Massage Therapy Body of Knowledge

Comment

Comment by Carl W. Brown on October 25, 2009 at 1:38pm

Mike, I suspect that you find our lack of communication as frustrating as I do. But I cannot see legislations setting the industry standards. Most of them are lawyers and I doubt that many states have even one legislator with massage training. They are also not doctors and they listen to the medical profession fro guidance in setting medical licensing standards. It is from documents like the MTBOK that they look to see what we as a profession deem is either absolutely necessary to practice safely and do no harm or what we feel should be the training to call oneself a massage therapist. We need to be clear as to what standard we are proposing or they will have not idea how to use this document.\

If the committee feels that this should be a guide to enhancing the respect and competency of people who want to call themselves “Massage Therapists” them state clearly so that everyone understands that this is the intent of the document. If not then I think you need to look at a minimalistic approach to what it takes to do safe work.

Comment by Mike Hinkle on October 25, 2009 at 1:12pm

Guys breathe,

I am not trying to make it easy or hard or anything. I don't even get to vote. I am not padding anything. I am looking out for the interests of lots of therapists, not medical, energy, or any specific modality. Your opinion is that the first draft of the BOK was padded. No one has seen the second. My opinion is, it is not padded.

The Model Practice Act will be created by the FSMTB. Not the BOK. No one is asking for anyone to be a PhD in nuclear physics, Carl. You creted that a few threads back.

Carl, I can not state anything in any document. There is the word "master"again, another one you are making up Carl.

This leaves me with no problem Carl. KSAs levels and competencies will be addressed by the BOK, not me. I believe the answer is for states to average their hours, accept that number as the mean and set one standard set of rules. That's all. It may not come out, in the end the way I want, but that is it in a nutshell.

Well, from what I saw of the CA plan you are promoting, it would cost easily that much money and years, depending on scheduling to complete the advanced training. You have level 1, level 2 and so on. This separates therapists too much in my opinion. Class warfare in a profession weakens it as a whole, to me.

Schools could separate their programs, prorate each level accordingly and charge about the same. I think, students like to get the school out of the way and then get advanced classes from superior teachers.

Sorry I don't like the system you want. Again you attack peoples education and that is wrong. There are some fantastic schools out there and a lot of well deserved pride. I don't determine what is and isn't massage Carl, states do. If you don't want to be a massage therapist, tell them.

And I'm sure you would like to tell them what is and isn't massage therapy. Sorry, states makes this decision and they don't care what you or I say are those modalities.

Comment by Carl W. Brown on October 25, 2009 at 1:10pm

Mike, I mentioned 100 hours because that is the minimal level need to get insurance. The insurance companies are comfortable the city of Walnut Creek where I hold one of my licenses is comfortable.

People have been doing massage for hundreds of thousands of years will less training. I did my first massage to save a woman’s life with 0 hours of training. My training actually started by taking advanced classes and one of the students said that she would never let anyone with less than 4 years of experience work on her but she kept picking me as a partner. Yet when I studied Swedish massage I found that I never got good at it and I believe that I could have had thousands of hours training and would never have gotten that kinesthetic sense needed to do good Swedish because my natural talents got in the way and I never as a child developed a good body sense.

I have had massage from non-professionals who have done much better jobs that the professionals. So what does it take for someone to start charging for something that many people do for free?

As to harm the insurance companies are either good at doing the actuarial studies of potential risk and they are willing to accept 100 hours and I understand that of my ABMP dues about $67 dollars goes to insurance which is cheap.

Actually I have found that at 100 hours the person is usually open to admit that have a lot to learn where I have had massages from 750 hours graduates who think they know everything.

I agree with Keith, in that people learn differently and certainly teachers teach differently and if you are setting standards then hours don’t mean anything. I think you need to measure competence. This may be difficult in that it is more like playing an instrument or as Keith alluded to, dancing.

When you get to the treatment side of massage, I think you will find that the field diverges and to be competent you have to master a specific and different BOK. For example I don’t think it is reasonable that you ask medical doctors to learn acupuncture.

Comment by Carl W. Brown on October 25, 2009 at 12:16pm

Mike, “You are trying to make it as easy as possible for students. Not what is needed for a profession.” A padded BOK is not valid set of minimal standards. The way to do this is to forego practice acts because now you are creating a restraint for trade problem for all thouse who are taking classes that they don’t need just to be able to practice something else. Then if you want a “massage therapist” to include a PhD in nuclear physics then fine.

If you separate the requirements into a must have to do massage at all level and the rest, you can still have a standard where the person at a higher level does everything from maintaining SOAP note to reading auras and can call themselves a “Massage Therapist”

At least state in the document that these are not a set of standards for minimal practice but rather a set of recommendations that you expect that a person calling them selves a “Massage Therapist” to master. These standards are not applicable to other forms of bodywork or hands on therapy.

This still leaves you with the problem that each KSA needs a level of competency or else this is not a standard.

It is an about using the law to require people like me to spend $10,000 and a year for training that is not only worthless but damaging to my training in addition to what is cost me for my other education so that I can operate within the law even if I don’t do massage.

You were concerned about states that already licensed massage therapy. They can stay therapists as long as they allow people wanting to do bodywork to pursue other avenues of education without naming explicit modalities as exceptions. But default all bodywork should be excluded except for “Massage Therapy”

Comment by Stephen Jeffrey on October 25, 2009 at 11:46am

Kieth you said
And for that "all other cases", the lessor someone may very well give the more satisfying massage. The best clinical practitioner is not necessarily the best kinesthetic practitioner.
I totally agree.

Mike, when it comes to duff massage treatments Im not sure you could garentee I would not get a duff treatment from canadian 3,000 hr qualified MT if I don't have "medical problems" what would his/her interest be in me? which is why I mentioned the specific cicumstances in which I would want his/her treatment.One of the most "duff" treatments I ever had to endure was 1hr "deep tissue massage" from an osteopath presumably because I had no specific problems for him to address.

Comment by Keith Eric Grant on October 25, 2009 at 11:46am

Bert said

It seems that an entry level requirement that specified a scope of practice would be a better answer

If one looks at the model of medical practice in the U.S., there is only one level of medical licensing with no state imposed scope of practice limitations. Specialty certification is stated to be "voluntary". However, industry standards of practice are such that, if one is not board certified in the area one practices, you likely will face restriction on use of facilities, insurance reimbursement, and referrals. This is another example of where certification for specific competency leads to health system credibility and the enforcement of standards is done outside of the rather blunt power of the state. The massage profession has been slow to catch onto this kind of specific competency management despite the model and application being right before our face. In other words, don't limit the scope of practice, but provide credentialing related to competency assurance for higher level professional performance.

Comment by Keith Eric Grant on October 25, 2009 at 11:06am

Stephen,

In contrast to something Mike said a few comments back, I know of few or no people advocating the unregulated practice of massage specifically within the health care system. I recall that David Palmer, for example, had argued for the minimal regulation of massage at the entry and chair massage level and something on the order of 1000 hours for practice in the health system. And, when someone starts with the goal of health care inclusions and their training is principle-based from the outset, one increase the effectiveness and efficiency of training considerable. I have also, in terms of health care inclusion, at time bandied about the concept that a residency would be something to consider. Expertise comes from doing with reflection, and real world practice on difficult cases with supervision and mentoring is an idea with merit.

In the California training document, I noted that a couple of groups had independently started "certifying" in medical massage. To my knowledge, this was strictly in an orthopedic focus (i.e. not acknowledging non-orthopedic medical applications) but was a response to current licensing and certification being too vague and unscientific in it's outcomes and approaches. I also believe that they missed an opportunity in applying an add-on approach (i.e. after 500 hours) rather than creating a curriculum that addressed the health care inclusion goal from the onset of training.

In short, I feel that Mike's "sadness" is unfounded in direction. Those thinking of minimalizing regulation are thinking of the area of practice that the BC HPC's scope of practice update refers to as "unregulated". In contrast, some of those same people feel that massage for health care inclusion should be a lot more focused and science-based than we are currently doing in the U.S., as is the BC scope of pratice. This once again goes back to my theme of having clear job descriptions and training effectively toward the necessary tasks, including the cognitive tasks of principle-oriented practice. Again, I recommend looking at Crandall, Klein, and Hoffman's Working Minds: A Practitioner's Guide to Cognitive Task Analysis. There certainly are some excellent resources out there, such as Chaitow and Delany's two volume set on Clinical NMT (which covers a lot of physiology an neurology), Erik Dalton's book and materials, Whitney Lowe's online course on clinical reasoning, ... The question is whether or not we are drawing on such material and using it effectively. Far too often, the answer is no.

And for that "all other cases", the lessor someone may very well give the more satisfying massage. The best clinical practitioner is not necessarily the best kinesthetic practitioner. You might do far better to find someone who came into massage with a history of dance, movement, or sports training. Because of the modular structuring of the classes I teach, I've had the joy of being part of the transition process for a number of such kinesthetically historied persons as they transition careers into massage.

Comment by Bert Davich on October 25, 2009 at 10:44am

Keith,
You are right on again, as usual.

Comment by Bert Davich on October 25, 2009 at 10:38am

Thanks Don,
That was a great article. This article articulates what I have been advocating as more effective practice among my peers. I welcome the term 'Principle based massage'. I have called it integrated massage (which is less definitive) for lack of a better term.

However, I am not so sure that such a demanding entry level requirement is a good thing because it eliminates opportunity for anyone who cannot pay the cost of time and tuition as well as favoring those who do well in a classroom environment over those who have the talent to become great practitioners but do not do well in long duration classroom environments. (see Keith's earlier comment with the story about the orthopedic surgeon who was great in class but incompetent in the operating room)

It seems that an entry level requirement that specified a scope of practice would be a better answer. It should also be pointed out that the U.S. lacks a system of social medicine that guarantees an expected reasonable return on such a high scholastic investment. A lower entry level requirement allows the Therapist to earn some income, get hands on experience and add the next layer of skill in an adaptable fashion.

I myself would have been one of those who were eliminated by the time and cost factor although, according to what I read in the article, I have been practicing principle based massage for some time. That transition required many hours of self education that if added up probably would amount to several thousand hours. I have learned from classwork, but mostly books, articles, DVD's and practical application because they are more effective for me. I can watch Art Riggs or Doug Alexander (on DVD) teach an assessment method over and over, and have done just that. (Doug has recently had some of his online courses approved for continuing education in Canada) Most of my time has no continuing education credit. My study choices were based on quality and content, not 'credits'.

I believe that when the entry level bar is too high, we deny opportunity to some who could be worthy contributors to our profession, and we deny their services to a public who desperately needs their services in the US.

Comment by Stephen Jeffrey on October 25, 2009 at 10:02am

I'm now thinking I want to treated by one of Dons 3,000 hrs MTs if for example.
I'm in hospitol needing expert massage therapy to assist/treat my health problem.

In all other cases I want to be free to chose a lesser but adiquately qualified registered MT. WHY because I believe there is enough evidence that this would be a perfectly SAFE choice to make.

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