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.


13 Replies to “If at first you don’t succeed….”

  1. I posted this on facebook and my blog yesterday. I had 32 comments in 12 hours mostly in agreement.

    MASSAGE PROFESSIONALS -If you agree please click LIKE and SHARE. Comments important. We need to let the LEADERS know that it is time to act.

    xxxxxxxx-I want the participants in the massage therapy leadership summit to agree to a position statement about entry level education, including competencies, model curriculum and recommended clock hours and time frame. The massage community must come to agreement about the entry level baseline before anything else can be acted upon.xxxxxxxx

    Summit organizations represented are Alliance for Massage Therapy Education (AFMTE); American Massage Therapy Association (AMTA); Associated Bodywork & Massage Professionals (ABMP); Commission on Massage Therapy Accreditation (COMTA); Federation of State Massage Therapy Boards (FSMTB); Massage Therapy Foundation (MTF); and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB).

    I absolutely agree with Laura. I was frustrated with the JTA and ELAP data just as Laura is. I hope enough people took it to get a real picture of the massage profession. Can you believe I had to write in massage as my main modality. It was not even listed.

    Some how I think we need a grass roots movement to push the organizations to knuckle down and get this job done. I really is not that huge of a task. The data is available and it just needs to be compiled and analysed. I think we need an independent expert to take all the data and make it happen. I am very frustrated.

  2. Lordy.

    We need a CE course with a certification on “Acronyms and What our Organizations Do and Why They Do It”.
    And a book written on how to pass the exam.

  3. “The modality is not the treatment — it’s the totality of what a practitioner brings to the session….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.”

    That right there should be the basis of any and all regulations in the massage therapy field. It’s immeasurable and completely subjective to the individual. Holistic.

    Keep them on their toes, Laura!

  4. Hitting the nail on the head again, Laura.

    My question–and not directed to anyone specific is this: Can anyone produce, for public distribution, the Allopathic Medicine Body of Knowledge, the Physical Therapy Body of Knowledge, the Psychotherapy Body of Knowledge, the Nursing Body of Knowledge, the Chiropractic Body of Knowledge…or any other Body of Knowledge for that matter? I’d love to know what else is out there.

    IMHO, you can’t confine a profession’s body of knowledge in a document. Isn’t it an ever evolving, ever expanding collection, or synthesis, of our academic knowledge, our ability to critically think, our experiences in our daily practice, and all the questions that are not answered yet?

    While I do NOT want to comment on how many hours, or credits,or what competencies each MT should have here in this blog, I do agree, and long for the day that we can all drop our shields and decide, once and for all, just what is the knowledge base and what are the skills necessary to SAFELY provide a general massage to the public at as an entry-level to the profession. After that, I’m fine with letting all those anacronyms fight out just what are the specialties in the field, and how to credential them. OMG, I’m asking for a common educational standard. For MASSAGE. Period. You know, the place where we all begin our professional practice and life.

    Until then, I’m going to continue to teach the basics (yes, the absolute you must know this to be safe basics) to my students, and continue as I have for the greater majority of my professional working life to offer massage for the well-being of my clients. Nothing more.

    I will also continue to offer continuing education and mentoring opportunities to entry-level (and beyond) practitioners whose desire is to take their professional knowledgebase and skills to a different (not next, not higher, not better) level.

  5. AGREED!
    I Graduated massage school as a therapist in 1988.
    102 hours.
    been giving damn-good massage ever since.

    To get the results my clients seek, my therapy method of choice is called Active Myofascial Therapy. AMT incorporates manual and movement-based therapy with the goal of increasing neuromuscular reeducation, strength and stability where needed, ALONG with relaxation of tissue tightness, adhesions, etc (which supports relaxation of mind and body, now doesn’t it?)

    I feel like saying, “Why can’t we all just get along?” Most therapists just want to be able to provide their service to as many clients/patients as they wish, with as few road-blocks, hurdles and red tape as possible.

    Like John (above- sorry, don’t know last name) I will continue to teach and mentor therapists how to be professional, credible, ethical, responsible team-player providers, no mater what type of massage they offer, as long as they continue to have the clients’ safety, and best interest in mind.

    Thanks Laura for bringing this to light.

  6. In response to John’s question about bodies of knowledge in other health care professions:

    You can access “The Essentials of Baccalaureate Education for Professional Nursing Practice” from this link: http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf

    This is a clear and well-articulated document developed by the American Association of Colleges of Nursing, which serves as a baseline description for what all nurses should know. There are many areas of specialized nursing practice, as well as advanced practice in nursing. They have their own bodies of knowledge that build upon this foundation.

    In the massage therapy field, we’re still struggling to get to consensus on what our own foundation looks like. As Laura pointed out in this blog post, the information-gathering efforts being used by our major organizations is skewed in a certain direction that is sure to leave out some of the most important components of entry-level knowledge, skills and attitudes.

    We must not abandon what is most essential to the practice of massage therapy in an effort to gain more recognition from the mainstream health care professions. In many ways, massage therapy holds a key piece of what is missing from the bulk of health care that is provided in this country — holistic, person-centered treatment, along with a focus on body awareness.

  7. . Data collection is great but as I have said too much of a good thing becomes a bad thing. Sooner or later- hopefully sooner we will have to come together on this. I think one way would be for an independent consultant who is objective—compile the data from the multipule sourses available, COMTA, NCBTMB, Federation, MTBOK and Alliance line by line analysis. An educational expert can certianly objectively develop what we need in an unbiased way. Why does the massage community agonize over this. As John said” just what is the knowledge base and what are the skills necessary to SAFELY provide a general massage to the public at as an entry-level to the profession”.

  8. Following Sandy’s comment:

    It may seem like a logical thing to call in “unbiased educational experts” to help the massage community determine a baseline set of entry-level standards. The problem with that is the fact that most people with those kind of credentials come from the world of mainstream education, which is heavily organized around cognitive learning. The realm of somatic, or body-based learning is generally unknown or misunderstood in traditional academic environments — as well as in the psychometric (testing) industry.

    Much of what makes massage therapy effective in the client/therapist relationship has been bypassed by these two dominant sectors. So, we’re in the situation where our credentialing exams fail to test for what is most important, and now another “expert” panel (for the ELAP project) is using the same kind of data gathering process to determine the ideal entry-level curriculum for massage schools. This is taking us even further off course.

    The focus on “safety” and “public protection” as the rationale for testing, licensure and certification is misplaced. The data shows that there is only a miniscule amount of actual physical harm done to clients of massage/bodywork/somatic therapies. This is because these approaches are non-invasive by their very nature.

    AMTA and ABMP can offer professional memberships for under $250/year that include malpractice insurance because that insurance coverage is cheap. It’s cheap because there is a low incidence rate of claims from this community of practitioners.

    The bigger and more important foundation to build our standards upon is EFFECTIVENESS. Not hurting a client is a low-level objective; we need to set our goals higher and pay attention to what makes a massage therapy session most successful and satisfying across the span of modalities and treatment philosophies that practitioners use.

    The set of existing state massage laws we have around the country were enacted on the premise that the unlicensed practice of massage is dangerous to the public. If this “PREVENTION OF HARM” rationale is fundamentally untrue, what are we left with?

    I recommend we (as an entire community of practitioners, educators, regulators and administrators) turn the focus to the “PROMOTION OF GOOD”. We can take the current state laws and rules, along with the processes of certification, and reframe their use to support the improvement of entry-level education, and to optimize the opportunities for post-graduate training and certification.

    The goal is better education, to improve the quality of treatment delivered at all stages of a therapist’s career. I’m not impressed by how many hundreds of millions of massages are delivered in a year; tell me what percentage of them are worth a damn.

  9. I agree with you Rick and yet there is a role for unbiased educational experts even is as you say “most people with those kind of credentials come from the world of mainstream education, which is heavily organized around cognitive learning. The realm of somatic, or body-based learning is generally unknown or misunderstood in traditional academic environments — as well as in the psychometric (testing) industry.” In many way, just as business is business— education is education. We are not the only “somatic” based profession and if you look at the competencies for nursing for example or even athletic training you will find nurturance and compassion as well as a whole body approach. I believe we need the educational experts to help us put all the collect data together. Without outside consultation I believe the result will be seen as biased as self serving product.

  10. Dear Laura.
    Thanks for raising these issues. While there is always room for improvement leaders of our industry’s biggest organizations should reconsider what they’re trying to achieve. In my opinion, establishing and enforcing costly and unjustifiable new hurdles to massage practice is misguided. A bigger problem that I believe they should address is practitioners who advertise and promote their services for painful back & limb disorders such as sciatica, carpal tunnel, etc., but lack formal training/experience in how to safely treat such cases. Many of these people provide forceful/vigorous “deep tissue” massage that causes further damages. This is totally wrong. And if one will decide to dedicate his career to provide much needed nowadays stress management massage it should be not only okay, and acceptable practice but have to be encouraged . Who possessing expertise in ororthopedic massage, as a professional, is not superior to one who are expert in stress management massage. Thanks again.
    Best wishes.
    Boris Prilutsky

  11. Laura: I fear that despite what I presume to be their good intentions, our industry leaders and State regulators are destroying our industry. Given regulatory agencies’ public interest mandate & legal liabilities regarding whom they license to practice, it seems right that their association (FSMTB) focuses all its efforts on insuring “public protection” issues be covered during entry level education and professional development CEs. Since about 2000, our trade group leaders seem to be caught up in efforts to create some form of private monopoly control over how to teach, which textbooks, videos & remote learning websites can be used to teach any of the myriad trademarked massage modalities, as well as, who can practice any of these modalities or even who can call themselves an advanced or specialized practitioner.

    I suggest that our trade group leaders would be well advised to stop endlessly striving to wrestle control of what is taught by the myriad massage modalities and instead establish a legally viable model massage scope of practice that includes what is common to them all as well as a clinical practice based form of certification that the public could use to easily distinguish between a basic/entry level practitioner qualified to work on the relatively healthy general public and a highly skilled specialist who has been properly trained or is experienced in collaborating with medical doctors treating diagnosed medical conditions.

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