Massage Regulation: What is the Point?

Seems like almost daily, on one of my networks, someone will post the question of “what good is massage regulation really doing?” They often throw up points like “prostitution still exists,” and of course it does and it always will. Other complaints are about how much money the state revenue department, or the licensing board, or the Federation, or the testing company is making.Then we’ve got the complaints about taking CE to satisfy the law, and how that’s just a money-making racket. As a CE provider, believe me when I say I’m not getting rich off of it, and very few are. But back to the question, what is the point?

The point of licensing in any profession is basically quality assurance for the public, for their own safety and protection. To get a license, you’re supposed to have x number of hours of education. You’re supposed to pass an exam proving entry-level knowledge . In most places, you’re supposed to get the continuing education in order to keep it. You’re supposed to agree to abide by a code of ethics and uphold standards of professional behavior. You’re supposed to first do no harm. You’re supposed to act in the best interests of the client.

There are now only a couple of states that are the last holdouts with no regulations in the works or already in effect…anyone may call themselves a massage therapist or any other derivative indicating massage, whether they actually know anything or not.

In reality, it’s hard to find out exactly how many members of the public have been harmed by massage therapy. The insurance companies and professional associations don’t like to release that information. Many of the state massage board websites do have license verification online, and some do list disciplinary actions, but in most cases that will only show up if you already know the name of the therapist that has been found guilty of some infraction. It must be said that not every single person who has been found guilty by a board is really guilty…there were times during my own five years of board service that I did not believe the accused person was guilty, but the majority voted that they were. It must be also be said that some therapists who are in fact guilty never ever get reported and thus keep preying on the public. There just aren’t any guarantees, just like with any other walk of life or profession. There are people in every profession that are dishonest or predatory, and massage therapy is no different.

All things considered, I think licensing has been a valuable thing, and personally, I’d like to see it in every single state. Yes, there are still people who will practice illegally. There are still prostitutes who will hide behind massage. But I think on the whole, licensing has brought a healthy amount of awareness and credibility to massage therapy.

I’m not resentful of having to get a criminal record check to get a massage license. If we were being singled out I’d be upset, but every other health care provider in our state has to do it. I’m not resentful of having to take continuing education….I love learning and I actually look forward to taking CE. However, I do think there comes a point in time when that should be optional. Realistically, should someone who has been practicing for 20 years need to attend an ethics class the same as someone who has only been practicing for a year and may not have even faced any kind of ethical dilemma yet?

I’m not happy with the present state of the CE environment, anyway. I think a person who is taking science-based classes or classes designed for public protection deserves more credit than people taking fantasy-based classes. With the long list of inappropriate classes that are currently approved, I really don’t see how attending a class in shape-shifting is doing anything to protect the public.

Some state boards are self-supporting. Some are at least partially subsidized by the state. Some try to educate the public. Some don’t. Some pursue illegal massage more than others. Nothing’s perfect.

The point, to me, is that the majority of us, by paying for that license and jumping through the hoops, are proving that we have at a minimum, the entry-level knowledge to practice massage safely. The majority of us have taken the education, and passed the exam, and meet our CE requirements. The majority of us are practicing ethically. The majority of us are trying to keep massage and sex separated. The majority of us abide by the rules. The majority of us are just here to take care of our clients and do the best we can. There will always be some bad apples, but I think requiring licensing has weeded out a lot that might otherwise be here. Just my opinion.

11 Replies to “Massage Regulation: What is the Point?”

  1. With the exception of background checks to make sure we’re not escaped serial killers, I still see very little justifying licensing at this point in the profession.

    There is no consensus on how much training is required, amounts varying from none in the unlicensed states to around 1000 hours. There’s even less consensus on what one needs to know to be licensed. While I haven’t done specific research, I’ve also never heard of any research showing MTs with 500 or even 1000 hours of MT school are noticeably superior to someone who apprenticed (or watched youtube videos) in unlicensed jurisdictions.

    Nor does there seem to be evidence school makes us any safer for our clients. Anecdotally, I see good evidence our educations leave many of us clueless. And you’ve seen it too in discussion after discussion in massage groups. (I won’t even mention the massage instructor who looked at pitting edema and called it “some shiatsu thing.”)

    Continuing education remains a farce and it will as long as any state accepts any of the bizarro world courses you reference for recertification. This is not to say there are not excellent courses taught by outstanding educators available. Only that those Dryads taint the entire system as a single worm might taint a whole apple salad.

    If our goal is “awareness and credibility” then licensing is largely irrelevant. Clients rarely, if ever, ask to see a license. I would bet most don’t know – or care – if the state even requires one. Those goals require national efforts that should be driven by our national organizations. And local supplementation by area MTs with their advertising. (Did you know massage has an effect on anxiety similar to psychotherapy? You’ll like our couch better.)

    Finally, the majority of us would practice ethically, separate massage and sex, and probably look for information we don’t have (self-driven further education) without licensing. Again, the unlicensed jurisdictions would likely provide evidence for this.

  2. I would like to see the state boards do more Advocacy. Our massage organizations and boards should invest in some sort of PSA against prostitution, human trafficking and the massage parlors. Tired of the lack of advocacy. Prostitution will never go away but tired of the intertwining in legislation.

  3. Over the past six years I’ve looked at the benefits and limitations of regulation and the influences of illicit massage on our profession, including prostitution and human trafficking. I’ve tried to look through as many eyes as possible, including as a former police officer, massage therapist, business owner and consumer and I’ve gotten to know many within the most at risk and marginalized groups who tend to be involved in illicit massage during that time as well. There are no easy answers and although prostitution will survive, as it has for centuries, I truly believe it does not need to hold such a strong grip on the image of our profession. I believe that when applied correctly regulatory oversight can serve us well, but we have to stop thinking in old ways in trying to address these issues and look at locations where success and not failure is occurring.

    In Oregon, it’s almost impossible for consumers, who refer to themselves as hobbyist, to find illicit massage parlors. In fact the unavailability there for the $50.00 to $200.00 price point for sexual services, where illicit massage resides, has driven another industry to exist to accommodate these sexual consumers in the form of lingerie modeling studios. From what I can tell the key there has been that state’s massage board putting a high priority on going after violators of their advertising regulations.

    Unlike here in Washington, where regulations are similar, the Oregon board actively and aggressively goes after ads that fail to include massage license numbers. Though this may sound trivial at first you only have to ask yourself where these businesses get their clients from. Not from personal or medical referrals like us, but from electronic advertising, the internet. If you doubt me look at the massage sections on or where you live and then look at the ads in Portland, Oregon, a city that was recently referred to as Pornland in a national news story. If you do see any sketchy ads there check out the phone numbers listed, almost all are from across the Columbia River and are posted by advertisers in Washington State, where the Oregon board has no authority.

    Next, look at California and the mess that’s only been made worse there by half assed regulation, and is due to sunset at the end of the year. No, this is not a success story, but one thing you will see happening now (stories below) after the state regulations took oversight away from cities is the possibility of the law being stripped away completely. Local communities are fed up and willing to take care of themselves now that they have seen what absolute failure looks like in controlling prostitution and human trafficking there. The key is not to turn everything over to the locals however, but rather to create a state law that criminalizes doing massage without a license, much like prostitution is criminalized now. This would allow local police to simply walk into a business and make a physical custody arrest after being offered a massage by an unlicensed provider.

    This would never work you say, well it already has just to the south of me in Bellevue, Washington where a local ordinance requiring “all necessary licenses” to do business in that city has allowed local police to reduce the number of marginalized massage businesses there from 27 two years ago to a mere handful today. A comprehensive state law like this that communities could choose to use in such a way would be preferred by most law enforcement administrators over embarrassing prostitution investigations that they often won’t admit they hate. Cops getting a massage in order to get an offer and agreement for sex leads to embarrassing news stories and court testimony that leaves the good guys red faced at best.

    There is more to this than I have described here, but this can work. Let the state massage regulators oversee educational programs, issue licenses and go after advertising while the cops can go after unlicensed massage and the other sexual offenses they already can prosecute.

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    You can also look at the following stories to see what’s going on in California.

  4. The purpose of creating and maintaining state-based occupational licensure requirements is to protect the public from harm. This is the common ground for the regulation of all professions. State legislatures adopt licensure laws based on the demonstration that the unlicensed practice of a particular profession is or would be harmful to the public.

    The “elephant in the room” for massage regulation — is that the practice of massage therapy is fundamentally harmless. The incidence of actual physical injury appears to be miniscule. No one croaks from a bad massage, while there are estimates of 250,000 people per year who die from medical errors in hospitals. Now that’s evidence of harm!

    So what do we do now? State-based massage regulation is more beneficial to the licensee than it is to the health care consumer. State licensure has eliminated most stupid local ordinances that treat LMT’s like sex workers. And there may be some marketing advantage to holding a state-issued credential.

    However, these benefits are outside of the legislative mandate for occupational regulation. AMTA and others who lobbied for licensure around the country over the past 20 years sold each state legislature a bill of goods when it came to producing actual evidence of the harm in the practice of massage therapy. That buck stopped cold in Vermont in 2010, when a state agency rejected testimony from both AMTA and ABMP in support of enacting massage licensure. That agency issued an opinion stating that the evidence submitted failed to demonstrate that the unlicensed practice of massage was harmful to the public. As a result, Vermont remains one of the few unlicensed states for massage therapy.

    Has massage regulation improved the quality of services delivered to the public? From my observation, I believe it has done the exact opposite, which is an example of the Law of Unintended Consequences. In each state where regulatory laws have been enacted, there has been a rapid increase the number of massage schools and programs. Most of the mushroom-like growth has come from publicly-funded community colleges, corporate-based career colleges, and schools from the cosmetology sector who have jumped into the massage business. Collectively, these institutions have changed the face of the massage therapy field.

    For an analysis of this phenomena, check out Ralph Stephens’ important column in Massage Today entitled, “the Seven Deadly Sins of Massage Education”.

    Massage regulation has made our field bigger, but not better. It’s time to get honest and turn attention and resources to improving entry-level education. One of the most meaningful things that state massage boards could do would be to adopt the AFMTE Core Competencies for Massage Therapy Teachers as a requirement for instructors in all schools under their jurisdiction. Until teacher training becomes standard practice in our field, we will not be able to improve the quality of massage therapy treatment provided to the public.

    The elephant in the room refuses to leave. Shall we continue serving tea and crumpets and ignore it?

  5. Agree with you, Laura. Two points: Regulation requiring more education and testing briefly raised spa pay rates in my area…Also, the stated reason for all licensing is protection of the public. The “real” reason is granting certain folks a franchise to make money if they have completed enough education and training in an area of expertise to hold themselves out as experts. I’d be happier with “adult companion” licenses for sex workers that make sure they get paid and have health care, with massage being reserved for those who actually do massage…..

  6. In addition to Rick’s points: Churn and burn career schools and real massage schools need to teach and test on ethics prior to graduation.

  7. While I live in a state that does not have state wide regulations, most major cities do require you to be licensed, have insurance, and do a background check before being able to practice. As stated in the article, I feel that being licensed offers quality assurance to the public a bit more than if you were not licensed. It makes us more professional and show that we have training and education to be doing what we are doing. I get asked all the time if I had to go to school for massage. Yes, of course I did, 2 years of it with continuing education. Naturally, there are going to be those individuals who are going to continue to add to the bad rep of massage, but us licensed therapists can add to the good.

    I have not done any CE stuff yet, but it does seem that the CE system needs work.

  8. This year I have been a massage therapist for 41 years. I have worked in three different cities at a time and I always went to the city I was working in to receive my license. And yes it was much more costly and humiliating than a simple but profound license from CMTC. This is an incredible HONOR to have our profession finally recognized as a health and wellness” Art”. Those of you that are complaining are really in the dark about how life was without the support we have in our profession now. I have lived a wonderful life style and put my daughter in the best schools. If I had not gone for my city license I would not have qualified for a home loan. I knew I wanted the respect my profession deserved and really had to hold strong to my believes and ethics. It was not an easy road but my work has been my saving grace. I love my work and seeing people recover and find greater balance in their lives through our profession. I now am semi- retired but will continue to work with clients for better health and wellness. This also includes my better health and wellness too.As a lifer I had to overcome my over working mentality and create more balance and peace in my life. Thank You CMTC ! !

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