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.

 

The ELAP Flap Continues

Earlier this week I received the ELAP (Entry-Level Analysis Project) Description from ABMP. I’ve been blogging about this for several weeks, first because I was upset that it was shrouded in secrecy; then last week because I finally got word of who is serving on this work group. While that information didn’t exactly smooth my ruffled feathers, I was gratified to see that I know some of the people working on it and know that they do the best job they can at whatever tasks they take on. And the document has changed quite a bit from the first proposal I saw, which I had numerous objections to (see previous blogs under this one). That being said, I’m still not thrilled with it.

I feel that there are some big pieces missing here, and that the profession would be better served by pointing resources in a different direction. To begin with, the document makes the point that how regulatory agencies arrived at the 500-hour minimum that has been a benchmark of entry-level education is unknown…that’s true, but it’s also unknown of how states with more hours arrived at those requirements. One thing that’s mentioned is the influence of federal financial aid, which presumably has led some schools  to offer more hours (or states to require them). As is the case with a lot of things, following the money trail often gives insight into real motivation.

Personally, I don’t think financial aid, or the lack of it, should be influencing this project at all. As a former school administrator, I’ve been involved in the financial aid process first-hand in the past. Whenever a recession and massive job layoffs happen, as they have here in my home state for the past three years or so, there’s a phenomenon that occurs. There’s an influx of displaced workers into the community college system, where financial aid is a given, and I’ve been told by students who had never even considered massage as a career that “the job counselor said I could get my schooling paid for if I would study massage.” That’s just not the reason I want to see people coming into the profession.

I feel there are some other tasks that need to be completed before anything like this is undertaken. The ELAP description states only two goals, one of which is to assess how many program hours are needed to attain this KSA (knowledge, skills, and abilities) goal, assuming capable instruction.

That’s a major issue, in my opinion—because you can’t and shouldn’t assume capable instruction. The Alliance for Massage Therapy Education is working on a National Teacher Education Standards Project to define the KSAs needed by teachers, both entry-level and more experienced/advanced. There is also a line-by-line review of the MTBOK going on. To charge headlong into the ELAP before these two initiatives are complete seems like putting the cart before the horse.  In all fairness, I am glad to see our organizations collaborating instead of refusing to play nice, but I would prefer to see them applying their resources to the National Teacher Education Standards project. The ELAP claims to be addressing what it takes to make a therapist able to practice competently. The fact is if the teachers aren’t competent in a 500-hour program, they’re not going to be any more competent in a 750-hour program until they are educated. We need educators who are competent enough to teach competencies, not just stand in front of a classroom for a longer number of hours.

Part of the rationale for this entire undertaking is the perceived  lack of competence of entry-level therapists. While the FSMTB is about to launch a new Job Task Analysis Survey, and the NCBTMB recently did the same, we ought to bear in mind what it is that a JTA shows. They tend to be snapshots of a day in the life of a massage therapist: see the clients, do the laundry, keep up the paperwork. If the perception is that therapists are not doing what they need to do in order to keep the public safe and practice competently, is asking them what they do all day really effective for this purpose? I don’t think it is. As one of the comments on last week’s blog said, “They don’t know what they don’t know.” There will be also be an accompanying survey within the JTA survey, intended to eliminate the “experience bias” present in these types of surveys, but I think that’s a tricky proposition. The return rate on these surveys tend to be very small–and usually answered by the minority of us who actually give a rip about the state of things. JTA surveys tend to be long and somewhat boring and it’s a very small percentage of people who will even fill them out to begin with.

Reportedly, the ELAP project was conceived to help address the problem of portability of massage between the states. One of the statements reads in part “we need to identify the key KSAs required to pass a national licensing exam and provide competent, safe massage in an early massage career.”

Right there is another problem. While the FSMTB would like to see every state exclusively using the MBLEx, it hasn’t yet happened. Since the NCBTMB is increasing the requirements for National Certification, leaving them with only the NESL options for entry-level exams in the states that accept those, the MBLEx will undoubtedly become exclusive in some places, but New York is not going to throw over their exam for the MBLEx, in my opinion. There is no such thing as national licensing, and there is never going to be. National licensing doesn’t exist in any profession I am aware of. If you’re a doctor, you still have to get licensed in each state in which you want to practice. While portability is a pain in the butt for massage therapists, it has never been shown to be harmful to the public or to the profession on the whole. Inconvenient, yes; but harmful, no.

The FSMTB is also working on the Model Practice Act, as mentioned in the ELAP description. While I wouldn’t go so far as to say it’s a waste of time, I don’t expect any influx of the regulated states lining up to change their existing practice acts to whatever the FSMTB comes up with. I’m sure it will be a helpful guideline for the unregulated states if and when they decide to join the fold, but it will be interesting to see how that document ends up harmonizing with the ELAP. Since the MBLEx has been an exam that uses the 500-hour threshold (and in fact, you can take that exam at any point during your education, prior to graduation), if this project somehow demonstrates that more hours are needed, is the FSMTB going to jack up the requirement to sit for the MBLEx? The Model Practice Act project was also undertaken prior to the ELAP project starting up, and while I haven’t seen a draft and don’t know what it includes, my prior knowledge of state practice acts demonstrates that those generally spell out required education and the breakdown of those hours, so presumably the ELAP would affect the Model Practice Act project as well.

Another part of the hoped-for result of this project is to cut down on the number of lawsuits and ethics complaints against entry-level massage therapists. Personally, I believe someone who is going to act unethically is going to do it regardless of how much education they have. When it comes right down to it, the injuries resulting from massage are a tiny fraction of what they are in other health-care related fields. I’m not saying there aren’t any, but on the whole it’s relatively insignificant when compared to the number of practitioners.

Lest anyone think I am against raising the standards of the profession on general principles, that’s not so. I don’t own a school, and I’m already licensed, so it’s not like this is going to inconvenience me personally. In fact, a few years ago when I was on the North Carolina Board of Massage & Bodywork Therapy, we looked at raising the hour requirement here (currently it’s 500 hours). Like any good organizational beaurocracy, the result of that was to appoint a committee to study the situation. The research they conducted was to ascertain whether or not students from schools with higher number of hours had a better pass rate on the exams than students from 500-hour schools. The answer to that was a big fat “no.”

I’m not sure how much money is being spent on this project; the first proposal I saw mentioned between $60-70,000 to be shared as an expense between the organizations. I urge, or rather, challenge, all of these organizations to pour an equal amount of money into the AFMTE Teacher Standards project. Improving the KSAs of entry-level educators—many of whom tend to be last year’s star students, who may be talented at massage but without a whit of experience and training in teaching methodology—will improve the KSAs of the students, the entry-level practitioners. That should be the important first step—the key word there being first. Don’t try to build a house without a good foundation. It’s a waste of time and money, and ultimately, it doesn’t work.

ELAP Work Group Members Announced

Anne Williams of ABMP has confirmed to me today the members of the group that are working on the Entry-Level Analysis Project that I have been blogging about for the past few weeks. Since the secrecy surrounding this project has been my main complaint about it, I will share that information here.  The members are:

Cynthia Ribeiro, President of AMTA (National), educator, and school owner.

Tom Lochhaas, University-level educator, author, editor with 24 years experience in developing college-level textbooks and ancillaries.

Elan Schacter, Massage therapist, instructor, text reviewer, contributing author.

Clint Chandler, Massage therapist and instructor, experienced in curriculum development.

Rick Garbowski, Massage therapist and instructor, experienced in curriculum development.

Jim O’Hara, Instructional designer.

Anne Williams, Director of Education for ABMP.

Williams stated that she was in the process of compiling the comments of those who were present at the Leadership Summit; that everyone present was now in support of it, and that much more information about the project would be forthcoming in the next two weeks. She further stated that this was intended to be a research project, and that what people do with the information will be their choice. As I said in my last blog, neither ABMP, AMTA, or any of the other organizations present at the Leadership Summit are regulatory organizations, and none of them have the power to dictate legislation. (Clarification: the FSMTB is an organization of regulatory boards, but is not regulatory in and of itself).

I am acquainted with several of the people on the work group. Cynthia Rebeiro, Pat Archer, and Elan Schacter do good work in all they endeavor to do. I would have liked it if this information had been put out there immediately, along with the rest of the details, but you don’t always get what you want. And actually, the fact that you don’t always get what you want is sometimes a good thing. As I also previously stated, the wheels of legislation turn very slowly…and just because our organizations want something to happen doesn’t mean it’s going to. If the evidence produced by this project turns out to show that 750 hours ought to be required for entry-level education, it will take many years for that to happen in every state. That’s my prediction, and I’ll be glad to take any bets on that.

I’ve been reviewing COMTA standards for the past couple of days in preparation for a site visit, and it would be great if those were a requirement for every school. I think the quality of education would increase exponentially if every school had to jump through the hoops to prove they’re doing things diligently and going beyond what most of the state boards require. I’ve also been revisiting the MTBOK, and while I still have a few issues with it, I certainly hope it is taken into consideration.

I personally still think that education should be about quality, and not quantity. 500 hours is arbitrary to me–and so is 750. Look at some of the Canadian provinces…their required hours are 4 digit numbers. Those are arbitrary too, when it comes down to it. It should be about competency, not about hours. From my own experience, and someone has made this comment to me before–in entry-level massage school, you learn what not to do. It’s when you begin practicing that you begin knowing what to do. My real education started when I walked out the massage school door, and it’s been that way for a lot of us.

This project is going to be released for comment in a couple of weeks, according to Williams. I urge everyone to take the opportunity to comment–beyond any job task analysis survey that gets spread around. Those show tasks, and don’t reflect opinion. This is of too much magnitude to the profession for opinion not to be considered. School owners in particular need to speak up. If you run a 500 hour school, how many of you can afford to increase that be 250 hours? How many would just fold? I advise you not to sit on your hands.  It’s like an election. If you don’t vote, you can’t complain, and complaining after the fact doesn’t have any impact. Express your opinion.

Inquiring Minds Want to Know

I’ve spent the past couple of weekends teaching at AMTA meetings; first in SC and this past week in Alaska. One of the classes I taught at both meetings was “Using Research to Market Your Massage Therapy Practice.” I’ve been on my research soapbox for a while now. The big question is, “Who gives a flip about research?” My answer to that is, inquiring minds want to know.

Except when they don’t want to know. Consider this: IF research validates an idea, a theory, or a belief you’ve had, doesn’t that make you happy? Don’t you want to give a thumbs-up and shout “Yes! I knew it all the time!” That would make anyone feel good, wouldn’t it?

So when research shows something that’s contrary to what we believe, we don’t like that. We don’t want to accept it. We don’t want to listen to it. We want to act as if it doesn’t exist, or that it applies to everyone except us.

I’ve been surfing PubMed this afternoon and reading interesting studies. I don’t have any research to back it up, but my educated guess is that maybe, just maybe, 20% of massage therapists actually read research studies…or even know what the difference is in a peer-reviewed study performed within the parameters of scientifically accepted procedures, as opposed to website hype making all kinds of unfounded claims.

I’ve also been on a roll lately looking at some of the more dubious products that are out there that massage therapists buy into, and foist upon the uninformed public. Some of my favorite (NOT!) claims are: Causes detoxification. Regulates the endocrine system. Flushes your lymphatic system. Gets rid of cellulite once and for all. Causes you to lose weight without making any effort. Contains negative ions. Balances your chakras while simultaneously regenerating your brain cells and your liver and revitalizing your sex drive. Makes your body totally alkaline. Connects more strands of your DNA…I could go on all day, but you get the picture.

Most people, if they’re going to buy a new car, do a little research…they want to know the gas mileage, the safety rating, the bells and whistles they get for the money they’re paying. And they wouldn’t buy a house without checking out the foundation and whether or not there’s mold in the basement. But the same people will buy some whacky, over-priced gizmo that doesn’t have any basis in reality and couldn’t possibly do all, if any, of what it claims to do, without doing any research at all, other than reading the hype that appears on the website or listening to the sales pitch at a multi-level marketing meeting.

The sad thing is, I don’t think most of these people are just seeing the dollar signs and thinking about how much money they can bilk clients out of. They just fall into believing these things actually work.

The Code of Ethics states that we are to avoid giving treatment when there is no benefit to the client and the only benefit is our own financial gain. It would serve everyone to think about that the next time they’re tempted to spend money on frivolous products with no proven benefits. If YOU want to lay out the big bucks for something and use it on YOURSELF, that’s one thing, but when you make claims to clients that this (machine, product, supplement, etc) is going to change their life, cure their disease, get rid of their pain, or whatever, that’s a clear-cut violation and one that you ought to be aware of. Do the research. Don’t just fall for every word on the company’s website and repeat that to the client like it’s fact. It isn’t.

Kudos, and a Few Thumps on the Head

The year is winding down; all the award shows have been on television lately, and I’d like to give out a few of my own, along with a thump or two on the head of those who need it. Call me a critic! These are my opinions only and should not be construed as the opinion of anyone else.

Kudos to Rick Rosen for starting the Alliance for Massage Therapy Education, and to the organization for putting on one of the best meetings I’ve ever attended earlier this year, and for taking the initiative to set some standards for teaching massage. If you are involved in massage education and you haven’t joined yet, I suggest you quit procrastinating.

Kudos to the Massage Therapy Foundation for all the work they do in promoting research in the field, and in particular for offering classes in Teaching Research Literacy. And to Ruth Werner for being such a fabulous ambassador for the organization.

Kudos to the executive officers and chairs of the Alliance for Massage Therapy Education, the American Massage Therapy Association, Associated Bodywork & Massage Professionals, the Commission on Massage Therapy Accreditation, the Federation of State Massage Therapy Boards, the Massage Therapy Foundation, and the National Certification Board for Therapeutic Massage & Bodywork for coming together this year at the Leadership Summit, and particular kudos to Bob Benson of ABMP for taking the responsibility for making that happen.

Kudos to Paul Lindamood, former CEO of the NCBTMB, for doing such a great job in putting that organization’s finances back in order. I was very sorry to see him go.

Kudos to AMTA, in particular the Oregon Chapter, and Glenath Moyle, National President, for putting on one of the best conventions in my memory. Kudos also the the thousands of AMTA members who volunteer at their chapters and the national level.

Kudos to ABMP for their generosity in allowing everyone, regardless of what organization they belong to (or none at all) to read Massage & Bodywork Magazine online for free, and for providing the huge forum at www.massageprofessionals.com, which is also open to everyone.

Kudos to Facebook. Not only are they my favorite place to hang out online, they are also spending millions of dollars building their new data center in my hometown, and providing much-needed employment in a very economically depressed area.

Kudos to Dr. Christopher Moyer, Bodhi Haraldsson, Paul Ingraham, Ravensara Travillian, Alice Sanvito, Rose Chunco, and the other folks out there who keep beating the drum for Evidence-Based Practice of massage.

Kudos to Jan Schwartz, Whitney Lowe, and Judith McDaniel of Education Training and Solutions. They don’t toot their own horn enough about some of the excellent work they have done for the Massage Therapy Foundation, the World Skin Project, and in general advancing excellence in online education.

Kudos to Angie Patrick of Massage Warehouse for her tireless work in the Sanctuary and raising money through massage for the Massage Therapy Foundation, the Liddle Kidz Foundation, and other worthy causes.

Kudos to all the massage therapists in the trenches, who give of their time in performing community service and their income to support deserving populations and those who can’t afford massage. I know hundreds of them so I just can’t list them all here, but every day, someone is out there donating the awesome power of touch in hospices, abused women’s shelters, the VA hospitals, homeless shelters, and hospitals. Bless them all.

Kudos to all those teachers out there who have what I refer to as “a higher calling.” Those who are teaching hospice massage, cancer massage, pediatric massage…There are too many to name, but they are led to work with the sick, the dying, the special-needs. Bless them all, and those they teach.

Kudos to any massage school and/or instructor who is teaching their students to be research literate.

And now, a few thumps on the head. The names have been omitted so as not to put the magazines who publish my blog in danger of a lawsuit, but you know who you are:

A thump on the head to the therapists who say “I’m better than any doctor or chiropractor. I will heal you when they can’t.”

A thump on the head to the therapists who say “I don’t refer out to anybody. No one is as good as I am.”

A thump on the head to the therapists who say to their clients “You really need this  (expensive water filter, nutritional supplements, foot patches, juice by so-and-so) etc that I am selling.”

A thump on the head to the therapists who say “I don’t need continuing education. I already know everything there is to know.”

A thump on the head to the therapists who impose energy work on every client who gets on their table, as if it is some God-given right, when the client hasn’t asked for it, doesn’t want it or believe in it, and it hasn’t been discussed.

A thump on the head to the therapists who are telling their clients that massage is detoxifying them and that they need to drink a lot of water to flush out their toxins.

A thump on the head to the therapists on massage forums who can’t behave and can’t have civil discourse, and instead resort to name-calling and personal attacks.

A thump on the head to the therapists on Facebook who are identifying themselves as MTs and posting pictures of themselves that look like they belong in the centerfold of Hustler.

I could thump all day–and give kudos all day–but I’ll save some for a future blog.

Massage: The Big Picture

I was just cruising through my social media sites, and it has reinforced for me something that I’ve known for quite some time about massage therapists: they’re a caring bunch. That’s not exactly a big surprise; after all, our job is helping people feel better. I’d say a certain amount of caring and compassion is a prerequisite for becoming a massage therapist. We all care about our clients…even when I see posts from people who may not be working in their ideal situation, that’s pretty consistent.

I’ve written over the years about why I think it’s important for massage therapists to care about The Big Picture–to be aware of and involved in what’s going on around them, and I want to expand on that on several fronts. It’s the 4th anniversary of my blog. Humor me, and I’ll tell you why I think it’s important.

I get a lot of “I’m busy running my business. I don’t have time to think about it,” in reply to something I’ve reported about massage regulation and legislation. If you’re in Alabama, why should you care about something happening in Michigan? Here’s the reality check: When something detrimental happens in the regulation of massage, it sets a precedent and makes it easier for it to happen somewhere else. That could be anything from the consistent referencing of our businesses as “massage parlors” in legislative language, something we’ve all wanted to get as far as possible away from, to crazy zoning laws requiring massage businesses to be located in seedy areas zoned for heavy industry, prohibitions on having a massage therapy business located in a shopping mall, or prohibiting massage being performed after 8 pm. Yes, indeed, those are all realities, but if they’re not affecting you personally, people don’t want to think about it. Based on my questioning therapists in the classes I teach, not even 10% have read the entire practice act in their own state. They don’t know the letter of the law even where they’re practicing. That’s a pretty sad state of affairs. I get questions all the time from therapists wanting to know “is it legal for me to do so-and-so?” and while I pride myself on being a fountain of information, it’s all right there on your board’s website. Read it.

Massage is suffering growing pains right now…I think of it as the evolution and revolution of massage. We’re stuck in that place in between being an industry and being a profession. Some don’t care which way it goes. I do. If something affects my right to practice massage, my license, my certification, my teaching of massage therapy, I want to be informed about it, and I want to be in a position to take action on it. I’m a provider of continuing education, approved by the NCBTMB, so I want to keep up with what they’re doing–and any other developments in the realm of teaching CE. At the current time, the Federation of State Massage Therapy Boards is working towards giving their own approval of continuing ed. I’m watching that like a hawk, because a) it could mean I have to fill out an application to get another approval from another entity–or even individual approval from each state I teach in b) it could end  up costing me more money for another approval, although that hasn’t been decided yet and c) if my class isn’t involved directly in public protection, it might not be approved at all. This initiative is still in the planning stages, and it serves me as a provider to stay informed and know what’s going on.

In the same vein of education, I am a member of the Alliance for Massage Therapy Education, and I encourage everyone else who has any involvement in education to join immediately. The Alliance is working on a project to define teaching standards on a national level…to spell out the knowledge, skills, and attributes that one needs to have in order to teach both entry level massage and CE. What if I don’t live up to those standards; will I be cast into the abyss? I don’t want to be clueless about what’s going on. I want to have some input into that project–and if you’re teaching, or aspiring to, you should want the same thing. This is going to happen; not overnight, but it is going to happen. I don’t intend to be the last to know. I’d rather make the effort to be involved in the process. I will never forget the statement made by Jan Schwartz at the last Alliance meeting: “If you’re not at the table, you’re on the menu.” I don’t intend to be chopped liver.

Then we’ve got the massage therapy associations. A lot of people just sign up for membership because they want the insurance, and they don’t care about the leadership, or the government relations, the networking opportunities, or anything else. I personally do care who is running them–and what they’re actually doing. I personally do care what they’re doing on the front of government relations. State boards cannot lobby–that is the domain of AMTA and ABMP–and any special interest group who has the wherewithal to hire a lobbyist–like the chiropractic associations, for example, or PT associations who think we’re encroaching on their territory. And if I think one of my membership associations is doing something that doesn’t protect the rights of massage therapists, or serve the highest good on that front, I am perfectly capable of calling them up and giving them an earful–or taking my membership dollars right out of the coffers. Let me add that my legislators also hear from me, and if I don’t like what they’re doing, I let them know that, and I don’t vote for them the next time.

Related to education, to me anyway, is the state of evidence-based practice of massage and the need for research literacy. I support the Massage Therapy Foundation, and if you have a single dollar to spare, I suggest that you support it, too. Research literacy should be taught in every massage school. I’ll go further and say the teaching of that should be mandated by state boards who license schools. Frankly, any school who is not teaching their students how to be research literate is not worth their salt. That doesn’t mean you have to be a researcher. It means you have to know what constitutes valid research and how to find it…which in turn will lead to throwing out some of the long-standing “myths of massage” that are perpetuated. If you’re still teaching that massage is detoxifying the body and that drinking a lot of water after the massage will flush those toxins out, you’re in dire need of research literacy. I just completed my first peer review and site visit for COMTA, and I am happy to say that the teaching of research literacy is one of their required standards. I have a new appreciation for them after really delving into their standards and it would be a great thing for every school to seek that accreditation. Basically, for a school or massage program, it means “I’m doing more than the state requires me to do in the interest of higher standards.” Amen to that.

I think a major stride was made a couple of months ago when the leaders of the profession all came together for the Massage Therapy Leadership Summit. Ego and personal agendas had to be left at the door. The ABMP, AFMTE, AMTA, COMTA, FSMTB, MTF, and the NCBTMB came together for the first time to discuss common problems. They’ll be doing it again in 2012. This wasn’t a “my organization is better than your organization” meeting. This was about The Big Picture.

So that’s where I’m at right now. I can’t roll along just surviving and only caring about my own clients and my own business. It’s not just about me. It’s not just about you. It’s about The Big Picture and massage therapy on the whole.

A Sermon on the Science of Massage

This isn’t one of my rants about massage research–although that’s definitely a sermon I plan to keep on preaching. It’s about the basic things that we all ought to know, if we’re calling ourselves massage therapists.

I love anatomy and physiology, and the study of pathology is fascinating to me. The human body is an amazing thing, and the more I know about the way it works, the more competent and empowered I feel to do a good job as a massage therapist. Sadly, that sentiment isn’t shared by everybody.

I’ve been tutoring students and teaching my class in how to pass the exams for over ten years. I can’t tell you the number of times someone has said to me “I just want to do massage. Why do I need to know this stuff?” A few weeks ago, I actually had someone who has graduated from massage school (but not yet passed their exam) ask me where the trapezius is located. I didn’t know whether I should feel sorry for them at their lack of education, or whether to give them a swift kick in the butt and point out how lazy they must be not to know this by this time.

Due to the lack of regulation in some places (there are still 8 states where anyone who wants to may call themselves a massage therapist with no education at all), and the time-honored tradition of grandfathering people when legislation does come in, there are thousands of people practicing massage who know nothing of the sciences associated with it.

Massage is an art form, to me anyway, as well as a science. And I’ll concede that there are people who can give an amazing massage that don’t know what the trapezius is. But the fact is, I don’t want a massage from any of those people.

If I go to get a massage and say “It hurts when I do this,” I feel much better about getting it from someone who knows what muscle does that. If I make an appointment for a hot stone massage, and then put on the intake form that I am suffering from a severe case of peripheral neuropathy, I’d like for that therapist to know that I shouldn’t be receiving that type of massage. If I’m taking muscle relaxers, I’d like for the therapist to know that my muscle reflexes are inhibited and my sense of pain tolerance is dulled, and that therefore a lot of deep thumb work could leave me bruised and feeling battered. If I have a raging case of shingles, I’d feel better knowing that the therapist would send me back home without a massage. I might have walked in the door as an uneducated member of the public thinking that a little cream spread around on me would make me feel better. I’ve had that happen during my career.

I don’t know everything there is to know–yet.  But I’m happy to say my education didn’t stop at the massage school door. It’s never over, and it will never be over. That doesn’t mean I’m sitting around reading an A&P book cover to cover for entertainment, but I figure the more I know about it, the better I become. When a client comes in and mentions a condition I’ve never heard of, or that they’re taking a drug I’ve never heard of, I’m going to take five minutes to look that up before I put my hands on them. When I can help someone by showing them a stretch, or giving them a few hints about how their body mechanics or the ergonomics in their work space can be involved in their pain, I’m empowering them to feel better and improve the quality of their daily living.

There are some brilliant minds in this profession, and the way I see it, they’ve gotten where they are not because they give a fabulous massage, but because they have knowledge. I made a FB comment one time about the way something works, and no less than Erik Dalton corrected me. I’ll defer to him in a heartbeat. It will take me years to know everything he knows, and he’s been at it a lot longer than I have. And even though he’s making a few noises about retiring to Costa Rica, I don’t think the day will come when he decides he knows enough. He’ll be basking in the tropical sun reading a fascia journal.

I’m never going to be the next Erik Dalton, and chances are you aren’t aspiring to that, either. But I think the burden is on us, as professionals, to soak up the science of massage like a sponge. At a minimum, knowing not just the names of a few major muscles but of all of them, along with their origins, their insertions, and the actions they perform. At a minimum, having an adequate pathology and drug reference handy or Internet access for looking those things up–and actually doing so–in our work spaces.That act alone will cause you to learn something new every day and it will only take a few minutes. That’s my sermon for today.

Get over the idea that only children should spend their time in study.  Be a student so long as you still have something to learn, and this will mean all your life. ~Henry L. Doherty

Teaching the Teachers

I inadvertently insulted a massage school owner yesterday by making a FB post saying that I wasn’t impressed by a school that had only one teacher to teach the entire curriculum, and that I wouldn’t choose such a school, personally. To begin with, I wasn’t speaking of his school when I made the post, and I had no idea that he was teaching his entire program himself, as his website gives a different impression, listing four faculty members. A couple of his satisfied graduates weighed in with the fact that they were pleased with their education, and many more who didn’t attend that particular school offered comments about the need for diversity and differing perspectives. Some said they’d rather have one good teacher than a bunch of bad ones. I’m going to stick to my guns on that one, and it is just my opinion and mine alone, that it wouldn’t be for me.

There’s no law anywhere that I’m aware of that prohibits one person teaching the whole program. The standards for massage therapy education vary from state to state. The quality of massage therapy education varies from school to school, and even from teacher to teacher. I also stated in my post that I’ve seen the good, the bad, and the ugly. There are brilliant and engaging teachers; there are teachers who know their subject but who are so droll and boring you can’t bear to sit through it; and the sad fact is that there are plenty of people teaching who shouldn’t be teaching at all. A good massage therapist and one who is good at teaching are two different things, many times.

Some states allow anyone who’s breathing to teach a class, and schools often take advantage of that by using last year’s graduates as this year’s teachers. At the other extreme are states with requirements that you must have a college degree in the area you are teaching, at least for science-based classes like A&P, or that you have been licensed as an MT for X number of years before you can teach hands-on classes.  There’s no consistency.

I’m at the end of my five years of service on the North Carolina Board of Massage & Bodywork Therapy, and I have served the School Approval Committee that entire time. Since I’ve been on the inside, I can state that our system isn’t perfect…we state in our rules that teachers should be “trained” but we don’t go far enough with that…there’s no set number of hours of training required, and each school basically does whatever they please on that front. One has a year-long training program. Another has a two-hour orientation and calls it their training program. The others fall somewhere in between. My pet project recently has been encouraging schools to teach research literacy to their students. It seems to be slow to catch on. Some school owners have the attitude that if something isn’t in their board’s requirements, they’re simply not going to do it, and that’s a shame.

So who teaches the teachers? The AFMTE is working on a big project, the National Teacher Education Standards Project. I applaud that wholeheartedly, but I will point out that the AFMTE isn’t a regulatory board and all they can do is put it out there, they can’t force anyone to participate. The Massage Therapy Foundation is offering classes around the country in teaching research literacy, but the same is true of them; since they’re not a regulatory board, they can’t force participation. That’s just too bad on both counts! I’d personally like to see teaching research literacy a requirement in every school. Both of these organizations are saying, “Here we are, here’s what we can do to improve education.” But again, since there’s no law requiring it, some–and by some I mean the vast majority–aren’t getting on the bandwagon. What I fail to understand is why any school owner or program director wouldn’t want to give their school–and their students–their best shot.

While I do concede that there’s a complainer in every crowd, when I see the same complaint from multiple students/graduates, it gets my attention. There is rarely a day that goes by that I don’t get emails or phone calls from students all over the country with some tale of woe about their school experience.

On last weeks’ blog, Self-Sabotage–or How I Got Your Clients, I offered up a bunch of the reasons that clients have given me about why they left another therapist and started coming to me. So here are some of the comments that I have received from students:

“Even though it’s in our school catalog that we have a dress code, our teachers don’t follow it themselves. They dress in the same way we’re told not to.”

“There’s no substitute. If a teacher has to be out the class just gets canceled.”

“The teacher is rude if anyone questions anything. Her answer is usually because I say so. I don’t think she knows the real answers.”

“Our teacher didn’t like teaching Ethics, so at every so-called Ethics class, they would just spend the whole hour talking about something else.”

“Our teacher doesn’t know anything about the licensing laws in our state.”

“Our teachers are always contradicting each other and you don’t know who to believe.”

“The A&P teacher couldn’t pronounce the anatomy terms.”

“Our teacher lets us out early all the time because she has somewhere to go. I don’t think I’m getting what I’m paying for.”

“My teacher has had affairs with several students.”

“My teacher’s girlfriend is in the class and he uses her for every massage demo.”

“All of our tests are open-book. I don’t feel like there’s any proof that we’ve learned anything.”

“My teacher tries to impose his religious beliefs on us.”

“My school told me it wasn’t going to be a problem that I had a criminal record but after I graduated I found out I couldn’t get a license.”

“The teacher just graduated last  year and in spite of the fact that she has failed the exam three times and doesn’t have a license, the owner feels sorry for her and is letting her teach.”

“There’s no diversity. One teacher teaches everything.”

“One of the female teachers gives every male student a hard time and picks on them constantly.”

“When I complained to the owner about the unprofessional behavior of one of the teachers, she told me I was free to drop out but I wouldn’t be getting my money back. She didn’t even listen to the complaint.”

“My school experience has been very disappointing but I’ve already paid the money and I’m just trying to stick it out until graduation.”

I honestly could go on for days with the comments. And like I said, when it’s just one whiner, I don’t pay much attention, but when I hear the same thing repeatedly about a school, I encourage those students to report it to the board. If our board gets a half-dozen complaints about the same school or the same teacher, you can bet we’re going to investigate it. I sometimes get emails from students who say they are afraid of retaliation if they complain, and that’s too bad. It just means that whatever problems are there will be perpetuated for the next class of students.

As a school owner or program director, your priority should be to get the best people you can get to teach your students, and to ensure that they are not only familiar with the subject, but that they are trained in teaching adult learners, that they incorporate research references into their class, that they are trained in teaching to diverse learning styles, and that they present themselves and behave themselves in a professional manner. If you allow your teachers to come to class looking like a homeless person, then the blame is on you as much as it is the teacher. If you look the other way while your teachers are having affairs with students, the blame is on you as much as it is the teacher. If you don’t listen with an open mind whenever a student has a complaint about an instructor, shame on you. If you’ve heard the same complaint more than once and haven’t discussed it with the instructor, double shame on you.

If you really want the education that you’re offering to be the best that it can be, you’ve got to teach your teachers. Don’t just hire someone and hand them a syllabus and think they’re going to do a good job. There are resources available and you should be using them.  If you’re not conducting a thorough teacher training program, or requiring your instructors to attend one, or not having teachers trained in research literacy and teaching that to students just because it isn’t a state law, then I urge you to step up to the plate and go beyond what the state law requires. Your school will benefit from it. Your students will benefit from it. The massage-seeking public will benefit from it.

Resources:

ABMP Massage School Instructor Resources

Alliance for Massage Therapy Education

AMTA School Advantage Newsletters

Center for Somatic Teacher Education

Education Training Solutions

Resource ETC

Teaching and Presentation Skills Series

Teaching Research Literacy from the Massage Therapy Foundation


More Myths of Massage

Last week I wrote a post on Facebook about some of the myths of massage. My statement on this issue was and continues to be that I am not accusing anyone of telling a deliberate lie, nor am I attacking the character of any teacher who has helped to perpetuate these myths. I choose to believe that everyone has good intentions.

Before I became interested in the evidence-based practice of massage, I’ve been just as guilty as sharing some of them myself. There seem to be so many of them, and in my opinion  people tend to blindly accept what they learn in massage school. We view teachers as authority figures, but the fact is, teachers have a tendency to repeat what they were taught in massage school…so they pass that on to their students, who in turn share that false information with their clients, with the best of intentions. Some of those same students go on to become the next generation of teachers, and those same myths just keep being perpetuated.

Yesterday I heard from Lee Kalpin of Ontario, who shared a few more of these massage myths with me. I am presenting them here, and if anyone has any valid research references that will back these up as fact, please feel free to post it for our enlightenment.

– Massage removes toxins from the muscles.

– Lactic acid is responsible for DOMS (Delayed Onset Muscle Soreness).

– Massage can get rid of cellulite.

– It is contraindicated to massage a person who has cancer (or had cancer).

– If you massage a person who has consumed alcohol, it will increase the effects and make them more intoxicated.

– You can strengthen muscles by performing tapotement.

– You can straighten a scoliosis by doing tapotement on the weak side and stretching on the tight side.

– Manual Lymph Drainage causes the lymphatic channels to collapse for 20 minutes so you cannot do any other manipulations after MLD.

– You should never do more than 3 trigger point releases in a treatment (no reason stated for this one – it was just stated as a fact).

– Ischemic compression for trigger point release should be done as deep as possible.

– Only deep massage is therapeutically effective – as deep as possible. Lighter massage is just for relaxation.

– You should not massage pregnant women during the first trimester.

– You should not massage the feet and ankles of a pregnant woman as it may cause her to miscarry.

– Drinking lots of water flushes toxins out of the system – encourage the client to drink water after a massage.

– You cannot massage a person who has “high blood pressure” – definition needed about how high is high, and cause of hypertension.

– You must massage toward the heart or you could damage the heart valves.

– It is contraindicated to massage pitted edema.

I must say that I have heard all of these at one time or another. Where did they come from? I don’t know. As one FB friend said “I heard it from some reputable teachers.” And they probably heard it from their reputable teachers.  So let’s just let the buck stop with us. If the words “research shows” are going to come out of your mouth, then back that up with the actual research reference, and if you can’t produce any, don’t say it–to your students or to your clients. If all the evidence you need is that massage helps people feel better, then let that stand for itself and don’t make wild claims. And please, as I said above, if you have the research to prove any of these statements, share that with the rest of us.

Pay in Massage Therapy: What’s for Real?

I just finished reading AMTA’s 2011 Massage Profession Research Report. It’s 66 pages of information that was created from several surveys conducted by AMTA and supplemented by government statistics.

The report covers many topics, including consumer demographics, information about massage schools and their students, where massage is fitting into the general scheme of health care in the US, and statistics on the practitioners themselves.

According to AMTA’s report, during 2010 the average massage therapist worked slightly less than 20 hours per week and made $41.00 per hour including gratuities. That was down from 2009, when the average therapist reportedly worked 20.4 hours per week and made 44.90.

In looking around for verification and figures to compare these to, I checked out the Massage Metrics by ABMP, and also referred to the AMA Health Care Careers Directory for 2009-2010 and the Bureau of Labor Statistics (BLS). The BLS has faulty statistics as far as I’m concerned, because they are based on a therapist working 40-hour weeks year round, which is usually not the case. Their formula shows the median pay to be $16.78 per hour. Many therapists only work part-time, sometimes keeping other jobs that provide them with needed benefits. The AMA publication cites therapists who do more like 15 hours of massage per week and make between $15,000-30,000.

I also conducted an informal survey recently of the 1200+ massage therapists who are on my Facebook page. I asked how much money self-employed therapists charge for massage, and asked for their location, and was not surprised to see how much variance there is from place to place. I got everything from $35 in rural areas to $120 in some of the bigger cities. However, you have to remember that’s the gross, and doesn’t take into account that the self-employed have overhead that can really cut into that. By the time one pays for space, advertising, telephone, utilities, laundry, and supplies, actual take-home income is probably half that, if not less.

As far as those who work for someone else, I personally know of a licensed massage therapist who makes less than $9.00 an hour working for a chiropractor. Another acquaintance who works in a ritzy day spa in Cape Cod during the summer makes as much as $2000 a week in take-home pay, but when she’s in North Carolina in the wintertime, has worked in day spas here for as little as $12 an hour plus tips. My own staff members are paid between $30-45 an hour depending on the work they do and how long they’ve been here, and I constantly hear from therapists who work elsewhere that I am the best-paying employer in our small town.

I believe all the above organizations did the best they could in compiling these reports. I also think they are all somewhat skewed (and in fairness, AMTA does quote a 3% + or – confidence level) by several things. No survey can possibly take in every massage therapist in the US. There are still unregulated states, and any therapist who isn’t a member of a professional organization or unrecognized by a licensing or certification board isn’t going to be included in any surveys. And people tend not to answer surveys; according to www.quora.com, a statistics site, a 3% return is about average on e-mail market studies. 10% is magnanimous. According to the laws of statistics, you can get an accurate sample from a little as a 1% response rate, but I think most of us have a hard time thinking that what happens with 1% applies to the rest of us.

When it comes to pay in massage therapy, what’s for real? It’s hard to say.