Category Archives: Modalities

An Interview with Paul Ingraham

A few years ago, I came across a website that has become one of my favorites. It’s at www.PainScience.com, and the writer behind it is Paul Ingraham.

Ingraham is a former Registered Massage Therapist from Vancouver, Canada. He practiced for ten years in downtown Vancouver, taking as many difficult chronic pain cases as he could. Since 2009, he has been the assistant editor for ScienceBasedMedicine.org. I recently had the chance to ask him a few questions about his life and work:

LA: Paul, one of the reasons I find you so interesting is because we share the circumstance of formerly being into energy work, and all sorts of things along those lines that we no longer embrace. Was there a defining moment when you decided to leave that behind and become the skeptic you are today?

PI: It was a series of defining moments, a gradual process, many things chipping away at my faith. For instance, I had a colleague who I shared some beliefs with. We both did energy work and talked shop about it. For me it was more like art and poetry, while for him it was much more literal and real, like he thought he was a Jedi in training or something, and he shredded his credibility with increasingly bizarre belief and overconfidence — like healing over the phone — until I one day I thought, “Wow, way too far. That is just not quality thinking!”

There were many more little disappointments like that over the years. Some were bigger. I remember a workshop taught by someone I greatly admired. I went in beaming, but came out rolling my eyes — a whole day of fringe science and sloppy, self-serving “logic.”

When I started questioning this stuff publicly, I got hate mail, even about stuff I thought was no big deal to question. And that finished the job. Seeing a steady stream of incoherent arguments from unhinged true believers — never calm, never gracious, never “balanced” — finally turned me into an actual card-carrying skeptic. It took about a decade to go from true believer to doubter to curmudgeonly skeptical gadfly.

LA: For years, your website was known as SaveYourself.ca. What precipitated your recent name change?

PI: PainScience.com is more serious and dignified. And just more descriptive of what I do.

I never really cared for the connotations of “save.” Some people immediately think of Jesus when they think of being saved. And I didn’t want to imply that anything I write can “save” anyone — it smacks of the same kind of unethical over-promising that I often criticize in health care.

PainScience fits great. It feels like putting on a nice suit after years of doing business in a Hawaiian shirt.
LA: I’ve seen a few snarky comments from people on the Internet concerning the fact that you’re not a scientist, but you write about science. What are your qualifications, and what do you say to your critics?

PI: Yes, that comes up a lot. And they’re half right: I am not a scientist! But of course hardly any science news and reporting comes directly from scientists, and it can’t, because scientists are busy doing their jobs. And hardly anyone outside of science actually reads scientific papers (least of all the kinds of people who complain that I’m not a scientist).

I am a writer, and my job is to understand and translate science as well as I possibly can — to be a liaison between scientists and clinicians and patients. It’s a tough job, but I care deeply about it and work my hind end off to do it right.

Information about the implications of science can and should only be judged on its own merits. It doesn’t matter who wrote it. Is it good? Is it reasonable and referenced?
LA: One thing I have always admired about your writing is that you provide footnotes for everything. How much time do you spend researching and preparing an article?

PI: It never ends! I never stop editing and upgrading articles, because science is a moving target. They need to change. This is a distinctive thing about PainScience.com: I don’t publish stuff and then just leave it there to rot on the server forever.

But a first draft of a typical 2500-word delve into a topic is usually about a 40-hour project, assuming I’m really going for it. The main way to distinguish yourself online these days is quality. You can’t just write a lot — you’ve got to write well. Serious polish. So I really get into making an article as good as I can possibly make it. It’s not unusual to thoroughly edit at least five or six times.
LA: Like my own blog, some of your articles have generated controversy and even gotten you some hate mail. Is there an article that stands out in your mind for that?

PI: By far the most hate-mail generating article I’ve ever published is Does Chiropractic Work? The modern version of it is more diplomatic and generates much less hate mail, while the original was somewhat snarky and made a lot of heads explode. But I still stand behind any statement I ever made there.

But the most interesting hate mail generator is this one: Trigger Point Doubts. It doesn’t generate a lot of hate mail, but some people just go bonkers when they think they’ve caught me in a contradiction. That is, criticizing “trigger points” while also selling a book about trigger points. Even though the article tackles this so-called contradiction head on. And of course it’s very intellectually healthy to question your own ideas. But I get mail from people who are just furious with me: they take me for a trigger point guru and then freak out when they find out I have concerns about trigger point science being half-assed.

LA: Painscience.com gets about 30,000 hits a day. I notice there’s no advertising on your site, but my guess is you’ve been offered plenty of deals; is that so? What’s your reason for running an ad-free site?

PI: I just like it better. Classier. Different than most of the rest of the internet. And I can generate enough revenue with e-book sales.

LA: You’ve written quite a few e-books. What is the focus of those?

PI: So far I have written eight books about eight musculoskeletal pain problems that are often puzzling and stubborn, like patellofemoral pain or chronic low back pain. The goal of the books is to explore the puzzle with the reader, who can be a patient or a professional: to dive into the interesting mysteries and try to figure out what works, what doesn’t, and why. My goal is to simply teach the reader as much as I possibly can about the condition. In the absence of proven treatments, good information is the next best thing.

LA: What’s the most gratifying thing about what you do?

PI: Oh, that’s easy: email from people who like my sense of humour! Best people in the world! Or librarians who recognize the mad genius of my bibliography.

But seriously, of course it’s the readers who feel that something they learned from me has really helped them. I do love that. That’s the whole point.

LA: Is there anything you haven’t accomplished yet that you plan to do? What’s next for Paul Ingraham?

PI: Lots! It’s taken me a few years to get PainScience.com going and prove that it can pay the bills. I’ve had to do a lot of technology work to get it to that point, which often distracted me from writing in a big way. Now it’s time to get back to the writing, and lots of it, both professional and personal. I’d like to get going on my first novel. And some other technology business projects with a genius buddy of mine, for the diversification and fun of it. Going to be a busy couple decades!

ELAP Final Report & Entry-Level Education Blueprint Released

The Entry-Level Analysis Project Final Report and the Entry-Level Education Blueprint were released today, and it’s a whopper…266 pages in the Report, and 527 pages in the blueprint. Obviously, I haven’t read that all this morning. I do want to take the time to express my appreciation for the collaboration among the Coalition (ABMP, AFMTE, AMTA, COMTA, FSMTB, MTF, and NCBTMB) and to Anne Williams of ABMP in particular, for spearheading the project. Both documents were co-authored by the ELAP workgroup, which included Pat Archer, Clint Chandler, Rick Garbowski, Tom Lochhaas, Jim O’Hara, Cynthia Ribeiro, and Anne Williams.

According to the Report, at the initial meeting of the Coalition in 2011, two pressing issues were identified: the inconsistent quality, depth, and focus of entry-level massage programs, and the lack of licensure portability from state to state.

The big recommendation is that 625 hours of education are needed just to give students the core basics that they need for entry-level competency. According to the report, currently 28 states only require 500 hours; 7 require between 570 and 600, and 10 states require more than 625 hours. In my opinion only, no matter how wonderful the Blueprint, those states that already have higher standards won’t be inclined to dumb it down for the rest. New York and Nebraska, for example, both have 1000-hour requirements. I don’t see portability happening there–ever–unless every other state decides to come up to that level. However, the Report does reference a 2012 study that states the average massage program in the US is 697 hours–so maybe even in the states with the 500-hour requirement, there is a tendency to do more than required–and that’s nice.

For those schools that are less than 625 hours, this recommendation would undoubtedly increase financial costs to the owner that would have to be passed along to the student.

The shocking news, to me, is the statement that 40-50% of graduates are leaving the field within two years of graduation! I would be interested to know exactly how those figures were arrived at.The Report cites unrealistic expectations about the physical demands of massage and compensation, and the evolving life circumstances of 20-somethings. I’m personally not sure how relevant the 20-somethings are; it’s been my own experience in the past 15 years that there are as many middle-aged people (whatever that is, nowadays) that take up massage as a second career as there are young people who jump in right out of high school.

The workgroup would like to encourage everyone to pay more attention to the core curriculum than the hours. According to the document, this can serve everyone:

  • The Federation can use it as a guideline for the Model Practice Act
  • The state boards can use it in setting hours for education
  • The AFMTE can use it in setting teacher standards
  • COMTA can use it in evaluating massage and bodywork criteria for accreditation
  • the NCBTMB can use it for identifying entry-level vs. advanced knowledge for Board Certification
  • Professional membership associations can use it in shaping membership criteria
  • School owners, administrators and faculty can use it in validating curricula and adopting consistent learning outcomes
  • Potential massage therapy students, as they are deciding where to enroll.

There is, within the document, the subtopics of Eastern bodywork, TCM, concepts of qi and all the accompaniments to that, with the caveat that schools may choose to integrate that according to their own philosophy. The focus is on the application of Shiatsu, tui na and Thai massage, which I will not argue the efficacy of, without personally buying into the theory behind them. I’m not going to have this argument here because it wears me out, and frankly, I’m outnumbered.

There is no doubt that a huge amount of work went into this project. Personally, I gave a lot of feedback on it during the calls for comments that happened some months ago, as did several other educators I know. I wasn’t crazy about this idea when it was initially introduced, and I was further distressed by the way the review and comment process was set up…I didn’t think it was good to have such a piecemeal approach to it, but in reality, I feel that the chance that many more people would have responded to the whole thing is probably relatively slim…it would have been just as long in any case. Anne Williams stated during one of the presentations on it that I attended last year that it isn’t perfect, but what is? I sincerely do commend everyone who gave of their time and effort on this huge undertaking. I plan to say more about it after I’ve read every page.

 

CE Providers React to NCBTMB’s New Approval Plan

In the past couple of weeks since the NCBTMB unveiled their new plan for CE providers, which includes doing away with organizational approval, the reaction of providers has for the most part been very negative–and frankly I’m not surprised. The long-standing organizations who are providing quality continuing education approved feel, for the most part, that the organization they have supported for many years is throwing them under the bus.

Some of the main concerns that I  have heard are from providers who have created proprietary classes and who have trained and approved their own instructors to go out and teach their work. They are now faced with the instructors that they have invested time and money in training and marketing classes for going out on their own, taking copyrighted teaching manuals and proprietary handouts with them, and acting as if they are under no obligation pay the percentage or per-student charge that they have agreed to pay as teaching members of the organizations. Those same instructors who have been mentored and marketed under our organizations are now saying “we’ll just be out on our own after 2014.” They are making it clear that they feel free to take our proprietary materials away with them—because the new rules are basically blessing that—and never give the organization that put them where they are another dime.

Those who have organizational approval do not want unqualified people teaching for their organizations and misrepresenting their good names, and have gone to considerable effort and expense to make sure that is not the case. While there is certainly nothing wrong with requiring us to provide proof of that, taking all instructors from under our organizational umbrella and putting them out there on their own is also going to create logistical nightmares. The organization has been responsible for collecting and maintaining registration forms, evaluation forms, etc. and issuing CE. In the case of Upledger, for example, now instead of one organization handling those administrative tasks, there will be more than 100 separate instructors keeping up with that. The organization will have no control and no more quality assurance that they will be able to exercise.

The organizations and schools that sponsor CE workshops at the national, state, and local levels will suffer from these changes as well. This is also financially crippling and over-burdensome to smaller organizations who may not teach that many classes each year. When it comes to education, quality and quantity are not the same thing.

The notion that having people turn in all their lesson plans as proof that they are a competent teacher is also flawed. My publisher hires me to write lesson plans all the time to go with their textbooks and for career schools who want customized plans. I’ve written at least 20 this year alone. If you have the money to hire me, I will write one for you. It still will not make you a competent teacher. A well-written lesson plan doesn’t necessarily indicate that you’re a great teacher; it indicates that you are either a competent writer, or that you hired someone like me to write it for you. Requiring people to send in a video of themselves teaching would be more indicative of whether or not they are competent, since the organization obviously cannot afford to vet every class in person.

In response to the outcry since the NCBTMB announced the plan, they have stated that they will consider some of these issues on a case-by-case basis. I would like to know how they plan to carry that out with volunteers—volunteers whose qualifications to judge us we have no knowledge of, as they are not releasing the names of the people on that committee. Are they experienced educators? Are they trained in teaching methodology? Are the research literate? We don’t know; we can only hope so.

I find it necessary to bring up that the reason the NCBTMB changed from vetting individual classes years ago was because the task became too overwhelming for the paid staff to handle and getting volunteers together to do it caused the process to move at the pace of molasses. It is unacceptable for someone to wait six months—as has been common at several points in time—to get their approval or denial. It is very apparent from the latest 990 filing that the NCBTMB cannot afford to hire new staff and that they will indeed be depending on volunteers until such time as this might generate enough money to enable that. This is one of the service problems that has come very close to knocking this organization to its knees in the past, and they do not need to go backwards instead of forward.

Considering things on a “case-by-case” basis also leaves this organization open to accusations of favoritism, if not worse. The massage community is a tight-knit and close community, in spite of the fact that there are thousands of us. Those of us who are organizational providers tend to attend the same events, and travel in the same circles. What you allow for one, you must allow for all. To do otherwise is simply unethical and unprofessional, and the first time it comes to light, and it certainly will, that any consideration given to one has not been given to all, it is going to be another public relations nightmare for the NCBTMB. I don’t think they can stand to have many more of those.

Let’s look at a few facts.

There are currently a half dozen states with their own CE approval process. The NCBTMB is not the only game in town…and it is that same complacency of thinking that has resulted in the FSMTB kicking their butt with the MBLEx. I would not fall into the mistake of thinking that the Federation isn’t willing to step up and do something about CE approval as well. They may seize upon the dissatisfaction of the current environment; they already have the infrastructure, and big cash reserves at their disposal. The Federation doesn’t “need” the money, and the perception here from providers is that the NCBTMB is trying to bail themselves out of the red with this plan.

There is no evidence to support that regulation, including requiring CE, has contributed to the safety of the public. There have always been unethical and incompetent practitioners, and for that matter unethical and/or incompetent CE providers, and they will continue to exist, regardless of the amount of rules and regulations. Look at how things stand in other professions. There are 17 states that don’t require nurses to obtain CE. There are 10 states that don’t require PTs to obtain CE. Even MDs have 7 states that don’t require them to obtain CE—but all three of these professions are licensed in all 50 states.

Other than the 30 or so of us (including myself) who were present at the meeting the NCBTMB convened in Chicago to discuss this issue a couple of years ago, there has been no attempt to gather the input of the (hundreds of) providers that are currently under the auspices of the NCBTMB.  I believe this organization is in need of our support, not our animosity and distress.

I urge them to abandon this plan, and gather input from a much broader slice of the profession before considering such drastic measures again.

NCBTMB Making Major Changes to CE Provider Approvals

Disclosure: I have agreed to pass along comments, questions and concerns to the NCBTMB on this matter, and the management there reads my blog. They are fully aware that I use this blog to express my own opinion whether it is in line with theirs or not. Your comments here will be seen by the CEO, Mike Williams, and the Board of Directors.

The NCBTMB has announced major changes in the works to their Approved Provider program for continuing education. You can read those here.They have also set up a page for Frequently Asked Questions about it, and you can read those here.

As soon as they sent out the press release I started getting emails and FB messages from people asking questions about it, some applauding it, and some complaining about it.The biggest change is that they will no longer be offering organizational approval. Every individual who teaches a continuing education class will need to obtain individual approval as a provider. That’s going to affect a LOT of entities: AMTA, the American Massage Conference, massage schools, and other organizations who have previously been able to take people in under their umbrella.

It’s affecting me, personally. I have organizational approval myself. I normally host a dozen or more teachers at my facility each year, and while 90% of them are approved providers in their own right, a couple are not. I don’t perceive it to be such a big deal for me…it’s not going to be a problem for them to get their own approval, and I have until the end of 2013 to prod them along into doing so. All who are approved as organizations have until the end of 2013 to get your act together and come into compliance under the new rules.

One of the first complaints, naturally, was about money, and people having to pay yet another expense. Organizational approval up to this point has cost $400. In reality, an organization that only has two teachers has been paying the same amount as one that has twenty, and that’s not really fair. Under the new paradigm, approvals will cost $175 and will last for three years. You must also pay a $25 fee for each class you submit to be reviewed. As a clarification to one point that has been brought up, if you have a full class and you teach portions of that, as sometimes happens at conferences and conventions, you are not having to pay $25 for each version of it…just the one fee. That’s good. I teach for a lot of AMTA chapters and I am often asked to cut an 8 hour class down to 6 hours or make a 3 hour class last for 4, so it’s good to know you’re not paying $25 for all derivatives of the same course.

People have also stated issues with them requiring a criminal background check. Some state boards require that, and some don’t. My particular state does, and if memory serves I think the fee is $30 or $35. It may be duplicating efforts for the NCBTMB to require it in some instances, but not in others.

I have personally had discussions with the powers that be at the NCBTMB over the approval of course content. They are now vetting individual courses again–to a point. The first concern I got wind of was from a colleague who was concerned that they would throw out everything that doesn’t fit in the box of Western medicine. Have no fear. My own wish is that they would get rid of some of the more questionable classes that are approved….at least they were questionable to me, and of course, I’m just one person with an opinion in a sea of many.

They have no intent of getting rid of energy work courses and other classes that don’t have any basis in science…as long as the course content shows some connection to or lineage from massage, it will still likely be approved. I say likely because during the vetting process, they are paying more attention to quality, whatever that truly means. For one thing, they are asking you to turn in your complete handouts, which has never been done before and which also has some people concerned about letting their proprietary information out of the bag. I have expressed my own concern that some of these courses people have invented that don’t have any basis in science and in fact have in some instances been proven to be totally contrary to accepted scientific principles are still going to be approved, so I’m not sure how “quality” that is. A lot of people disagree with me on that front. There is obviously a very huge demand for those types of classes, or they wouldn’t continue to exist.

What I would personally like to see happen is a national certification for science-based education. I’m going to keep after them about that; you can count on it. People can do all the unsubstantiated things they like, but there are some who would like to have a credential that is based on the actual evidence-informed practice of massage. I am one of them. Does that mean I am claiming to be better than you? No, it does not. It just means I would like for there to be something out there that differentiates those who want to be known as evidence-based practitioners as opposed to those who don’t.

Other questions I’ve been asked include exactly who is doing this, and the names of the committee members have not been released that I am aware of. They just state on their website (which is new and snappy-looking, incidentally) that it is a team of experienced practitioners and educators.

People ought to be aware that the buck doesn’t really stop with the NCBTMB. They, along with numerous other certification agencies,  are accredited by the Institute for Credentialing Excellence (formerly NCCA, National Commission for Certified Agencies).  They are the only national accreditation body for private certification organizations, in all disciplines, to demonstrate adherence to established standards. Among the certifying agencies that this organization accredits include healthcare programs in chiropractic, dentistry, EMT, nursing, medical assisting, nutrition, prosthetics and orthotics, and pharmacy. They also accredit certification programs in the arts, construction trades, and a host of other things. And ICE is accountable to the Council for Higher Education.

Bottom line: changes are coming, and you can either go with the flow or go away…while a few states have their own approval process, the vast majority still depend on the NCBTMB for approving continuing education.

I’d like to state for the record that I personally am acquainted with the majority of the people at the NCBTMB, and I have certainly written my share of criticism of the organization in the past–and patted them on the back when I thought they deserved it. The fact is that if they stand on their head and whistle Dixie, it is never going to suit all of the people all of the time. I think they are a dedicated and hard-working group of people. I certainly don’t agree with everything they do, and I take frequent advantage of my status as a certificant and an approved provider to let them know that.

Here’s your opportunity to comment, so take it. As I said, these comments will be seen by the CEO and Board members.

If at first you don’t succeed….

Try, try again. That’s what the regulatory board in my home state of North Carolina is recommending when it comes to getting the Federation of State Massage Therapy Boards to do something about the confusing status of continuing education approvals.

Two years ago, the NC Board of Massage & Bodywork Therapy introduced a resolution at the Annual Meeting of the FSMTB (which was held in Puerto Rico). This document instructed the Federation’s Board of Directors to “begin the process of developing a new national approval program for continuing education providers and courses.” The organization’s leadership responded positively to the resolution, and announced to the profession in the Spring of 2011 the launch of a comprehensive project to do just that. They also invited AFMTE, AMTA and ABMP to work with them to provide input that would help shape the project.

In spite of this clearly stated intention to develop a “centralized quality assurance process for all courses taken by massage and bodywork therapists for the renewal of State licensure or State certification” (quoted verbatim from the FSMTB press release dated 3/29/11), the outcome of this process missed the mark by a country mile. The MOCC Proposal, which stands for Maintenance of Core Competencies, failed to deliver what the state boards asked for, and what FSMTB promised.

To remind you, the MOCC Proposal was based on a new (and unproven) concept of separating continuing education that relates to “public protection” from all other CE that is taken for “professional development”. MOCC recommended that only CE related to “public protection” be required by state boards for renewal of licensure, and everything else be put into the voluntary category, to be regulated by… well, the proposal didn’t even mention NCBTMB. If this all weren’t bad enough, FSMTB would become the exclusive provider of coursework needed to maintain “core competency” in the subjects related to “public protection”.

For more background on the MOCC issue, refer to my blog posts of 3/14/12 and 4/15/12. It’s also illuminating to read the press release AMTA issued on 4/23/12 which contained a complete repudiation of the Federation’s proposal.

In a friendly game of golf, you can take a “mulligan” every now and again–a “do-over”. My colleagues at the NC Board are giving the FSMTB leadership an opportunity to take a mulligan on this vitally important CE approval issue. They have recently submitted another resolution to be discussed by Member Boards at the upcoming FSMTB Annual Meeting in New Orleans on September 27-29. This resolution is much like the original from two years ago, and its appearance at this point in time indicates that the need for a single-source national CE approval program has not gone away.

The primary rationale is contained in this statement from the new resolution:
“Reliance upon the NCB Approved Provider program has been problematic for state boards because (a) NCB is a private, non-profit corporation that lacks oversight from and accountability to state regulatory boards; (b) its program has not adequately evaluated the quality or relevance of CE courses; (c) administration of this program has had notable service delivery problems over an extended period of time.”

That’s all true, but the opera ain’t over ’til the fat lady sings. The NCBTMB has the infrastructure already in place–and this will be nothing more than another case of duplicated efforts if the Federation steps in and tries to take it away without consideration of the NCB’s position in that marketplace. I think a collaboration would be more appropriate; by contracting with the NCB to administer CE approvals, FSMTB could establish the accountability structure that state boards must have with NCB, and FSMTB wouldn’t have to reinvent the wheel. They could just improve upon it.

Yesterday, I conducted one of my Scientific Facebook Polls, and asked the questions: How many MTs REALLY care what is happening with our professional organizations and what they are doing? How many people care about the MTBOK, the ELAP, the MOCC (don’t y’all love all these acronyms) or even know what they really are? How many people care about the legislation and regulation of massage? How many people care that there are initiatives to raise standards for teachers of massage therapy and for massage education in general? Do you care about all those things, or would you rather just be left alone to do massage?

I got 75 replies in a 24-hour period, and one thing is apparent: to the average massage therapist trying to make a living, many perceive our organizations to be all about politics and all about money. To some extent, that’s true…the one with the most money wins. The perception is also that they all have their own agendas. Actually, recently some of them seem to have the same agenda, but they’ve wasted time and money in duplicating efforts, or opposing each other’s efforts, and scrapping over turf wars. In a recent blog I urged the NCBTMB to take themselves out of the entry-level exam market and suggested that the FSMTB assists them financially in return for their doing so. Earlier this week, in a piece published in Massage Today, Ralph Stephens called on AMTA and ABMP to offer “substantial and ongoing financial support” to COMTA and AFMTE, to further their important efforts to improve the quality of massage therapy education.

FSMTB and the NCB have recently conducted new Job Task Analysis surveys, both of them seriously flawed, in my humble opinion. These surveys show a strong bias towards the clinical/medical side of massage therapy, and contain virtually nothing about the KSA’s related to delivering massage therapy as a primary means of facilitating well-being and integration. From my perspective, the latter is of equal or greater importance.

In addition, the FSMTB survey has a special add-on section to gather data for the Entry-Level Analysis Project (ELAP). This dual-purpose survey does ask lots of questions about specific medical conditions, but it contains nothing about the client/therapist relationship. The word “relax” does not appear anywhere, and the word “relaxation” shows up just once.

There’s also an over-focus on the huge number of modalities that are marketed in this field. Many of these listed are obscure and little-understood. It’s wrong to ask a therapist to define themselves by a single named modality. Practitioners typically use a broad range of methods with clients. The modality is not the treatment — it’s the totality of what a practitioner brings to the session.

Finally, this Federation JTA is similar to the recent JTA from NCBTMB: another duplicated effort that still falls short of giving an accurate picture of what happens in the real world of massage therapy. You can count how many times a week we give a massage or take SOAP notes, but that’s not what it’s really about. It’s about our rapport with the client, and what kind of results we are able to produce, and what kind of trust we can inspire in our therapeutic relationships. The MTBOK generally missed the boat on this as well, although I have high hopes that the line-by-line analysis and re-mapping of the MTBOK that was conducted by AFMTE will give us a usable body of knowledge.

As a result of these large-scale projects, it’s likely that the kind of incomplete and disjointed training that is typical in our field will get further enshrined as the baseline for education. Skewed survey questions produce skewed data. Using that data to build a new standard for the entire field is not just wrong, it’s a crime against the lineage of massage therapy. Just look at what has happened to the other health care professions who have organized themselves around the mechanistic/reductionistic model. People are treated as parts, and no discipline ever looks at the whole person. Massage therapists still have the ability to treat holistically. Relaxation is being relegated to a lower-class status of therapeutic effect, when it’s one of the most valuable aspects we offer with this work.

This whole scenario illustrates one thing: the time has never been more ripe for getting our act together, and that isn’t going to happen while there’s all this push and pull and one-upmanship going on with the organizations. When the leaders of the seven primary stakeholder groups sat down at the table for the first time last September, the ELAP proposal appeared out of nowhere–it wasn’t even on the agenda and it got slid in anyway. I would like to see them sit down again, and take a serious look at these issues. Put ego and profit aside. Take a real look at the flaws in your information-gathering processes. If you want to see what massage therapists really think, sign on to my Facebook page and you might get a rude awakening at their opinions of you. You wouldn’t exist without us, and what we think does matter. A Job Task Analysis survey asks what we do--and frankly, it isn’t near as important as what we think. Consider that.

 

Report from the AFMTE Annual Meeting

I spent last weekend in toasty Tucson, AZ at the Alliance for Massage Therapy Education annual meeting, and for the third year in a row since this organization started, it was one of the best things I have ever attended. There were quite a few new people attending this year, and attendance was up slightly from last year. The meeting was held at the El Conquistador resort, a beautiful venue with gorgeous mountain and desert views.  I was late getting there and unfortunately missed the opening ceremony and the keynote presentation by Benny Vaughn, which I heard was fantastic.

As usual, there were great continuing education offerings…I attended Tracy Walton’s class on “Busting Myths and Critical Thinking Skills,” which was informative and entertaining, and I heard nothing but praise from attendees of the other classes, which included offerings by Stephanie Beck, Martha Brown Menard, Susan Beam, Cherie Sohnen-Moe, Terrie Yardly-Nohr, Nancy Dail, Pat Benjamin, and Ben Benjamin. Bear in mind, these classes aren’t your average CE class–they are directed at massage therapy educators. When these great teachers weren’t teaching a class, they could be found attending someone else’s class. That is one of the most wonderful things about this gathering to me; it is attended by some of the most well-respected and well-known educators in this profession–and they all have the attitude that they’re not finished learning. Kudos to every one of them.

Nancy Dail organized a “Meet the Authors” gathering, and it was amazing. I was humbled to be included in such awesome company. I doubt if I can name all these people   in the correct order in the picture so I won’t even try. Mark Beck was out of the room when the picture was taken but he was present as well. The group included (in alphabetical order) Timothy Agnew, Sandra K. Anderson, Pat Archer, Ben Benjamin, Pat Benjamin, Andrew Biel, Celia Bucci, Iris Burman, Nancy Dail, Sandy Fritz, Julie Goodwin, Martha Menard-Brown, Carole Osborne, David Palmer, Cherie Sohnen-Moe, Ralph Stephens, Tracy Walton, and Terrie Yardley-Nohr. Also absent was David Lauterstein, who had an airline travel nightmare, but his book was present along with the others authored by these amazing people. I don’t know when I have ever seen such talent present in one room.

All the major organizations had representatives in attendance, with the exception of ABMP. I’m not sure if they were making a statement by not showing up or not. I had actually spoken to Bob Benson, the Chairman of ABMP, a few days before the meeting and asked him if they would be in attendance, and he did not make any mention of political reasons for staying away…of the likely candidates that would have attended, several were on vacation, one was attending a family wedding and so forth. Still, their absence was notable, no matter what the reason. AMTA, the FSMTB, and COMTA were all in attendance. There was also chair massage offered at the meeting to benefit the Massage Therapy Foundation, and thanks to the efforts of Taya Countryman who organized that effort, over $900 was raised for the Foundation.

Elections were held, and the standing officers were all re-elected. Two new board seats were also added. The AFMTE Board has let go of their management company and are handling it themselves, and the two new board members are needed to help with the many tasks of the organization. Stephanie Beck and Heather Piper were elected as members-at-large.  I agreed to serve on the marketing committee….I don’t do boards anymore of any kind, since that would interfere with my blogging, or at least the perception thereof, but I’m glad to serve the organization on this committee.

Breakout sessions were held to discuss numerous topics of interest to educators, including all the various projects that are going on at the moment, not the least of which is the Teacher Education Standards Project. Other breakout sessions were to talk about the MOCC proposal from the FSMTB, the new policies announced by the NCBTMB, and other issues facing the profession.  There weren’t any formal votes in any of the discussions I sat in on, but a number of people I talked to all said the same thing–that there are a lot of duplicated efforts going on, which is a waste of time and resources. John Weeks, Executive Director of ACCAHC, also gave a keynote address where he stated that we have a tendency to get ourselves trapped in whirlpools–and how much influence we could have because of our sheer numbers, if we would just get out of them.

During the business meeting, President Pete Whitridge announced that the organization has no debt. That’s a fabulous position to be in, but I would like to state that we need and welcome corporate sponsors, as well as individual members. The Alliance has worked very hard to keep membership fees reasonable–and to hold our meetings in reasonable places. Although the El Conquistador is the lap of luxury and a beautiful place, we got a room rate of $99 per night. Many meals were provided as well, so financially, it’s a bargain to join. Please visit the AFMTE website to find out about the many benefits available to you as a member. There are also vendor opportunities and sponsorship opportunities at the annual meeting. Thanks to exhibitors Biotone, Bon Vital, Books of Discovery, the Center for Embodied Teacher Education, F.A. Davis, the International Association of Massage Business, Massage Envy, the Massage Therapy Foundation, Massamio, the National Accrediting Commission of Career Arts & Sciences, Performance Health/Biofreeze, Wellx, and Wolters Kluwer Lippincott Williams & Wilkins. Thanks also to sponsors of the meeting, Massage Today, Massage Magazine Insurance Plus, the Florida State Massage Therapy Associaton, Massage Envy, Books of Discovery, Pearson, Biofreeze, and SOAP Vault. Soothing Touch , Oakworks, and Massage Warehouse, along with many others also donated door and raffle prizes.

On a personal note, I had a big fat time socializing with so many friends and making a few new ones. I had dinner the first night with Julie Onofrio, Kathleen Gramzay, and Karen Hobson. I met with Mike Noble, the new acquisitions editor at Lippincott, and Shauna Kelley, their marketing manager, for dinner on Friday night to discuss a couple of projects, and Saturday night, I had a blast with the team from Massamio and a bunch of other friends–both FB friends and the real variety. I went to lunch one day with Allissa Haines and Gregory Hurd…we went sneaking out to the In-and-Out-Burger for a junk food fix. I spent a couple of hours talking with Ryan Hoyme (aka The MassageNerd), and just in general enjoyed myself and enjoyed seeing everyone. I tried to sit with someone different at every meal and every class so I could visit with as many people as possible, and wish I could have personally talked to everyone there. I did have a few good but short conversations, with Sandy Fritz, Sue Toscano, Susan Beck, Mark Beck, and other good folks. As usual, there just weren’t enough hours in the day.

The biggest thanks, and deservedly so, goes to Cherie Sohnen-Moe. Tucson is Cherie’s home town, and she really went over and beyond the call of duty in helping to organize the event. She’s probably ready for a vacation!

I urge you to join the Alliance for Massage Therapy Education. We are hoping to accomplish some great things, and we need your expertise and your input. We are a non-profit organization and of course donations are welcomed, but what we’d really like is your membership fee–AND your participation. We want and appreciate active members! There are a lot of things going on in our profession right now, as I have reported right here. We need to be sure that education evolves in a way that serves the highest good of the profession, in total transparency, and that our membership gets plenty of input. That’s one thing that is very evident about this group of people–they do want to hear what the members think….and here we have some of the best and brightest minds in the business. You could almost get star-struck at this meeting–but there is not a standoffish person in the bunch. Don’t wait until the next meeting; join us now, and get involved. If you are an educator, school owner, administrator, or industry partner, we need you. And I’m going to shamelessly use the same quote that I used from Jan Schwartz at last year’s meeting: “If you’re not at the table,  you’re on the menu.”

Massage Regulation: A Comedy of Errors

I’ve spent the last hour reading legislative updates pertaining to the regulation of massage…in the past, I’ve sometimes referred to this as the good, the bad, and the ugly. This time, I’m just going to call it a comedy of errors. I don’t know whether to laugh or cry.

I’m not even going to address all the discrepancies in the number of hours of required education and/or exams required for licensure, or the discrepancies in the hours of required continuing education, or even the wide variances in licensing fees. I’ve commented on that a number of times, and that situation isn’t likely to change at any time in the near future.

Everybody has seen those “outdated laws” posts before, silly laws that are still on the books, like “It’s illegal to ride a horse without a saddle on Main Street after 5 pm every other Sunday.” You get the picture. Some of our massage laws seem about as archaic. You just have to wonder at the logic that goes into some of these things…and you also have to believe that these most assuredly were not proposed by, nor are they likely supported by, massage therapists. It’s the bureaucracy at work.

Many of the statutes that have been proposed or enacted in the past few years are a direct result of the economy and state governments being so deep in dept. Several states are now taxing, or considering taxing services (like massage, hair and nail services, even grass-mowing). Even self-supporting boards have in some cases had their monies raided in the interest of feeding the state’s general operating fund. NH is seeking to abolish their massage board altogether, in the interest of saving money. And in the state of West Virginia, HB 2502 seeks to combine the administrative functions of the massage board with the acupuncture board (not so weird) and with the forestry board (weird), the board of licensed dietitians, and the hearing aid dealers board (at least the last two are still health-related). It makes you wonder what we have in common with foresters. Are foresters out there planting trees while naked or committing some other unethical act? Maybe so.

A lot of states don’t require any fingerprinting and/or criminal record submissions of applicants for a massage license. A convicted rapist or violent criminal can get one. Some states require licensees to provide proof of liability insurance, but most don’t. I personally think that one’s a good idea.

There is so much discrepancy between the states on modalities that have to be licensed. In NC, where I live, Bowen therapy, craniosacral, Rossiter, Zero Balancing, and 24 other modalities are specifically spelled out as requiring a massage and bodywork license.  We don’t regulate reflexology, which I really don’t get. I’ve had plenty of reflexology and I would have to say that there is at least as much tissue manipulation going on as there is during a session of acupressure, which we do require licensing for.  NY licenses both acupressure and reflexology, and Polarity therapy. I know practitioners who will argue that every modality mentioned in this paragraph is energy work and not massage. You might as well agree to disagree and get a license if it’s required of you.

Speaking of NY, earlier this year SB 1030 was proposed, got stuck in the Higher Education committee, and may have expired due to lack of action. It provides that the commission of prostitution offense by any person upon premises at which a massage therapist regularly engages in his or her profession, or the commission of any such offense by a massage therapist constitutes professional misconduct; provides that upon 3 or more convictions of such offenses upon such premises, or any conviction of a massage therapist of any such offense, the massage therapist’s license shall be revoked. So basically, you can prostitute once or twice, but don’t do it three times or you’ll lose your license. You might even lose it if you weren’t personally prostituting but someone else on the premises was. It’s worded a little vaguely, in my opinion.

In the summertime, not much is happening, because legislatures tend to pack it up and go home. Some things are always left on the table for the next session, and some (hopefully) will never see the light of day again. And some things are urgently needed, like regulation in the 8 states that don’t have any. In each of those states, there are therapists working for licensing, and just as many fighting against it.

You can find regular updates about what is going on in the regulatory world of massage on the legislative briefing pages on the websites of both ABMP and  AMTA.

What’s in a Name?

I’m abandoning my politics for a moment to have a little rant about something else: modality names.

Rolfing, Feldenkrais, and Trager, for example, are what I would describe as old classics. They’ve been around for many decades, and came about when bodywork and/or movement therapies were still in their infancy, at least in the Western world.

I’ve seen a trend recently, though, that I have to confess bothers me, and that’s the plethora of people naming techniques after themselves.

Last week, I made a post on one of my networks that I was looking for instructors for next year’s lineup of continuing education. I was a little bit shocked that half of the respondents sent me proposals for modalities that they have named after themselves. I’m going to be nice and not name any of these people, or their modalities. I must confess, though, that my first thought whenever I hear about a “new” modality that someone has named after him or herself, is usually that they’re being pretty presumptuous to think that they have actually invented something new, or that they’re on an ego trip.

A rather uppity young man who needed taking down a few notches told my chiropractor the other day that he had invented the “muscle elongation technique.” The chiropractor laughed out loud and said, “Son, don’t kid yourself, I learned that in chiropractic school in 1984.”

I can think of a number of modalities that are kind of unusual that actually could have excusably been named after their developer, but they aren’t, and even a number of massage therapy instructors who are internationally well known, that have resisted the urge to name their techniques after themselves. Kudos to them.

Everything old is new again, as the saying goes. But when I think back on all the things I learned in massage school and all the CE classes I’ve taken in the years since, I think about the basics…the movements of Swedish massage, the trigger point work, the myofascial release techniques, the joint mobilization modalities, and even the energy work. It is what it is.

In my opinion, we’re all standing on the bodywork path because someone trail-blazed the way for us years ago. I tend to take all those things that I’ve learned over the years and roll them into an eclectic mixture of whatever I’m led to do with a specific client on a specific day. What works for one doesn’t necessarily work for another.

And don’t hold your breath waiting for “The Laura Allen Method.”  It isn’t on the horizon.