Massage Therapy Body of Knowledge

Comment

Comment by Carl W. Brown on October 9, 2009 at 9:39am

Keith, I think the problem with tackling the problem logically is the pressure to inflate the minimal training. I feel that the McKinnon 100 hour starter course was just that and it gave me more than adequate training to get started. However, a lot of people feel that we need to make is hard for people to enter the profession. Learning massage is like learning to drive a car. The problem that I see is that a people progress through school they is a shift in attitude form wonderment to a feeling that they “know it all”. They start out with simple techniques that are harmless and move on to more advanced studies where they learn how to really hurt people. Inflating the curriculum not only produces people more likely to harm others but it trains people in a cookie cutter fashion. My primary training did not fit into a traditional educational frame work so it would never be accepted by any public credentialing agency so I had to take massage training just to be able to practice.
I am fighting for future non-traditional bodyworkers for whom the licensing training is a total waste of time and money because their training conforms to a different BOK.
If the laws were written to exempt all non-conforming bodywork then I would not have this issue. If you want to be arbitrary about your profession and do things stupidly fine, but this is killing mine.
Actually I believe that they should make a doctorate in Physics mandatory as a prerequisite and then we would be limited to practitioners who would see the folly in the regulations.
By the way how many of the 100 hour graduates out there are hurting people?

Comment by Carl W. Brown on October 9, 2009 at 9:02am

Mike, a note on contraindications and precautions. Unfortunately we cannot assume that what we were taught in school is true. For example I was told not to massage anyone with diabetes and that massage can spread cancer. In my lymphatic class they warned about using too much pressure. I traced the Vodder recommendations back to the original research and fond that the pressures were actually 70 times greater before the dogs suffered any negative effects and nothing on whether the effects were just temporary.

Comment by Keith Eric Grant on October 8, 2009 at 11:38pm

Carl, Yes one would have to attain the specified levels of competency in each element of a BOK in order to perform the associated tasks safely and effectively.

If one couldn't perform the necessary tasks, then either some required tasks necessary for success were never specified in the requirements (which, BTW, is the case with current licensing requirements), or the KSAs required for specified tasks were inadequately identified.

On the other hand, if there are KSAs in the BOK not required for safe and effective performance of job tasks, then either the task identification or the BOK were improperly done. This can mean that there are tacit tasks than were never properly identified and discussed or it can mean that the BOK suffers from "shopping cart" syndrome.

A job description can also contain multiple, independent clusters of tasks, leading to independent sets of KSAs. Effectively, this means that the job description and task analysis can be split into independent sets. A person could perform effectively in any such subset by mastering the KSAs of the subset. An extreme example would be if an executive hired a single person to be both their personal secretary and their pilot. The person would need two sets of KSAs, largely independently teachable and assessable. They might also have meta-skills, such as conscientiousness, that would be applicable to both domains.

A more massage-related example of tasking would come in teaching massage history. A practitioner could well-practice fine without knowing much at all about the history of massage. It might be useful to know, such history, however, in marketing of massage and in speaking to groups about massage. Thus, this specific item would be associated with business tasks and more specifically to speaking/marketing. An advantage of such clear delineation, is that the need for this as a KSA can be specifically discussed in terms of the associated tasks AND that discussion might lead to identifying other tasks and/or KSAs that would otherwise have been missed.

Paula Alsher had an article in Chief Learning Officer (CLO) that covers some of the above. Validating Knowledge Through Testing and Assessment.

Comment by Carl W. Brown on October 8, 2009 at 8:13pm

Keith, “In a domain of professional activities, a BOK should derive from the tasks necessary for competent performance and make the connection between the tasks and knowledge components evident.” I presume that this means that to achieve minimal competency in that domain, one is expected to achieve at a minimum the designated competency in each and every KSA in the BOK relation to that domain of knowledge. This is because it has been proven that mastery of each and every KSA is necessary and that it can be demonstrated that lacking any one of these competencies is detrimental to the subject’s performance. For example if they do not have proper body mechanics they not only will deliver a substandard session but possibly injure themselves. They cannot make up for lack of draping skills by mastering energy techniques. You don’t want people to practice who do not understand ethics or were never taught about HIPPA privacy requirements.

Comment by Carl W. Brown on October 8, 2009 at 7:59pm

Mike I have been thinking of a use for mapping things that embrace the entire domain of massage and bodywork. I do believe that safe practices and contraindication that cross modalities would be valuable for therapists. You don’t need to know the modality but knowing what you have to master and what to beware of makes sense. You learn Swedish but are taught about the precautions needed not to burn someone so that you know ahead of time what you need to learn to practice safely. This would also introduce people to the modality without actually master any part of it.

Comment by Carl W. Brown on October 8, 2009 at 3:56pm

Bert, I think it is possible. The point of practice acts is to prevent harm. This means that if you want consistent laws you need to have a scope of education and levels of competence that you can prove by correlation to prevent irreparable harm.
As to titles the important one is the term massage because if its misuse for prostitution. To do that you need to forget about all other forms of bodywork a focus and what it takes to be minimally competent. Most people equate the term massage with Swedish so take it a define what it take to be minimally competent and prove it by testing your model with actual practitioners. Then you have defensible standards for both practice and title acts.

What is see is a list of foods without any idea of what you store carries, what the nutritional values are and if any selected set of foods can be combined into a plausible recipe. When such a list to presented to legislators different foods will be selected and different opinions will per vale. In all cases the list will probably not be very functional.

I my example of using a scientific hypothesis that you do not prove is that it not only is worthless as a tool but cannot be defended against other competing hypothesis.

I agree with both you and Mike that we need consistent laws if we ever hope to get any kind of reciprocity. We just disagree on how it should be done. I believe that if tests and curriculum that can be defended by proving that they produce better MTs and don’t contain extraneous material that is irrelevant to establishing minimum competency then we can standardize the laws.

Mike is right that energy modalities offer a lot to practitioners and clients but how do you prove irreparable harm do to improper treatment? I personally think that the issue should be dealt with by private certification not by state governments. I think that because written test do not prove that you are effective at energy work they also should be done outside of the public realm. The down side is that you may not be able to call yourself a “Massage Therapist” unless you know Swedish. If you do things like Shiatsu you must also do Swedish to call yourself a massage therapist. You can always call yourself a Shiatsu practitioner.

Comment by Keith Eric Grant on October 8, 2009 at 10:49am

I have to agree with Bert that much of this has strayed far from trying to critique what a Body of Knowledge should encompass and to compare that to what is being done.

A body of knowledge should organize the information within a domain of endeavor, define key terms, and reveal the structure and interconnections of that knowledge.

A body of knowledge should delineate the reliability of its components and the basis for estimating such reliability, otherwise it should be considered as a literature review. Where there is no objective basis to substantiate a cluster of concepts, the area should be noted as (i.e. demoted to the level of) a belief system, which may or may not be internally consistent and coherent. It should also be noted that a conceptual map can lead to protocols that have effectiveness yet be completely erroneous in it's explanation. Thus it's important to separate observations of the effectiveness of an intervention from untestable hypotheses of the explanation.

In a domain of professional activities, a BOK should derive from the tasks necessary for competent performance and make the connection between the tasks and knowledge components evident. Without such a clear delineation of connections between tasks and knowledge, one generally only achieves a shopping cart full of concepts that someone knows or that someone likes to teach.

A BOK should, if following the above principles, facilitate the creation of more concise and more effective teaching and learning methodologies. By delineating how items of knowledge contribute to task performance, it facilitates both evaluating the effectiveness of teaching and improvement of the process. It also allows discussion and evaluation of whether material has become extraneous and distracting.

A BOK, if objectively supportable and supported, can provide a legal background for practice issues. Without such support, it can open any actions based on it to legal challenge. In this sense also, a BOK should be clear on what is evidence-based, objective knowledge and what might be legally be construed to be a system of spiritual beliefs unsupported by scientific methods. Scientific methods can include consideration of systemic feedbacks and phenomena emergent from integration of our sense of having a body (i.e. computational artifacts of our brain and nervous system, include feedbacks via emotional/immune connections, include perceptual effects of synesthesia, but should not be inclusive of things in outright contradiction of scientific understanding or things that are untestable/unknowable. The latter fall into the domain of belief systems, not of knowledge.

I'll not that Epstein and Hundert have provided a paper on Defining and Assessing Professional Competence as an outgrowth of the Accreditation Council for Graduate Medical Education's Outcome Projects. Epstein has since followed with an extensive paper on Assessment in Medical Education. Both papers provide considerable guidance.

I also, strongly believe, that we need to promote a better understanding of the development of usable knowledge and expertise within the realm of massage education. In this area, it is worth looking at both Benner et al.'s "Expertise in Nursing Practice" and Frederick Reif's recent "Applying Cognitive Science to Education".

In short, a body of knowledge should facilitate understanding and development of improved methods, not simply document what is present in existing textbooks, which may or may not have a solid basis for being there. One needs to filter misinformation as well as record and document the basis of current understanding.

I'll also note that "modalities" as it applies to creating a diversity of names is a distraction. One should focus not on what things are being called, but on what is done as an intervention, the context of intervention, and the kinesthetic and cognitive requirements for the intervention to be effective. In most cases, their are generic names that are well-established and quite sufficient for the purpose. The rest can be relegated to a dictionary of marketing terminology.

Comment by Mike Hinkle on October 7, 2009 at 7:38pm

Bert, Keep the Faith!!!

Comment by Bert Davich on October 7, 2009 at 6:08pm

Carl, I appreciate that you started this discussion. However, It would be helpful if you would stick to the issue and eliminate your personal experiences. They water down your insights. As Mike stated your first & last paragraphs pertained to the issue.

If you go to the links I sent you will see that cities and counties in CA are now moving to use the title & practice acts to control what the state has not. That is not a problem in MO but any state that happens in will make all the more difficult any attempt to make licensing portable.

Mike, I am in agreement with your statement "if there is one central (accepted) Practice Act and one central set of Title Acts that state boards and legislators use and/or develop, we would have a port system. Congress can't but a unified effort by state boards to do this can. Keep watching, there is always a way!..... I would support an effort to achieve this end, however I don't believe this is politically possible.

Comment by Mike Hinkle on October 7, 2009 at 2:58pm

Carl, Your first and last paragraphs had to do with the issue. The rest was a great lifestory. I noticed you had problems accepting how things were with each of those also.

Mike it looks like you want a list of all the KSAs involved in all modalities of massage. But this is a bucket list. You only cover a selected subset of modalities. Much of this country thinks of massage as a form of recreation. To leave out spa services is wrong if you want to define all of massage not just therapeutic versions. Do that mean that you are going to recommend that if not done for therapeutic reasons that we should not license massage?

Someone said there are basically 15 different basic modalities and the rest can be placed into one of these KSA's. That is for educators to decide. If it is needed to done, then let's get it done. You keep looking at this with a negative veiw. I choose to see the glass 90% full. I believe we can do this right.

Without a set of standards one has no idea if what they have learned is actually a minimal workable subset of skills. There is no way that one can be expected to master all of the bodywork modalities before one can practice and without a guide, no idea what subset and to what skill levels are appropriate. This also means that you cannot use it to develops a test for minimum competency.

First you explain one good reason we need to have it, then you say we can't do it? Carl one more time, the BOK isn't trying to get any body to "MASTER" anything. We are trying to set standards and terminology and graduate a massage therapist that will be entry ready to work in the profession after passing their licensure test. There are few Masters out there. Are the rest of us operating illegally?

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