Regulation and licensing of somatic therapists is again making news. After several years of little or no activity in this area, several states are now considering if licensing, in the form of practice acts or title protection acts, is superior to the "unlicensing" regulations now approved in Minnesota and being considered elsewhere.

I know of precious few issues within the massage therapy and bodywork realm that stimulate such response as the issue of whether or not to regulate the profession. It seems to make otherwise rational people froth at the mouth, and normally caring, sensitive, client-centered individuals stand on their soapboxes and hurl vindictive epithets toward any individual speaking for the "other side"!

I would like to explore a few issues concerning regulation in this column, in the hopes that it stimulates an ongoing discussion among you, the readers. Nothing would please me more than to have Massage Today become a clearinghouse for the ideas and concerns surrounding licensing. This is a big issue affecting us all, so please share your opinions on the subject!

In this column, I'll limit my thoughts to the issue of state licensure. It is my opinion that municipal regulation of somatic therapies isn't worth discussing, as it is (in almost all cases) actually attempting to regulate prostitution instead of whatever the title of the section of the law reads. Municipal regulation, in the absence of state licensing, is in my opinion, detrimental to the profession. It is confusing to practitioners, employers, educators and the public. I am familiar with no other health care profession that deals with municipal as opposed to statewide regulation.

Perhaps that is an element of the problem -- many of us don't see ourselves as part of the greater health care field. A state employee who oversaw many allied health groups once said to a group of massage therapists arguing this point, "Excuse me, you already are part of health care. Get over it!" Coming to grips with what it means to be a part of the overall health care environment may be important in this discussion. In my experience, the municipal regulations don't particularly address health care. The people I know who practice in nonregulated states have stories to tell: doing outcall in five communities and needing business licenses from five different jurisdictions; needing blood testing and fingerprinting in some towns and criminal record checks in others; and some towns requiring CEUs and others not; some requiring work on same-sex clients only, others requiring windows on all treatment-room doors. How ludicrous. How demeaning. Occupational therapists, physical therapists, dental hygienists, psychologists, nurses, opticians, etc, would never put up with such nonsense, but many massage therapists accept this situation as customary and normal.

As I gear up for a rant here, let me also say that I am positively sick to death of those who argue against regulation by demanding "proof" of harm against the public. (Many states require evidence of harm before granting regulation.) They will sit and fill bandwidth on web pages, listservers and publication "letters" sections stating that there is no measurable proof of public harm, and that therefore it is unconscionable to regulate the practice. They choose to define harm in their own terms for their own purposes, and develop tunnel vision that "harm" means only "grievous physical harm." As most who have served on massage regulatory boards know, there is a constant stream of instances of public harm from massage therapists. These are frequently confidential in nature, so they aren't normally used in the conduct of a public discussion. Such instances of harm run the gamut from inappropriate touch to unethical business practices, but certainly they all constitute harm to the public. Unfortunately, a somatic practitioner practicing in an unethical or unsanitary fashion can also cause the physical harm the regulation naysayers find so little evidence of.

This certainly begs the question as to whether licensing will do away with those who abuse good practice and ethical behavior. Of course it won't do away with them, but the jury is still out on whether licensing minimizes or lessens the frequency of public harm. What I see as a good argument for licensing is that it frequently provides a peer review process for those against whom complaints are made. Most states already have laws enacted to deal with inappropriate touch and unethical business practice, but require filing of criminal charges to do so. For most matters dealing with unhonored gift certificates, scope-of-practice concerns, etc., I see real benefit to peer investigation and adjudication rather than police and/or court intervention. I'd prefer the police investigate meatier issues.

As I see it, the issue is not whether the profession should be regulated, but by whom, and to what standard! I encourage massage therapists to impact their own destiny by expressing their thoughts and opinions on such issues as who should be included/excluded form massage regulation; what scope of practice entails; what the eligibility criteria should be; and how a therapist demonstrates initial and current competency. Coalitions are usually the best vehicle for determining the answers to these questions and obtaining a semblance of consensus. The Federation of Therapeutic Massage, Bodywork and Somatic Practice Organizations has a very workable model for a coalition at www.adeptsys.com/federation/Legislative_Packet/legislative_packet.html.

I suggest the key point to this discussion should not be whether there is evidence of harm, or whether or not licensing "legitimizes" the profession, but whether consumer access and confidence are enhanced or diminished, and whether it gives practitioners more or fewer professional career choices.

Thanks for listening!

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