In Jan 2023, I had my 35th anniversary of having my own massage business in Downtown Seattle. Through the many years I have watched the profession and wrote about it on my many websites (starting back in 1999 with thebodyworker.com which turned into www.massageschoolnotes.com; www.massagepracticebuilder.com started in 2002, now this site and www.lookbeforeyoubookamassge.com) . I have watched the number of therapists and massage schools go up and down and the current drop in the number of massage schools and therapists is concerning considering the growth of massage chains, an aging popluation and the increase in stress in our daily lives. I have looked at our history of massage and saw how we began as a grass-roots effort with organizations like AMTA who started out meeting in people’s homes and paving the way for what was to come. Their intentions were to elevate the profession, separate us from sexually oriented businesses and get massage therapists the recognition as health care. Massage therapists who were disgruntled with AMTA started ABMP in about 1987, splitting up the profession in two.
Is it a Profession or Industry?
I have always referred to us as a profession, yet others call it an industry. When I think of industry, I think of blue collar workers in factories (industry).
The Oxford English Dictionary defines Profession: a. An occupation in which a professed knowledge of some subject, field, or science is applied; a vocation or career, especially one that involves prolonged training and a formal qualification.
Pub Med’s article “Profession”: a working definition for medical educators says: “The proposed definition is as follows: Profession: An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served and to society.”
Are We a Profession Yet?
Back in 2008, this white paper On Becoming a Profession, 2008 (PDF) from Rick Rosen, a leader in the massage profession wrote these words:
“Despite the fact that it has become commonplace to refer to this occupational domain as “the massage therapy profession”, it lacks a number of essential elements that are considered to be hallmarks of a full-fledged profession. These include: a well-defined body of knowledge; educational standards; teacher training requirements; common terminology; standards of practice; and a regulatory system that affords public protection and allows inter-state mobility for practitioners. While some of these elements exist on a limited scale, there is little consistency among them.
The massage field has grown haphazardly over time, without a central organizing template to shape its development. It can be likened to a patchwork quilt—with a lot of holes in it. By contrast, a profession is based upon a coherent structure and universal standards. Until the work is done to establish this foundation, massage and bodywork will continue to spread across the landscape but our overall situation will not improve. Truth be told, we are not yet a profession, and the mere use of the term does not make it so.
Here are the action steps that will get us there:
• Establish a Body of Knowledge
• Improve the quality of massage therapy education
• Reorganize the credentialing process by putting licensure before certification
• Create parity among our state massage laws to increase portability
• Develop and promote a unified professional identity
• Use lessons learned from other professions
~Rick Rosen, On Becoming a Profession, 2008 (PDF) Body Therapy Institute. North Carolina
The Body of Knowledge
The Body of Knowledge was created in 2009. The only evidence of it is currently on archive.org Nothing has been done with this important document since then. I am not sure who owns the domain, but the massage profession needs to get it back online.
Does it need to be updated? I would guess so but not really sure. Who is using it is another issue. Do people even know it is there or need it?
Quality of Massage Education
The Alliance for Massage Therapy Education was created to “advance the therapeutic massage and bodywork professions by strengthening and elevating educational practices and standards through supporting, credentialing, and engaging educators.”
Teachers at massage schools are often just recently graduated massage therapists who need jobs but lack teaching skills and expertise.
The paper from Rick Rosen called for the need to address these six critical areas in our education systems:
- Improve Curriculum Design.
- Require Teacher Training
- Focus on Body Mechanics and Self-Care.
- Increase Training in Business, Ethics, and Professional Relationships
- Be Selective in the Admissions Process
- Resolve the Accreditation Conundrum.
Improve Curriculum Design
Rosen’s call for improved curriculum design called out the fact that most schools “present too many modalities and specialized applications in too short a period of time. There is a general tendency toward an over-emphasis on techniques, and an insufficient amount of time spent on the fundamental competencies.” Not much has changed in this arena. It is further complicated by the profession declining to define the many techniques such as deep tissue massage and medical massage. The recent surge in massage competitions that focus on the moves and techniques is evidence that it is not changing. CE classes for business are the last ones to be filled at conventions.
Require Teacher Training
The Alliance for Massage Therapy Education was actually created as a result of this white paper and has been consistently working on a comprehensive effort called the National Teacher Education Standards Project (NTESP). The initial phase of this project involved the development of the competency standards for teachers, which are broadly applicable across the continuum of entry-level, continuing education, advanced massage therapy and bodywork training programs, and specialty certification programs. Overall, the goal of the NTESP is to create a culture of teaching excellence in our field. The Certification Process Committee (CPC) has created a voluntary certification program as a way for educators to demonstrate they have achieved the Competencies.
Focus on Body Mechanics and Self-Care.
The statistic that is often quoted is that most massage therapists leave the profession after 5 years due to injury and burnout. Included in this should be the low pay, long hours and unfair work places that misclassify massage therapists as independent contractors when they should be employees. AMTA used to have lawyers hired by their chapters to help with understanding the laws and working with labor departments to help sort this all out.
AMTA and ABMP websites are full of self-care classes and articles. Everyone knows what they need to be doing for self-care but the main problem is that most don’t do it just because an article or class says to. What could make the difference is requiring participation in Supervision and Peer Supervision Groups. The CE requirements across the states have so many different requirements, yet none have ever made it so Supervision was required. Supervision and Peer Groups are one of the main methods that can actually help massage therapists by allowing them to talk and learn from others that they are not alone in this profession. Learn more about Supervision on my other site—www.massagepracticebuilder.com
The Massage Therapy Foundation in 2019, created a study on body mechanics to assist massage therapists in using proper ergonomics. Learn more about The Massage Therapy Ergonomics Project.
Increase Training in Business, Ethics, and Professional Relationships
The call for more training in Business, Ethics and Professional Relationships has not happened in massage schools. The main complaints from our massage boards are still sexual assault by massage therapists and not taking the required CE classes. Massage schools have never been able to have enough business classes, but it really isn’t their job. Massage school is there to teach massage. You really have to go to business school to understand business and run a business. There are many coaches, mentors and others who have paid programs to help massage therapists with their business. After looking at about 500 massage school websites that I have listed on this site, none of the schools seem to cater to their graduates by providing job boards or after massage school programs to build their careers.
Be Selective in the Admissions Process
I am not sure where schools are on this but hopefully they have seen the consequences of just accepting anyone and everyone into a massage program. The current shortage of massage therapists though has been creating innovative admissions processes that make it so massage school is very low cost or even free if they work for the clinic or spa that the school is connected to. That just really brings people looking for low cost or free education and not necessarily those who really want to be there.
Resolve the Accreditation Conundrum.
“In other professions, accreditation of educational institutions and specialty programs is the norm. Most commonly, there is a single accrediting agency for a given profession. An example would be the Commission on Accreditation in Physical Therapy, which oversees the 200 college-level training programs in the U.S. This kind of structure ensures consistency across a spectrum of institutions.” ~Rosen
In the massage profession this is the Commisison for Massage Therapy Accreditation which currently shows there are 68 schools accredited. My current guess is that there are about 800-900 massage schools, but we really don’t know.
Licensing First Before Certification
The National Certification Board of Massage and Bodywork (NCBTMB) was the go to testing option for state licening for a very long time. It’s so called National test was confusing and was overtaken by the FSTMB’s MBLEx test. It was never a national test that let you move easily to other states. Most states have moved to using the MBLEx test created by the Federation of Massage State Boards as the licensing test. The NCBTMB has changed their exam into the Board Certification in Therapeutic Massage and Bodywork (BCTMB®).
The long, confusing history of the NCBTMB (on www.massageschoolnotes.com) has left massage therapists unsure about it’s importance but the NCBTMB is trying to get back on track. Whitney Lowe explains the reasons why Board Certification is the way to go in his article The Future of Advanced Massage Credentialing.
Our licensing and legislation is really a mess across the US because of the variety of laws and state requirements. Our associations could have done more work on this. What could have helped was creating model licensing legislation that everyone could agree on and implement it across the US. I talk about it in another article on license portability. We need consistent laws based on data like the Entry Level Analysis Project (ELAP) and that needs to be updated regularly.
The National Certification Board for Massage and Bodywork is in deep financial trouble, but is working on reviving itself. The history of this organization is so up and down and all around, that it is a wonder it is still here today. Currently, (Jan 2023) it is almost totally funded by AMTA from what I hear through the grapevine.
Creating Parity of our massage laws to create portability
“State licensing laws are never identical from one to the next, but they are said to be in parity when they are based upon a common set of standards and requirements. The many discrepancies among our massage laws are the reason that professional mobility is so limited.” Rick Rosen, On Becoming a Profession (PDF)
License portability is being worked on but not by creating licensing laws that would allow massage therapists to move more easily around the US. It is being done by the Dept. of Defence who wants to create a State Licensing Compact called IMpact. I just wrote about it on my other site. Right now, 3 states have bills in process but two of the states have stopped the bills mainly because of the issue of the required number of hours of education. The other option for portability is to finish the Model Legislation idea created by the FSTMB back in 2011 and get states to pass laws that are similar in language, number of hours required for massage licensing and CE (See my article on the massage compact.)
Licensing and Legislation
Our state laws are all over the place when it comes to definitions of massage, scope of practice, education requirements and CE requirements making it so difficult to move about the country. Some states consider massage therapists to be healthcare providers; some don’t.
Most states have laws that say an unlicensed person cannot use the terms massage yet our cities are filled with Brothel’s disguised as massage businesses. The media portrays them as ‘Illicit massage businesses” and “massage parlors, when in fact they are SOB’s (Sexually Oriented Businesses), further confusing and entangling massage therapists. The language that is being used is what is entangling us with these businesses. Our professional assocations are not doing anything about the use of language. I bought a site last summer to do that work –www.lookbeforeyoubookamassage.com to try to work on that issue.
Once again, Model legislation could help us get together to look like we know what we are doing. (See the What else can be done at the end of this article.)
Develop and Promote a Unified Professional Identity
What does that even mean or look like? The modality or different types of massage wars have created confusion and many misconceptions about what massage is or isn’t. No one really knows what medical massage, sports massage, deep tissue massage or anything else really is. Our professional identity is marred by the long-term and consistent misuse of the word massage by sex workers. Our associations stand by watching it happen. When one thinks of a doctor, nurse or chiropractor one thinks only of a doctor, nurse or chiropractor. When one thinks of someone giving massage, they wonder if there is something else going on behind closed doors. (Wink wink, smirk, smirk).
Our professional associations are the ones who should be standing up and defining massage and the many confusing terms: Medical massage, bodywork, somatic practices, reflexology, structural integration. Some of these things are left out of massage licensing laws and do not have their own regulatory boards, leaving us with more confusion.
“Doctor. Nurse. Physical Therapist. Attorney. Chiropractor. Psychologist. Members of each of these licensed professions have dozens of areas of specialization within their respective scopes of practice—yet they have achieved a unified identity that is immediately recognizable by the public. By contrast, our field has been mired in an identity crisis which shows no signs of
abating. One mark of an immature discipline is an over-association with the small details, and an inability to see the big picture. To date, we have no official definitions that effectively differentiate massage, bodywork and somatic practices. Confusion reigns both within our field, and within the minds of those who are seeking hands-on therapies. Most people have no idea what distinguishes one modality from another, yet therapists commonly use modality names from Ashiatsu to Zero Balancing as their primary identifier.” ~Rick Rosen, On Becoming a Profession, 2008 (PDF)
The demand for massage therapists is growing, the number of massage schools and massage therapists is decreasing. Issues of low pay, misclassification of employees, lack of advocacy plagues us. Our associations are working on things but they are not forthcoming with information on what they are doing. AMTA chapters are filled with volunteers doing the best they can watching legislation, massage boards and trying to get massage therapists together for networking and advocacy. A few states have additional associations working locally for changes. None of these talk to each other regularly for think tanks and planning so we are all over the place with advocacy work.
Being covered by health insurance/Medicare/Medicaid.
AMTA has consistenly said that massage therapists and the public use massage for healthcare reasons and want massage to be covered by their health insruance. (See all the last Industry Fact Sheets.) WA State has been able to have massage therapy paid for by health insurance for medically necessary conditions since 1999 or so. It came about after a long battle with insurance carriers in which the insurance commissioner won (See the Report that was created and the timeline of events). While this was great until about 10 years ago when carriers cut allowable fees in half and started creating prior-authorization requirements making it so many have left the networks. The Affordable Care Act had provisions that would have helped make it so across the US. Some plans in some states are covering massage. AMTA has said that Medicare Advantage Plans are Covering Massage. The VA sometimes covers massage but there are not any resources to help MT figure out how to do that.
Plagued by Employment Challenges.
The first Union was created last year at an Elements Massage Studio (link to Youtube video) in Denver Colorado. The number of brothels disguised as massage businesses is increasing (see Facebook post). The misclassification of massage therapists as independent contractors is rampant across the US.
Plagued by CE requirements
CE is a requirement for license renewal in most states, yet no studies have been done to see what is actually needed to Continue one’s education beyond massage school. Massage Boards are in existence to protect the public from harm and most of the current harm is coming from sexual assault cases. Continuing education needs are different for each therapist depending on where they are in their career and what they want to focus on – wellness or healthcare. A massage therapists right out of school may need more support and training to get through their first years of practice than someone who has been a massage therapist for over 10 years, over 20 years and more. There are no CE requirements that actually do keep a massage therapist up to date on the actual science and art of massage therapy. Massage therapists continually believe the many myths of massage and are not up to date on laws and rules in their state. I have repeatedly written about the CE conundrum in the massage therapy profession/industry on my other site.
What’s the massage profession/industry to do?
Your guess HERE.
Chip Hines says
As theProject Manager for the Massage Therapy Body of Knowledge (MTBOK), I’m pleased to see that there is some interest in continuing what the massage professional associations promised the community would be a “living document.” An extraordinary group of professionals volunteered to spend much of a year developing a product that would meet the needs of this amazing and diverse profession. We envisioned that the initial MTBOK would grow and be extended by the community, and set it up in a way that would allow schools to implement it in a way that would evolve the profession in a collaborative but consistent direction. I hope the profession will revitalize the MTBOK and restart an ongoing process to institutionalize it and fulfill its file in the community. Good Luck and best Wishes!
Theresa Talley says
I as well have seen so many changes in my 32 year career span . I practiced in Pennsylvania up to 2011 when licenses were not required. I had the opportunity to practice massage alongside my husband/chiropractor in our office right after I graduated from the holistic health and education program I attended . When I rejoined the massage field in 2017 I had to take the MBLEX which made me officially a LMT . My diploma from school gave me the tittle of certified massage practitioner as the naturopathic doctor who trained me instilled in us that therapy implied there was something wrong with someone and we were going to fix them . As a practitioner I was to recognize their whole being as perfect if I was going to be able to help them..
Today I have a holistic orthopedic massage practice for horses and their humans . I am thrilled to have my services in demand . It truly takes about 30 years to know a little . Helping others with functional mobility issues along with reducing stress and anxiety is the greatest way to express gratitude for this amazing gift we have been given by the pioneers before us.
I describe massage therapy as “ helping Spirit move others along”. We can study biomechanics and physiology, increase educational requirements similar to nursing programs, LPN , RN from associates to doctorate or let the machines take over for us . It’s been amazing being apart of all sides of this journey.