns me is that most laws are based on using Swedish Massage as the core of a massage students training and uses it for testing purposes. How did we ever come to the conclusion that swedish massage is needed to become a massage therapist? Do people who learn cranio-sacral massage , structural integration, Breema, The Rosen method, Hakomi therapy, acupressure, shiatsu, aromatherapy, Bowen therapy or any of the hundreds of different types of massage really need to learn Swedish Massage and effleurage and petrissage?
Here are some of the various definitions for various states:
NY State: “Definition of practice of massage therapy.
The practice of the profession of massage therapy is defined as engaging in applying a scientific system of activity to the muscular structure of the human body by means of stroking, kneading, tapping and vibrating with the hands or vibrators for the purpose of improving muscle tone and circulation.”
OHIO : “Massage therapy is limited to the treatment of disorders of the human body by the
manipulation of soft tissue through the systematic external application of massage
techniques including touch, stroking, friction, vibration, percussion, kneading,
stretching, compression, and passive joint movements within the normal
physiologic range of motion; and adjunctive thereto, the external application of
water, heat, cold, topical preparations, and mechanical devices.
A practitioner of massage therapist may treat temporomandibular joint
dysfunction provided that the patient has been directly referred in writing for such
treatment to the practitioner of massage therapist by a physician currently licensed
pursuant to Chapter 4731. of the Revised Code, by a chiropractor currently licensed
pursuant to Chapter 4734. of the Revised Code. or a dentist currently licensed
pursuant to Chapter 4715. of the Revised Code.
New Mexico: ““Massage therapy†means the assessment and treatment of soft tissues and their dysfunctions for therapeutic purposes primarily for comfort and relief of pain. It is a health care service that includes gliding, kneading, percussion, compression, vibration, friction, nerve strokes, stretching the tissue and exercising the range of motion, and may include the use of oils, salt glows, hot or cold packs or hydrotherapy. Synonymous terms for massage therapy include massage, therapeutic massage, body massage, myomassage, bodywork, body rub or any derivation of those terms. Massage therapy is the deformation of soft tissues from more than one anatomical point by manual or mechanical means to accomplish homeostasis and/or pain relief in the tissues being deformed, as defined in the Massage Therapy Practice Act, NMSA 1978, Section 61-12C-3.E.”
With such a wide range of definitions no wonder massage is still not widely accepted as a health care profession.
The other reason why we need to define the massage profession is because if we don’t, someone else will. And it is already happening here in WA State with the definition of medical massage being defined by insurance companies with the creation of a medical massage therapist credentialling by one insurance company here.
How can we create a defininion that allows all types of massage and touch therapies to practice what they want to practice? How do we create standards of practice for all of these various therapies that are acceptable to the political arenas demand for protecting the public (which does not really apply to our profession since there hasn’t been proof of harm - but that is a whole other post!)
Do you know how massage is definined in your state and how does this affect what you do and how you practice massage? Are you allowed to do treatment massage? Are various disciplines exempt like Reiki, Structural Integration or Reflexology? Are there confusing issues such as in OH where one therapist said that “If someone has been diagnosed with TMJ, you can only work in their mouth if they are referred by a doctor or dentist. If they haven’t been diagnosed with it, or do not disclose it, you can work away without any legal repercussions - just make sure you document intake and ask if they have TMJ.”
And is states without licensing - Does not having a licensing requirement affect your ability or right to work with clients in any way? Are you able to bill auto insurance companies?
As I ask these questions what I am finding is that most do not even know what their laws require of them nor have they ever questioned them which really makes me wonder what is going on out there in this profession. We want massage to be accepted by the public but keep our heads in the sand and don’t participate unless it directly affects our own practice.
Just some thoughts to hopefully get you thinking about what it is that you want for the massage profession and yourself.
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